Pulmonary atelectasis associated with relative hyperperfusion

Perfusion is usually diminished to areas of the lung that are poorly ventilated. A case is presented which demonstrates not only preservation of perfusion, but also an apparent increase in relative perfusion to an atelectatic lobe.

Influence of food on tianeptine and its main metabolite kinetics

The influence of a test meal on the absorption and disposition of tianeptine (Stablon), a new antidepressant, was investigated in 12 healthy subjects in a two-way, randomized, open cross-over study. Single 12.5-mg oral doses of tianeptine were administered following a night of fasting or immediately after a standardized breakfast. When subjects received tianeptine under fasting conditions the lag time before absorption onset, and the time of the maximum plasma concentration were 0.55 +/- 0.26 hours and 1.29 +/- 0.29 hours, respectively. The maximum plasma concentration was 322 +/- 44 ng/mL, and the total area under the curve 994 +/- 248 ng/hr/mL. When tianeptine was given at the end of the meal, several significant changes were found for tianeptine kinetic parameters; the lag time increased by 0.3 hour and the maximum plasma concentration was lowered (decreased by 25%) and occurred later (tmax increased by 0.5 hour). However, no significant change was found in the area under the plasma concentration-time curve. The trend and extent of changes in the MC5 metabolite parameters were similar to those observed for the parent drug. Absorption of tianeptine is slightly delayed and slowed down without modification of its extent when tianeptine is given at the end of a meal. These slight changes are not clinically relevant for an antidepressant administered three times a day. Despite the changes observed, tianeptine may be given at meal times to improve compliance with treatment.

Both cell substratum regulation and hormonal regulation of milk protein gene expression are exerted primarily at the posttranscriptional level

The mechanism by which individual peptide and steroid hormones and cell-substratum interactions regulate milk protein gene expression has been studied in the COMMA-D mammary epithelial cell line. In the presence of insulin, hydrocortisone, and prolactin, growth of COMMA-D cells on floating collagen gels in comparison with that on a plastic substratum resulted in a 2.5- to 3-fold increase in the relative rate of beta-casein gene transcription but a 37-fold increase in beta-casein mRNA accumulation. In contrast, whey acidic protein gene transcription was constitutive in COMMA-D cells grown on either substratum, but its mRNA was unstable and little intact mature mRNA was detected. Culturing COMMA-D cells on collagen also promoted increased expression of other genes expressed in differentiated mammary epithelial cells, including those encoding alpha- and gamma-casein, transferrin, malic enzyme, and phosphoenolpyruvate carboxykinase but decreased the expression of actin and histone genes. Using COMMA-D cells, we defined further the role of individual hormones in influencing beta-casein gene transcription. With insulin alone, a basal level of beta-casein gene transcription was detected in COMMA-D cells grown on floating collagen gels. Addition of prolactin but not hydrocortisone resulted in a 2.5- to 3.0-fold increase in beta-casein gene transcription, but both hormones were required to elicit the maximal 73-fold induction in mRNA accumulation. This posttranscriptional effect of hormones on casein mRNA accumulation preceded any detectable changes in the relative rate of transcription. Thus, regulation by both hormones and cell substratum of casein gene expression is exerted primarily at the post transcriptional level.

A clonal derivative of mammary epithelial cell line COMMA-D retains stem cell characteristics of unique morphological and functional heterogeneity

