Multiple-section radionuclide tomography of the kidney: a clinical evaluation

The clinical utility of radionuclide emission tomography of the kidney in comparison with conventional gamma-camera imaging has been assessed from scans of 60 patients suspected of having space-occupying lesions of the kidney. Nineteen patients had renal tumour, 17 had cysts and seven had renal pseudotumours; the remainder had no lesion. Objective trials using four observers showed only a slight, statistically insignificant advantage from the addition of tomographic sections to conventional images. However, in several individual cases tomography had aided diagnosis, particularly in obese patients, when an alternative non-invasive investigation (ultrasonography) was inconclusive. In seven patients a positive diagnosis of renal pseudotumour was made possible by tomography; definite identification of ectopic functioning cortical tissue at the location of a mass suspected after urography was considered to be a distinct diagnostic advantage gained from emission tomography of the kidney.

Implications for acute intervention related to time of hospital arrival in acute myocardial infarction

The time from onset of symptoms to arrival in the hospital emergency room (ER) was studied in 778 patients randomized into a study of acute myocardial infarction (AMI) size limitation. Patients at relatively high risk of death after AMI (including those with preexisting diabetes mellitus, systemic hypertension or congestive heart failure), women and older patients arrived significantly later in the ER than did patients without these characteristics. A significantly higher mortality rate was observed in patients who arrived late, i.e., those who arrived more than 2 hours after the onset of chest pain, even though patients with hemodynamic compromise (bradycardia, hypotension) tended to arrive earlier. The difference in long-term mortality between those who arrived early (within 2 hours of onset of chest pain) and those who arrived late was accounted for by the baseline differences between these 2 groups. These baseline differences may influence the effects of early interventions in AMI. In addition, these findings have implications for education of high-risk patients who could benefit the most from aggressive early intervention.

Circadian variation in the frequency of onset of acute myocardial infarction

To determine whether the onset of myocardial infarction occurs randomly throughout the day, we analyzed the time of onset of pain in 2999 patients admitted with myocardial infarction. A marked circadian rhythm in the frequency of onset was detected, with a peak from 6 a.m. to noon (P less than 0.01). In 703 of the patients, the time of the first elevation in the plasma creatine kinase MB (CK-MB) level could be used to time the onset of myocardial infarction objectively. CK-MB-estimated timing confirmed the existence of a circadian rhythm, with a three-fold increase in the frequency of onset of myocardial infarction at peak (9 a.m.) as compared with trough (11 p.m.) periods. The circadian rhythm was not detected in patients receiving beta-adrenergic blocking agents before myocardial infarction but was present in those not receiving such therapy. If coronary arteries become vulnerable to occlusion when the intima covering an atherosclerotic plaque is disrupted, the circadian timing of myocardial infarction may result from a variation in the tendency to thrombosis. If the rhythmic processes that drive the circadian rhythm of myocardial-infarction onset can be identified, their modification may delay or prevent the occurrence of infarction.

Clinical trial of 252Cf neutron brachytherapy vs. conventional radiotherapy for advanced cervical cancer

252Cf, a neutron emitting radioactive transplutonium isotope, was tested for its efficacy against advanced bulky Stage III-IV cancers of the cervix in a clinical trial at the University of Kentucky Medical Center. Eighty-two patients were treated during 1976-1979 and followed for 5-year survival and tumor control. Three different treatment methods went on sequentially and concurrently, that is, (a) conventional whole pelvis photon with delayed 137Cs implants, (b) conventional photon therapy with delayed 252Cf implants, and (c) 252Cf implants ("early") preceding photon therapy. There were 12% 5-year survival for Stage IIIB cancers by conventional therapy, and 15% by delayed 252Cf implant therapy. For early 252Cf implant therapy there were 54% 5-year survivals with 4% complications and 65% 5-year local control, but distant metastases became a prominent delayed failure pattern.

