CD1 expression on B-CLL lymphocytes

In a previous report we showed that D47 CD1a monoclonal antibody positively labelled B-CLL cells of some patients. Six cases were selected to further characterize CD1 antigenic expression at the leukaemic cell surface using flow cytometry with a battery of six CD1a, two CD1b and two CD1c monoclonal antibodies. CLL cells were positively labelled with CD1a antibodies except OKT6 and NA1/34; in all cases they were CD1b negative and CD1c positive. These results suggested that CD1a, c epitopes can be detected on leukaemic B cells in addition to other T cell differentiation antigens. In view of recently published data demonstrating the presence of CD1c molecule in normal B cell subsets, our results further question the relationship of B-CLL with a restricted subpopulation of B cells.

Emergency knee joint salvage utilizing a free musculofasciocutaneous flap based on the anterior tibial artery: case report

A young adult male presented with a traumatic amputation at the upper third of his left leg and an extensive soft tissue loss around his left knee. A free musculofasciocutaneous flap was elevated on the anterolateral part of the amputated segment and transferred to the soft tissue defect around the proximal left tibia in order to avoid an above-knee amputation. The entire flap depends on the anterior tibial artery for its blood supply. The anatomy of the flap is outlined. The importance of the musculocutaneous blood supply as well as the presence of an extensive fascial component make the flap very reliable. An 18-month follow-up period showed a uniformly well-contoured soft tissue coverage and an optimal functional result.

Cholestatic effect of cyclosporine in the rat. An inhibition of bile acid secretion

Cyclosporine administration in patients with organ transplants may cause cholestasis. In the rat, intraperitoneal administration of cyclosporine, 10 mg/kg, for three weeks did not cause liver function test abnormalities or hepatic histological lesions. However a significant reduction of bile flow and bile acid secretion rates was observed. The fact that reduction of bile flow was related to a decrease of the bile acid-independent flow suggests that cyclosporine-induced cholestasis results from an inhibition of bile acid secretion. Whether this inhibition is caused by the parental molecule or by cyclosporine metabolites needs to be clarified.

Diabetes-induced rat tracheal segment supersensitivity to carbachol

Contractile responses to carbachol of tracheal segments isolated (i) from rats made diabetic 4 months prior by a single intravenous injection (50 mg/kg) of streptozotocin (group B), and (ii) from diabetic rats that had been treated during the same period with a daily dose (2-4 U/animal) of long-acting insulin (group C) were compared with the contractile responses of trachea isolated from age-matched control animals (group A). Tracheal segments from group B were significantly more responsive to carbachol than those from group A or C at low, but not at high carbachol concentrations. Carbachol pD2 values were higher in group B (6.85 +/- 0.05) than in groups A (6.46 +/- 0.07) or C (6.37 +/- 0.06), but were not significantly different between groups A and C. These data indicate that diabetes induces a supersensitivity to carbachol in airway smooth muscles, possibly related to a diabetes-induced vagal autonomic neuropathy.

Linkage disequilibrium between RFLP haplotype 2 and the affected PAH allele in PKU families from the Berlin area of the German Democratic Republic

Probands from 26 PKU-affected families of the Berlin area were analyzed with respect to the allele frequency distribution of six RFLPs in linkage with the normal and the PKU alleles of the phenylalanine hydroxylase gene. These investigations confirm most of the RFLP haplotypes observed by Güttler and colleagues in the Danish population and describe two additional ones. They detect no significant differences in the single RFLP or RFLP haplotype distribution on the normal chromosomes in comparison with the Danish families and confirm a prevalent association of the RFLP haplotypes 1, 4, and 7 with the normal PAH allele. In contrast to the Danish investigations, in our study the PKU allele is found most frequently linked to haplotype 2, rather then to haplotype 3. In one of our patients we found a substitution of the normal 19-kb MspI fragment by a 13.5- and a 5.5-kb fragment, reported up to now only in one other German family.

