Familial systemic lupus erythematosus. Presence of a cross-reactive idiotype in healthy family members

Sera of 27 members of 3 human kindreds with familial systemic lupus erythematosus (SLE) were examined for expression of a cross-reactive idiotype present on anti-DNA antibodies of SLE patients. By radioimmunoassay, serum samples from 6 of 8 SLE patients and 15 of 19 family members had high-titered reactivity with the antiidiotype, 3I. Isoelectric focusing and Western blot analysis of 3I-reactive bands revealed two patterns of reactivity: either a pattern of bands present at pH 5-7, or bands present at pH 5-7 with additional bands present at pH 7-8.5. Cationic bands were found to correlate with the presence of anti-DNA antibodies, indicating that immunoglobulin charge may be a factor in determining specificity for DNA. Millipore filter analysis revealed anti-DNA antibodies in sera of 4 of 8 SLE patients and 2 of 19 family members without SLE. In 2 additional SLE patients and 2 additional family members, anti-DNA antibodies were revealed when sera were analyzed under conditions that dissociate immune complexes. This study indicates that expression of an idiotype associated with anti-DNA antibodies is significantly increased in relatives of SLE patients and usually occurs in the absence of anti-DNA activity.

Assessment of esophageal abnormalities in progressive systemic sclerosis using radionuclide transit

Radionuclide transit (RT) is a noninvasive test of esophageal function with a sensitivity equivalent to manometry. Using RT, 34 patients with progressive systemic sclerosis (PSS), 15 with diffuse scleroderma and 18 with the CRST variant, were studied and compared to 22 patients with other connective tissue diseases and 20 normal volunteers. Abnormalities were present in 87% of patients with diffuse scleroderma, 72% with CRST, 38% with other connective tissue diseases and in none of the controls. The most frequent abnormality in PSS was that of adynamic transit. Abnormalities correlated with disease duration in the diffuse scleroderma group but not the CRST group. There was a positive association between abnormal RT and the presence of esophagitis in the PSS patients (p = 0.003).

IgG binding enhances DNAase I sensitivity of N-acetoxy-N-2-acetylaminofluorene-modified phi X-174 RF DNA

DNA restriction fragments of phi X-174 RF were modified with the carcinogen, N-acetoxy-N-2-acetylaminofluorene (N-Aco-AAF). Immune complexes of 5'-32P-labeled AAF-modified DNA and rabbit immunoglobulin (IgG) against AAF-guanosine were specifically bound by surface membranes of Cowan I strain micrococci whose protein A binds the Fc portion of IgG. DNAase I sensitivity of the bound DNA was 20-fold greater than in solution, but the normal pattern of hydrolysis was not altered, as determined in sequencing gels. Nonadducted DNA ligated to AAF-modified DNA acquired the enhanced sensitivity to DNAase I hydrolysis when the ligation hybrid was immunobound.

Chlorpromazine-associated haemolysis in anorexia nervosa

Chlorpromazine therapy in a patient with anorexia nervosa was associated with haemolytic anaemia. In vitro red cell findings included an increased degree of red cell autohaemolysis and a chlorpromazine-dependent Heinz body formation both corrected with exogenous glucose. Activities of red cell enzymes involved with the glycolytic pathway or glutathione metabolism were normal.

Red cell ferritin content: a re-evaluation of indices for iron deficiency in the anaemia of rheumatoid arthritis

In iron deficiency anaemia basic red cell content of ferritin is appreciably reduced. This variable was determined in 62 patients with rheumatoid arthritis to evaluate conventional laboratory indices for iron deficiency in the anaemia of rheumatoid arthritis. For 23 patients with rheumatoid arthritis and normocytic anaemia irrespective of plasma ferritin concentration, red cell ferritin content did not differ significantly from that for non-anaemic patients with rheumatoid arthritis. For 27 patients with rheumatoid arthritis and microcytic anaemia, the mean red cell ferritin content for patients with a plasma ferritin concentration in the 13-110 micrograms/l range was appreciably reduced. It was indistinguishable from that for patients with rheumatoid arthritis and classical iron deficiency anaemia, indicated by plasma ferritin concentrations of less than 12 micrograms/l. In contrast, the mean red cell ferritin content for patients with rheumatoid arthritis, microcytic anaemia, and plasma ferritin concentrations above 110 micrograms/l did not differ from that for patients with rheumatoid arthritis and normocytic anaemia. Oral treatment with iron in patients with rheumatoid arthritis, microcytic anaemia, and appreciably reduced red cell ferritin concentrations was accompanied by significant increases in haemoglobin concentration (p less than 0.01), mean corpuscular volume (p less than 0.01), and red cell ferritin contents (p less than 0.05). This treatment, however, did not produce any appreciable change in haemoglobin concentration in patients with rheumatoid arthritis, normocytic anaemia, and normal red cell ferritin contents. These findings suggest that the indices for iron deficiency in patients with rheumatoid arthritis and anaemia should include peripheral blood microcytosis together with a plasma ferritin concentration of less than 110 micrograms/l.

Probable chloroquine-resistant Plasmodium falciparum malaria in south-western Africa

Chloroquine-resistant Plasmodium falciparum malaria has been described in East, Central and West Africa. We report on 2 patients with probable chloroquine-resistant P. falciparum malaria in south-western Africa. Both patients had been in northern SWA/Namibia and southern Angola, but had taken prophylactic chloroquine. Despite the subsequent administration of adequate courses of chloroquine therapy, the parasitaemias failed to clear completely. Eventual clinical and laboratory-proven cure was only obtained in 1 case after combined quinine and tetracycline therapy. To our knowledge, these represent the first cases of probable chloroquine-resistant P. falciparum malaria acquired in this area.