Electrocardiographic, enzymatic and scintigraphic criteria of acute myocardial infarction as determined from study of 726 patients (A MILIS Study)

Methods for detecting acute myocardial infarction (AMI) were compared in a prospective study of 726 patients with pain presumed to be caused by ischemia that lasted 30 minutes or longer and was associated with electrocardiographic changes (ST-segment deviation greater than or equal to 0.1 mV and/or new Q waves or left bundle branch block). Using MB-CK values of more than 12 IU/liter as the standard criterion for detection of AMI, 639 patients (88%) were judged to have AMI. Total plasma CK values, technetium-99m stannous pyrophosphate images 48 to 72 hours after admission, and serial 12-lead electrocardiograms over 10 days were analyzed by investigators blinded to other clinical and laboratory data. For detection of AMI, total CK, electrocardiograms (ECGs) and pyrophosphate imaging were all highly accurate and sensitive (total CK accuracy 97%, ECG 92%, pyrophosphate 88%; total CK sensitivity 98%, ECG 96% and pyrophosphate 91%). However, both pyrophosphate and ECG were less specific than total CK (p less than 0.01) (total CK specificity 89%, pyrophosphate 64% and ECG 59%). The sensitivity (p less than 0.05) and accuracy (p less than 0.01) of total CK and pyrophosphate for those patients with Q-wave development were slightly greater than for those in whom Q waves did not evolve. The ECG was less accurate (p less than 0.02) and pyrophosphate was less specific (p less than 0.04) in patients with prior MI compared with those with initial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Neutron brachytherapy is better than conventional radiotherapy in advanced cervical cancer

Californium-252 (252Cf), a fast-neutron emitting radioisotope, was used for neutron brachytherapy (NT) of 82 patients with advanced (stage III and IV) cervical cancer. The results were compared with caesium-137 brachytherapy; both isotopes were given in combination with high-dose fractionated pelvic radiotherapy. In patients with stage IIIB disease (ie, tumour to the pelvic side-wall), 252Cf intracavitary therapy resulted in 54% 5-year survival compared with 12% in the caesium group. To be effective, Cf-NT must be given before external beam (photon) therapy.

Urinary metabolites of orally administered di-(5-hexenyl) phthalate and di-(9-decenyl) phthalate in the rat

Di-(5-hexenyl)- and di-(9-decenyl) phthalates were administered to male CD rats by gavage. The urinary metabolites retaining the phthalate moiety were identified by chromatographic and mass-spectrometric techniques. Di-(5-hexenyl) phthalate gave rise to epoxide and vicinal diol metabolites not previously seen with phthalic acid esters of saturated alcohols. Neither epoxide nor diol were detected when di-(9-decenyl) phthalate was fed. The distributions of carboxyl-terminated metabolites suggested that somewhat different pathways were followed for the two test compounds. The formation of epoxides from these unsaturated phthalate esters may have relevance to their potential toxicities. Like the metabolites of di-n-butyl phthalate, the metabolites of di-(5-hexenyl) phthalate included glucuronide conjugates; like the metabolites of di-(2-ethylhexyl) phthalate, those of di-(9-decenyl) phthalate did not.

Effect of propranolol on myocardial-infarct size in a randomized blinded multicenter trial

A multicenter randomized single-blind study was performed to evaluate the effects of propranolol administered during the evolution of myocardial infarction. Five centers enrolled a total of 269 patients, with 134 receiving propranolol and 135 placebo. Propranolol or placebo was given intravenously upon randomization (0.1 mg per kilogram of body weight) and then orally for nine days to keep the heart rate between 45 and 60 beats per minute. Less than 2 per cent of patients were treated within 4 hours after the onset of symptoms, but 50 per cent received therapy within 8 hours of onset of chest pain, and the remainder between 8 and 18 hours. The heart rates in the propranolol-treated group were significantly lower than those in the placebo group (P less than 0.001). Base-line characteristics, including the mean heart rate (79.6 vs. 81.3) and the left ventricular ejection fraction (49.0 vs. 49.5), were similar in the two groups. The primary end point evaluated--infarct size as estimated from plasma MB creatine kinase activity--was virtually identical in the two groups, averaging 13.3 and 13.6 gram-equivalents of MB creatine kinase per square meter of body-surface area. Peak plasma levels of the enzyme were also similar in the two groups. No significant difference was observed between the propranolol and placebo groups in the change in left ventricular ejection fraction, extent of area involved in pyrophosphate uptake, R-wave loss on electrocardiograms, or mortality (after three years). These results do not support the use of propranolol administered four or more hours after the onset of symptoms to limit infarct size.

