Primary peritonitis. An unusual operative diagnosis

Primary peritonitis, or spontaneous bacterial peritonitis, is a highly morbid and often fatal complication of cirrhosis and other conditions associated with ascites. Prompt antibiotic therapy may be lifesaving, as may early surgical intervention in patients who have signs and symptoms of an acute abdomen. During a 5-year period, 12 patients had 14 episodes of primary peritonitis diagnosed in our hospital. Three patients had exploratory laparotomy, and gram-positive organisms were obtained from peritoneal fluid in two patients. The clinical features, patho-physiology, and natural courses of these patients are presented and the current literature reviewed.

Recombinant interferon alfa therapy for chronic hepatitis C. A randomized, double-blind, placebo-controlled trial

Infection with the hepatitis C virus may result in chronic liver disease for which no effective therapy is now available. We studied the effects of recombinant human interferon alfa in a prospective, randomized, double-blind, placebo-controlled trial in patients with well-documented chronic hepatitis C. Forty-one patients were enrolled in the trial, 37 of whom were later found to have antibody to hepatitis C virus. Twenty-one patients received interferon alfa (2 million units) subcutaneously three times weekly for six months, and 20 received placebo. The mean serum aminotransferase levels and the histologic features of the liver improved significantly in the patients treated with interferon but not in the patients given placebo. Ten patients treated with interferon (48 percent) had a complete response, defined as a decline in mean serum aminotransferase levels to the normal range during therapy; three others had a decrease in mean aminotransferase levels of more than 50 percent. After treatment ended, however, serum aminotransferases usually returned to pretreatment levels; 6 to 12 months after the discontinuation of interferon therapy, only two patients (10 percent) still had normal values. We conclude that interferon alfa therapy is beneficial in reducing disease activity in chronic hepatitis C; however, the beneficial responses are often transient.

Effects of tail docking and castration on behaviour and plasma cortisol concentrations in young lambs

Behavioural and cortisol responses of lambs to the usual husbandry practices of castration and, or, tail docking using tight rubber rings were investigated between birth and seven days old. There were four treatments: control handling and blood sampling (n = 52), tail-docking (T) (n = 57), castration plus tail-docking (CT) (n = 54) and intravenous adrenocorticotrophin injection (ACTH) (n = 52). After treatment there was a transient rise in plasma cortisol concentration, the magnitude and duration of which increased in the following order; control, T, CT and ACTH. Behavioural characteristics indicative of distress included restlessness (standing up and lying down frequently, rolling, kicking, stamping), lateral recumbency, immobility with neck extension and hyperventilation. Using changes in cortisol concentrations and behaviour the lamb responses were characterised as reflecting 'mild disturbance without distress' (control, ACTH), 'mild distress' (T) and 'marked distress' (CT). The mild distress lasted for about 30 minutes in T lambs and marked distress for about 60 minutes in CT lambs.

Changes in the cortisol responses of lambs to tail docking, castration and ACTH injection during the first seven days after birth

Cortisol responses of Dorset and Scottish Blackface lambs were investigated at six ages between birth and seven days. There were four treatments: control handling and blood sampling (n = 52), tail docking (T) (n = 57), castration plus tail docking (CT) (n = 54), and intravenous adrenocorticotrophin (ACTH) injection (n = 60). Most lambs exhibited transient rises in plasma cortisol concentrations after treatment and the results in individuals were expressed as the area under the cortisol curve (integrated response). Postnatal changes in the integrated responses of control, T and CT lambs differed significantly between the two breeds; in Dorsets they increased markedly between four hours and one day and then decreased, whereas in Scottish Blackface lambs there were no significant changes. The cortisol responses of ACTH lambs decreased markedly between four hours and seven days in both breeds. The results shed light on postnatal changes in the activity of the hypothalamic-pituitary-adrenal axis and suggest for both breeds that the average increments in ACTH secretion caused by noxious stimuli increased markedly during the first one to three days after birth. Whether this reflected parallel increases in the levels of distress experienced by the lambs remains to be clarified.

