Abnormalities in T-cell associated rearrangement of T-cell receptor gamma chain genes in B-cell chronic lymphocytic leukemia

Non-random rearrangement of genes encoding the gamma chain of the T-cell antigen receptor is known to occur in a developmentally regulated fashion during thymocyte differentiation. We show here that peripheral blood T lymphocytes from patients with B-cell chronic lymphocytic leukemia display marked abnormalities in the spectrum of gamma variable region gene rearrangements compared with normal peripheral blood. Of seven patients studied, all displayed a reduction of rearrangements into V9 (subgroup V II), while two cases had, in addition, over-representation of specific rearrangements involving subgroup V I; one V 2/4, the other V 5. These observations have a number of implications relevant to mechanisms of disease pathogenesis, and may provide new insight into the basis of T-cell dysfunction that is frequently associated with this condition.

Randomised double-blind placebo-controlled trial of feverfew in migraine prevention

The use of feverfew (Tanacetum parthenium) for migraine prophylaxis was assessed in a randomised, double-blind, placebo-controlled crossover study. After a one-month single-blind placebo run-in, 72 volunteers were randomly allocated to receive either one capsule of dried feverfew leaves a day or matching placebo for four months and then transferred to the other treatment limb for a further four months. Frequency and severity of attacks were determined from diary cards which were issued every two months; efficacy of each treatment was also assessed by visual analogue scores. 60 patients completed the study and full information was available in 59. Treatment with feverfew was associated with a reduction in the mean number and severity of attacks in each two-month period, and in the degree of vomiting; duration of individual attacks was unaltered. Visual analogue scores also indicated a significant improvement with feverfew. There were no serious side-effects.

Failure of dopexamine to maintain haemodynamic improvement in patients with chronic heart failure

Ten patients with chronic heart failure were given a continuous infusion of dopexamine after an initial stage of dose titration. On the dose selected the cardiac index initially rose by 56%, as a result of an increase in both heart rate and stroke volume index. Systemic vascular resistance fell by 34% and the mean arterial pressure did not change. Within 18 hours of the start of the continuous infusion, however, all the variables except heart rate had returned to preinfusion values. Nine of the 10 patients were withdrawn from the 48 hour study, six because of haemodynamic deterioration and two because of side effects. If the premature loss of therapeutic effect reflects an intrinsic property of this agent, dopexamine may be of limited clinical value.

25- to 30-nm virus particle associated with a hospital outbreak of acute gastroenteritis with evidence for airborne transmission

Between November 1 and 22, 1985, an outbreak of acute, nonbacterial gastroenteritis occurred in a 600-bed hospital in Toronto, Ontario, Canada. Illness in 635 of 2,379 (27%) staff was characterized by fatigue, nausea, diarrhea, and vomiting and had a median duration of 24-48 hours. The finding of virus-like particles measuring 25-30 nm in six stool specimens and low rates of seroresponse to Norwalk virus (3/39) and Snow Mountain agent (1/6) suggest that a Norwalk-like virus was responsible for the outbreak. The outbreak was of abrupt onset and high incidence, affecting 79 people in a single day. No common food or water exposure could be identified. The attack rate was greatest (69%) for staff who had worked in the Emergency Room. Of 100 patients and their companions who visited the Emergency Room on November 11-12 for unrelated problems, 33 (33%) developed gastroenteritis 24-48 hours after their visit, versus 0 of 18 who visited the Emergency Room on November 8 (p less than 0.001). An analysis of housekeepers who worked at least once during the period from November 9-13, which included those who became ill during the period of November 9-14, showed that the risk of becoming ill was four times greater for those who visited or walked through the Emergency Room than for those who did not (p = 0.028). These data are consistent with the possibility of the airborne spread of a virus.

Expression of functional interleukin 2 receptors on chronic lymphocytic leukaemia B lymphocytes is modulated by recombinant interleukin 2

In 16 of 18 chronic lymphocytic leukaemia (CLL) patients examined, a significant proportion of B cells in the leukaemic clone bound monoclonal antibodies specific for the interleukin 2 (IL-2) receptor site (CD25). B lymphocytes from patients tested showed a direct response to recombinant interleukin (rIL-2) during culture in vitro as shown by: (a) a ligand-mediated upregulation in the level of IL-2 receptor (IL-2R) expression (12 of 12 patients), (b) an increase in cell size (eight of nine patients), (c) an increase in 3H-thymidine uptake (four of six patients). Taken together, this evidence suggests that the majority of leukaemic B cells from all the CLL patients examined expressed functional IL-2 receptors in vitro. Intriguingly, maximal receptor upregulation or increase in cell size was achieved at a lower concentration (50 u/ml) of rIL-2 than was required to achieve maximal 3H-thymidine incorporation.