Discordant heart xenografts in the rat. Additional effect of plasma exchange and cyclosporine, cyclophosphamide, or splenectomy in delaying hyperacute rejection

Natural antidonor antibodies are known to play a prominent role in hyperacute xenograft rejection. The aim of this work was to devise an experimental protocol to prolong the survival time of guinea pig heart xenografts transplanted into rats. A technique of continuous plasma exchange adapted to small animals was used to remove the natural cytotoxic antibodies from the recipient prior to the transplantation. In some experiments, cyclosporine (CsA), cyclophosphamide (CY), or splenectomy were associated with the plasma exchange. In this highly discordant xenogenic donor-recipient combination, the mean graft survival time in nontreated rats was 16 min. When an exchange of 1.5 plasma volume was performed 24 hr before the transplantation, no prolongation of the graft survival time was observed. When CsA, CY, or splenectomy were associated with the plasma exchange, the graft survival time was significantly increased by more than 2500% (up to 418 min with CsA). When used isolately, none of these 3 immunosuppressive methods was able to prolong the graft survival time. Natural cytotoxic antibodies were monitored by a complement-mediated cytotoxicity assay. After a plasma exchange, the titers decreased from 1:16-1:32 to 1:1-1:2. When no immunosuppressive method was associated with the plasma exchange, the antibodies returned to their initial level within the 24 hr that preceded the transplantation, and the graft was rejected as in nontreated animals. When an immunosuppressive method was associated with the plasma exchange, and particularly in the case of CsA, the titers remained low, and the hyperacute rejection was delayed. Therefore, it can be concluded that plasma exchanges, associated with CsA, are an efficient experimental protocol in the rat to increase the survival time of guinea pig heart xenografts. The effect of the treatment is correlated with the decrease in natural cytotoxic antidonor antibodies.

Post-natal evolution of rat cardiac beta-adrenoceptors

Cardiac beta-adrenoceptors (beta AR) were studied using membranes prepared at birth (day 0) and at days 7, 10, 15, 21, 30, 45 and 60. Saturation experiments using the antagonist ligand (125I)-iodocyanopindolol (ICYP) allowed the determination of beta AR number (Bmax) and ICYP dissociation constant (Kd), while (-)isoproterenol competition curves of ICYP binding, performed in the absence or presence of Gpp(NH)p (10(-4) M), were used to measure the relative proportions of high and low affinity states of the beta AR for the agonist and to assess the ability of beta AR to couple with the GTP-binding protein. Rat cardiac beta AR evolved at 3 distinct periods: during the first period (days 0-10), the receptor density and ICYP Kd were half that of adults, and beta AR were present only in an homogeneous high affinity state. The second period (days 15-21) was characterized by a progressive increase in beta AR number and ICYP Kd, while analysis of (-)isoproterenol competition curves indicated that beta AR were poorly coupled to the GTP-binding protein. In the third period (days 30-60), ICYP Bmax and Kd were respectively 53.9 +/- 1.2 fmoles/mg protein and 106.4 +/- 2.9 pM, while analysis of (-)isoproterenol competition curves showed the existence of high and low affinity binding states in equal proportions in the absence of Gpp(NH)p, and of one homologous low affinity state of the receptor in its presence. These data indicate that beta AR follow a postnatal evolution marked by an increase in beta AR density concomitant with a decrease in affinity toward the antagonist ligand ICYP, accompanied by the progressive appearance of a poorly-coupled beta AR. However, the number of efficiently coupled receptors was found to be similar in adult and newborn rats.

Prevention of death following one-hour occlusion of the portal vein in the rat

This study was conducted to evaluate various methods to reduce the mortality rate following acute portal vein occlusion in rat: systemic heparinization, intravenous saline infusion, enteral antibiotics and simultaneous clamping of the superior mesenteric artery were tested alone or in combination. Each of these treatments improved the survival rate after 45 or 60 min occlusion of the portal vein; combination of all treatments provided better results than each treatment alone. These results indicate that, following acute portal vein occlusion in the rat, several factors cooperate to cause death. The decrease in mean arterial blood pressure during occlusion of the portal vein was correlated with the mortality rate; this correlation was significant in the animals with 45 min occlusion of the portal vein. It appeared in this study that, when used in association, simple therapeutic methods are highly effective in improving the survival rate following acute portal vein occlusion in the rat.

