[Effect of posture on the diuretic treatment of decompensated cirrhosis and heart failure]

The diuretic effect of the supine position was evaluated in six patients with cirrhosis and ascites and six with congestive cardiac failure. All patients received 1 mg bumethanide intravenously and were randomly assigned to either bed rest in the supine position or normal daily activity in the upright position for the next six hours. The diuretic response was similar in patients with heart failure and cirrhosis, and was significantly greater in the supine than in the upright position: mean 1,133 v 626 ml/6 h (p less than 0.01). The natriuresis was similarly greater during recumbency: mean sodium 96 v 45 mmol (mEq)/6 h (p less than 0.01), and the excreted potassium in six hours was similar in both postures. The glomerular filtration rate was 100 and 66 ml/min (p less than 0.01) and the heart rate 76 and 83 beats/min (p less than 0.05) in the supine and upright positions, respectively. Plasma concentrations of noradrenaline, renin, and aldosterone rose significantly during the upright position. The results suggest that the attenuated response to intravenous bumethanide in the upright position and during normal daily activity may be due to the activation of several, homoeostatic mechanisms which may reduce the excretion of water and salt.

Cross-sectional study of health effects of cryolite production

A cross-sectional health study of 101 cryolite workers was performed, using spirometry and a questionnaire. Multiple regression analysis revealed a significant correlation between the index of smoking and a decrease in FEV1 (per cent). There was no significant correlation between work-related exposure and lung function. Many cryolite workers described a group of symptoms appearing after 15 to 30 min of heavy dust exposure: nausea, followed by epigastric pain with relief after spontaneous or provoked vomiting. Thirty-four (33.6 per cent) workers complained of nausea, vomiting or diarrhoea in relation to work, compared to 3.8 per cent of 1752 men participating in the Copenhagen Male Study.

Chromium induced clinical improvement in symptomatic hypoglycemia

The present study included 20 patients indicating clinical symptoms of hypoglycemia, of which 19 showed a minimal glucose level in the tolerance curve above 2.2 mmol/L (limit for glucose induced hypoglycemia). This clinical state is defined here as "symptomatic hypoglycemia." All individuals were studied for effects of a daily intake for three mo of a yeast chromium supplement (125 micrograms Cr/d). The patients were followed by means of their oral glucose tolerance curve (1 g glucose/kg body wt) and by an interrogation scheme prior to during and after chromium supplementation. During three mo of chromium supplementation, a decrease was found in the negative part of the glucose tolerance curve, i.e., the part of the curve being below the fasting level in eight patients (40%). However, one mo after treatment, 10 patients out of 13 (77%) showed decreased areas of the negative part of the glucose tolerance curve compared to the values during treatment, and 11 out of 15 (73%) showed decreases in the negative part of the curve when post-treatment data were compared to ante-treatment data. The subjective clinical effects were followed by means of a questionnaire. Subjectively, the effects of organo-chromium were especially pronounced on chilliness. Thus seven (47%) indicated improvement and two (15%) indicated that the chilliness disappeared. However, trembling, emotional instability, and disorientation symptoms improved as well.

