Immunochemical analysis of plasmid-encoded proteins released by enteropathogenic Yersinia sp. grown in calcium-deficient media

Enteropathogenic Yersinia sp. releases plasmid-associated proteins of low molecular mass (26-67 kilodaltons) at 37 degrees C. In this study, the optimum conditions for the release of proteins were assessed and the released proteins (RPs) were analyzed for the manner of release, immunochemical characteristics, and the location of the genes necessary for their synthesis. Protein release was strongly enhanced when growth media were markedly depleted of calcium ions by precipitation with oxalate or chelation with EGTA [ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid]. RP yields were greatest when Yersinia spp. were in the exponential growth phase. The RPs appeared to be released from the Yersinia spp. by secretion rather than by pinching off of membrane vesicles, because the RPs did not sediment during high-speed centrifugation nor were they contaminated to any significant degree with lipopolysaccharide. Moreover, immunoblot analysis revealed only traces of protein species related to RPs within the outer membranes of plasmid-positive Yersinia spp. grown at 37 degrees C under calcium-restricted conditions. Immunoblot studies also showed that the RPs of Y. enterocolitica serotypes O:3, O:8, and O:9 and the RP of Y. pseudotuberculosis serotype I are highly cross-reactive. Finally, the immunoprecipitates of the products of minicells which harbor Yersinia plasmids were used to demonstrate that at least three proteins immunochemically related to the released fraction were plasmid encoded. These results suggest that at least three of the RPs may be related to or identical with previously described plasmid-encoded Yersinia outer membrane proteins.

Synthesis of a fluorescent analogue of phosphatidylcholine

A fluorescent analogue of phosphatidylcholine was synthesized by acylation of 1-oleoyl-sn-glycero-3-phosphocholine with 6-N-(tert-butyloxycarbonyl)aminocaproic acid anhydride employing the catalyst 4-pyrrolidinopyridine. Removal of the protective group by treatment with HCl in chloroform was followed by subsequent reaction with 7-chloro-4-nitrobenzo-2-oxa-1,3-diazole (NBD-Cl) to form the fluorescent analogue of phosphatidylcholine, 1-oleoyl-2-(NBD)aminocaproyl-sn-glycero-3-phosphocholine, in good yield and with high isomeric purity.

Somatostatinoma--the most recently described pancreatic islet cell tumor

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Hyperinsulinism after removal of a pheochromocytoma

The finding of hypoglycemia after the surgical removal of a pheochromocytoma in two patients in a previous study led to monitoring of the serum glucose and plasma C-peptide levels in two other patients with a pheochromocytoma and one with unilateral adrenocortical hyperplasia. In the two patients with a pheochromocytoma endogenous insulin secretion, as measured by a C-peptide assay, was suppressed before removal of the tumours and resumed immediately after removal. The serum glucose levels decreased in these patients, but sufficient intravenous administration of glucose prevented postoperative hypoglycemia. In the patient with adrenocortical hyperplasia the plasma C-peptide level was not decreased before tumour removal, nor did it increase abruptly following removal. It therefore seems likely that the rapid fall in the serum glucose level following removal of a pheochromocytoma is caused by prompt resumption of beta-cell activity, with rebound hyperinsulinism.

Plasmids of human strains of Yersinia enterocolitica: molecular relatedness and possible importance for pathogenesis

One-hundred fifteen strain of Yersinia enterocolitica were examined for plasmids and plasmid-mediated pathogenic properties. Human strains of serotypes O:3 and O:9 harbored plasmids of 46 and 44 megadaltons, respectively, with 90% homology of DNA sequences. The plasmid-mediated properties were calcium dependence, survival in human serum, conjunctivitis provocation in guinea pigs, and O agglutinogens. One strains of serotype O:8 harbored a 42-megadalton plasmid with 75% sequence homology with plasmids of serotypes O:3 and O:9. An additional plasmid-mediated property was lethality for white mice. Filter hybridization of restriction endonuclease-digested plasmid DNA indicated that a 5.6-megadalton fragment of the plasmid of serotype O:8 had virtually no sequence homology with plasmid DNA of serotypes O:3 and O:9 and therefore may be associated with the lethal factor for mice.