Introduction of genomic diagnosis of classical phenylketonuria to the health care system of the German Democratic Republic

The phenylketonuria (PKU) dispensary of the Children's Hospital of the Charité, Berlin, GDR, cares for about 140 affected families, representing about one-third of all PKU families in the GDR. Of these families, 15 expressed their desire for an additional child given the availability of a reasonably reliable prenatal diagnosis procedure. They were investigated by linked RFLP analysis applying a phenylalanine-hydroxylase-cDNA probe. Full genetic predictability for prospective fetuses could be obtained for all of them. In eight cases this was possible by the use of one restriction enzyme, and in the remaining seven by a combination of the information from two restriction-enzyme patterns. No recombination between linked RFLP and the PKU phenotype could be observed in 40 meioses from the investigation of eight families with two affected children each.

Prenatal diagnosis of classical phenylketonuria by linked restriction fragment length polymorphism analysis

Since the isolation of a recombinant containing a cDNA sequence for human phenylalanine hydroxylase (hPH) (Woo et al., 1983; Speer et al., 1986) prenatal diagnosis by linked restriction fragment length polymorphism (RFLPs) has become possible for families in which phenylketonuria (PKU) occurs (Lidsky et al., 1985a). We describe here the application of a Hind III three-allele RFLP in a single family, which allowed the prenatal diagnosis of an affected fetus.

Topological similarities between a cyclic enkephalin analogue and a potent opiate alkaloid: a computer-modeling approach

The cyclic enkephalin analogue H-Tyr-cyclo[-D-N delta-Orn-Gly-Phe-Leu-] (1-c) and the rigid narcotic alkaloid 7 alpha-[(1R)-1-hydroxy-1-methyl-3-phenylpropyl]-6,14- endo-ethenotetrahydrooripavine (PEO) were studied by using computer graphics methods to investigate potential geometrical congruencies of their respective pharmacophoric elements. Particular emphasis was placed on the relative spatial disposition of the tyramine moiety and the additional aromatic ring that occurs in both molecules. A three-dimensional vector map was generated defining the locus of the C21 aromatic ring for all those conformers of PEO having up to 10 kcal above the minimum energy conformer. A systematic conformational search on the cyclic peptide afforded four allowable sets of conformers whose side chain of the phenylalanine residue coincided with the vector map of PEO. Local energy minima for the peptide within the revised mutual vector space were found and subjected to bimolecular energy refinement with correspondingly local energy minima for the opiate alkaloid. Several low-energy conformers of the cyclic peptide were identified that permitted a good fit with the alkaloid provided that the tyramine moiety of the respective molecules does not coincide. In the designated conformations the basic nitrogen of the former occupies a distinct geometrical locus, and the side chain of the leucine residue has no structural correlate in the alkaloid.

Hydrolysis of Pro-Ala dipeptides by lysosomal hydrolases. Models for the study of lysosomotropic amino acid prodrugs of penicillins

Peptidic lysosomotropic prodrugs of antibiotics and antitumoral agents could be of advantage in chemotherapy, providing that free, active drug is released at, or close to, the desired site of action. Thus, aminoacyl derivatives of doxorubicin, e.g., where the drug is attached to the amino acid by a primary amino function, are sensitive to lysosomal hydrolases. We have examined whether a similar approach can be used for drugs carrying a carboxyl group such as beta-lactam antibiotics. Because the C adjacent to the carboxyl group in beta-lactams has the D configuration, we have examined and report here the synthesis and susceptibility of model peptides, namely Boc-D-Pro-L-Ala and Boc-L-Pro-L-Ala to lysosomal hydrolases. Hydrolysis of the D isomer proceeds considerably more slowly than that of the L isomer. Lysosomal carboxypeptidase(s) and/or amidases appear therefore to have a much narrower specificity than aminopeptidase(s), which will severely limit the applicability of the concept of peptidic lysosomotropic prodrugs.