Selenium in chronic neurologic diseases. Multiple sclerosis and Batten's disease

The selenium levels in whole blood and the activity of glutathione peroxidase in hematogenous cells of normal Danes have been defined taking into account sex and confounding factors such as smoking and aging. No differences related to sex could be found with regard to the selenium level, and peroxidase activity assayed with hydrogen peroxide. However, the peroxidase activity assayed with t-butyl hydroperoxide was higher in females than in males (p less than .05). The peroxidase activities are dependent on age. Thus, the peroxidase levels assayed with both substrates show a minimum value in the age group from 40 to 50 yr for both smokers and nonsmokers. Smokers did show more homogeneous values as a function of age than nonsmokers. Smokers had significantly lower selenium values than nonsmokers, but glutathione peroxidase values identical with those of nonsmokers. Multiple sclerosis (MS) patients suffer from a chronic relapsing/remitting demyelinating disease. A theory explaining the pathogenesis of MS concerns increased stickiness of cellular plasma membranes, hampering normal vascular function of the brain. In agreement with that theory, the present communication demonstrates significantly lowered selenium values and lowered glutathione peroxidase activities of major types of hematogenous cells. In close agreement with these findings, hematogenous cells in MS show increased peroxidation rates. A nonblinded biochemical dietary experiment on MS patients showed that all abnormalities could be normalized by daily intake of selenium, vitamin E, and vitamin C. Batten's disease is a recessive inherited neurodegenerative disorder clinically characterized by progressive loss of vision, epilepsy, and dementia. Neuropathologically, this disease is characterized by storage of lipofuscin in nervous tissue. We have in a few cases documented a low selenium status and low glutathione peroxidase activities of hematogenous cells. As in MS, we normalized the biochemical abnormalities by an antioxidative treatment. Like in similar Finnish studies, the biochemical parameters can be normalized. Further, the Finnish studies indicate it possible by an antioxidative treatment to inhibit progression of the mental deterioration. The data presented will be discussed in relationship both to specific pathological parameters of the diseases and to the low dietary energy expenditures of handicapped immobile patients.

Comparison of whole blood selenium values and erythrocyte glutathione peroxidase activities of normal individuals on supplementation with selenate, selenite, L-selenomethionine, and high selenium yeast

The selenium levels and the glutathione peroxidase activity GSH-PX of whole blood and of erythrocytes, respectively, were determined in 139 normal Danes and related to sex and smoking habits. No differences were found in relation to sex apart from a higher GSH-PX activity of females when assayed with tertiary butyl hydroperoxide. Smokers showed significantly lower selenium values than non-smokers (p less than 0.05), but the two groups had identical GSH-PX activities. Individuals from the above-mentioned group were divided into four groups, receiving daily oral doses of 200 micrograms of selenium in the form of selenite, selenate, L-selenomethionine, and selenium as contained in yeast. Whole blood selenium values and the erythrocyte glutathione peroxidase activities were determined during three months of supplementation followed by a withdrawal period of four months. Both the inorganic selenium compounds and the organic derivatives gave rise to steady state levels of GSH-PX after one month of supplementation. However, the selenium levels in the groups receiving organic selenium showed a steady rise during the whole period, whereas those supplemented with inorganic selenium leveled off after a period of one to three months. The data for smokers and nonsmokers revealed identical results when organic selenium was supplemented. However, selenite gave rise to significantly higher selenium levels and GSH-PX activities in smokers than in non-smokers. Less significant (p less than 0.08) elevations of both parameters were also observed among the smokers in the selenate group. By taking both the selenium level and the GSH-PX activity into consideration, organic selenium (i.e., L-(+) selenomethionine) was judged to be more bioavailable than selenite and selenate.

The Use ofIn VitroCultured Lymphocytes for Tracing Mutagenic Activities of Chemicals

Lymphocytes from normal, non-smoking human individuals not taking drugs were isolated from the peripheral blood by means of the lymphoprep method. The cells were cultured in RPMI medium with 10% fetal calf serum and stimulated with Phytohemagglutinin. A mutagen such as 3-methylcholanthrene was added for varying periods of time. Then the subspecies of DNA, i.e. double and single stranded DNA (ds-DNA and ss-DNA), were separated by the alkaline elution technique and quantitated by fluorimetric estimation. The mutagen induced a significant rise in the level of ss-DNA, but no changes in ds-DNA could be traced. The time-dependent changes increased for at least four days of exposure, indicating that the repair enzymes were not able to compensate for the DNA damage.

