cDNA clones coding for the complete murine B chain of complement Clq: nucleotide and derived amino acid sequences

We have isolated cDNA clones covering the complete B chain of the complement subunit Clq from mouse; this subunit initiates the classical complement pathway. Deoxynucleotide sequence analysis shows that these clones contain 156 nucleotides of the 5' untranslated region, followed by sequences coding for the 25 amino acids of the signal peptide; all of the 228 amino acids of the mature protein; and 140 nucleotides of the 3' untranslated region, including a poly A additional signal. The coding region for the mature protein contains 261 nucleotides for the Gly-X-Y repeat and 408 nucleotides for the globular portion of Clq. By comparing the nucleotide sequence of the mouse B chain of Clq with the human B chain (Reid, K.B.M., 1985, Biochem. J. 231, 729), we find a high homology (80%) within the mature protein, a lower homology within the signal peptide (59%) and the 3' untranslated region (47%) and no homology (26%) in the 5' untranslated region.

The effect of acute joint inflammation on flexion reflex excitability in the decerebrate, low-spinal cat

Experiments were performed to investigate whether acute knee joint inflammation, induced by intra-articular injection of carrageenan and kaolin, significantly influences the magnitude of the flexion withdrawal reflex of knee flexors in the decerebrate, low-spinal cat. It was observed that after injection of these inflammatory agents, reflex intensity increased with a time course that matched the development of the inflammatory process, as assessed by monitoring the intra-articular temperature. Control experiments involving intra-articular injection of saline showed neither a rise in intra-articular temperature, nor any change in reflex intensity. The normal pattern of modulation of reflex intensity with changing joint angle was abolished in the inflamed joint with the reflex being equally intense at all positions tested. Abolition of neural activity in the inflamed joint by intra-articular injection of lignocaine resulted in a marked decrease in the reflex back to control values, suggesting that there is no maintained increase in central excitability in the absence of joint afferent input. It was also observed that the spontaneous activity of knee flexor motor units was modulated during continuous passive rotation of the knee, with activity being greater in extension than in flexion. This pattern reversed when the knee was acutely inflamed, but could be returned to the control pattern by joint anaesthesia, although now the response was attenuated when compared to the control.

Durable response to etoposide-loaded platelets in refractory immune thrombocytopenic purpura: a case report

A 23-year-old female presented with widespread purpura and ecchymoses as a result of immune thrombocytopenia which was refractory to corticosteroids, splenectomy, and immunosuppressive agents. In view of the extent and serious nature of her bleeding, salvage therapy with etoposide-loaded platelets was undertaken, which was associated with a lasting complete remission.

The effect of mechanical stimulation of knee joint afferents on quadriceps motor unit activity in the decerebrate cat

The present experiments demonstrate that repetitive activation of as few as two joint afferents by an imposed mechanical stimulus results in entrainment of stretch-induced firing of quadriceps motor units. There is no significant input from extracapsular receptors as the effect is abolished during local anaesthetic block of the joint nerve. These results indicate that joint receptors can exert potent effects on motoneurone excitability which may be of considerable functional significance.

Risk of unexplained stillbirth at different gestational ages

In 40,635 deliveries in 1978-85, unexplained stillbirths were an important component (nearly a quarter) of all perinatal deaths. The rate of unexplained stillbirth (unexplained stillbirths divided by total births) was highest among preterm deliveries, fell to a minimum at 39-40 weeks' gestation, then rose at 41-42 weeks. Rate is generally accepted as measuring risk, but since it is the population of undelivered, not delivered, infants that is at risk of intrauterine death, stillbirth risk would be better measured as the number of impending stillbirths divided by the total number of undelivered fetuses. With this measure the risk of unexplained stillbirth was least in preterm pregnancies, rising fourfold after 39 weeks to a maximum at 41 weeks. At this time, it was also four times higher than at 33 weeks, in contrast to the rate, which was nineteen times lower.

