Retropharyngeal calcific tendinitis: report of five cases and review of the literature

Retropharyngeal calcific tendinitis is an inflammation of the longus colli muscle tendon, which is located on the anterior surface of the vertebral column extending from the atlas to the third thoracic vertebra. Five cases of acute retropharyngeal calcific tendinitis seen in the emergency department (ED) over a 15-month period are reported. In addition, a retrospective review of four cases diagnosed as retropharyngeal abscess and admitted to the hospital revealed that two of these cases actually represented retropharyngeal calcific tendinitis. A review of the literature and potential differential diagnoses are presented. For those primary care physicians who must evaluate patients with acute cervical pain, sore throat, or odynophagia, an x-ray study of the neck revealing retropharyngeal calcium deposition should raise the question of the diagnosis of acute retropharyngeal tendinitis. Clinical characteristics of this entity include a painful condition which is treatable and is often mistaken for retropharyngeal abscess, pharyngitis, or peritonsillar abscess. In our opinion, this condition may be more prevalent than the literature suggests.

Pharmacological modification of DDT-induced tremor and hyperthermia in rats: distributional factors

Pretreatment of rats with hydantoin (75 mg/kg, PO, an anticonvulsant), trihexyphenidyl (10 mg/kg, SC, a muscarinic cholinergic antagonist), or piperonyl butoxide (500 mg/kg, PO, a metabolic inhibitor) had no effect on the whole blood or brain tissue levels of orally administered DDT (75 mg/kg) or its metabolites DDD and DDE. Hydantoin and piperonyl butoxide decreased DDT-induced tremor and hyperthermia due to DDT when measured 12 h after DDT exposure, while trihexyphenidyl augmented some components of DDT-induced tremor. Additional experiments found that pretreatment with piperonyl butoxide increased tremor due to permethrin exposure (120 mg/kg, PO), while having no effect on tremor due to chlordecone administration (60 mg/kg, IP). Pretreatment with ellipticine (30 mg/kg, IP, a metabolic inhibitor) also decreased tremor 12 h after DDT exposure. The effects of piperonyl butoxide and ellipticine on DDT-induced tremor are postulated to occur through direct actions of these compounds on nerve or muscle tissue. Hydantoin-induced attenuation of DDT-induced neurotoxicity may be due to the ability of hydantoin to block repetitive firing of nerves by binding to the inactivation gates of sodium.

Expression of a cross-reactive idiotype on rheumatoid factor in patients with Sjogren's syndrome

Primary Sjogren's syndrome (SS) is a systemic autoimmune disorder characterized by lymphocytic infiltration of salivary and lacrimal glands. These patients have evidence of marked B cell hyperactivity, including the production of autoantibodies such as rheumatoid factor (RF) and an increased frequency of non-Hodgkin's lymphoma. We now demonstrate that RF from 12/15 SS patients contains a cross-reactive idiotype (CRI) on their kappa light chain defined by a monoclonal antibody (MoAb 17-109) and immunoblotting. This CRI was associated with immunoglobulin (Ig) A-RF, and to a lesser extent with IgM-RF molecules on the basis of direct binding studies. With the use of immunoperoxidase techniques to stain frozen tissue sections, B cells containing cytoplasmic Ig reactive with MoAb 17-109 were detected in the salivary gland biopsies from 11/12 SS patients at high frequencies, and in the blood from the same patients at much lower frequencies. One patient with pre-existant SS developed non-Hodgkin's lymphoma with tumor cells and RF paraprotein reactive with MoAb 17-109. Evaluation of serial biopsies over a 4-yr period showed a progressive increase in the proportion of B cells bearing the CRI. In contrast, synovial membrane biopsies from RA patients lacking sicca symptoms did not contain B cells expressing the CRI. Because previous studies have demonstrated that MoAb 17-109 detects a CRI on RF paraproteins from patients with lymphoma, B cells bearing this CRI may have increased frequency of neoplastic transformation. SS patients provide an opportunity to study the expression of this CRI and to understand the transition of B cell clones from autoimmune proliferation to neoplastic transformation.