Diuretic treatment in decompensated cirrhosis and congestive heart failure: effect of posture

The diuretic effect of the supine position was evaluated in six patients with cirrhosis and ascites and six with congestive cardiac failure. After fasting overnight in bed the patients received bumetanide 1 mg intravenously and were then immediately randomly assigned to either bed rest in the supine position or normal daily activity in the upright position for the next six hours. Two days later the procedure was repeated, the patients being assigned to the other posture. The diuretic response was similar in patients with heart failure and cirrhosis, and was significantly greater in the supine than in the upright position: mean 1133 v 626 ml/6 h (p less than 0.01). The natriuresis was similarly larger during recumbency: mean sodium 96 v 45 mmol(mEq)/6h (p less than 0.01), and the excreted potassium in six hours was similar in both postures. The glomerular filtration rate was 100 and 66 ml/min (p less than 0.01) and heart rate 76 and 83 beats/min (p less than 0.01) in the supine and upright positions respectively. Plasma concentrations of noradrenaline, renin, and aldosterone were all raised even when the patient adopted the supine position, and a further significant rise was observed during the upright position. The results suggest that the attenuated response to intravenous bumetanide in the upright position and during normal daily activity may be due to the activation of several homeostatic mechanisms that may reduce the excretion of water and salt.

Characterization of DNA and RNA in circulating immunocomplexes in multiple sclerosis, amyotrophic lateral sclerosis and normal controls

The total levels of DNA and RNA in serum immunocomplexes from multiple sclerosis (MS) patients and healthy control persons were compared. Furthermore, the levels of single-stranded DNA (ss DNA) and double-stranded DNA (ds DNA) in serum immunocomplexes from MS patients, amyotrophic lateral sclerosis (ALS) patients and controls were studied. The mean values of DNA and RNA were found to be elevated (P less than 0.01) in MS compared to the control means. Furthermore, the RNA/DNA ratio and the ratio ss DNA/ds DNA were decreased in MS. In contrast the ss:ds DNA ratio in ALS was increased. In ALS, however, the sum of ss DNA and ds DNA was lower (P less than 0.05) than the control mean value.

Effect of multiple sclerosis alpha 2-macroglobulin on mitogen induction of lymphocyte proliferation

Electrophoretic studies on microheterogeneity of alpha 2-macroglobulin (alpha 2M) have revealed the presence of an abnormal acidic form of alpha 2M in multiple sclerosis (MS). In the present study we have characterized alpha 2M chemically and compared the inhibitory effect of MS and normal alpha 2M on the mitogen induction of lymphocyte proliferation. The antitrypsin activity and total reducing sugar content of MS alpha 2M were comparable with those of normal alpha 2M. However, the sialic acid content of MS alpha 2M was found to be significantly higher than that of normal alpha 2M. In agreement with previous studies, normal alpha 2M was found to inhibit the mitogen induction of lymphocyte proliferation in more than 90% cell cultures. However, MS alpha 2M was found to inhibit the mitogen-induced lymphocyte proliferation in less than 35 percent cell cultures. The effects of MS or normal alpha 2M on the lymphocyte cultures of either groups were found to be apparently the same. The possible explanations for the loss of the above-mentioned inhibitory effect of MS alpha 2M have been discussed.

Membrane-bound 2',3',-cyclic nucleotide 3'-phosphohydrolase activity of lymphocytes, granulocytes and erythrocytes in multiple sclerosis

A sensitive fluorimetric method was used for the assay of 2',3'-cyclic nucleotide 3'-phosphohydrolase (CNP) activity of lymphocyte, granulocyte and erythrocyte membranes from patients with multiple sclerosis (MS). The data obtained were compared with the corresponding data from normal individuals. CNP activities of granulocyte and erythrocyte membranes of the 2 groups did not differ significantly. However, a 40% decreased membrane CNP activity of MS lymphocytes was found when the data were compared with the normal lymphocytes' activity (P less than 0.0005) by both the non-parametric median test and Student's t-test. A role of CNP in immunoregulation is suggested.