The abnormal T lymphocytes in lpr mice transcribe interferon-gamma and tumor necrosis factor-alpha genes spontaneously in vivo

The autoimmune mouse strain MRL/MPJ/lpr/lpr is characterized by accumulation of an abnormal T cell population which does not express CD4 or CD8 surface antigens. These cells were thought to be immunologically inert based on their inability to proliferate in response to a variety of T cell mitogens. We investigated the capacity of these cells to express lymphokine genes using a sensitive RNase protection assay. RNA was isolated from abnormal T cells which were purified directly from diseased animals, either as CD4-/CD8- or as fluorescence-activated cell sorter-isolated B220+/Thy-1+ cells. These RNA preparations contained no detectable interleukin (IL) 2, IL 4, IL 5 or IL 6 transcripts, but did contain transcripts of genes for interferon-gamma and tumor necrosis factor-alpha. Thus, this expanded population of abnormal cells spontaneously expresses these two lymphokines which have many interacting effects on the immune system, and may have important roles in the pathogenesis of autoimmune disease in lpr mice.

Glucopenia-mediated release of somatostatin from incubated rat hypothalamus: monosaccharide specificity and role of glycolytic intermediates

Rat hypothalamic somatostatin (SRIF) release in vitro is inversely related to medium glucose concentration and is stimulated by agents interfering with neural glucose uptake or metabolism. The present studies examined monosaccharide specificity of this effect by comparing the ability of glucose and nonmetabolized sugars (ribose, fructose, and galactose) to reverse glucopenia-mediated SRIF release. Removal of glucose from incubation medium resulted in a 7-fold stimulation of hypothalamic SRIF release (24.9 +/- 3.0 to 169.0 +/- 46.2 pg/5 min) that was promptly and fully reversed by readdition of glucose (21.5 +/- 6.0 pg/5 min). Depolarizing concentrations of potassium (40 mM) added to medium after incubation in the presence or absence of glucose produced similar 4-fold biphasic stimulation of SRIF release, suggesting that tissue viability was unimpaired by short term glucopenia. By contrast, nonmetabolized sugars (ribose, fructose, or galactose) at concentrations up to 28 mM were unable to reverse glucopenia-mediated hypothalamic SRIF release. These findings suggest that neural metabolism of glucose specifically influences hypothalamic SRIF release, an effect likely to depend on glycolysis with resulting energy production. This explanation is supported by the finding that the glycolytic intermediates dihydroxyacetone and glyceraldehyde were partly, and pyruvate completely, able to restore glucopenia-mediated SRIF release toward basal, with a maximal effect at 14 mM. Our present studies suggest that rat hypothalamic SRIF release reflects ambient glucose status, is stimulated by glucopenia, and may explain inhibition of GH secretion in the rat during hypoglycemia.

MESA is a Plasmodium falciparum phosphoprotein associated with the erythrocyte membrane skeleton

The mature-parasite-infected erythrocyte surface antigen (MESA) of Plasmodium falciparum is an antigenically variable, high molecular weight protein of trophozoites and schizonts that is located at the erythrocyte surface membrane. It is first synthesized at the late ring stage and continues to be synthesized until late schizogony. MESA cannot be detected on the external surface of erythrocytes infected by trophozoites and early schizonts but is located at the internal surface in association with the erythrocyte membrane skeleton. The degree of association with the membrane skeleton varies among parasite lines, being greater in knobby parasite lines. MESA is phosphorylated and is present in a similar location to another phosphoprotein, the ring-infected erythrocyte surface antigen (RESA). However, it differs from RESA in being detected at a later stage of asexual development of the parasite.

Late Niemann-Pick disease with neurovisceral storage: a classification problem

A 51 year old man presented in 1969 with slowly progressive cerebellar ataxia of unknown origin. He was admitted to hospital aged 68 after a fall, and a ruptured spleen was removed at laparotomy. Histological analysis of the spleen suggested Niemann-Pick disease, which was subsequently confirmed. He deteriorated and died of bronchopneumonia shortly afterwards: subdural haemorrhage with storage material in neurones was found at necropsy. This late onset case of Niemann-Pick disease with neurovisceral storage is unusual and may represent a variant.

Kniest dysplasia is characterized by an apparent abnormal processing of the C-propeptide of type II cartilage collagen resulting in imperfect fibril assembly

Epiphyseal and growth plate cartilages from four cases of Kniest dysplasia have been studied. In each case collagen fibril organization appeared abnormal by electron microscopy compared with age-matched normal cartilages: fibrils were much thinner, of irregular shape and did not exhibit the characteristic banding pattern. This was associated with the absence (compared with normal cartilage) of the C-propeptide of type II collagen (chondrocalcin) from the extracellular matrix of epiphyseal cartilages, although it was detected (as in normal cartilages) in the lower hypertrophic zone of the growth plate in association with calcifying cartilage. The C-propeptide was abnormally concentrated in intracellular vacuolar sites in Kniest cartilages and its total content was reduced in all cases but not in all cartilages. Moreover, it was not a part of the procollagen molecule. In contrast, type II collagen alpha-chain size was normal, indicating the formation of a triple helix. Also type II collagen content was normal and it was present in extracellular sites and only occasionally detected intracellularly. These observations suggest that the defect in Kniest dysplasia may result from the secretion of type II procollagen lacking the C-propeptide and abnormal fibril formation, and that the C-propeptide is normally required for fibril formation.