Rapid identification of periodontal pathogens in subgingival dental plaque. Comparison of indirect immunofluorescence microscopy with bacterial culture for detection of Bacteroides gingivalis

A large body of research implicates Bacteroides gingivalis in the etiology of adult periodontitis, however, the application of this information to clinical diagnosis and treatment has been hampered by the need for a simple, rapid, and reliable means of detecting this microorganism. In the present study, indirect immunofluorescence microscopy using species specific, polyclonal antisera and a monoclonal antibody was evaluated in the clinical identification and quantitation of B. gingivalis in human subgingival dental plaque. One hundred and twenty subgingival plaque samples were obtained from predetermined sites by means of sterile paper points from 20 human subjects including 10 adult periodontitis patients and 10 periodontally normal subjects. The proportions of cultivable B. gingivalis in each sample were determined following anaerobic culture on nonselective blood agar media and selective media containing kanamycin. These results were then compared to quantitative estimates of B. gingivalis by indirect immunofluorescent microscopic evaluation of heat-fixed plaque smears. Using both immunofluorescence microscopy and bacterial culture, the present study confirms the importance of B. gingivalis in adult periodontitis previously described by culture. The organism was cultivable from 70% of the adult periodontitis patients but not from any of the normal adults. In contrast, indirect immunofluorescence microscopy detected the organism in up to 40% of the subgingival sites in 100% subgingival sites in 100% of the adult periodontitis patients as well as four sites in the periodontally normal subjects. The sensitivity of indirect immunofluorescence microscopy compared to culture ranged from 91 to 100% while the specificity varied from 87 to 89%.(ABSTRACT TRUNCATED AT 250 WORDS)

The inferior vena caval pseudo thrombus sign: diagnosis by dynamic CT after arm vein injection

Pseudothrombus of the inferior vena cava has been observed after pedal infusion. Previously it has been suggested that this pitfall results from technique and that this finding would not be observed following fast computed tomographic scanning after arm vein injection. However, we have observed similar flow artifacts using the latter technique. A scan obtained up to 14 minutes after the start of the bolus or reinjection with delayed dynamic scanning can exclude thrombus without further investigation.

Simultaneous high-performance liquid chromatography assay of acetylsalicylic acid and salicylic acid in film-coated aspirin tablets

A reversed-phase high-performance liquid chromatography (HPLC) method has been developed for the simultaneous assay of acetylsalicylic acid (I) and salicylic acid (II) in film-coated aspirin tablets. As little as 0.1% II (relative to I) can be quantitatively determined. Using a 5-microns octadecylsilane column with water-acetonitrile-phosphoric acid (76:24:0.5) as the mobile phase enabled the chromatographic separation to be completed in 4 min. Due to the slow rate of decomposition of I to II in the extraction solvent, acetonitrile-methanol-phosphoric acid (92:8:0.5), the analysis of many samples was routinely performed by means of automated HPLC equipment. Other compounds (non-aspirin salicylates, caffeine and acetaminophen) were also separated by the chromatographic system.

Gene dosage and complementation analysis of ataxia telangiectasia lymphoblastoid cell lines assayed by induced chromosome aberrations

An approach of general applicability to mammalian radiosensitive mutants has been used in the analysis of gene dosage and complementation in ataxia telangiectasia (A-T). Thymidine residues in DNA of one parental lymphoblastoid cell line were substituted with bromodeoxyuridine before fusion with a second parental cell line, to allow differential staining of the two sets of chromosomes. Following gamma-irradiation, induced chromosome aberrations were scored in diploid and homokaryon cells from each parental line as well as in heterokaryons. Four complementation groups were ascertained among 7 A-T cell lines. Analysis of heterokaryons formed between appropriate combinations of normal, A-T homozygote and A-T heterozygote cells, gave a quantitative measure of gene dosage and demonstrated increasing radiosensitivity with increasing numbers of A-T alleles.

L1210(A) mouse lymphoma cells depleted of glutathione with L-buthionine-S-R-sulfoximine proliferate in tissue culture

L1210(A) mouse lymphoma cells have been adapted to long-term tissue culture in the presence of L-buthionine-S-R-sulfoximine in concentrations of 1-10 mM. As a result of the inhibitory action of this compound on the synthesis of gamma-glutamylcysteine, the dipeptide precursor of glutathione, the cells are depleted of more than 90% of their normal cellular glutathione content. The residual 10% seems to resist depletion at high concentrations of buthionine sulfoximine. Glutathione depleted cells proliferate at a rate similar to that of non-depleted cells, and show full viability. Upon transfer of cells into inhibitor-free medium, they fully regain their original glutathione content. It is concluded that these cells contain at least two pools of glutathione: a large cytoplasmic pool and a smaller, possibly mitochondrial, pool. It is further concluded that the large pool of cytoplasmic glutathione is not obligatory for cell growth and mitosis.

Establishment and characterization of a human monocytoid leukemia cell line, CTV-1

A new human monocytoid leukemic cell line, CTV-1, was established from a patient with relapsed acute monoblastic leukemia. The characteristics of this cell line were evaluated by morphologic and cytochemical analyses, electron-microscopy, chromosome study, surface marker analysis and a study of differentiation potential with tumor-promoting agents.