Cardiac adenylate cyclase activity in streptozotocin-treated rats after 4 months of diabetes: impairment of epinephrine and glucagon stimulation

Adenylate cyclase (AC) activities of cardiac membranes prepared (a) from rats that had been made diabetic 4 months previously by a single i.v. injection (50 mg/kg) of streptozotocin (STZ), and (b) from diabetic rats which had been treated during the same period by a daily dose of long-acting insulin (2-4 U/animal), were compared with the AC activity of cardiac membranes prepared from age-matched control animals. Basal (Mg++-dependent) and Mn++ (7 mM)-dependent activities, as well as Gpp(NH)p (3 X 10(-7) M) stimulation and Ca++ (pCa = 3.9) inhibition of cardiac AC were not significantly different in the three groups. At the EC50 concentration epinephrine (5 X 10(-7) M) stimulation of AC was reduced in diabetic animals but no change was observed at higher concentrations (10(-4) M). Glucagon stimulation was impaired at both the EC50 concentration (10(-7) M) and at higher concentrations (10(-5) M). Insulin treatment of the diabetic animals partially prevented the impairment of hormone stimulation. These results confirm observations that alterations of cardiac AC activity in STZ-treated rats are indeed due to diabetes and not to STZ-toxicity and suggest that AC-coupled receptors are altered either by an diabetes-induced alteration of cardiac sarcolemma.

Characterization of trypsin stimulation of cardiac adenylate cyclase

The activity of adenylate cyclase present in a purified dog heart sarcolemmal preparation in the presence of magnesium as cosubstrate is biphasically influenced by increasing concentrations of trypsin: Stimulation at low concentrations (0.5 to 1 microgram/mL) is followed by inhibition at higher concentrations. In the presence of manganese in place of magnesium, the stimulation phase is abolished but the inhibition is still observed at the same trypsin concentrations. The trypsin stimulatory effect does not occur when trypsin is preincubated with cardiac membranes prior to the addition of ATP. When trypsin is added with ATP, the stimulation is expressed by an increase in the Maximal Velocity (Vmax) rather than a decrease in the Michaelis constant (Km). The stimulatory effect of trypsin on AC activity is rapid, linear and irreversible. GTP, Gpp(NH)p and adrenaline stimulatory curves are shifted to the left in the presence of trypsin. These results suggest that protease stimulation of cardiac AC involves the GTP-binding protein (N) activity, but the exact mechanism remains to be determined.

The proprietary hospital industry: a financial analysis 1972-1982

This paper evaluates the performance of both specific firms within the American for-profit hospital industry and the industry as a whole. First, traditional financial analysis is used to evaluate individual publicly traded for-profit chains. Then, industry performance from 1973 to 1982 is evaluated using a set of measures based on Modern Portfolio Theory. The traditional financial analysis indicates that the industry seems increasingly profitable as well as increasingly healthy from the perspective of utilizing its assets and reducing its collection period. However, the industry's rapid growth rate has strained its ability to use additional debt funding and has created a potentially dangerous liquidity position. Measures based on Modern Portfolio Theory indicate that the average return of the industry has improved over the past 5 years. However, its risk has also increased. Nevertheless, the increase in risk is more than offset by the increased average return. In addition, recent legislation designed 'to reward the efficient' has introduced a significant degree of uncertainty into the industry's performance for the coming years. Thus, hospitals' ability to maintain the substantial profitability and rate of growth they have experienced over the past decade will depend on how well they will adapt to the changing environment.

Circadian changes in carrageenin-induced edema: the anti-inflammatory effect and bioavailability of phenylbutazone in rats

The circadian variations in paw-edema produced by carrageenin and the anti-inflammatory effect of phenylbutazone were studied, in rats kept under a 12 light-12 dark regimen, in comparison with the variations of plasma phenylbutazone and oxyphenbutazone levels. When the experiment was performed during the light span (08.00 and 14.00 h), the rats were highly sensitive to the phlogistic effect of carrageenin, the plasma levels of phenylbutazone and oxyphenbutazone were lower, and the anti-inflammatory effect of phenylbutazone, weaker. Opposite results were obtained when the experiment was performed during the dark span (02.00 and 20.00 h). The results indicate that the chronoeffectiveness of phenylbutazone is influenced by both its chronokinetics and the chronesthesy of the biosystem involved.

[Infertility caused by uterus bipartitus. Value of the Bret-Palmer operation]

Among the uterine malformations responsible for infertility, uterus bipartitus is one of the most amenable to surgery. The operation devised by Bret and Palmer is intended for those cases where the malformation is due to non-resorption of the medial septum and not for those where it is due to lack of fusion of the Mullerian ducts. The results are excellent, since 70% or 80% of previously infertile women subsequently became pregnant.