Response of thyrotropin-secreting pituitary adenomas to a long-acting somatostatin analogue

Thyrotropin-secreting pituitary adenomas are aggressive, invasive tumors that respond poorly to available surgical and medical treatments. Inappropriate release of thyrotropin by these tumors can result in hyperthyroidism. We treated five patients who had thyrotropin-secreting pituitary adenomas with the long-acting somatostatin analogue SMS 201-995, which was administered by subcutaneous injection in doses of 50 to 100 micrograms every 8 to 12 hours. Serum levels of thyrotropin were dramatically reduced by treatment in four of the five patients, and levels of another tumor marker, the alpha-subunit of thyrotropin, were reduced in all five. In two patients with hyperthyroidism due to production of excess thyrotropin by the tumor, treatment with the somatostatin analogue resulted in a sustained euthyroid state. One patient who was treated for more than 16 months had a persistent reduction in serum levels of thyrotropin and iodothyronines. We conclude that SMS 201-995 is an effective means of controlling hypersecretion of thyrotropin and the associated hyperthyroidism due to thyrotropin-secreting pituitary tumors.

Effects on the murine mononuclear phagocyte system of chronic administration of liposomes containing cytotoxic drug or lipid A compared with empty liposomes

In experiments designed to examine the adverse effects of chronic liposome administration in vivo on the mononuclear phagocyte system (reticuloendothelial system), the presence of drug entrapped in the liposomes may increase the level of reticuloendothelial impairment. We have compared the effects on the mononuclear phagocyte system in mice of chronic administration of empty liposomes with the effects of liposomes containing the anti-leishmanial drug meglumine antimoniate. We have also examined the effect on the mononuclear phagocyte system of continued injections of liposomes containing lipid A, a component of bacterial lipopolysaccharide, which is responsible for macrophage activation. Ten intravenous injections of multilamellar liposomes composed of dipalmitoylphosphatidylcholine and cholesterol (1:0.75 M ratio) were given to ICR mice over a 25-day period. Two individual groups of mice received endotoxin-free liposomes in which meglumine antimoniate was either present or absent. One addition group received liposomes containing lipid A derived from Escherichia coli lipopolysaccharide. A control group received sterile saline injections. In each group, a depression of the phagocytic index, as measured by reduction of uptake of particulate carbon, was observed among some of the individual animals 24 h after the first injection. In many mice a marked splenomegaly was observed. A depressed phagocytic index and splenomegaly were most marked for mice receiving lipid A liposomes. However, there was a large individual variability among mice receiving these preparations and some mice in each group had normal spleen size and a nearly normal phagocytic index. Tissue distribution of liposomes containing [14C]dipalmitoylphosphatidylcholine as a phospholipid marker was examined in all groups in mice 24 h after the last injection.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of long-term Intralipid administration in mice

Intralipid was administered intravenously to mice at a level of 2 g kg-1 day-1 for 23 days. No alterations in phagocytic index, liver or spleen size were observed in the chronically injected mice as compared with control mice that received saline injections. Tissue distribution of 0.45 micron multilamellar liposomes of egg phosphatidylcholine:cholesterol (2:1) was similar in mice that had been chronically injected with Intralipid to that in control mice. Mice chronically given the same total amount of phospholipid in the form of 0.2 micron liposomes of phosphatidylcholine:cholesterol (2:1) rather than as a lipid-triglyceride emulsion showed altered tissue distribution of entrapped label with decreased liver uptake and increased splenic uptake, which is indicative of reticuloendothelial blockade. Tissue distribution of [14C]dipalmitoylphosphatidylcholine Intralipid was compared with that of [14C]dipalmitoylphosphatidylcholine 0.2 micron MLV of phosphatidylcholine:cholesterol (2:1). Intralipid was taken up 2- to 3-fold less by liver and 5- to 10-fold less by spleen than liposomes. Blood levels of Intralipid were higher than those of liposomes. [14C]dipalmitoylphosphatidylcholine Intralipid was eliminated from the body at a faster rate than [14C]dipalmitoylphosphatidylcholine liposomes. The lack of reticuloendothelial blockade caused by Intralipid as compared with liposomes appears to be related to its diminished uptake into reticuloendothelial tissues. This diminished uptake may be related to differences in apolipoprotein uptake of Intralipid, which is primarily in the form of a phospholipid monolayer, and liposomes, which have their phospholipid organized into a bilayer.