Waldenstrom macroglobulinaemia treated with sequential hemibody irradiation

A 40-year-old man presented with symptoms of anaemia and blurred vision. Waldenstrom macroglobulinaemia was diagnosed on the basis of plasmacytoid lymphocytes in the peripheral blood, extensive bone marrow involvement, and an IgM kappa monoclone in the plasma of 48 g/liter. Symptoms were immediately reversed by isovolaemic continuous-flow plasmapheresis coupled with red cell transfusion. Specific therapy was undertaken with sequential hemibody irradiation. At two years of follow-up the patient enjoys excellent health, has improved haematopoietic reserve in the bone marrow, and the only therapy required is intermittent plasmapheresis to control symptoms relating to rising viscosity. Thus, systemic irradiation, which is well tolerated and objectively reduces marrow tumour bulk, offers an alternative to chemotherapy in the palliative management of active macroglobulinaemia and may diminish but not prevent the need for intermittent plasmapheresis.

Complete nucleotide sequence of the N-terminal domains of the murine alpha-1 type-III collagen chain

We present the complete nucleotide (nt) sequence and derived amino acid (aa) sequence of the N-terminal portion of the murine alpha-1 type-III collagen chain. The detailed structure of this region is important for the understanding of type-III collagen biosynthesis in normal tissue and during fibrosis. The cDNA clones, pCIII-1-C119, pCIII-1-C534 and pCIII-1-C572, covering a total of 1485 nt, code for 19 nt of the 5' untranslated region, the 24 aa of the signal peptide, the 130 aa of the N-terminal propeptide, the 9 aa of the telopeptide and 334 aa of the helical domain.

Aluminium loading during therapeutic plasma exchange

Graphite furnace atomic absorption spectroscopy was used to demonstrate a fivefold increase in the median plasma aluminium levels of four patients undergoing therapeutic plasmapheresis. This plasma aluminium loading resulted from contamination of albumin incorporated in the replacement fluids and took place during its preparation, with albumin aluminium levels of 646, 669, and 715 micrograms/liter present in three representative samples. Aluminium overload may result in the development of encephalopathy and osteomalacia in patients with renal impairment, indicating the need to monitor aluminium levels in the albumin-containing replacement fluids to avoid this potential hazard.

Lack of short-term effects on the donor during continuous-flow selective mononuclear cell collection

In 50 individuals, intensive harvesting of relatively pure mononuclear cell fractions from the peripheral circulation was carried out in 195 procedures. Serial collections from bone marrow donors (group 1: n = 35) or isolated procedures from volunteers (group 2: n = 15) were without morbidity. A median yield of 4.0 X 10(9) mononuclear cells were recovered in a final volume of 104 ml of cell-rich plasma, for which 4,300 ml of venous blood was processed in 107 minutes. In neither group were changes documented in donor white cell count or lymphocyte numbers. In group 1, a statistically significant but clinically unimportant and transient fall occurred in the platelet count at the end of the 5-day intensive schedule. It is concluded that mononuclear fractions can efficiently be collected from normal donors without the development of relevant cell depletion.

Evidence for an immunocompromising effect of bovine pestivirus on bovid herpesvirus 1 vaccination

Five calves were given live intranasal vaccine against bovid herpesvirus 1 (BHV1) two days after intranasal inoculation of bovine pestivirus (BVDV). Another 5 were vaccinated in the absence of BVDV. Control unvaccinated groups were also maintained. All calves were challenged with virulent BHV1. The unvaccinated calves developed signs of infectious bovine rhinotracheitis (IBR) and both vaccinated groups showed a similar degree of clinical protection from IBR. Those given BVDV before vaccination shed up to 140 times more BHV1 (P less than 0.01) in the nasal mucus following challenge than those which had received BHV1 vaccine alone. The epidemiological significance of this is discussed.

Emergency surgery and refractory immune thrombocytopenic purpura. A case report

A 35-year-old woman with post-splenectomy refractory immune thrombocytopenia presented with an acute abdominal emergency requiring laparotomy. Her platelet count was raised from 10 to 96 X 10(9)/l using a combination of high-dose methylprednisolone, plasma exchange against fresh-frozen plasma, infusion of gammaglobulin and a single mega-unit of platelets. The surgical procedure was uneventful, and with no further therapy the platelet count rose to a peak of 244 X 10(9)/l, but over the following 7 days fell back slowly to 10 X 10(9)/l, at which time the patient was discharged well.