Synthesis and biological activities of [beta-Malyl1]- and [beta-Malyl1, Leu8]-angiotensin II analogues

The synthesis of [beta-Malyl1]- and [beta-Malyl1, Leu8]-angiotensin II using a solid phase procedure is reported. The replacement of the N-terminal amino group of aspartic acid by a hydroxyl group gives analogues with lower affinity than [Asn1]- and [Asn1, Leu8]-AII. However, the isoster [beta-Malyl1]-AII shows higher potency than [Asn1]-AII and this may be due to metabolic or enzymatic resistance.

Response to secondary therapy in patients with adenocarcinoma of the breast previously treated with adjuvant chemotherapy

The response to secondary therapy, chemotherapy or hormonal, is examined in 26 patients with adenocarcinoma of breast who failed adjuvant chemotherapy. Response rates to tamoxifen or combination chemotherapy, cyclophosphamide, methotrexate, and 5-FU (CMF) or Adriamycin and vincristine (AV) were similar to response rates reported for Stage IV patients, never exposed to cytotoxic agents. Survivals in these 26 patients were similar to those reported for Stage IV patients never exposed to cytotoxics. It is concluded that adjuvant chemotherapy does not lessen future response to secondary therapies or decrease survival.

Multimodality therapy of stage III adenocarcinoma of the breast

The results of a pilot multimodality program (surgery + radiotherapy + chemotherapy) are reported in 34 women with advanced stage III and IV adenocarcinoma of the breast. The median relapse-free survival for all patients was 24 months, with 74% of the premenopausal patients and 37% of the postmenopausal alive at five years (P = 0.18). The relapse rate was significantly lower in premenopausal patients when compared to the postmenopausal subgroup. Estrogen receptor status was not predictive for relapse or survival.

Prognostic value of the estrogen receptor level in pathologic stage I and II adenocarcinoma of the breast

The relationship between estrogen receptor levels and recurrence of breast cancer was examined in 302 patients with adenocarcinoma of the breast, pathologic stage (PS) I and II. All 117 patients with PS II adenocarcinoma of the breast received adjunctive chemotherapy. In this series, there was no association between the estrogen receptor level and recurrence in either the 185 patients with PS I adenocarcinoma of the breast or the 117 patients with PS II adenocarcinoma of the breast. The most important prognostic variable was the presence or absence of axillary metastases.

The conformational properties of somatostatin. IV. The conformers contributing to the conformation equilibrium of somatostatin in aqueous solution as found by semi-empirical energy calculations and high-resolution NMR experiments

The results of a conformational study by 1H and 13C high-resolution NMR at 270 and 500 MHz on the peptide hormone somatostatin have been compared with a series of conformers generated by semi-empirical energy calculations. The use of specifically deuterated phenylalanine residues has enabled us to confirm and supplement the identification of all but the phenylalanine aromatic resonances in the proton spectra of somatostatin. In order to minimize the risk of overlooking some low-energy conformations, four different strategies have been used for the generation of the conformers: two based on combinations of conformations of fragments that had been studied before, one on a random procedure and one on the conformational constraints existing in bicyclic analogs with high biological activity. The experimental values of 3JNH-C alpha H and 3J alpha beta coupling constants and the existence of several ring current shifts allowed us to select from the calculations those families of low-energy conformers that are compatible with the NMR results. The NH temperature coefficients do not warrant the existence of any stable beta or gamma turns in the molecule, although the region SRIF8-12 seems to be the most stable in this respect. In addition there are several upfield shifts: 0.2-0.4 ppm on the Lys9 side-chain, 0.3-0.5 ppm on the Phe6 alpha, beta and Phe7 alpha protons, as well as some 0.2-0.3 ppm shifts on parts of two phenylalanine ring systems. Almost all of these shifts decrease considerably with increasing temperature. Most of the observed NMR results are compatible with the properties of one family of low-energy conformations whose main features are a double beta II bend Trp8-Lys9, Thr10 -Phe11, a close proximity of the Trp8 and Lys9 side chains and an orientation of Phe7 towards the Phe6 alpha, beta protons. We conclude that this set of conformations forms a major contribution to the conformational equilibrium at room temperature. The properties of this and several other sets of low-energy conformations that do not dominate in aqueous solution are discussed in relation to al available experimental evidence.