Making the most of colostrum at lambing

Lambs require between 180 and 210 ml colostrum/kg bodyweight during the first 18 hours after birth in order to provide sufficient fuel for heat production. Colostrum intakes of this order would usually provide enough immunoglobulins for protection against infections. Ewes which are well fed during late pregnancy produce more colostrum than their lambs need, those with singletons having enough for a second lamb, but in most underfed ewes the lamb's requirements for colostrum exceed the ewe's production. Colostrum can be readily obtained and stored for subsequent use. The yields are increased markedly when hand milking is preceded by an oxytocin injection, the intravenous dose being 5 iu and the suggested intramuscular dose being 10 to 15 iu. There is little practical benefit in milking ewes more than three times during the first 18 hours after birth.

Abomasal size and emptying time in healthy lambs and in lambs affected by watery mouth

Contrast radiography (barium sulphate suspension fed by stomach tube) was used to assess abomasal profile area (a reflection of tone in the abomasal wall) and the rate of abomasal emptying in healthy lambs aged four to 144 hours and in lambs affected by watery mouth. In healthy lambs abomasal profile area increased from 15.1 +/- 0.56 cm2/kg at four hours of age to 23.1 +/- 1.07 cm2/kg at 24 to 48 hours (P less than 0.001). There was no change up to 48 to 72 hours but after this age there was a substantial decrease to 12.8 +/- 0.76 cm2/kg at 120 to 144 hours (P less than 0.001). The rate of abomasal emptying decreased as abomasal profile area increased. Complete emptying of the abomasum was observed within three hours of feeding in the majority of lambs aged four hours (seven out of eight) and 120 to 144 hours (13 out of 16) but only in a minority of lambs aged 24 to 48 hours (one out of 11). In lambs affected by watery mouth (mean age [+/- se] 33 +/- 2.8 hours, n = 34) abomasal profile area was greater and the rate of abomasal emptying was slower than in healthy lambs aged 24 to 48 hours. These findings confirm the previous suspicion that watery mouth is associated with an impairment of gut motility. Abomasal emptying time was prolonged in lambs aged four hours when either ewe or cow colostrum was included with the contrast medium. A similar effect was observed in lambs aged 24 to 48 hours when cow colostrum was included. The castration of lambs aged four hours with rubber rings immediately before the administration of contrast medium had no effect on the rate of abomasal emptying.

Effects of maternal nutrition on the availability of energy in the body reserves of fetuses at term and in colostrum from Scottish Blackface ewes with twin lambs

Ewes carrying twin fetuses were maintained during late pregnancy on a uniformly high plane (n = 22), a uniformly low plane (LP) (n = 24) or a low plane increasing to a high plane (n = 14) of nutrition. Seven ewes at each nutritional level were killed at 142 days of gestation and the liver and muscle glycogen and body lipid concentrations of the fetuses were determined. The rest of the ewes lambed naturally at about 145 days and the colostrum yields were obtained by hand milking after oxytocin injections during the first 18 hours after birth. The lactose, lipid and protein concentrations of colostrum were determined. Undernutrition in the LP group did not apparently affect the body concentrations of available glycogen, reduced available body lipid by about 47 per cent and reduced the lactose, lipid and protein available in colostrum during the first 18 hours by about 50 per cent. Refeeding previously underfed ewes to a high plane during the last five to 10 days of pregnancy did not improve the available reserves of glycogen or lipid in the lambs but did increase the yields of colostral constituents by about 30 per cent. The relative contributions of body reserves and colostral constituents to the maintenance of high, medium and low metabolic rates in lambs from different groups was assessed. It was concluded that under normal field conditions refeeding undernourished ewes during the last weeks of pregnancy would improve only marginally the survival potential of the lambs and that most lambs would be compelled to draw on their body glycogen reserves in order to maintain heat production during the first 18 hours after birth, even when they consumed all the available colostrum.