Birth planning and fertility transition

In 1971 the government of the People's Republic of China launched the third birth control campaign. The goals were to raise the age at marriage, lengthen the birth interval, and limit the number of births per family to two in the cities and three in the countryside. A birth-quota and pregnancy-authorization system was instituted. The campaign was greatly facilitated by the nationwide network of free community-based contraceptive and abortion services and generous incentives. By the early 1980s the contraceptive prevalence rate rose to 70 percent, and the total fertility rate fell to about 2.5 children per woman of reproductive age. The year 1979 saw the introduction of the one-child campaign. By 1982 first births accounted for 47 percent of total births, and 42 percent of the one-child families had pledged to have no more children. The successful implementation of the one-child campaign will, however, lead to a rapid aging of the population. The percentage of the population older than 64 years of age will increase rapidly, from 5 percent in 1982 to 7.3-7.7 percent in 2000 and to 23-27 percent in 2050. With such a high aged-dependency ratio, caring for the aged will entail heavy fiscal outlay in the twenty-first century.

Familial melanoma associated with dominant ultraviolet radiation sensitivity

Sensitivity to ultraviolet radiation was studied in lymphoblastoid cell lines derived from 32 members of two families with histories of multiple primary melanomas in several generations. As assayed by colony formation in agar or by trypan blue exclusion following irradiation, cellular sensitivity showed a bimodal distribution. All persons with melanoma or multiple moles were in the sensitive group, while some family members exhibited responses similar to those of controls. Cells from four cases of sporadic melanoma showed normal levels of sensitivity. The data are consistent with a dominantly inherited ultraviolet light sensitivity associated with these examples of familial melanoma. Spontaneous and ultraviolet light-induced sister chromatid exchange frequencies were similar to those in control cell lines. No defect in excision repair was detected in any of the above cell lines, but the sensitive group showed postirradiation inhibition of DNA replication intermediate between controls and an excision-deficient xeroderma pigmentosum cell line.

Differences in lymphoproliferative responses to the bacterium Actinomyces viscosus in various mammalian species

A water-soluble extract of Actinomyces viscosus (AVS) was tested for its capacity to induce DNA synthesis in lymphocytes from man, monkeys, mice and guinea pigs. The results indicated that the AVS induced an in-vitro lymphoproliferative response, as assessed by tritiated thymidine incorporation, in mouse-spleen cells, in the majority of human peripheral blood samples tested and in macaque monkey spleen cells. The AVS also elicited a blastogenic response from spleen, lymph node and peripheral blood lymphocytes from guinea pigs immunized with A. viscosus. The AVS did not elicit a lymphoproliferative response from human-cord blood cells, monkey peripheral blood lymphocytes, or peripheral blood and spleen lymphocytes from non-immunized guinea pigs. Thus there was a difference in the ability of A. viscosus to induce DNA synthesis in lymphocytes from the different animal species tested.

Cell-mediated and humoral immune responses of guinea-pigs to the oral bacterium Actinomyces viscosus

Actinomyces viscosus is a Gram-positive facultative rod indigenous to most human mouths. The guinea-pig was evaluated as a model for assessing cellular immune responses to a human strain of A. viscosus. Guinea-pigs, immunized with heat-killed A. viscosus cells or a water-soluble extract from A. viscosus (AVS), were tested for delayed-type hypersensitivity responses to A. viscosus 4 weeks after immunization. A week later, the guinea-pigs were terminated. Lymphocytes from peripheral blood, lymph node and spleen were tested for in-vitro blastogenic responses to heat-killed A. viscosus or the water-soluble extract. Plasma from these guinea-pigs were tested for the presence of precipitating antibodies. Positive in-vivo delayed-type hypersensitivity reactions and antibody responses to AVS occurred only in immunized guinea-pigs. A strong in-vitro blastogenic response to AVS or heat-killed A. viscosus occurred in lymphocytes from immunized guinea-pigs, but a weak response was detected in un-immunized animals. These data suggest that the guinea-pig can be used to evaluate different parameters of the immune response to oral bacteria such as A. viscosus.

Huntington's disease: implications of associated cellular radiosensitivity

Ionizing radiation sensitivity was studied in a series of Huntington's Disease (HD) patients and controls by measurement of radiation-induced chromosome aberrations in lymphocytes and by clonogenic survival of lymphoblastoid cell lines. As a group, HD patients were found to be significantly more radiosensitive than controls (p less than 0.001), but there was an overlap between values for the two groups such that an absolute distinction is not possible. These data are consistent with an association between HD and radiosensitivity but not with identity between HD and a radiosensitive phenotype, so that cellular radiosensitivity cannot be used for individual diagnosis. Analysis of three families including 5 HD patients and 11 first-degree relative confirmed this conclusion and demonstrated that even within a given family presymptomatic diagnosis cannot be based on measurement of radiosensitivity. However, the common association of cellular radiosensitivity with HD probands and their families provides a potential lead to the identification of HD gene(s) and so to an eventual understanding of the aetiopathogenesis of this disease at the molecular level.