Effect of protein concentration and protein source on the degradability of dry matter and protein in situ

Degradability of DM and CP was determined in situ for barley, canola meal, corn gluten meal, barley silage, and four concentrate mixtures. Crude protein percent of concentrate mixtures 1 to 4, respectively, were barley plus canola 1, 15.1; barley plus canola 2, 21.0; barley plus corn gluten 1, 17.1; and barley plus corn gluten 2, 19.6. Degradability of each feedstuff was measured on each of four basal diets consisting of barley silage and one of the above concentrate mixtures fed in the proportion 40:60 (DM). The resulting CP percent of diets containing concentrates 1 to 4 were 12.3, 16.1, 13.8, and 16.4. Effective degradability for DM and CP, assuming a rumen outflow rate of .08 h-1, were: barley 77.7 and 79.8; canola meal 60.9 and 66.6; corn gluten meal 18.9 and 11.0; barley silage 47.0 and 81.1; barley plus canola 1, 76.4 and 77.4; barley plus canola 2, 72.5 and 71.8; barley plus corn gluten 1, 72.8 and 55.8; barley plus corn gluten 2, 70.2 and 47.4. With two exceptions (DM degradability of concentrate 4 and CP degradability of concentrate 2), basal diet had no significant effect on effective CP or effective DM degradability. Crude protein degradability of concentrate mixtures 1 to 4, respectively, as measured (77.4, 71.8, 55.8, and 47.4) was similar to degradability estimated on the basis of their ingredient content (75.7, 72.1, 49.6, and 43.0).

Analysis and isolation of leukaemic and residual normal B lymphocyte populations from patients with chronic lymphocytic leukaemia

Two colour fluorescent staining using anti-Leu-1 and anti-B1 monoclonal antibodies has been combined with continuous flow microfluorimetry to analyse and isolate the T and B cell populations in B cell chronic lymphocytic leukaemia (B-CLL) patients. In Rai stage 0 patients two distinct B1 positive populations were detected and sorted; one was Leu-1- and the other Leu-1+. Analysis of the isolated populations showed that the former (Leu-1- B1+) represented the residual normal B cells, whereas the latter represented monoclonal CLL B cells. Short term culture of these cells in vitro showed that the Leu-1+ B1+ population secreted IgM, but not IgG, following PMA stimulation.

Mobile nylon bag for estimating intestinal availability of rumen undegradable protein

The objective was to develop a method for estimating intestinal availability of rumen undegradable protein. One-gram samples of six feedstuffs were placed into small (3.5 X 5.5 cm) nylon bags (pore size 48 micron). Bags were heat sealed and ruminally incubated in a polyester mesh (lingerie) bag in quadruplicate for each of six time periods (0, 2, 4, 8, 12, 24 h). Two bags from each rumen incubation time were inserted into the small intestine via a duodenal cannula at the rate of one bag per 45 min. Bags were mechanically washed either upon removal from the rumen--for determination of rumen degradability, or when recovered from the feces--for estimation of intestinal availability. Dried bags plus contents were digested intact for nitrogen analysis. Rumen degradable protein and apparent intestinal availability of undegradable protein (based on 8 h of rumen incubation) for corn gluten meal, fish meal, meat and bone meal, soybean meal, canola meal, and alfalfa hay, respectively, were 11.8, 95.0; 28.5, 82.8; 46.7, 73.0; 55.1, 99.3; 69.7, 79.2; and 68.8, 71.2. Results support the use of this technique as a rapid method for estimating both ruminal degradability, and intestinal availability of rumen undegradable protein.

Membrane damage by hemolytic viruses, toxins, complement, and other cytotoxic agents. A common mechanism blocked by divalent cations

Hemolytic viruses, bacterial and animal toxins, the components of activated complement, cationic proteins, and detergents induce a sequence of permeability changes at the plasma membrane that are in every case sensitive to changes in ionic strength and to divalent cations. Individually, each agent exhibits positive cooperativity; when two agents are present together, they show synergy. It is concluded that such cytotoxic agents damage membranes by a common mechanism. Hence permeability changes are unlikely to depend on the formation of specific, protein-lined channels, as previously envisaged in the case of activated complement or certain bacterial toxins.

Simultaneous flow cytometric deoxyribonucleic acid and acid phosphatase analysis of benign and malignant lesions of the prostate

Flow cytometry can differentiate benign from malignant lesions of the prostate through deoxyribonucleic acid distribution analysis. A method has been developed that permits simultaneous cytometric determination of deoxyribonucleic acid and acid phosphatase activity in the cell cycle compartments of prostatic biopsy specimens. Histograms of prostatic carcinoma reveal higher acid phosphatase activity and greater deoxyribonucleic acid content in the S and S + G2/M populations than the histograms representing benign lesions. This compartmental difference may have prognostic usefulness.