Comparison of left ventricular function and infarct size in patients with and without persistently positive technetium-99m pyrophosphate myocardial scintigrams after myocardial infarction: analysis of 357 patients

One hundred nine patients with persistently positive technetium-99m pyrophosphate (Tc-99m-PPi) myocardial scintigrams 6 months after acute myocardial infarction (MI) (Group A) and 185 patients without such persistently positive scintigrams (Group B) were compared with regard to enzymatically determined infarct size, early and late measurements of left ventricular (LV) function determined by radionuclide ventriculography, and preceding clinical course during the 6 months after MI. The CK-MB-determined infarct size index in Group A (17.4 +/- 10.6 g-Eq/m2) did not differ significantly from that in Group B (16.0 +/- 14.6 g-Eq/m2). Similarly, myocardial infarct areas in the 2 groups, determined by planimetry of acute Tc-99m-PPi scintigrams in those patients with well-localized 3+ or 4+ anterior pyrophosphate uptake, were not significantly different (35.7 +/- 13.4 vs 34.4 +/- 13.1 cm2, respectively). However, patients in Group A had significantly lower LV ejection fractions than those in Group B, both within 18 hours of the onset of MI (0.42 +/- 0.14 vs 0.49 +/- 0.14, p less than 0.01) and at 3 months after MI, both at rest (0.42 +/- 0.14 vs 0.51 +/- 0.14, p less than 0.01) and at maximal symptom-limited supine bicycle exercise (0.44 +/- 0.17 vs 0.51 +/- 0.17, p less than 0.01). Peak exercise levels achieved in the 2 groups were not significantly different. Furthermore, patients in Group A demonstrated a greater incidence of congestive heart failure during the initial hospital admission (41 vs 24%; p less than 0.01) and a greater requirement for digoxin (p less than 0.05) and furosemide (p less than 0.01) after discharge.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiographic and clinical criteria for recognition of acute myocardial infarction based on analysis of 3,697 patients

Over a 34.5-month period, all admissions to 5 university hospital coronary care units were screened for eligibility for the Multicenter Investigation of the Limitation of Infarct Size (MILIS), an ongoing study of the effects of hyaluronidase, propranolol and placebo on myocardial infarct (MI) size. Of 3,697 patients with greater than or equal to 30 minutes of discomfort that was thought to reflect myocardial ischemia who were assessed for the presence or absence of certain electrocardiographic abnormalities at the time of hospital admission, the electrocardiogram was considered predictive of acute MI if greater than or equal to 1 of the following abnormalities was present: new or presumably new Q waves (greater than or equal to 30 ms wide and 0.20 mV deep) in at least 2 of the 3 diaphragmatic leads (II, III, aVF), or in at least 2 of the 6 precordial leads (V1 to V6), or in I and aVL; new or presumably new ST-segment elevation or depression of greater than or equal to 0.10 mV in 1 of the same lead combinations; or complete left bundle branch block. In the screened population, the diagnostic sensitivity of the electrocardiographic criteria was 81%, whereas the overall infarct rate in the total population screened was 49%. The diagnostic specificity of these entry criteria was 69% and the predictive value 72%.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunologic aspects of otitis media with effusion. II. Nature of cell-mediated immunosuppressive activity in middle ear fluid