Plasmodium falciparum strains from Papua New Guinea: culture characteristics and drug sensitivity

Seven strains of Plasmodium falciparum from Papua New Guinea have been established in continuous in vitro culture. Samples with a high initial parasitaemia were more likely to form continuous lines, possibly due to the time required for transport of infected blood samples from Papua New Guinea to laboratories in Australia. Most but not all established lines were resistant to chloroquine and all were resistant to pyrimethamine, possibly reflecting the parasite strain characteristics in that region.

Antigen structural requirements for immunoglobulin isotype switching in mice

L-Tyrosine-p-azobenzene-p-arsonate (RAT) is immunogenic and serves as a carrier for anti-hapten antibody responses in guinea pigs, rats, and mice. However, the murine anti-N-2,4-dinitrophenyl (DNP) plaque-forming cell (PFC) response to the bifunctional antigen 2,4-dinitrophenyl-6-amino-caproyl-L- tyrosine-p-azobenzene-p-arsonate (DNP-SAC-RAT; or BI-1) is extremely weak (2,000-4,000 PFC/spleen) and exclusively IgM in both primary and secondary responses. The 6-amino-caproyl group serves as a spacer in this antigen between the DNP haptenic and RAT carrier epitopes. In view of recent evidence indicating that different T helper cells synergize for optimal antibody responses, a trifunctional antigen, N-2,4- dinitrophenyl-6-amino-caproyl-L-tyrosine-p-azobenze-p-arsonate-(proline)9-L- tyrosine-p-azobenzene-p-arsonate (DNP-SAC-RAT-PRO(9)-RAT; or TRI), was prepared to investigate the effect of adding a second RAT epitope to BI-1. The nonaproline spacer between the two RAT epitopes in TRI is assumed to be a rigid rod of approximately 28 A. TRI induced about twice as many PFC as BI-1 in primary responses of A/J mice, and induced both IgM and IgG PFC in secondary responses. Furthermore, TRI induced IgG PFC responses in mice primed with p-azobenzene-p-arsonate-keyhole limpet hemocyanin, BI-1, or RAT, whereas boosting with BI-1 failed to induce IgG PFC, even in mice primed with TRI. These findings indicate that the minimum antigen structural requirements for inducing IgG PFC in mice are two carrier epitopes and one haptenic epitope. In addition, priming with a mono-epitope carrier (RAT) is sufficient preparation for IgG responses to a trifunctional immunogen. Because TRI differs from BI-1 by the (proline)(9) spacer as well as the additional RAT epitope, two other compounds, N-2,4-dinitrophenyl-6-amino- caproyl-(proline)(9)-L-tyrosine-p-azobenzene-p-arsonate (DNP-SAC-PRO(9)-RAT; or BI-2) and N-2,4-dinitrophenyl-6-amino-caproyl-(proline)(9)-L-tyrosine-p- azobenzene-arsonate (DNP-SAC-RAT-PRO(10); or BI-3), were prepared to evaluate the possible role of the spacer in the observed responses. BI-2, but not BI-3, induced IgG as well as IgM PFC in TRI-primed mice. However, BI-2 failed to induce IgG responses in RAT-primed mice, indicating that TRI and BI-2 were not equivalent immunogens. Because anti-prolyl antibodies had been found in guinea pigs immunized with N-2,4-dinitrophenyl-(proline)10-L-tyrosine-p- azobenzene-p-arsonate (DNP-PRO(10)-RAT), it seemed possible that priming with TRI might induce anti-prolyl antibodies, which, in turn, could cross-link BI-2 molecules into aggregates containing at least two carrier epitopes. To help resolve this question, mice were immunized with acetyl-(proline)10-L- tyrosine-p-azobenzene-p-arsonate and boosted with BI-2. IgG PFC responses were detected, suggesting that anti-prolyl antibodies were indeed responsible, because priming with RAT and boosting with BI-2 did not induce IgG formation. Accordingly, the observations that IgG responses in RAT-primed mice were induced only by TRI and not by any of the bifunctional antigens indicate that two carrier epitopes per antigen molecule are indeed required for IgG induction. They also provide indirect evidence for synergistic help in the switching of immunoglobulin isotypes.