Kinetics of inhibition of mitogen-induced proliferation of human lymphocytes by alpha 2-macroglobulin in serum-free medium

The effect of alpha 2-macroglobulin (alpha 2M) on the ability of human lymphocytes to proliferate in response to stimuli by 3 mitogens, concanavalin A, phytohaemagglutinin and pokeweed mitogen was investigated in in vitro lymphocyte cultures in serum-free medium. The following experiments were performed: 1. lymphocytes were treated with alpha 2M prior to stimulation with the mitogens; 2. alpha 2M and mitogens were added simultaneously to the lymphocyte cultures; and 3. alpha 2M was added to the lymphocyte cultures after they were stimulated with the mitogens. In all cases, alpha 2M was found to inhibit mitogen induced proliferation of the lymphocytes as evaluated by (6-3H)-thymidine uptake of the cells. The mechanisms involved in the inhibition of lymphocyte proliferation by alpha 2M are discussed.

Quantitation of multiple sclerosis specific central nervous system antigens in various regions of MS brains

We have estimated the levels of partially purified multiple sclerosis (MS) specific glycoproteins (MSG2) in gray matter, white matter, spinal cord and brain stem of MS autopsy brains by an enzyme immunoassay in which antisera to a pooled MSG2 was employed. Similarly, the levels of KG2 (non-MS brain isolate corresponding to MSG2) were assayed in various topographic areas of non-MS autopsy brains. Comparison of data on MS and non-MS groups revealed that the MS specific antigens may be preferentially located in the normal appearing white matter of MS brains. The concentration of MS antigens was found to be highest in the normal appearing white matter of MS brains, followed by periplaque and finally plaque. These results indicate that the MS specific antigens are not the degraded products of MS brains. They further support the view that normal appearing white matter of MS brains should be the target tissue for the isolation of MS specific antigens.

State-dependent variations in brainstem auditory evoked responses in human subjects

BAERs from 16 subjects during 3 sessions varied in the latency or amplitude of some components depending upon level of arousal as indicated by EEG patterns. There was a general tendency for activation to produce the fastest responses with the largest amplitudes and for drowsiness to produce the slowest responses with the smallest amplitudes. The latency of P2 was significantly prolonged during drowsiness, relative to those during relaxation or activation. For right-ear stimulation, P5 latency was longest during drowsiness, and shortest during activation while for left-ear stimulation the shortest latency occurred during relaxation. The amplitudes of Wave II and Wave VII were significantly smaller during drowsiness than during activation. Although the differences were below the level of clinical significance, the data indicate a modification in the characteristics of brainstem transmission as a function of concurrent activity in other brain areas.

Demential syndromes and the lipid metabolism

The present communication surveys the present knowledge about the extent to which formation of free radicals in the central nervous system may give rise to cross-linking reactions finally ending in the deposition of lipofuscin pigments. Free radicals may be formed by autoperoxidation of polyunsaturated fatty acids. These fatty acids, e.g., C22:6 omega 3, are enriched in rods and cones of the eye and in phosphatidyl ethanolamine of synaptosomes. By peroxidation, malondialdehyde is formed. This aldehyde may cross-link through amino groups of proteins and certain phospholipids. Hereby, lipofuscin is deposited. The peroxidation process is counteracted by certain enzymic systems and by antioxidants. Thus, glutathionperoxidase (GSH-Px), catalase and superoxid dismutase may eliminate peroxides. GSH-Px is a selenium-containing enzyme. Peroxides are also formed by metabolic transformation of dopamine. 3 demential syndromes, i.e. Alzheimer's, Parkinson's and Batten's diseases, are discussed with regard to whether the "free radical theory" may explain the pathogenesis. Finally, it is discussed whether an antioxidative treatment including vitamins E and C as well as a supplement of selenium, e.g. sodiumselenite, may be a therapeutic alternative to other types of treatment of demential syndromes or a direct supplement to the L-DOPA treatment of Parkinson's disease.