Effects of maternal nutrition on udder development during late pregnancy and on colostrum production in Scottish Blackface ewes with twin lambs

Effects on udder development and colostrum production of changing the level of ewe nutrition were investigated. Udder weights at term were derived from their linear dimensions and yields of colostrum were obtained by hand milking on three occasions between one and 18 hours after birth. The linear dimensions of the udder increased progressively in all animals between 100 days of gestation and term (about 145 days), but udder development was retarded significantly within three days of the onset of underfeeding at 105 days of gestation. Underfeeding reduced the total yield of colostrum during the first 18 hours after birth by decreasing the prenatal accumulation of colostrum and its subsequent rates of secretion. Improving the ewe's nutrition from one hour after birth tended to increase the secretion rates of colostrum between 10 and 18 hours. Refeeding previously underfed ewes to high levels from about five days before birth had no effect on udder growth but did increase the prenatal accumulation of colostrum and its subsequent rates of secretion to levels which, when corrected for differences in udder weight, were similar to those of ewes which were fed well throughout. Calculations revealed that by ignoring udder growth the Agricultural Research Council recommendations for the energy requirements of pregnant ewes underestimate the cost of tissue synthesis during the last four weeks of pregnancy by about 100 per cent.

alpha-Glucosidase-albumin conjugates: effect of chronic administration in mice

Enzyme albumin conjugates have been proposed as a means of increasing the efficacy of enzyme use in vivo and decreasing immune response to the enzyme. Particulate drug carriers, however, have a pronounced tendency to localize in the mononuclear phagocyte (reticuloendothelial) system. We have examined in mice the effect on phagocytic index, tissue distribution and organ size of continued administration of conjugates of alpha-glucosidase with either homologous or heterologous albumin. Mice received 10 X 2-mg injections of bovine serum albumin (BSA) or mouse serum albumin (MSA), either free, polymerized or conjugated with alpha-glucosidase. Experiments involving BSA had to be terminated before the end of the experiment because of anaphylaxis, but these reactions were less severe to the polymerized albumin than to free albumin. Free BSA, BSA polymer and BSA-enzyme conjugates all caused a decrease in phagocytic index after six injections. Mice receiving MSA showed no evidence of anaphylaxis, but mice receiving six or more injections of free MSA, MSA polymer or MSA-enzyme conjugate had significantly decreased phagocytic indices as compared to controls. Phagocytic indices had returned to normal by 7 days after the final injection. Tissue distribution of 125-I-labeled albumin preparations was determined in either naive or chronically injected mice.

Chronic liposome administration in mice: effects on reticuloendothelial function and tissue distribution

Liposomes have a pronounced tendency to localize in the reticuloendothelial (RE) system, a major host defense system. We have examined, in mice, the effect of chronic i.v. administration of low to moderate liposome doses on drug metabolism, phagocytic index and spleen and liver size. Little effect on the rate of pentobarbital metabolism was noted, except when mice received 80 mg/kg of sphingomyelin-containing liposomes in a series of 10 injections over 3.5 weeks. Impairment of RE phagocytic function was found to be related to liposome size and composition, size and frequency of liposome dose and the presence of lipid peroxides. The effects on tissue distribution of liposome-entrapped [14C]sucrose was also determined in mice receiving chronic liposome injections. In RE blockaded mice there was a consistent trend in favor of decreased liver uptake and increased spleen uptake. No significant uptake of liposome contents was seen in non-RE tissues even in mice with severe RE blockade, indicating that the induction of RE blockade by predosing with empty liposomes may not be a successful strategy for increasing liposome uptake to non-RE tissues. Liver to spleen ratios of [14C]sucrose appeared to be a sensitive method for quantitating RE blockade. Sphingomyelin-containing liposomes produced the greatest RE blockade, distearoylphosphatidylcholine-cholesterol liposomes were intermediate and egg phosphatidylcholine-cholesterol liposomes produced the least impairment in RE function. Liposomes which contained 1% vitamin E as an antioxidant had slightly less effect on RE function than liposomes not containing vitamin E.(ABSTRACT TRUNCATED AT 250 WORDS)

