Pheochromocytoma: operative strategy

We studied 28 patients who had undergone 30 operations for pheochromocytoma since 1964. The tumor types included bilateral, extra-adrenal, malignant, recurrent, and multiple endocrine neoplasia, with 20 tumors confined to the adrenal gland. The preoperative studies used to localize the tumor included ultrasonography, intravenous urography, angiography, and computed tomography. Patients underwent exploratory operations via flank, subcostal, bilateral subcostal, midline, or thoracoabdominal approaches. In one case, that of a recurrence after bilateral adrenalectomy, surgical exploration discovered a tumor that had not been localized during the preoperative workup. Two patients underwent splenectomy because of injury incurred during operative exploration. Our experience suggests that preoperative localization is highly reliable, and therefore the benefits of extensive surgical exploration may be outweighed by its risks. We believe that with the exception of tumors that occur in association with childhood or pregnancy, multiple endocrine neoplastic syndromes, or recurrent disease, a direct approach to the tumor, possibly via the flank, is justified. Our results suggest that exploration of the contralateral adrenal or periaortic area is not so important as to be worth jeopardizing the spleen or other organs by a complex or extensive dissection.

Three synchronous multiorgan primary cancers. All stage I

A patient who has three separate, synchronous, early (stage I) primary cancers of the right lung, right breast, and stomach and whose disease is simultaneously diagnosed and successfully treated sequentially within a single hospital admission is unique. While multiple primary malignant neoplasms are not uncommon, to our knowledge, there has been no report of triple stage I synchronous carcinomas in separate major organ systems. Age, immunodeficiency, somatotype, hereditary tendencies, hormonal and environmental factors, and previous therapy have been incriminated as etiologic factors. Accurate tissue diagnosis and tumor staging are mandatory. In patients with diagnosed cancer, pulmonary lesions should never be presumed metastatic. Individual tumors should be treated independently of other concomitant lesions, and each treatment approach should be curative in nature. Patients with proven multiple malignant neoplasms carry a higher risk of developing other primary neoplasms.

Neuropeptide Y (NPY)-like immunoreactive amacrine cells in retinas of frog and goldfish

The distribution of neuropeptide Y (NPY)-like immunoreactivity in rat, rabbit, chick, frog and goldfish retinas was investigated by immunohistochemistry. Positive results were observed only in the frog and goldfish retinas. NPY immunoreactivity was associated with a small population of amacrine cell bodies in the inner nuclear layer and cell processes in the inner plexiform layer of both retinas. In the frog retina, three distinct layers containing immunoreactivity were observed in the inner plexiform layer. In contrast, the immunoreactivity in the same area of the goldfish retina was more or less separated into two layers. Convincing evidence could not be found for the co-existence of NPY-like material with other putative transmitter-like substances in the two retinas. Radioimmunoassay revealed the presence of small amounts of NPY-like immunoreactivity in the rabbit retina; the goldfish and frog retinas contained significantly more immunoreactive material. High performance liquid chromatography of the immunoreactive material in frog and goldfish retinas showed each retina containing different molecular forms of NPY-like proteins, neither of which resembled porcine NPY or PYY. The endogenous NPY-like material of the frog retina can be released by potassium depolarisation in a calcium-dependent way. In view of all these data an NPY-like protein must now be considered a potential retinal transmitter.

Protein synthesis and secretion by the human endometrium and decidua during early pregnancy

To investigate the role of the endometrium in sustaining early pregnancy, specimens of endometrium from early pregnancy were incubated in vitro with radiolabelled amino acids, and protein synthesis and secretion were studied by subsequent fluorographic analysis of one-and two-dimensional polyacrylamide gels. Seventeen secreted endometrial proteins (EP) were identified. Changes were demonstrated in the rate of synthesis and/or secretion of a number of these proteins during early pregnancy. Two proteins, EP 14 and EP 15, are the principal secretory proteins of pregnancy endometrium. EP 14 (subunit mol. wt 32 000) is associated with decidualized endometrium and its rate of synthesis/secretion increases during early pregnancy. EP 15 (subunit mol. wt 28 000) is also synthesized and secreted by the secretory endometrium during the menstrual cycle, and during early pregnancy, but its secretion declines to undetectable levels by week 15-16. These proteins may provide useful markers of endometrial function and differentiation during the menstrual cycle and pregnancy.