The effects of middle ear effusions from patients with serous, seromucoid, mucoid, and purulent forms of otitis media with effusion on lymphoproliferative responses and polyclonal immunoglobulin synthesis were determined in peripheral blood and adenoidal lymphocytes. The responses were studied after stimulation of lymphocytes by phytohemagglutinin, pokeweed mitogen, purified protein derivative, herpes simplex virus, sheep red blood cells, or ovalbumin. Serous and seromucoid middle ear effusions resulted in significant suppression of proliferative responses to phytohemagglutinin, purified protein derivative, and herpes simplex virus and of polyclonal immunoglobulin synthesis in response to pokeweed mitogen, sheep red blood cells, and ovalbumin. The suppressive activity appeared to be associated with low-molecular-weight soluble products liberated by esterase-positive adherent population of cells in middle ear fluid.

Kidney pseudotumour diagnosed by emission computed tomography

Emission computed tomography is a new, useful imaging technique; when a rotating gamma camera capable of such imaging is used multiple adjacent transverse sections may be obtained simultaneously, from which coronal and sagittal sections may be computed. The technique was used in a man undergoing urological investigation in whom excretion urography indicated a space-occupying lesion in the left kidney. Ultrasonography and radionuclide imaging showed nothing abnormal, but emission computed tomography using a rotating gamma camera showed that functioning cortical tissue extended across the middle of the left kidney. Radiographs were therefore reviewed and ultrasonography repeated, and it was concluded that the abnormality was a hypertrophied column of Bertin. Emission tomographic imaging of the kidney is a useful adjunct to other non-invasive studies.

Immunologic aspects of otitis media with effusion: characteristics of lymphocyte and macrophage reactivity

The characteristics of cellular elements in the middle ear effusions, peripheral blood, and adenoidal tissue and ther effects of middle ear macrophages on the functional activity of lymphocytes were examined in 50 subjects with chronic otitis media. Macrophages were the predominant cell type in middle ear effusions, and they constituted up to 63% of the total number of cells. T cells were 11%-66% of the total number of cells. The proliferative responses induced by phytohemagglutinin or pokeweed mitogen in middle ear lymphocytes were generally low compared with the responses observed in peripheral blood and adenoidal lymphocytes. Cocultures of middle ear macrophages with adenoidal lymphocytes resulted in a significant depression of proliferative response and immunoglobulin synthesis in the lymphocytes. These observations suggest that macrophages in the middle ear may have a profound influence on the regulation of the immune response in the middle ear in patients who have otitis media with effusion.

Stimulation of growth rate of chondrocytes by Rous sarcoma virus is not coordinated with other expressions of the src gene phenotype

Infection and transformation of chondrocytes by Rous sarcoma viruses (RSVs) (Schmidt-Ruppin, Prague) stimulated the rate of cell growth. In contrast, several transformation-defective (td) mutants (tdPRA, tdNY105, tdNY106, tdNY107, and tdNY108) retaining various sizes of the src gene did not stimulate cell growth, indicating that the stimulation of growth of chondrocytes is due to the function of the src gene. With the use of various T (transformation)-class temperature-sensitive (ts) mutants of RSV, growth stimulation of chondrocytes by the src gene was examined. It was found that there are two types of T-class ts mutants with regard to the stimulatory effect on the growth of chondrocytes. One type (tsNY68) stimulates cell growth at both permissive (36 degrees C) and nonpermissive (41.5 degrees C) temperature, as does the wild type of RSV. Another type (ts GI201 [clone 9]) stimulates cell growth only at the permissive temperature. Chondrocytes infected with either of these two types of T-class ts mutants showed ts properties in other transformation markers, such as uptake of 2-deoxy-D-glucose, change of cell morphology, and focus formation. These data indicate that the effect of the src gene on cell growth does not occur coordinately with other transformation markers.