A review of selected foster care-adoption research from 1978 to mid-1982

What can be learned from the research conducted during this 5-year period? Although none of these studies pinpointed why it took so long to make permanent plans for children, an experiment [Stein et al. 1978] in California indicated that changes in child welfare practice can achieve permanence for more children: behavioral contracting and intensive contact with biological parents expedited return home or adoption. With regard to recent adoption research, the finding that children adopted at older ages encounter more difficulties is certainly not news to adoption workers. What may be of interest, however, is that when the effects of age are controlled for, youngsters adopted transracially or by single parents fare as well as children adopted inracially or by two-parent families. In addition, adoption workers may want to give further consideration to helping adoptive parents deal with the reactions of their extended families, since recent research has suggested that the extended family can have an important influence on a youngster's adjustment. Research on foster parents underscored the importance of training. It has been suggested that foster fathers are more likely to become involved when training provides explicit information. Other studies have indicated that social workers should be sensitive to foster parents' values regarding sex education and should be more careful in distinguishing foster care from adoption. Recent research also is beginning to show the dimensions of the problem of recidivism. Recognition that a proportion of foster children do reenter the system is a necessary first step toward developing strategies to reduce recidivism. Further research, with controls, to examine whether aftercare services can reduce recidivism is warranted, now that the characteristics of this vulnerable population have been identified.

A clinical comparison of subdural screw pressure measurements with ventricular pressure

Simultaneous recordings of intracranial pressure (ICP) from a single-lumen subdural screw and a ventricular catheter were compared in 10 patients with severe head injury. Forty-one percent of the readings corresponded within the same 10 mm Hg ranges, while 13% of the screw pressure measurements were higher and 46% were lower than the associated ventricular catheter measurements. In 10 other patients, also with severe head injury, pressure measurements obtained with the Leeds-type screw were similarly compared with ventricular fluid pressure. Fifty-eight percent of the dual pressure readings corresponded, while 15% of the screw measurements were higher and 27% were lower than the ventricular fluid pressure, within 10-mm Hg ranges. It is concluded that subdural screws may give unreliable results, particularly by underestimating the occurrence of high ICP.

Management of traumatic intracranial haematoma

Deciding which head-injured patients should be transferred to a neurosurgical unit can be difficult. Traditional criteria emphasise the development of deteriorating responsiveness but lead to delayed diagnosis and to avoidable mortality and morbidity. To discover if a more liberal admission policy improved results a study was conducted analysing data collected prospectively from 683 patients who had a traumatic intracranial haematoma evacuated in the Glasgow neurosurgical unit between 1974 and 1980. In the first four years, before the change in policy, mortality was 38% but decreased to 29% afterwards. This reflected a reduction in the proportion of patients who talked after injury but who deteriorated into coma before operation--that is, 31% before the change in policy, 16% afterwards. If the potential benefits of CT scanning in the management of head injuries are to be realised patients must be scanned sooner than in the past. This will usually mean that more patients should go to a neurosurgical unit and that simple criteria for transfer should be established.

Effects of feeding ewe colostrum, cow colostrum or ewe milk replacer on plasma glucose in newborn lambs

The plasma concentration of glucose was monitored for six hours in lambs fed either ewe colostrum, cow colostrum or milk replacer by stomach tube at one hour of age. The feeding of ewe colostrum resulted in an elevation of the mean (+/- se) plasma glucose concentration from 2 . 6 +/- 0 . 3 mmol/litre before feeding to 7 . 3 +/- 0 . 92 mmol/litre three hours after feeding and this elevation was maintained. A similar rise was observed in the lambs fed cow colostrum but this was of shorter duration. A marked hyperglycaemia was observed after the feeding of milk replacer with a maximum value of 23 . 4 +/- 1 . 33 mmol/litre three hours after feeding. The practical implications of these results are discussed.

Observer variability in grading patients with subarachnoid hemorrhage

The management of individual patients with subarachnoid hemorrhage depends greatly on assessment of the patient's clinical condition. Difficulty in applying current grading systems prompted the authors to conduct studies of observer variability and to attempt to identify sources of inconsistency. Observers graded 15 patients by both the Hunt and Hess and Nishioka systems. Considerable observer variability was found, with up to four different grades being selected for the same patient. Kappa statistics were used to evaluate the data. This method determines observer agreement occurring in excess of chance. Kappa values for each grading system showed observer agreement to be significantly better than chance, yet revealed marked observer variation. Most variation occurred when Grade 3 was selected, irrespective of the system used. In a further study where observers graded clinical summaries, similar variation occurred; therefore, inconsistency was due mainly to difficulty in matching patients with levels described in the grading system, rather than to fluctuation in the patient's clinical condition or difference in the observers' examination technique. Variability was high when patients with systemic disease or vasospasm on angiography were graded with the Hunt and Hess system. The studies show that a simpler and more reliable grading system is required, and emphasize and need for caution when interpreting the results from different published series.