The COMMA-D cell line derived from mammary epithelial cells of midpregnant mice was shown previously to be heterogeneous as determined by phase-contrast microscopy, immunocytochemical staining, DNA content, and oncogenic potential (K.D. Danielson et al. (1984) Proc. Natl. Acad. Sci. USA 81, 3756; D. Medina et al. (1986) J. Natl. Cancer Inst. 76, 1143). Clonal subpopulations of COMMA-D cells have now been isolated by both transfection and selection using a dominant-selectable gene transfer vector and by limiting dilution. Despite their clonal origin, these subpopulations in many cases retained the heterogeneity of the parental COMMA-D line. Of 18 clonal lines assayed, only 5 were able to express beta-casein mRNA. Pooled populations of G418-resistant cells expressed substantially higher levels of beta-casein mRNA than the clonal lines. One of the expressing clonal lines, BNW-7, was characterized further, using immunocytochemical techniques. Approximately 10% of BNW-7 cells expressed casein under the appropriate hormonal and cell-substratum conditions by indirect immunofluorescent staining. Casein immunoperoxidase staining of BNW-7 cells on floating collagen gels revealed that casein-producing cells were localized in small alveolar structures, which were formed in a non-hormone-dependent fashion. The cells in these alveolar structures were cuboidal with basally located nuclei, expressed keratin intermediate filament proteins preferentially, and comprised approximately 18% of the total cells. Cells elsewhere on the surface of the gel displayed a flattened morphology, and expressed vimentin intermediate filament proteins preferentially. A proportion of COMMA-D cells, therefore, appeared to have some of the characteristics of mammary stem cells, and retained the ability to differentiate and form phenotypically heterogeneous cell populations in vitro.

Infarction of the upper limbs associated with oligohydramnios and intrauterine compression

We describe a case of neonatal infarction involving both upper extremities. Oligohydramnios, resulting in compression of both arms within the uterus, is proposed as the cause of this congenital gangrene. Despite attempted conservative management, both arms became flaccid and moist. By the third day of life, the infant's worsening cardiovascular status necessitated amputation. This rare disorder has varying degrees of presentation. Limbs have been salvaged with conservative management of the extremity, coupled with appropriate surgical intervention, and neonatal intensive care.

A transfected alpha-casein minigene bypasses posttranscriptional control by hormones, but retains cell-substratum regulation in mammary epithelial cells

DNA-mediated gene transfection using an alpha-casein minigene cloned into a bovine papilloma virus (BPV)-based neomycin-selectable expression vector has been employed to study the mechanisms by which hormonal and cell-substratum interactions regulate milk protein gene expression. Permanently transformed clones and pooled populations of normal midpregnant mouse mammary epithelial cells (COMMA-D) containing the minigene express an authentic rat alpha-casein mRNA, as well as a series of larger cytoplasmic RNA transcripts. These transcripts are correctly initiated and spliced; however, a large proportion also contain additional sequences at the 3'-end. Constitutive expression of the minigene in the absence of PRL and glucocorticoids in COMMA-D cells grown on floating type I collagen gels is observed. Thus, the minigene-BPV construct apparently overrides the normal posttranscriptional regulatory mechanisms which are responsible for the expression of unstable casein gene transcripts in the absence of PRL and glucocorticoids. In contrast, this minigene-BPV construct is regulated appropriately by cell-substratum interactions in pooled transfectants. Minigene expression is undetectable when pooled transfectants are plated on a plastic substratum, and readily detectable when cells are grown on floating type I collagen gels. Thus, hormones and cell-substratum interactions may regulate different steps in the same differentiation pathway leading to increased casein gene expression.

Tissue-specific expression of the rat beta-casein gene in transgenic mice

The rat beta-casein gene is a member of a small gene family, encoding the principal milk proteins. In order to understand the mechanisms by which its stage- and tissue-specific expression are regulated, initially, a 14 kb genomic clone containing the entire 7.5 kb rat beta-casein gene with 3.5 kb of 5' and 3.0 kb of 3' flanking DNA was microinjected into the germline of mice. Eight F0 transgenic mice were generated with copy numbers ranging from 1-10; five transmitted the transgene to their offspring in a Mendelian pattern. A specific RNase protection assay was developed to quantitate the level of expression of the rat beta-casein transgene as compared to the endogenous mouse beta-casein gene. Using this assay expression was demonstrated predominantly in the lactating mammary gland of transgenic mice at a level of 0.01-1% of the endogenous mouse beta-casein gene. The transgene employed the authentic transcription initiation site observed previously in the analogous rat beta-casein gene. In one line, a reduced level of expression of the transgene was also observed in the brain. The site of integration, therefore, plays an important role in influencing the level of expression of the transgene, but not its general pattern of tissue-specificity. The transgene appears to be developmentally-regulated in accordance with the endogenous mouse beta-casein gene. These lines of mice generated carrying the rat beta-casein transgene should provide useful models for studying the developmental and hormonal regulation of milk protein gene expression.