Impacted common bile duct stones

The impacted common bile duct stone can be managed either surgically or radiologically using methods such as percutaneous basket extraction or endoscopic papillotomy. At operation, if an impacted common bile duct stone cannot be removed by the usual methods, duodenotomy and sphincteroplasty are indicated. If the patient's condition is good, sphincteroplasty should not be avoided in the belief that other means of stone removal are superior. However, if the patient's condition is not ideal, sphincteroplasty should be deferred in favor of delayed removal by percutaneous or endoscopic techniques. In patients without percutaneous access to the biliary tree, endoscopic papillotomy can be effective in removing impacted stones, or at least in relieving the obstruction and allowing improvement in the patient's condition before surgical intervention is attempted.

Intravenous nitroglycerin control of blood pressure during resection of phaeochromocytoma

The majority of patients presenting for resection of phaeochromocytoma require some form of antihypertensive therapy during operation. Phentolamine and sodium nitroprusside have both been used successfully for this purpose, but each has disadvantages. This report describes the use of intravenous nitroglycerin, a rapidly acting venodilator with no appreciable toxicity, as the sole antihypertensive agent in two patients with phaeochromocytoma and partial alpha adrenergic blockade. Hypertensive episodes were quickly and effectively controlled in each case. There were no hypotensive periods and no side effects.

Hyperparathyroidism. A review

Hypercalcemia with and without clinical manifestation appears to be diagnosed with increasing frequency. If hypercalcemia persists with no other obvious reasons, hyperparathyroidism can be suspected with a high degree of certainty. Surgical treatment requires confidence, patience and a thorough knowledge of the embryologic peculiarities and anatomic variations of these glands. In 88 percent of our 71 patients, a solitary benign parathyroid adenoma was diagnosed by light microscopy. Parathyroid four-gland hyperplasia was found in 5.6 percent of the patients and multiple adenoma in 3 percent. The cause of hypercalcemia was not found in 3 percent. All patients treated with parathyroidectomy responded well, with calcium levels returning to normal. Our results confirm that this conservative approach to parathyroidectomy without multiple gland biopsy is the better and more acceptable method of dealing with hyperparathyroidism. Multiple gland dissection biopsy, chest exploration and parathyroid implantation are necessary only in very difficult cases.

[Long term effects of splenectomy on the immune-status of Hodgkin's disease patients depending on the modality of treatment (author's transl)]

In a total group of 103 Hodgkin's disease patients the immune-status of splenectomized and non-splenectomized individuals is compared in subgroups characterized by the modality of treatment (RT, CT, RCT). The mitogenic stimulation of peripheral lymphocytes showed a decreased response of splenectomized patients in each therapy group. The percentage, but not the absolute number/mm3, of peripheral T-cells was reduced after splenectomy. Splenectomized patients, who received combined radiation and chemotherapy showed significantly lower IgM-levels than non-splenectomized patients after the same treatment. EBV-VCA-titers and skin-test-reactivity were not influenced by splenectomy.

[Hodgkin's disease: effect of spenectomy on the immune status (author's transl)]

In 22 untreated Hodgkin's patients the following parameters were studied before and after splenectomy: the total WBC, lymphocytes, B- and T-cells and mitogenic stimulation of peripheral lymphocytes using autologous and control serum. The results were correlated to patient groups with favourable and unfavourable prognosis according to pathological stage, histology, spleen involvement and constitutional symptoms. 1. All Patients. Significant increase of the absolute number of peripheral lymphocytes and B-cells. Significant increase of the spontanous DNA synthesis in the presence of AB-control serum, but no change after mitogenic stimulation of peripheral lymphocytes. No change in the number of peripheral T-cells. 2. Patients with Favourable Prognosis. Significant increase of the absolute number of peripheral lymphocytes and B-cells. Significant increase of the spontanous DNA synthesis in the presence of AB-control-serum. Significant decrease of the T-cell function (PHA- and Con-A-stimulation in the presence of autologous serum). Significant decrease of the PHA-, Con-A- and PWM stimulation rate using control serum in the lymphocytic predominance and nodular sclerosis group. No change in the number of peripheral T-cells. 3. Patients with Unfavourable Prognosis. No change in the absolute number of B-cells, of the spontanous DNA-synthesis using autologous serum and of the PHA- and Con-A-stimulation. Significant increase of the EBV-induced blastogenesis in the mixed cellularity and lymphocytic depletion group.