Effects on the rate of increase in fetal girth of refeeding ewes after short periods of severe undernutrition during late pregnancy

A technique is described by which daily changes in the thoracic circumference (girth) of individual fetal sheep were observed during the last 60 to 70 days of pregnancy. The girth technique and a previously published method for measuring daily changes in the curved crown-rump length were both used to examine fetal growth responses when ewes were refed at 116 days of gestation after short periods of severe underfeeding. Refeeding ewes after nine or 16 days of severe underfeeding was associated in most cases with an immediate increase in fetal growth rate, whereas refeeding after 21 days had no effect on the rate in any fetus. Possible mechanisms underlying these effects are discussed. Using girth as an index the growth rates of individual lambs were measured before and after birth. There was a 3.3 fold increase in growth rate immediately after birth.

Effects of long term undernutrition of the ewe on the growth rates of individual fetuses during late pregnancy

Fifteen ewes were fed at between 0.6 and 0.8 times the recommended rates in order to reproduce the liveweight changes observed in Scottish Blackface sheep on hill farms. The curved crown-rump length (CRL) of individual fetuses was measured daily between 90 and 142 days of gestation and fetal dimensions and placental weight were measured at 142 days. Fetal growth rate decreased progressively from about 5.9 mm per day between 90 and 111 days of gestation to about 3.6 mm per day by 130 days. At 142 days of gestation the placental weight and the fetal CRL, girth and weight were all significantly lower than in fetuses of well fed ewes. The mechanisms responsible for the reduction in fetal growth rate after 111 days of gestation and the implications for animals on hill farms are discussed.

Assessment of the consequences of subarachnoid haemorrhage

The management of patients with subarachnoid haemorrhage depends greatly on assessment of the patient's clinical condition. Difficulty in applying currently used grading systems prompted us to conduct studies of observer variability and to attempt to identify sources of inconsistency. Observers graded 15 patients from the Hunt and Hess and Nishioka systems. Kappa statistics were used to evaluate the data. Marked observer variability was found, this being greatest when Grade 3 was selected, irrespective of the system used. When observers graded clinical summaries, similar variability was found, indicating that this was due to difficulty in matching patients' clinical states with specific levels within the grading system. The study shows that a simple and more reliable grading system is required.

Effects of placental weight and maternal nutrition on the growth rates of individual fetuses in single and twin bearing ewes during late pregnancy

Daily changes in the curved crown-rump length (CRL) of individual fetal sheep were measured using a device inserted into the fetus at about 90 days of gestation. Fetal dimensions and placental weight were measured at 142 days. Fetal growth rates were determined from changes in the observed CRL after 100 days of gestation, published data on the relationship between CRL and weight, and the observed weight at 142 days. In ewes that were adequately nourished throughout pregnancy the fetal CRL increased by about 6.5 mm per day until at least 120 days of gestation and then the rate decreased to a minimum of 3.7 mm per day by 132 days. When ewes were fed an inadequate diet between 112 and 142 days, the rate of change in fetal CRL decreased within three days from about 6.5 to 3.7 mm per day and subsequently decreased to 2.9 mm per day by 132 days of gestation. In ewes that were adequately nourished except for a period of inadequate feeding between 112 and 132 days of gestation the fetal CRL increased at similar rates to those in the second group until 132 days and then at 3.6 mm per day. Within each group placental weight was correlated positively with the total increments in CRL (observed) and weight (derived) between 112 and 142 days of gestation and with the 142 day values for CRL, girth and weight. Most differences between single and twin fetuses were attributable to differences in placental weight.

Cationic composition of 22 species of bacteria grown in seawater medium

Twenty-two species of bacteria of marine, estuarine, and terrestrial origin were analyzed for cationic content by atomic absorption spectrophotometry after growth in a basal seawater medium. Alcaligenes marinus was analyzed from eight separate but replicate determinations yielding the following cationic concentrations: Na, 5,600 +/- 2,260; Mg 1,580 +/- 740; K, 700 +/- 360; Ca, 790 +/- 390; Mn, 1.7 +/- 0.5; Fe, 256 +/- 57; Ni, 1.7 +/- 0.7; Cu, 14 +/- 4; Zn, 122 +/- 27; Cd, 2.8 +/- 0.7; and Pb, 10 +/- 3 ppm/(dry weight). Washing A. marinus cells before analyses was necessary due to interstitial medium within the cell pellets after centrifugation and loose cationic retention by the cells. The principal source of error in the procedure was ascribed to variability due to washing cells with 0.5 M ammonium formate. The mean cationic concentrations for trace elements in the 22 bacterial cultures grown in the basal seawater medium to constant optical density and washed three times with 0.5 M ammonium formate were: Mn, 2.4 +/- 3.8; Fe, 262 +/- 112; Ni, 2.3 +/- 1.8; Cu, 24 +/- 17; Zn, 146 +/- 72; Cd, 3.8 +/- 2.5; and Pb, 17 +/- 21 ppm (dry weight). Major ions were concentrated only occasionally by the cells after washing, whereas Mn, Fe, Ni, Cu, Zn, Cd, and Pb were concentrated from the medium by the following factors on the average: 180, 1,600, 140, 1,200, 750, 1,900, and 900, respectively.