Resolution of a photopenic lesion on bone imaging following chemotherapy for metastatic disease

Resolution of abnormal foci of increased radiotracer deposition on bone imaging occurs commonly. Photopenic areas due to avascular necrosis and infarcts have been reported to resolve. This report describes serial changes in a photopenic lesion due to metastatic disease and demonstrates that such lesions can resolve following chemotherapy.

Scintigraphic criteria for the diagnosis of renal arteriovenous fistulas

Visualization of the inferior vena cava (IVC) on renal perfusion imaging occurs in cases of renal arteriovenous (AV) fistulas. A review of consecutive renal scans demonstrated IVC visualization in three of 217 patients without AV fistulas. IVC visualization occurred 3-6 seconds after peak aortic activity in normal patients. With renal AV fistulas, an intrarenal focus of increased activity is seen and IVC visualization occurs coincident with peak aortic activity.

Nontraumatic fat embolization. A rare cause of new pulmonary infiltrates in an immunocompromised patient

Diffuse pulmonary infiltrates and hypoxemia are common in immunocompromised patients. We describe a patient with lymphoma who developed hypoxemia and diffuse pulmonary infiltrates during treatment with corticosteroids. Open lung biopsy and postmortem examination indicated that the cause of the infiltrates was nontraumatic fat embolization (NTFE). Most previous cases of NTFE have implicated a fatty liver as the source of emboli; however, this patient had no fatty changes of the liver. The diagnosis of NTFE in an immunocompromised patient is difficult to make because its distinguishing features, such as hypoxemia, petechiae, and altered mental status, are nonspecific in this setting.

Significance of single ventilation/perfusion mismatches in krypton-81m/technetium-99m lung scintigraphy

The significance of a single area of ventilation/perfusion (V/P) mismatch in lung scans performed on patients suspected of pulmonary embolism (PE) was evaluated. Ten of 20 patients with this scan finding were found to have PE. An intermediate probability of PE was found with segmental (71%) or subsegmental (45%) single V/P mismatches. Seven of 16 patients with a single V/P mismatch and without a matching radiographic opacity had PE. Three of the four patients who had a V/P mismatch and a matching radiographic opacity were found to have PE. Multiview ventilation imaging with 81mKr was found to have advantages for the evaluation of single V/P mismatches. Based on the data available at this time, a single V/P mismatch suggests an intermediate probability of PE.

Isolation and characterization of milk protein nuclear RNAs in rat mammary gland

Methods have been developed to isolate high-molecular-weight pre-mRNAs from lactating mammary gland, a tissue high in RNase levels. These methods involved isolation of nuclei at -20 degrees C in 50% glycerol, and nucleic acid extraction using a guanidine thiocyanate-CsCl protocol. Specific RNAs were detected using alpha-, beta-, and gamma-casein and whey acidic protein nick-translated cDNA and genomic DNA probes by hybridization in situ to pre-mRNAs fractionated on agarose gels containing 10 mM methylmercuric hydroxide. Using these techniques it was possible to isolate poly(A)-containing gene-sized primary transcripts in the case of the two smaller genes, beta-casein and whey acidic protein. A very complex pattern of pre-mRNAs was observed for the beta-casein transcripts, including detection of a species which may represent an excised intron. Probes for the alpha- and gamma-casein genes revealed much lower abundance and complexity of RNA precursors. These methods have proven useful in the initial analysis of RNA processing of these hormonally regulated milk protein gene transcripts.

Evolution of the casein multigene family: conserved sequences in the 5' flanking and exon regions

The rat alpha- and bovine alpha s1-casein genes have been isolated and their 5' sequences determined. The rat alpha-, beta-, gamma- and bovine alpha s1-casein genes contain similar 5' exon arrangements in which the 5' noncoding, signal peptide and casein kinase phosphorylation sequences are each encoded by separate exons. These findings support the hypothesis that during evolution, the family of casein genes arose by a process involving exon recruitment followed by intragenic and intergenic duplication of a primordial gene. Several highly conserved regions in the first 200 base pairs of the 5' flanking DNA have been identified. Additional sequence homology extending up to 550 base pairs upstream of the CAP site has been found between the rat alpha- and bovine alpha s1-casein sequences. Unexpectedly, the 5' flanking promoter regions are conserved to a greater extent than both the entire mature coding and intron regions of these genes. These conserved 5' flanking sequences may contain potential cis regulatory elements which are responsible for the coordinate expression of the functionally-related casein genes during mammary gland development.