Acute cerebral revascularization

Fifteen patients evaluated for acute cerebral ischemia underwent acute cerebral revascularization between March, 1979, and May, 1983. Clinical presentation included crescendo transient ischemic attacks (TIA's) in eight cases, progressing neurological dysfunction in three cases, and completed nonfluctuating deficits in four cases. Nine patients received intravenous heparin but did not improve neurologically. The patients with crescendo TIA's were operated on within 4 hours of their last event; those with progressing deficits were operated on while the deficit was developing, and those with established deficits were operated on 4, 6, 9, and 12 hours, respectively, after the event began. The clinical picture for 10 patients had resolved within 10 hours after surgery. One patient with crescendo TIA's, two with progressing deficits, and two with established deficits had postoperative residual deficits, of which three were mild and two severe. One patient, who had a saphenous vein graft to the middle cerebral artery, developed an intracerebral hematoma. In this prospective noncontrolled nonrandomized study, acute cerebral revascularization was performed safely, had limited risks, and offered the potential to help some patients. Further controlled randomized studies are indicated.

Inhibition by metoprolol of the antihypertensive effect of aspirin in young rats

A group of 21-day-old, spontaneous hypertensive rats (SHR) received either aspirin (75-100 mg/kg), metoprolol (1.0-1.5 mg/kg) or both in their drinking water for 56 days. Controls received plain water. Groups of normotensive Wistar-Kyoto rats (WKY) received the same drug treatment as did the SHR. Blood pressure, heart rate and body weight were determined weekly, and water consumption was monitored on a daily basis. Renal prostaglandin (PG) activities were determined in a separate group of rats at 7 and at 56 days on each protocol. Blood pressures in the SHRs remained in the range of the WKY during 56 days of treatment with aspirin or metoprolol, but increased to hypertensive levels after exposure to plain water. Blood pressures in the WKY receiving aspirin or metoprolol were also lower than those receiving plain water, but the antihypertensive effect was somewhat slower in onset. The antihypertensive effects of aspirin and of metoprolol were lost in the SHR but not in the WKY when both drugs were given simultaneously in the drinking water. In comparison to rats receiving plain water, renal PG activity (PGF1 alpha and PGF2 alpha) was lower in rats receiving aspirin, metoprolol or both together. The mechanism for the antihypertensive effect of aspirin in the young SHR may be related to a decline in renal PG content, or to the release of other hormones controlling water and electrolyte balance. Reports that the cyclooxygenase inhibitors, such as aspirin, can block the antihypertensive effect of the beta adrenoceptor antagonists is confirmed in chronic studies using the SHR model.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypercalcemia in carcinoma of prostate. Its cure by orchiectomy

A case report of a patient with carcinoma of the prostate and hypercalcemia is presented. We believe this is the first such case documenting ectopic parathormone from this tumor. Resolution of the hypercalcemia followed orchiectomy.

Immunochemical detection and characterization of pregnancy-associated endometrial alpha 1- and alpha 2-globulins secreted by human endometrium and decidua

Antisera raised against the soluble antigens of the endometrium of early pregnancy detected two antigenic proteins of alpha 1 and alpha 2 mobility in extracts of this tissue and were termed antigens A and B. Neither antigen was detected in pregnancy sera or extracts of proliferative endometrium, but antigen B was detected in extracts of secretory endometrium and both were present in amniotic fluid and medium from in-vitro incubations of pregnancy endometrium. Fractionation of radiolabelled medium on ion-exchange chromatography demonstrated that antigens A and B co-eluted with the proteins from which EP14 and EP15 were derived and which were the major secretory polypeptides of pregnancy endometrium in vitro. Further biochemical purification revealed that EP14 (Mr 32 000) was derived from a protein of native molecular weight 36 000 which existed in two forms, whereas EP15 (Mr 28 000) was derived from a dimeric glycoprotein of native molecular weight 56 000. Immunochemical studies demonstrated that antigens A and B are identical to these two secretory proteins and have been termed pregnancy-associated endometrial alpha 1- and alpha 2-globulins (alpha 1- and alpha 2-PEG).