Organochlorine compounds in human breast fat from deceased with and without breast cancer and in a biopsy material from newly diagnosed patients undergoing breast surgery

Epidemiological studies have related the incidence of mammary cancer to the dietary intake of fat and/or meat. Since organochlorine compounds (e.g., polychlorinated biphenyls (PCB) and DDT (and its metabolite DDE] are accumulated in the adipose tissue it was tempting to suggest a relationship between levels of PCB and "DDT" (i.e., DDT + DDE) in breast fat tissue and the occurrence of mammary cancer. To elucidate this theory, the organochlorine levels of 14 breast fat tissue samples from breast cancer patients and similar samples from 18 deceased mammary cancer patients were compared to that of 21 similar samples from noncancer patients and finally to adipose tissue samples from 35 non-cancer autopsy specimens. No significant differences were traced. Thus it seems that the accumulation of PCB and DDT measured in breast fat tissue do not relate to the occurrence of mammary cancer.

Glutathione peroxidase and reductase, glucose-6-phosphate dehydrogenase and catalase activities in multiple sclerosis

Our previous studies have demonstrated a decreased glutathione feroxidase (GSH-Px) activity of erythrocytes and leucocytes from multiple sclerosis (MS) patients. In the present communication these activities were compared with the activities of associated enzymes (glutathione reductase (GSSG-RD), glucose-6-phosphate dehydrogenase (G-6-PD) and catalase). All enzymic activities were compared between MS patients, other neurologic patients (ON patients) and normal control individuals. Compared to data of ON patients and normal controls, in MS the ratio of GSHPx/GSSGRD in lympho- and granulocytes was significantly decreased (2 alpha less than or equal to 0.05) by 35% and 51%, respectively. The significant correlation between GSSG-RD and the GSH-Px activity (2 alpha less than or equal to 0.05, r = 0.501) found in control lymphocytes was not present in MS lymphocytes. However, the lymphocyte GSH-Px activities of controls as well as of MS correlated with the corresponding serum selenium levels (2 alpha less than or equal to 0.05, r = 0.594 and 2 alpha less than or equal to 0.01, r = 0.967, respectively). The G-6-PD activity was insignificantly increased by 41% in MS lymphocytes compared to normal control. Catalase activity was unchanged in lymphocytes but decreased 50% in MS granulocytes compared to normal control. No significant differences were found between MS and the ON group. The catalase activity of MS erythrocytes was increased by 63% (2 alpha less than or equal to 0.05) in comparison with both the normal control and ON data.

Electron microscopical study of rat mast cell maturation

The development of peritoneal mast cells in rats in the early post-natal period was found to take 7-8 weeks. A slightly shorter time was needed for the reappearance of mature peritoneal mast cells following their total destruction in adult rats. In both groups of animals mast cell ultrastructure was studied in successive phases of development. The maturation process was gradual, but no well-defined morphological stages could be demonstrated. The morphology of young peritoneal mast cells seems to indicate that they arise in the peritoneal fluid from macrophage-like cells.

Estimation of levels of IgG to multiple sclerosis specific brain antigens in the cerebrospinal fluid of MS patients

The binding of partially purified multiple sclerosis (MS) specific brain antigens (MSG2) and of the corresponding antigens of non-MS brains (KG2) to cerebrospinal fluid IgG of patients with MS and other neurological diseases was assayed employing sandwich enzyme linked immunosorbent assay (ELISA). Assay of the antigen-antibody binding revealed that the concentration of MSG2 required for the optimum binding to IgG in the undiluted MS CSFs was lower than that of KG2 in all cases. The index for IgG binding capacity of an antigen (IgBC) was expressed as a ratio of the optical density of the enzymic products in ELISA at the optimal antigen-antibody binding to the lowest concentration of the antigen required for the optimal binding. The IgBC of MSG2 was found to be linearly correlated with the IgG concentration in the CSF of MS patients. These results indicate that IgG with specificity to MSG2 may be present in the CSF of MS patients.