Water intake induced by spaced deliveries of salted and sweetened liquid food

The water intake of food-deprived rats was evaluated under conditions where liquid food was presented occasionally. In the first experiment, when soybean milk alone was presented every 30 sec, little water was consumed. However, when sodium chloride was added to the soybean milk, water intake increased directly with salt concentration from 0.9 to 14.4%. At salt concentrations of 7.2 and 14.4%, the drinking induced by soybean milk resembled in several respects the adjunctive drinking educed by spaced presentations of dry food. In a second experiment, adulterating soybean milk with sugar in concentrations of 7 to 56% did not affect water intake significantly when the food was delivered every 30 seconds. These findings extend the range of conditions known to generate schedule-induced drinking, and point out a previously unknown constraint on the phenomenon.

Exploring the twisting road to and from the staging post

Approaches developed by the DHSS's central analytical team as a basis for comparing national priorities are explained by Gordon Harris, an economic adviser to the department, and Colin Parker, who recently completed a period of secondment to the department as an operational research consultant.

Expanded linkage map of Vibrio cholerae

An expanded linkage map of the Vibrio cholerae classical strain 162 chromosome has been prepared using a variety of new auxotrophic mutants. The chromosome consists of a single, linear linkage group. The map consists of 17 markers, which have been ordered; 20 mutational sites, which are tentatively ordered; five markers (ura-1, ser-2, mal-1, man-1, suc-1), which are linked but unordered; and three mutations (aro-2, cys-2 and cys-6) which showed little or no linkage. A proposal is made to standardize genetic nomenclature in V. cholerae genetic studies.

The Structure and Synthesis of Cytokinin Metabolites. II. Lupinic Acid and O-β-D-Glucopyranosylzeatin From Lupinus angustifolius

Two new metabolites of exogeneously supplied zeatin have been identified in de-rooted lupin seedlings as L-lupinic acid (2) and O-β- D-glucopyranosylzeatin (3). Their structures have been confirmed by syntheses which provide new and general methods for the preparation of these types of compounds.

Intestinal fluid accumulation induced by oral challenge with Vibrio cholerae or cholera toxin in infant mice

The diarrheal response of orally inoculated infant mice to viable Vibrio cholerae and purified cholera toxin was quantitated by means of a fluid accumulation (FA) ratio. The FA ratio is defined as the gut weight/remaining body weight. FA ratios were determined in relation to time of exposure and dose. Onset of fluid accumulation with viable cells of strains CA401 and 569B occurred 8 h postinoculation and reached a near maximum of 16 h. A dose of 4 x 10(6) colony-forming units of strain CA401 was required for a positive response 16 to 18 h postinoculation. Several other classical cholera strains demonstrated a similar dose-related response. Strain 569B, however, required a 100-fold higher dose to give a positive response. Several mutant cholera strains were decreased virulence in other model systems elicited FA ratios decreased from wild-type values. Onset of fluid accumulation which cholera toxin occurred 6 to 8 h postinoculation and reached a maximum by 10 h. A dose of 0.5 microng was required for a positive response 10 to 12 h postinoculation. The positive response to toxin could be inhibited by preincubation with specific antitoxin.

Rapid delipidation of and particulate removal from human serum by membrane filtration in a tangential flow system

Approximately 50% of the total lipids and virtually all of the colloids and particulates which impart turbidity to human serum are removed by filtration through 0.1 micrometer-poresize membrane filters in a high-volume tangential flow device. The advantages of the method over solvent extraction are: (a) no organic solvent(s) is added to the serum at any time, (b) filtrations can be performed rapidly at room temperature, (c) unstable lipoproteins and particulates are removed in 1 step, (d) scaleup from hundreds of ml to hundreds of liters is readily achievable, and(e) process time is markedly reduced.

Acoustic Tracking of Ocean-Dumped Sewage Sludge

With a modified 200-kilohertz acoustic echo sounder, it has been possible to detect and map sewage dumped into the ocean over several hours. The three-dimensional distribution of suspended material and its rate of diffusion are indicated after digital processing of the data.