Nutritional assessment in patients with chronic gastrointestinal symptoms: comparison of functional and organic disorders

We assessed the nutritional status of 119 patients with chronic gastrointestinal symptoms due to organic disorders (inflammatory bowel disease, IBD; peptic ulcer, PU; malabsorption syndrome, M; and malignant gastrointestinal tumours, T), by standard anthropometry and marker proteins (albumin; retinol-binding protein, RBP; and thyroxine-binding prealbumin, TBPA). We also studied 31 patients with irritable bowel syndrome (IBS) and 75 age-matched healthy controls (C). Compared with healthy controls, patients with organic bowel disease had significant abnormality of two or more anthropometric measurements (P less than 0.05). Plasma albumin was reduced in patients with IBD, M and T (P less than 0.001), but RBP and TBPA measurements were lower in all patient categories (P less than 0.01) including IBS. Stepwise discriminant analysis of the patient data alone, using three to six parameters, correctly separated 65 per cent PU patients, 66 per cent IBD and M, 72 per cent IBS and 88 per cent patients with T from other disease categories. We conclude that patients with chronic gastrointestinal symptoms often have some nutritional disturbances and that simple anthropometric and protein measurements might help us to distinguish patients with functional bowel disease from those with organic bowel disease.

Monoclonal antibodies recognizing epitopes carried on both glycolipids and glycoproteins of the human milk fat globule membrane

The molecules of the human milk fat globule membrane (MFGM) which bind four murine monoclonal antibodies (LICR LON M3, M8, M18 and M24) raised against the human MFGM have been identified. By using 'Western' blotting [Burnette (1981) Anal. Biochem. 112, 195-203] it was shown that each antibody reacted with a different set of proteins. M3 and M24 were similar in their pattern of reaction with the membrane proteins, but were quite distinct from M8 and M18, which also differed from each other. Glycopeptides prepared from the MFGM by exhaustive Pronase digestion were able to inhibit partially the binding of M3 and M24, and prevent totally the binding of M8 and M18, to the MFGM in an enzyme-linked immunoabsorbent assay. Oligosaccharides obtained by the deproteination of human milk also completely inhibited the binding of M3, M18 and M24 to the MFGM. However, the binding of M8 was not inhibited by these saccharides, and therefore M8 may not be recognizing a simple carbohydrate determinant. By using an enzyme-linked assay, M8 and M18 were shown not to bind to MFGM glycolipid, whereas M3 and M24 did, and this was confirmed by overlaying thin layer chromatograms of MFGM lipids with these antibodies. Both M3 and M24 showed a similar complex pattern of reaction, binding to more than one glycolipid moiety. By these means all four antibodies have been shown to react with antigens which involve carbohydrate side chains carried on different proteins, and two were also shown to react with such determinants on glycolipids.

Can a sponge fractionate isotopes?