The effect of serial therapeutic plasmapheresis on platelet count, coagulation factors, plasma immunoglobulin, and complement levels

One hundred therapeutic plasmaphereses were carried out at biweekly intervals in seven patients, without morbidity or mortality, using the IBM 2997 blood fraction separator. In standardised procedures, 1.5 times the calculated plasma volume was replaced with an electrolyte solution containing 4% salt-free human albumin. Anticoagulation was achieved using a whole venous blood to acid-citrate dextrose ratio of 11 to 1. Median flow rates, plasma collection, and procedure times were respectively 40 ml/minute, 20 ml/minute, and 3 hours. Haemoglobin and total white cell counts were not significantly affected by the procedures. In contrast, platelet count, fibrinogen, immunoglobulin levels, total haemolytic complement, as well as C3 and C4 fractions fell, and the prothrombin and partial thromboplastin times were lengthened by the exchanges. All these measurements had returned to normal within 24 hours, apart from the fibrinogen, which took between 48 and 72 hours, and the immunoglobulin level, which required 35 days to return to baseline. In a further patient, more detailed studies (n = 13) were carried out to characterise the behaviour of antithrombin III and factor VIII. Both levels were markedly reduced immediately following the procedure and, like fibrinogen, had returned to normal within 48 hours. These data indicate that in an isovolemic plasmapheresis there was a transient but rapidly reversible effect on all the factors studied, with fibrinogen level, antithrombin III, and factor VIII returning more slowly to normal than the others, and immunoglobulin levels responding the slowest. None of these changes was associated with clinically significant haemostatic abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Transit of alpha-mannosidase during its maturation in Dictyostelium discoideum

We proposed that Dictyostelium discoideum contains two linked pools of mature alpha-mannosidase (Wood, L., R. N. Pannell, and A. Kaplan, 1983, J. Biol. Chem., 258:9426-9430). To obtain physical evidence for these pools, cells were pulse-labeled with [35S]methionine, homogenized, and subjected to Percoll gradient centrifugation. After immune precipitation of alpha-mannosidase, its polypeptides were separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis and detected by fluorography. After a 30-min pulse with [35S]methionine, the precursor and small amounts of cleaved enzyme were detected in a low density fraction (1.04 g/ml). Subsequently, cleaved enzyme was transferred to higher density fractions (1.05 and 1.07 g/ml) that were enriched in lysosomal enzymes. The half time for formation of the 1.07 g/ml pool was approximately 45 min, whereas formation of the 1.05 g/ml pool was not detected until 1.5 h after the pulse. The transfer of mature forms out of the 1.04 g/ml pool was inhibited by monensin (3.5 microM). Thus, alpha-mannosidase precursor appears to be cleaved in a prelysosomal organelle. The data also indicate that starving cells secrete precursor directly from this organelle to the extracellular space, whereas cleaved forms are first transferred into lysosomes before they are secreted. Furthermore, 2 h after starvation, the secretion of mature forms ceases even though both transit of mature forms between the two pools and secretion of precursor continues. From this we inferred that the cessation of secretion of mature forms is due to a halt in fusion of lysosomes with the plasma membrane and that precursor follows a different route to the plasma membrane.

Cyclosporin A in the treatment of severe acute aplastic anaemia

Twelve consecutive adults with severe acute aplastic anaemia, not having a bone marrow transplantation option, were prospectively randomized to receive either cyclosporin A alone or an equivalent amount of this immunosuppressive agent in combination with antilymphocyte serum. The minimum follow-up is 36 months, with half the patients developing nephrotoxicity, which was easily reversible in all but one. No response could be attributed to either regimen. Cyclosporin A does not appear to have a place as primary form of treatment for adults with severe acute aplastic anaemia, either on its own or in combination with antilymphocyte serum.

Splenic pathology in immune thrombocytopenia

Splenic pathology was analysed in 73 patients with immune thrombocytopenic purpura who underwent splenectomy for bleeding that had been resistant to adrenocorticosteroids. The mean splenic weight was 100 g. The only notable macroscopic feature was the prominence of Malpighian corpuscles in 15 cases. Microscopic examination showed formation of germinal centres in the lymphoid tissue of the white pulp in 40 cases, prominence of the histiocytes in the red pulp in 18 cases, and infiltration with neutrophils in the same area in 49 cases. Myeloid metaplasia throughout the splenic tissue was minimal in 58 cases, moderate in 15, and extreme in two. No distinguishing features were found in the spleen from patients who had not received previous immunosuppressive treatment (n = 3), those treated with prednisone (1 mg/kg/day) for a median of 14 days (n = 62), or those who had received the same dose of prednisone and additional azathioprine or cyclophosphamide (2 mg/kg/day) for a median of four weeks (n = 8). No correlation could be shown between histological features and the age of the patient or titre of antiplatelet antibodies. Similarly, no distinguishing features were found in patients with associated systemic lupus erythematosus (n = 8), hyperthyroidism (n = 6), immune haemolysis (n = 3), or recent viral illness (n = 3).