Optical modeling of stratospheric aerosols: present status

A stratospheric aerosol optical model is developed which is based on a size distribution conforming to direct measurements. Additional constraints are consistent with large data sets of independently measured macroscopic aerosol properties such as mass and backscatter. The period under study covers background as well as highly disturbed volcanic conditions and an altitude interval ranging from the tropopause to approximately 30 km. The predictions of the model are used to form a basis for interpreting and intercomparing several diverse types of stratospheric aerosol measurement.

Gallbladder perforation: diagnostic utility of cholescintigraphy in suggested subacute or chronic cases

The preoperative cholescintigrams of 16 patients with subacute or chronic gallbladder (GB) perforation demonstrated at surgery were reviewed, and the scintigraphic findings were characterized. Persistent GB nonvisualization was found in each study. Additional findings included a band of increased pericholecystic hepatic activity (PCHA) (n = 7) and/or a photopenic region in the GB fossa (n = 7). PCHA and photopenic region findings, when visualized, were most commonly associated with a subacute localized perforation with pericholecystic abscess formation. However, the sensitivity of each of these findings was only 44%. Cholescintigrams did not directly demonstrate the perforation site in any patient. Although the presence of the PCHA sign and/or GB fossa photopenic region appears to identify a subgroup of patients at increased risk for perforation, cholescintigraphy is relatively insensitive for detection of subacute or chronic GB perforation.

The biodistribution of radiolabeled antilymphocyte monoclonal antibody in the rat

The biodistribution of radiolabeled mouse anti-pan T monoclonal antibody (W3/13) against rat lymphocytes was examined in normal rats. Monoclonal antibody to human prostate-associated antigens (PAA) served as a control. In vitro studies demonstrated a 38% maximum binding of radiolabeled W3/13 to lymphocytes, which was significant (P less than 0.001) when compared with the control (PAA) value of 3.4%. In vivo, intravenously administered 111In labeled W3/13 and 131I labeled W3/13 exhibited similar tissue distribution patterns. The localization of W3/13 in lymphoid tissue was significantly greater than that achieved with PAA. W3/13, however, did not demonstrate significant localization in the intact thymus and accumulated to a higher degree (6-10% ID/g) than expected in bone marrow at 24 h. These findings suggest that radiolabeled anti-lymphocyte monoclonal antibodies may not be well suited for the treatment of lymphoreticular neoplasms and allograft rejection in patients.

Effect of respiratory motion on pulmonary activity determinations by positron tomography in dogs

The effect of respiratory motion on pulmonary activity determinations by positron emission tomography (PET) was studied in dogs with experimentally created pulmonary emboli (PE). The location of the PE was evaluated by planar 99mTc lung imaging to determine the appropriate sites for transaxial PET scans. PET scans of the lung then were obtained after i.v. injection of 68Ga-labeled microspheres. PET scans were acquired during slow (15 breaths/min) and fast (30 breaths/min) breathing with the same minute ventilation and then postmortem. Lung perfusion patterns were documented by i.v. injection of India ink before sacrifice. Cross sections of the excised lungs were made at the same levels as the PET scans, and eight sections containing 14 perfusion defects were analyzed. The scans obtained during slow breathing consistently showed edge blurring and demonstrated defects less well than scans obtained during fast breathing or postmortem. The normal-to-defect activity ratios during fast breathing and on the postmortem studies were similar and approximately 17% higher (P less than .01) than in scans obtained in the same animals during slow breathing. The results demonstrate the need for motion correction during quantitative analysis of regional lung activity by positron tomography, and suggest that high-frequency respiration at small tidal volumes may be one means for obtaining this correction.