The study has unequivocally demonstrated that siliceous sponges Spirastrella cuspidifera and Prostylyssa foetida from the same microecological niche exhibit a high degree of species specificity, while accumulating a host of heavy metal ions (Ni, Cr, Cd, Sn, Ti, Mo, Zr). S. cuspidifera accumulated, in addition, 60Co and 63Ni, showing discrimination against other radionuclides, 137Cs and 131I, present in the ambient waters receiving controlled low level waste discharges from a B.W.R. nuclear power station. P. foetida, on the other hand, accumulated only 131I and showed discrimination against other radionuclides including 60Co, although the stable iodine concentrations in both the sponges were the same. The specific activity of 60Co (in becquerels per gram of 59Co) in S. cuspidifera and 131I (in becquerels per gram of 127I) in P. foetida were at least two orders of magnitude greater than in the ambient sea water. That of 63Ni (in becquerels per gram of 62Ni) in S. cuspidifera, on the other hand, was lower by two orders of magnitude than in either abiotic matrices from the same environment. Thus, not only did both the species show bioaccumulation of a specific element, but also preferential uptake of isotopes of the same element, though they were equally available for intake. Such differential uptake of isotopes can possibly be explained in terms of two quite different mechanisms operating, each applicable in a particular case. One is that the xenobiotic isotope enters the environment in a physicochemical form or as a complex different from that of its natural counterpart. If equilibration with the latter is slow, so that the organism acquires the xenobiotic in an unfamiliar chemical context, it may treat it as a chemically distinct entity so that its concentration factor differs from that of stable isotope, thus changing the specific activity. Alternatively, if the xenobiotic is present in the same chemical form as the stable isotope, the only way in which specific activities can be modified is by fractionation on the basis of mass of isotope. In view of the remarkable concentration factors observed for stable and radioactive isotopes of the same element and the specific activities reached, it is desirable that species of sponges, especially from the coastal and estuarine environments, be monitored to detect levels of pollution due to anthropogenic substances.

Effects of fluorescein on tear breakup time and on tear thinning time

A simple, noninvasive method of in vivo precorneal tear film stability analysis is described. The method involves observing the first catoptric (first Purkinje) image. The effect of fluorescein on the results and the relation with standard tear breakup time (BUT) are presented.

Purification of a human plasma membrane glycoprotein from human red blood cells by affinity chromatography using a monoclonal antibody

Using the monoclonal antibody LICR-LON-Fib75.1 coupled to Sepharose as an affinity chromatography column, a membrane glycoprotein with an apparent molecular weight of 18,000 on sodium dodecyl sulfate-polyacrylamide gels has been purified from human red blood cells. The purified protein contained 25% carbohydrate by weight, the predominant sugars being galactose, mannose, and glucosamine. Amino acid analysis indicated that the protein was relatively rich in aspartate, glutamate, valine, and leucine and had a low proline and methionine content. The molecule could be removed from intact red blood cells by trypsin and could be labeled with iodine by lactoperoxidase-catalyzed cell surface iodination of red blood cells. The protein could also be labeled using the lipidsoluble photoactivatable reagent 3-(trifluoromethyl)-3-(m-[125I]iodophenyl) diazirine) and partitioned into the lower phase of the phase-separable detergent Triton X-114. During size-exclusion chromatography in different detergents alterations were observed in the apparent molecular weight of the protein. These results suggest that this Fib75.1-binding protein is an external red blood cell membrane glycoprotein which is capable of binding detergent. Proteins with a similar molecular weight have also been isolated from two human tumor cell lines by immunoprecipitation with this monoclonal antibody.

In vitro stimulation of macrophages by quadrol [N,N,N',N'-tetrakis(2-hydroxypropyl)ethylenediamine]

Mouse peritoneal macrophages, when exposed to Quadrol [N,N,N',N'-tetrakis(2-hydroxypropyl)ethylenediamine] in vitro, show a dose dependent enhanced spreading over a four-hour period. In vitro Quadrol induced phagocytosis of polystyrene beads was found to be time and concentration dependent. The rate and extent of the enhancement of phagocytosis was comparable to that observed for lipopolysaccharide and tuftsin.

Aggressive choroid plexus papilloma

A young woman, who was initially treated for an Arnold-Chiari malformation, was found 7 years later to have a posterior third ventricular tumor. A superior cerebellar approach allowed total resection of the mass, which was an aggressive choroid plexus papilloma. The patient was treated with whole cerebrospinal axis radiation. There is no clinical or computed tomographic evidence of recurrence after 4 years. The literature is reviewed and a discussion of aggressive choroid plexus papilloma (carcinoma) is presented.