A nuclear membrane-associated DNA complex in cultured mammalian cells capable of synthesizing DNA in vitro

A DNA-nuclear membrane complex has been isolated by two different methods from the nuclei of cultured mouse fibroblast (3T3) cells. One method, utilizing the detergent sarkosyl (sodium lauroyl sarkosinate), yields a DNA-nuclear membrane complex (the M band), which contains virtually all of the DNA in the nuclei. However, treatment of the M band by sonication, vortexing, or freeze-thaw reduces the amount of DNA in the complex by approximately 50-80%, depending upon the phase of the cell cycle from which the complex was extracted. The remaining DNA is tightly bound to the nuclear membrane and resists further shearing procedures. Over 90% of the choline-labeled phospholipid present in nuclei is also found in these sheared M bands. The percentage of DNA associated with the nuclear membrane varies during the cell cycle and correlates well with the onset, continuation, and cessation of DNA synthesis. Thus, although DNA-membrane complexes can be detected throughout the cell cycle, the percentage of DNA bound to membrane increases during late G1 and S and decreases during G2. In addition, there are distinct qualitative differences in the type of DNA present in the membrane fraction, with a more highly d(A-T) rich DNA being present in confluent (G0) cells than in cells during the S phase. This d(A-T) rich DNA may be related to the mouse satellite DNA identified by others. The M band can be separated into two DNA-nuclear membrane subfractions by centrifugation through a continuous sucrose gradient. The relative proportions of these two subfractions depend upon the percentage of sarkosyl present in the M band prior to centrifugation, with complete removal of sarkosyl resulting in a very large increase in the sedimentation velocity of the complex and in the formation of only one fraction. Evidence that this is a complex of DNA with membrane is given by the finding that DNA is dissociated from the complex with Pronase, deoxycholate, or high levels of sarkosyl. Removal of virtually all of the DNA with DNase from this rapidly sedimenting complex does not dissociate any of the phospholipid which still sediments rapidly as a single band. A second method, which yields a DNA-membrane fraction from nuclei, utilizes sedimentation of lysed nuclei to equilibrium in CsCl density gradients. This low-density CsCl fraction contains only 10-15% of the total DNA, but contains most of the nascent DNA, which may be chased into a membrane-free fraction. The DNA-membrane fraction from CsCl gradients possesses properties in common with the M-band fraction and can be converted into an M band. DNA membrane complexes from sucrose gradients, as well as the crude M-band preparation and a non-membrane-associated DNA fraction from nuclei can synthesize DNA in vitro without the addition of an external DNA template or DNA polymerase. In contrast to the activity in the non-membrane-associated DNA fraction, the membrane-associated polymerase activity is strongly stimulated by adenosine triphosphate and is unaffected by ethidium bromide...

Electrofocusing and kinetic studies of adult and embryonic chicken pyruvate kinases

Chicken embryos less than 15 days old contain only the K isozyme of pyruvate kinase, which appears to exist in vivo as an R,T conformational set with pI values of 7.2 and 6.6, respectively. Sets of lower pI and higher pI K-isozyme variants also are obtained. Whole embryos of 15 days or more of development show progressively increasing amounts of higher pI, lower K0.5S enzymatic variants. Tissue distribution and kinetic properties suggest that the highest pI form (pH 8.8-9.0) is an M-isozyme analogue. The intermediate forms are postulated to be hybrids. Adult liver extracts contain only the embryonic K isozyme; no evidence for an L-isozyme analogue was obtained. All major forms of the enzymes are compared with respect to saturation by phosphoenolpyruvate in the absence of effector and in the presence of fructose 1,6-diphosphate, alanine, serine, phenylalanine, tryptophan, and/or Mg-ATP.