Fluid compartmentation and articular mechanoreceptor discharge in the cat knee joint

Experiments were performed to determine the effect of alteration of intra-articular pressure in different areas of the cat knee joint on the discharge of slowly adapting mechanoreceptors in the posterior region of the joint. At physiological (subatmospheric) pressures the anterior and posterior regions of the knee joint are not hydraulically continuous. However, at supra-atmospheric pressures between 2.5 and 9 cmH2O there is free communication between these areas. The discharge of receptors in the posterior region of the joint is influenced by intra-articular pressure changes in the posterior region when these are supra-atmospheric. However, pressure changes in the anterior region of the joint have little effect on the discharge of these receptors until free communication occurs between anterior and posterior regions. It is suggested that articular mechanoreceptors detect tension changes in collagen fibrils rather than volume changes of the joint capsule.

Complement activation in type 1 human diabetes

Complement activation was quantitated in serum and plasma of diabetic and normal subjects by sensitive competitive equilibrium radioimmunoassays (RIA) for C3a, C4a, C5a, Factor B, and a newly described C5 neoantigen (termed C5 activation antigen, and abbreviated C5-AA) in a stable 54-kDa fragment of C5. Plasma C3a levels were significantly elevated in 8 of 16 patients with newly diagnosed Type 1 diabetes (P less than 0.0005) with the mean C3a concentration for these patients being more than 10-times greater than the mean value of normal controls. C4a levels were also elevated in 2 of these patients (P less than 0.02), but C5a levels, although higher than normal, were not significantly increased. In contrast, the levels of C5-AA in the serum of all patients (11/11) with chronic Type 1 diabetes were significantly higher than in control Type 2 patients (noninsulin-dependent diabetes) (P less than 0.0005) and 4 of 7 patients with new onset insulin-dependent diabetes mellitus also had significantly higher levels of C5-AA than the Type 2 patients (P less than 0.01). The levels of Factor B in the serum of 5 of 9 patients with new onset diabetes were significantly higher than normal (P less than 0.0025). Five recent onset Type 1 diabetes patients were evaluated longitudinally for C3a, C4a, and C5a: in 3 the levels of C3a were elevated during new onset disease decreasing into the normal range during remission; in 2 of these patients C4a was also significantly elevated and the levels decreased during remission; and in 3 patients the levels of C5a were not significantly elevated but they decreased during remission. Purified human complement proteins and complement hemolytic assays were used to measure complement activation in serum during incubation with rat pancreatic islet cells. With diluted normal human serum, less than 20% of C3 or Factor B were consumed during 30 min at 37 degrees C, while with new onset Type 1 diabetic patient sera up to 90% of C3 and Factor B were consumed in 5/6 sera and 4/6 sera, respectively. These findings suggest (a) that complement activation fragments C3a, C4a, and C5a are generated in vivo in new onset Type 1 diabetes; (b) that both the classical and the alternative complement pathways may be activated; and (c) that this may result in a measurable activation of C5 generating biologically and immunologically active C5a and other C5 activation fragments.(ABSTRACT TRUNCATED AT 400 WORDS)

Lipids in milk and the first steps in their digestion

Human milk contains 3.0% to 4.5% fat. The fat is contained within membrane-enclosed milk fat globules. The core of the globules consists of triglycerides (98% to 99% of total milk fat) whereas the globule membrane (which originates from the mammary secretory cell's Golgi and cell membranes) is composed mainly of phospholipids, cholesterol, and proteins. Milk fat content and composition change during lactation. Whereas the triglyceride level rises, the phospholipid and cholesterol concentrations decrease during the transition from colostrum to mature milk, resulting in an increase in the size of the milk fat globules. Digestion of milk fat depends on the consecutive action of several lipases. The first step is the partial hydrolysis of the milk fat globule core by lingual and gastric lipases in the stomach. Hydrolysis continues in the duodenum, where the bile salt-stimulated lipase of human milk and pancreatic lipase complete the process initiated in the stomach.