Polyclonal orbital and systemic infiltrates

Two unusual cases of benign lymphoproliferative disease associated with orbital and systemic involvement are described. Both have occurred in adults with longstanding histories and clinical manifestations that have mimicked lymphomas. The orbital disease has been both antecedent and subsequent to the systemic lesions. These cases emphasize the spectrum of lymphoproliferative disorders and call attention to the possibility of multisystem disease in patients with benign lymphoproliferative lesions.

Variability of peak flow in wheezy children

A study of peak flow variability was carried out among a population sample of 63 wheezy children aged 9-11 years. Recordings were made over 12 days at three times during the day--first thing in the morning, on returning home from school and at bedtime. Eighty nine per cent of the children had symptoms during the diary period. The mean amplitude (difference between the highest and lowest daily peak flow values) was 17% of the mean daily value (range 4-48%). By cosinor analysis the amplitude was 12% of the mean value (range 1-53%). In 65% of the children the lowest point of the daily rhythm as determined by cosinor analysis lay between midnight and 8am; the rhythm was, however, statistically significant in only fourteen individuals (22%). These levels of variability are considerably lower than those previously reported in hospital based studies of adult asthmatics. As a method of demonstrating variable airflow obstruction, which is the defining physiological characteristic of asthma, the use of a peak flow diary alone appears to be of limited value in children.

Dopaminergic neurones in various retinas and the postnatal development of tyrosine-hydroxylase immunoreactivity in the rabbit retina

The localisation of tyrosine-hydroxylase immunoreactive neurones in retinas of a variety of animals were examined. Immunoreactivity was associated with specific populations of amacrine neurones in all species examined, viz; rabbit, guinea pig, monkey, cow, frog, pigeon and goldfish. Only in the goldfish was immunoreactivity also associated with processes situated in the outer plexiform layer showing that in this species catecholamine interplexiform cells exist. The development of tyrosine-hydroxylase immunoreactive neurones in the rabbit retina was also analysed. The first immunoreactive positive cells were observed by the third postnatal day. The immunoreactive positive neurones at this stage are weak and lack processes. The intensity of the immunoreactivity increases with development, but processes are lacking, until the 10th postnatal day. The immunoreactive neurones only appear fully developed by the 22nd to 28th postnatal day. Autoradiographical analysis of 3H-dopamine uptake strongly suggests that neurones containing tyrosine-hydroxylase immunoreactivity in the different retinas have the capacity to take up exogenous dopamine. It is therefore concluded that localisation of either 3H-dopamine uptake or tyrosine-hydroxylase provides a means of locating catecholamine neurones.

Red cell phenotyping using hexadimethrine bromide (Polybrene) in a microplate system

To provide rapidly phenotyped units of blood, we adapted the hexadimethrine bromide (Polybrene) technique to microplate technology. Pilot samples from 282 donor units were phenotyped for antigens in the Rh, Kidd, Kell, Duffy, and Ss systems with a standard tube-testing method and a Polybrene-microplate (P-MP) technique. Diluted antisera and a 1 percent red cell suspension were used to give P-MP reactions that were accurate and easy to interpret. One microplate, containing 96 tests, was prepared and read within 15 minutes for P-MP tests yielding direct agglutination (Rh, Jkb, Fya, Fyb), or within 19 minutes for P-MP tests requiring an antiglobulin phase (Jka, K, S, s). No false-positive results were found. No false-negative reactions were found in typing for Rh, K, S, s, or Jka antigens. Phenotyping for Jkb and Duffy antigens gave a false-negative rate of less than 0.015. Considerable savings in reagents were obtained through microplate miniaturization and through the enhancement of apparent antibody avidity in the Polybrene/low ionic medium which permitted dilution of reagent antisera. The P-MP technique affords a rapid, accurate, simple, and inexpensive means of phenotyping large numbers of donor units.