Torsade de pointes induced by N-acetylprocainamide

N-Acetylprocainamide (NAPA), a class III antiarrhythmic drug, caused torsade de pointes in a 72 year old woman who had this arrhythmia on two previous occasions while being treated with quinidine and disopyramide. Initial evaluation with an intravenous infusion of NAPA indicated a favorable antiarrhythmic response. The QTC interval was prolonged, but the 2.4 ms/microgram per ml incremental QTC interval lengthening caused by NAPA was not greater than usual. During subsequent oral therapy with NAPA, torsade de pointes developed at plasma levels of this drug that appeared to be well tolerated during the initial evaluation.

Percutaneous drainage of pancreatic pseudocysts

Ultrasonography was used to diagnose, localize and direct the percutaneous transabdominal needle aspiration of 10 pancreatic pseudocysts in 9 patients. Thirty-four aspirations were performed without complication. In 9 pseudocysts no other treatment was necessary, and in all patients relief of pain or obstructive symptoms when present was obtained. None of the cysts have recurred with a mean follow-up of 26 months.

Role of immunoglobulin classes in experimental histoplasmosis in bats

Pooled normal bat serum was separated by gel filtration to give fractions rich in IgG-, Iga- and IgM-like proteins. These fractions were analogous to the corresponding human immunoglobulin classes by immunoelectrophoresis and SDS-polyacrylamide gel electrophoresis. Rabbits were immunized with the fractions and the antisera absorbed. Neotropical bats (Artibeus lituratus) were infected with Histoplasma capsulatum and serum samples were collected weekly and tested for specific serologic response to the fungus. A radial immunodiffusion test was devised to monitor changes in concentrations of IgG, IgA and IgM in the same sera. Bats infected with a low dose of fungus had significantly increased levels of IgM and IgA between 2-6 weeks post-infection. Bats receiving a high dose maintained elevated levels of IgM and IgA through the end of the study. Significantly elevated levels of IgG were not detected until late in the disease (8-9 weeks). In bats with histoplasmosis, IgM and IgA appeared to contribute primarily to the early positive serologies, while precipitating antibodies of the IgG class were detectable later in the disease. These results are similar to the serologic profile seen in human histoplasmosis, and extend our understanding of comparative immune responses in an important wildlife reservoir of human mycotic pathogens.

Pancreatic pseudocyst: management by ultrasonically guided aspiration

Five pancreatic pseudocysts were managed by percutaneous transabdominal needle aspiration under ultrasound guidance. Thirteen aspirations were performed without complication. In four cysts this was the sole treatment required. None of these cysts have recurred, with a follow-up of between 6 and 12 months. Surgery of acute pseudocysts can be postponed or eliminated by this technique. Relief of pain and of obstructive symptoms can be obtained and time gained, when necessary, for maturation of the cyst wall.

Omental transposition as an aid in genitourinary reconstructive procedures

Mobilization of an intact omental pedicle graft for supportive use has been carried out in a variety of genitourinary reconstructive procedures. Mobilzation is accomplished by detachment of the omentum from the transverse colon and by separation from the greater curvature of the stomach. The right gastroepiploic artery is generally preserved as the blood supply to the omental pedicle. Further pedicle lengthening can be achieved as necessary by selective division of the omentum, based on the arterial anatomy. The rich vascular and lymphatic supply of the omentum and its attendant potential to contribute to healing, even in the presence of infection, while maintaining its suppleness and allowing epithelization to occur over its surface, makes the omental pedicle graft an extremely useful adjunct in the following difficult situations: complicated vesicovaginal, prostatorectal, and rectovaginal fistulas; reconstruction of the bladder neck and bulbo-membranous urethral areas; extensive injury to the bladder; and a variety of renal and ureteral reconstructive procedures.

Repair of vesicovaginal fistula by a suprapubic transvesical approach

Thirty-four vesicovaginal fistulas of various causes were repaired using a suprapubic, transvesical approach modified after the original technique of O'Connor. Only four failures resulted. Two of the failures were attributed to residual or recurrent carcinoma and two to poor tissue healing resulting from an inadequate delay between the initial surgical procedure and an attempt at reconstructive surgery. Surgical complications included three wound infections and one instance of severe gastrointestinal bleeding. Technical considerations thought to be important include excision of all diseased tissue in the bladder and vagina; complete separation of the bladder from the vagina with a margin of healthy tissue in all directions; careful, watertight closure of both bladder and vagina without tension; interposition of peritoneum or omentum between the closed bladder and vagina, and initial postoperative maintenance of an uninfected and dry suture line.