Functional and metabolic studies of platelets from patients with Lesch-Nyhan syndrome

Platelet function was investigated in three patients with the Lesch-Nyhan syndrome. Platelet count, morphology and size distribution was normal in all patients. Platelet turnover was normal. Electron microscopy did not reveal any ultrastructural abnormality. Template bleeding times were normal and prolonged after aspirin ingestion in two out of the three patients: the patient that failed to respond to the aspirin challenge also had decreased retention of platelets on a glass bead column. Biochemical studies revealed that total platelet ATP was reduced by 34% in the presence of a normal level of ADP in the storage pool. These platelets failed to incorporate radioactive hypoxanthine but did incorporate radioactive adenine to produce adenine nucleotides and a trace amount of guanine nucleotides. The results indicate that normal platelets have a functionally intact pathway for utilizing hypoxanthine as a source of preformed purine, and that the failure to salvage this purine, as in the Lesch-Nyhan syndrome, results in a decreased level of total platelet ATP. These findings suggest that platelets can function normally despite a one third reduction in total ATP content.

Self-transfer and genetic recombination mediated by P, the sex factor of Vibrio cholerae

Vibrio cholerae cells, infected with the sex factor P, produce discrete, plaque-like clearings when plated on lawns of P(-) cells. We investigated the nature of these clearings and conclude that they are probably sites of active mating. We developed a quantitative assay for P(+) cells and used it to study the kinetics of sex factor spread in broth cultures. Both established and newly infected donor populations were efficient sex factor donors, indicating that P is not self-repressed. We also investigated the kinetics of recombinant formation in broth matings. In 1-hr matings, we routinely found recombination frequencies of 10(-6) per donor cell. Kinetic studies of recombinant formation showed that the markers tested all appeared at early times. Thus P, the V. cholerae sex factor, seems to resemble F in its transfer properties.

Production of Bacteriophage-Associated Materials by Vibrio cholerae : Possible Correlation with Pathogenicity

Classical and El Tor strains of Vibrio cholerae were examined for production of bacteriophage or bacteriophage-related material by electron microscopy of mitomycin C-induced cultures. The strains were also tested for pathogenicity by using the ligated ileal loops of adult rabbits. Of the 27 strains tested, 25 showed a correlation between the production of bacteriophage-related material and pathogenicity. Both P + and P − strains produced bacteriophage tails. The bacteriophage tails of strains 569B and ATCC 9168 and other strains were shown to occur in an extended form with tail appendages.

Cystitis cystica and glandularis: a study of 40 cases

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Radioimmunoassay for the measurement of adenosine 3',5'-cyclic phosphate

A sensitive and specific radioimmunoassay for adenosine 3',5'-cyclic phosphate (cyclic AMP) has been developed which allows measurement of the nucleotide in extracts of 5-10 mg of tissue. The radioimmunoassay is sufficiently specific for cyclic AMP to eliminate the need for prior chromatographic separation of the cyclic nucleotide from other tissue nucleotides. The radioimmunoassay system is based upon competition of cyclic AMP with a labeled cyclic AMP derivative of high specific activity for binding sites on an antibody specific for the cyclic nucleotide. Antibody to cyclic AMP was obtained by immunizing rabbits with an antigen prepared by conjugating succinyl cyclic AMP with human serum albumin. A high specific activity derivative of cyclic AMP was prepared by synthesizing succinyl cyclic AMP tyrosine methyl ester (SCAMP-TME) and iodinating the phenolic hydroxyl group of the tyrosine moiety with (125)I. Free and antibody-bound (125)I-SCAMP-TME were separated by precipitation of the antibody-bound fraction with a second antibody (goat anti-rabbit gamma globulin). Displacement of (125)I-SCAMP-TME by unlabeled cyclic AMP when plotted as a semilogarithmic function was linear over a concentration range of 2-100 picomoles. The specificity of the antibody was tested against structurally related nucleotides, nucleosides, and purine bases. All had less than 0.005 per cent of the potency of cyclic AMP in inhibiting (125)I-SCAMP-TME binding. The marked differences in affinity of the various cyclic nucleotides to cyclic AMP antibody would suggest that antibodies can be developed for each of the cyclic nucleotides by the principles used in this work.