Effects of intraaortic balloon counterpulsation on myocardial blood flow in patients with severe coronary artery disease

The purpose of this study was to test the hypothesis that myocardial blood flow distal to a critical stenosis would increase during intraaortic balloon counterpulsation. Accordingly, 13 patients with severe coronary artery disease were studied at the time of elective preoperative insertion of an intraaortic balloon catheter. Hemodynamic measurements and measurements of myocardial blood flow were made before and during counterpulsation. Myocardial blood flow was measured with a xenon-133 washout technique. Compared with control measurements, the heart rate decreased from 87.8 +/- 18.8 to 82.8 +/- 13.4 beats/min (p = 0.02) and systolic arterial pressure decreased from 112.1 +/- 17.9 to 97.8 +/- 14.8 mm Hg (p = 0.004) during counterpulsation. Diastolic arterial pressure increased from 72.2 +/- 10.1 to 120.2 +/- 21.4 mm Hg (p = 0.00002) during counterpulsation. Myocardial blood flow for the entire group decreased from 48.8 +/- 14.1 to 42.6 +/- 11.0 ml/100 g per min (p = 0.008). Regional flows in the left anterior descending and circumflex distributions also decreased. Left anterior descending artery blood flow decreased insignificantly from 51.5 +/- 14.4 to 47.4 +/- 11.7 ml/100 g per min (p = not significant), while circumflex flow decreased from 50.7 +/- 12.2 to 41.1 +/- 8.9 ml/100 g per min (p = 0.008). When normalized for the rate-pressure product, myocardial blood flow was 53 +/- 16 X 10(-4) at rest and 55 +/- 12 X 10(-4) (p = not significant) during counterpulsation.(ABSTRACT TRUNCATED AT 250 WORDS)

Postnatal development of serotonin-accumulating neurones in the rabbit retina and an immunohistochemical analysis of the uptake and release of serotonin

The serotonin-accumulating neurones in the rabbit and bovine retina were studied with the use of immunohistochemistry to localize serotonin. It was established that a subpopulation of amacrine cells in both tissues has the ability to take up and store serotonin. The uptake process is very specific; known serotonergic uptake blockers, viz. chlorimipramine and Lilly 110140, abolish transport, while benztropine, a dopamine-uptake blocker, is ineffectual. The serotonin accumulated by the serotonergic neurones can be released by potassium depolarization in a calcium-dependent manner. All these results form a strong case for serotonin being a likely transmitter in the mammalian retina. The subpopulation of serotonin-accumulating neurones in the rabbit retina appears to be determined prenatally, as they can be observed immediately after birth. On the basis of the serotonin content in retinas from animals of different ages, it is suggested that the serotonin-accumulating cells mature around the 24th postnatal day. The same maturation period has been proposed for the rabbit retinal dopamine cells (Lam et al., 1981).

Fine needle aspiration cytology of the adrenal gland

The cytologic appearance of fine needle aspiration (FNA) specimens emanating from both symptomatic and incidental masses of the adrenal glands in 22 patients who attended a large cancer institution from 1976 to 1981 is described. Eligibility for the study required thorough clinical and radiologic follow-up for at least two years following the initial cytologic diagnosis. Histologic and ultrastructural correlations were performed when possible. Nine patients were found to have benign lesions, including five adrenal cysts, two adenomas, one nodular hyperplasia and one adrenal myelolipoma. Thirteen patients had malignant lesions, of which six were primary adrenal tumors, either neuroblastoma (two) or adrenocortical carcinoma (four). The overall sensitivity of FNA in detecting the presence of malignancy was 85%, while the number of patients correctly classified for all adrenal masses was 90%. The test was 100% specific for malignant lesions. It is concluded that FNA of adrenal masses is a safe and simple procedure with a high degree of accuracy. Its use appears to be especially justified in those patients with primary neoplasms of nonadrenal sites, in whom silent adrenal lesions are detected during radiologic surveys for metastatic disease. Fifteen of the patients fell into this category, yet over half (53%) of them were shown to have benign adrenal lesions, treatable with a conservative approach.