Platelet collection using the IBM 2997 cell separator

Platelets were collected using the dual-channel module on the IBM 2997 Blood Fraction Separator. We carried out 320 procedures to harvest platelets for therapeutic purposes and yielded 5.1 +/- 1.5 X 10(11) platelets (mean +/- SD). Infusion into previously unsensitized recipients with hypomegakaryocytic thrombocytopenia achieved increments at 1 hr of 19 +/- 7.3 X 10(9)/liter/m2 (mean +/- SD) and at 24 hr of 15 +/- 6.3 X 10(9)/liter/m2. The only consistent donor reaction was mild hypocalcaemia, easily corrected by calcium gluconate infusion. Changes in donor packed-cell volume and white cell count were not statistically altered (p greater than 0.05) but donor platelet counts fell from 216 +/- 43.1 X 10(9)/liter to 162.5 +2- 41.7 X 10(9)/liter (mean +/- SD) (p less than 0.01). Additional plateletphereses were carried out in seven normal volunteers, using the same technique, in order that the function of the harvested platelets could be studied. Following radiochromium labelling and reinfusion into the same donors, normal in vivo recoveries were obtained at 10 min (59.4 +/- 3.4%; mean +/- SD) and platelet mean life span was also normal (218 +/- 12 hr; mean +/- SD). Furthermore, in vitro platelet factor III availability and aggregation patterns of the harvested platelets did not differ from control values and their ultrastructural appearance was normal.

Cyclophosphamide-related intravascular haemolysis during continuous-flow plasma exchange

The plasma of a patient being prepared for allogeneic bone marrow transplantation was found to be severely lymphocytotoxic to donor cells. Three isovolaemic plasma exchanges carried out using a continuous-flow technique were required to reduce this titre to undetectable levels. Neither these procedures nor pretransplantation conditioning of the patient with 60 mg/kg or cyclophosphamide on two consecutive days resulted in overt haemolysis. However, a single identical plasmapheresis 12 hours after completing the second dose of the alkylating agent resulted in profound intravascular haemolysis requiring red cell transfusion. Subsequent studies in five patients receiving the same cyclophosphamide regimen demonstrated that red cell life span, when measured with radiochromium, was reduced from a normal of 25-35 days to a median of 11.5 days. Further studies in the same five patients carried out simultaneously demonstrated that red cell fragility, when assessed in vitro with osmotic or mechanical stress, was marginally increased but became clearly abnormal in only one individual. These doses of cyclophosphamide may result in accelerated but subclinical red cell destruction, and plasma exchange in this period may be associated with rapid intravascular haemolysis. This complication should now be added to the list of those that can occur when plasmapheresis is required in this specific clinical situation.

Acute locked facet syndrome and its treatment by manipulation under local periarticular anesthesia--Part I: Clinical perspective and pilot study proposal

The clinical features of prolapsed intervertebral disc and facet joint pain are described and the condition referred to as "acute locked facet joint syndrome" is differentiated. Treatment by manipulation, with and without epidural or general anesthesia are considered, and a clinical trial of manipulation under local periarticular anesthesia is proposed.

The professional nurse in the Cell Support Unit

The well-trained nurse is the central figure in the efficient operation of the Cell Support Unit. This individual is responsible for the safety of those undergoing the procedures, whether they be volunteer donors or patients and has as a prerequisite thorough training and competence in intensive nursing care.

Response of slowly adapting articular mechanoreceptors in the cat knee joint to alterations in intra-articular volume

Recordings were obtained from slowly adapting mechanoreceptors innervating the posterior aspect of the cat knee joint capsule. It was observed that, with rising intra-articular volume, initially both intra-articular pressure and the neural discharge increased. This increase was dependent on the rate of fluid accumulation within the joint. However, the joint nerve discharge invariably levelled out despite increasing intra-articular volume and pressure. This suggests that there exists some limit to capsular distension in the posterior joint region beyond which fluid is diverted to other areas of the knee joint.

Patients with delusional and bizarre thinking

Patients with delusional or other types of bizarre thinking are often incorrectly labeled as schizophrenic. This error has significant medical and social implications to the patient. Delusional thinking has been linked with a variety of nonschizophrenic problems including the use of licit and illicit drugs, a wide variety of medical diseases, and nonschizophrenic psychiatric disturbances. A series of case studies in which the diagnosis of schizophrenia was incorrectly made elucidates the problem and helps the physician consider the alternatives.