Early childhood pneumonia in Aborigines of Bourke, New South Wales

We carried out a retrospective survey of all children born in the district of Bourke , New South Wales, over a three-year period to determine the frequency of lobar pneumonia in the first three years of life. Although more non-Aboriginal children (167) than Aboriginal children (103) were born during this period, there was a striking difference between these groups in the frequency of pneumonia. Twenty-six (25.2%) Aboriginal children had one or more episodes of lobar pneumonia, compared with only five (3%) non-Aboriginal children born during the same period. Characteristic features of the disease in the Aboriginal children included a high rate of recurrent pneumonia (35%), frequent involvement of the upper lobe of the right lung (77%), and often a family history of pneumonia in early childhood. Of those with siblings, 39% of the affected infants had siblings who had suffered from pneumonia in early childhood. No perinatal factors which correlated with the subsequent development of lobar pneumonia could be identified. However, a greater proportion of the affected than of the non-affected children lived in substandard housing conditions.

A study of the reliability of carcinoembryonic antigen blood levels in following the course of colorectal cancer

Twenty-three patients were studied to assess the reliability of carcinoembryonic antigen (CEA) levels in following the course of colorectal cancer. CEA estimations were made prior to surgery and again postoperatively. The resected specimens were allocated a Dukes' Stage and histological grading (well, moderate or poorly differentiated). In addition, sections were stained for the presence of CEA by an immunoperoxidase method. Of the 23 patients, twelve had either disseminated disease at initial surgery or subsequently developed metastasis/recurrence. Eleven remain disease-free at a minimum follow-up of one year. In all of these the reliability of plasma CEA values in reflecting the disease status has been assessed. No false positive elevations of CEA were found. Three factors emerge as positive predictors of CEA estimation reliability: pre-operative CEA elevation; tumour grading as well differentiated; dark staining for the presence of CEA. These factors identified 15 of the 18 patients (83%) in whom CEA appeared reliable and were not present in any of the five patients where CEA was not reliable. This reliability achieves statistical significance (X2 = 8.5, p less than 0.02). Histological demonstration of CEA may contribute to the reliability placed on plasma CEA estimations and should be considered if serial estimations are to be performed.

Composite gastric carcinoid and adenocarcinoma

The light microscopical, histochemical and ultrastructural features of an unusual gastric tumour are presented. Microscopically, the neoplasm showed the features of both a conventional carcinoid tumour and of a mucin-producing adenocarcinoma. The ultrastructural demonstration of individual cells containing both endocrine granules and mucin globules supports the view that gastric enterochromaffin cells are of endodermal origin.

Altered neural conduction with epidural bupivacaine

The sites and magnitude of evoked potential response alterations induced by varying masses and concentrations of epidurally administered bupivacaine were assessed from electrodes positioned along the conducting pathways of the monkey. The mass of bupivacaine was the major factor in determining the level and degree of response alterations. At the lower levels of total drug mass, effects were limited to the dorsal root entry zone, whereas higher levels of mass not only increased the response attenuation at the gray matter level but resulted in additional changes in those responses recorded from the spinal cord white matter tracts. With all other factors stable, increasing concentration was associated with a greater degree of response attenuation, especially at the lower levels of total mass. These findings indicate that the mass of the drug is the major factor in determining the magnitude and level of bupivacaine-induced epidural analgesia. Increased concentration influences the local anesthetic's penetration at the dorsal root entry zone and, to a lesser degree, at the white tracts of the spinal cord.

Epidemic of hospital-acquired infection due to methicillin-resistant Staphylococcus aureus in major Victorian hospitals

During 1979, the Victorian Health Commission received reports of a rising proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates from an increasing number of institutions. At least 31 metropolitan hospitals were involved, and six of these reported MRSA totaling between 20% and 40% of all Staph. aureus isolates. Since that time, the problem has continued. In some university teaching hospitals, strains of MRSA now cause from 200 to 300 new cases of hospital-acquired infection each year. Sepsis occurs mainly in patients who underwent surgery, premature neonates and in the immunocompromised or debilitated patients. The organism involved is multiresistant. Recent isolates show increasing resistance, particularly against gentamicin, chloramphenicol and, more lately, fusidic acid and rifampicin. Only vancomycin can be relied upon for empirical treatment. There is concern that increasing use of vancomycin will select vancomycin-resistant strains of MRSA, so that, in the near future, there may no longer be any effective antibiotic therapy against hospital staphylococci.

Enzymes of the gamma-glutamyl cycle in 'aging' WI-38 fibroblasts and in HeLa S3 cells

gamma-Glutamyltransferase ((5-glutamyl)-peptide:amino-acid 5-glutamyltransferase, EC 2.3.2.2) activity of WI-38 fibroblasts decreased only slightly in relation to a constant amount of cell-associated protein as the cells were carried in culture serially from middle to late passage numbers leading toward senescence, e.g., from population doubling level 27 through 41. Also, when the enzyme activity was expressed on the basis of a unit number of cells or unit amount of DNA, little change occurred over that range of PDLs. As the culture approached 'phase-out', the transferase activity rose sharply regardless of how the activity was expressed. The possibility is considered that the large increase in activity could be a reflection of a significant increase in size of cells and therefore changes in the membranes where the transferase is located. The occurrence of other enzymes of the 'gamma-glutamyl cycle' in WI-38 and HeLa S3 cells also was demonstrated. These included gamma-glutamylcyclotransferase ((gamma-L-glutamyl)-L-amino-acid gamma-glutamyltransferase (cyclizing), EC 2.3.2.4) and 5-oxoprolinase, whose activities showed no large increase comparable to that of the gamma-glutamyltransferase, as the culture approached 'phase-out'.

XANTHOMA TUBEROSUM MULTIPLEX

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