Coexistence of pheochromocytoma, adrenal adenoma and hypokalemia

A 56-year-old woman had a 22-year history of hypertension. Investigation showed hypokalemia and kaliuresis without pronounced suppression of plasma renin activity or elevation of urinary aldosterone excretion. There was biochemical evidence of catecholamine metabolite excess but the usual clinical features of pheochromocytoma were absent. Laparotomy revealed a pheochromocytoma and adrenal adenoma in the right adrenal gland. Excision of the tumours was followed by resolution of the hypertension and metabolic abnormalities.

Hypoglycemia following excision of pheochromocytoma

In two patients hypoglycemia developed in the immediate postoperative period after removal of a pheochromocytoma. In one patient the serum insulin value was elevated when he was hypoglycemic. Preoperative preparation of patients with pheochromocytoma requires use of an alpha-adrenergic blocking agent to decrease blood pressure and allow the plasma volume to expand; in the two patients referred to phenoxybenzamine was given orally. It is difficult to recognize hypoglycemia postoperatively because of the altered consciousness associated with a major operation, analgesics, anesthetic agents and the effects of adrenergic blocking medications; hence the physician must watch closely for this complication.

[Results of radiotherapy of bronchial carcinoma (author's transl)]

In a joint retrospective study by 17 radiotherapy clinics in German-speaking countries the results of treatment of bronchial carcinoma after radiotherapy were analysed in 7503 cases. The age peak was between the 60th and 70th year. Squamous-cell carcinoma was the most frequent histological type, followed by anaplastic carcinoma, with adenocarcinoma being rare. There was a high proportion of histologically not clearly identified cases (27% in central and 35% in peripheral carcinomas). Survival rate at one year was 31% for central (3662 patients) and peripheral (961 patients) tumours, but only 2% at five years. Prognostically there was no difference between histological types and kind of radiotherapy or technique, but total dose affected survival rate. At a total dose of less than 5000 rd the survival rate at five years was minimal. The prognosis of combined surgical and radiotherapeutic measures was slightly better than with a radiotherapy alone, but results were unpredictable for the individual case. It is concluded that radiotherapy aiming at cure should be used in imoperable bronchial carcinoma if the tumour state and general condition of the patient appear to make a cure possible. But if this is not the case, radiotherapy should be used only palliatively, i.e. only to ameliorate symptoms.

[Results of radiotherapy of prostatic carcinoma as monotherapy]

A report is given of the results of histopathologic examinations of subsequent biopsies carried out on 54 patients with prostate carcinomas and of the clinical development of the prostate carcinomas of 89 patients. All these patients were treated only by therapeutic radiology. Then follows a discussion whether the radiation or the hormone therapy has the preponderant values. The possible complications of the two therapy methods are compared.

[Kidney stress in percutaneous abdominal radiotherapy]

Percutaneous abdominal radiotherapy leads to an obligatory simultaneous stress of the kidneys. This partial stress of the kidneys can be reduced to a bearable minimum if the medicophysical irradiation planning methods, already developed nowadays. are used. The improved irradiation technique basing on these methods was examined, by administering abdominal irradiation, in a corresponding collective of patients. Clinical, laboratory-chemical, roentgenologic, and nucleo-medical examinations were carried out in different intervals. The significant control results certified the kidney protecting method of our radiotherapy.