Ultrastructure of the tympanic membrane in the Rhesus monkey

The tympanic membranes of 8 Rhesus monkeys (macaca mulatta) were investigated by transmission electron microscopy. The interface of the epidermis and the fibrous framework appeared rather smooth and the contact between the basal cell layer and the lamina propria was secured by a dermo-epidermal junction. Cross-sectioned fibrils varied in shape and thickness, the thin fibrils being quadrangular. The findings of this study indicate a great similarity between the tympanic membrane of man and that of the Rhesus monkey. A corresponding similarity has been documented concerning the function of the Eustachian tube--middle-ear system, and it is concluded that the Rhesus monkey is highly suitable for studies of the tympanic membrane.

Serum antibodies against cytosol antigens in multiple sclerosis

Immunologically pure IgG was isolated from serum of multiple sclerosis (MS) patients and normal controls. The F(ab)2 moiety of IgG was then isolated by salting out between 12.5 and 19.0% Na2SO4 of the pepsin digest of IgG. The ability of the 131I-labelled F(ab)2 to bind to subcellular brain fractions (nuclei, synaptosomes, mitochondria, myelin, microsomes and cytosol) of MS and control brains was assayed and expressed as radioactivity/mg protein of respective fractions. No significant difference could be traced with regard to F(ab)2 binding to the particulate fractions from MS patients and normal controls. MS F(ab)2 did, however, bind about two times more to MS cytosol than to non-MS cytosol antigens and up to 50% more MS than the control F(ab)2 did bind to the MS cytosol. MS F(ab)2 and control F(ab)2 did bind equally to control cytosol. The immunoprecipitate of MS F(ab)2-MS-cytosol was isolated and used for immunization of rabbits. The antiserum formed could be demonstrated by means of crossed immunoelectrophoresis to contain antibodies to one to three MS antigens. Thus it must be concluded that MS serum contains antibodies to one to three MS antigens occurring in MS brain cytosol.

Leucocyte glutathione peroxidase activity and selenium level in Batten's disease

The glutathione peroxidase (GSHPx) activity was found significantly reduced in whole lymphocytes from patients suffering from Batten's disease. By means of two different procedures for isolation of subcellular fractions of lymphocytes it was possible to demonstrate an increased GSHPx activity of the particulate fractions (20.000 g-av and 105.000 g-av precipitates). However, the GSHPx activity of the supernatants was decreased. The GSHPx activity of the 20.000 g-av supernatant correlated significantly with the serum selenium content both in normal controls and in Batten's disease. A similar correlation was traced with GSHPx activity of erythrocyte haemolysate and serum selenium level in Batten's disease but not in normal controls. The GSHPx activity was also found decreased in the 20.000 g-av and 105.000 g-av supernatants of granulocytes. The abnormal subcellular distribution of GSHPx activities was related to the distribution of enzymes which were used as markers for different subcellular components. The data presented are discussed in relationship to the theory that Batten's disease is due to an increased peroxidation damaging the cellular membranes.

Thymidine uptake by lymphocytes in the presence of supernatants of polymorphonuclear leucocytes incubated with multiple sclerosis brain antigens

The effects of factors secreted by polymorphonuclear leucocytes (PMNL) incubated with multiple sclerosis (MS) and control brain antigens (MSG2 and KG2 respectively) were evaluated by assay of thymidine uptake by lymphocytes from normal individuals and MS patients. It was found that the cellular uptake of thymidine of both MS and normals was significantly lower in the presence of MSG2-PMNL supernatants compared to that in the presence of KG2-PMNL or without antigen-PMNL supernatant. The findings indicate that an inhibitor of lymphocyte proliferation either may be released from PMNL by the action of MSG2 or may be synthesized in response to challenge by MSG2.

Fetal arterial involvement in Behcet's disease: an electron microscope study

A fetus, 16 weeks old, was removed by hysterotomy from a patient suffering from Behcet's disease. The patient received systemic steroids during pregnancy. Electron microscopy of the fetal thoracic aorta revealed edema of the sub-endothelial space and of the luminal part of the tunica media, as well as a pronounced rarefaction and disarrangement of the smooth-muscle cells. Results obtained from two human fetal aortae used as controls suggest that the fetal aortic lesions were caused by the maternal disease and not by the exposure to steroids.