In adult acute nonlymphoblastic leukaemia extended maintenance chemotherapy has no benefit

Fifty-two consecutive and previously untreated adults with nonlymphoblastic leukaemia underwent remission induction chemotherapy with a combination of the epipodophyllotoxin VP16-213, cytosine arabinoside, and doxorubicin (Adriamycin). Complete remission was achieved in 23 of the 52 patients (44%) by means of a single course of therapy in 20 individuals, two courses in two, and three courses in one; median duration of complete remission was 48 weeks. Failure to achieve remission status was due to primary drug resistance in 13 patients (25%), and adequate trial of therapy was not possible in 16 patients (31%) owing to their late referral and accounts for the low remission rate. Individuals achieving complete remission were randomly assigned to receive either 6 (n = 8) or 15 months (n = 13) of maintenance therapy; respective median survival was 95 and 78 weeks (P greater than 0.10). These data confirm previously reported results for complete remission induction with this three-drug combination and fail to show any difference between short (6 months) and long (15 months) maintenance chemotherapy.

Comparison of filtration to continuous-flow centrifugation for plasma exchange

The Asahi Plasmaflo Hollow Nylon Fibre Filtration System (n = 13) was directly compared to the NCI-IBM 2990 Continuous-Flow Blood Fraction Separator (n = 10) for plasma exchange. The systems were equally efficient in achieving plasma separation. There were significant differences favouring filtration for clearance of fibrinogen (P less than 0.05), and the fourth component of complement (P less than 0.01). Greater loss of urea (P less than 0.05) was found after plasma exchange, using the cell separator. The flow characteristics were markedly different. In a standardised 4-L plasma exchange, filtration took place at 35 ml/minute, with a procedure time of 109 +/- 45 minutes in contrast to centrifugation at a plasma flow collection rate of 19 ml/minute, requiring 208 +/- 17 minutes. This time advantage for the former procedure was offset by 195 minutes required to regenerate the hollow nylon fibre unit and a further 90 minutes required for cleaning under strictly controlled aseptic techniques prior to reuse. Each filter was regenerated at least twice and reused without infection, but there was incremental loss of filtration efficiency demonstrated by decreasing clearance of an intravascular marker dye. In two of the 13 procedures using the Plasmaflo system, serious reactions necessitated termination of the procedure; this did not occur using the cell separator. Restriction of the number of times that the filter unit could be regenerated without loss of efficiency, the prolonged time required for regeneration and cleaning, coupled with the need for artificial vascular access to meet high blood flow rates required, limit the usefulness of this technique for plasma exchange.

The function and structure of granulocytes collected using the IBM 2997 separator

The effect of oral methylprednisolone and the sedimenting agent, hydroxyethyl starch, on granulocyte recovery, morphology, and function was studied in a volunteer donor programme. Using the IBM 2997, 10 litres of whole blood were processed, with an average procedure time of 2.4 hours and a collection volume of 300 ml. Donors not receiving methylprednisolone (n = 80) had a mean total granulocyte count of 3.5 X 10(9)/litre (range 1.6-5.3 X 10(9)/litre) and mean granulocyte yields were 1 X 10(10) (range 0.2-3.0 X 10(10)). Those receiving 48 mg oral methylprednisolone 6-8 hours before the procedure (n = 320) had a mean granulocyte count of 6.3 X 10(9)/litre (range 3.2-11.4 X 10(9)/litre) and significantly superior mean granulocyte yields of 2.0 X 10(10) (0.3-6.5 X 10(10)) (P less than 0.05). For both groups the mean packed cell volume of 0.08 litre/litre (range 0.02-0.17) and platelet contamination 1.9 X 10(11) (range 0.3-5.0 X 10(11)). In all these procedures, hydroxyethyl starch was added to the blood entering the centrifuge channel. In none of the procedures were any untoward symptoms experienced by the donors. Light microscopy and ultrastructural studies showed no difference between control granulocytes and those collected following the addition of hydroxyethyl starch or after oral methylprednisolone. Similarly, granulocyte function measured with a random migration, chemotaxis, phagocytosis, and intracellular killing was not significantly different between control cells and those exposed to the sedimenting agent or the adrenocorticosteroids (P greater than 0.10). It is concluded that donor premedication with methylprednisolone significantly enhances granulocyte yields in the presence of hydroxyethyl starch and neither agent has any demonstrable effect on granulocyte morphology or function.

Activity of lysosomal cysteine proteinase during differentiation of rat skeletal muscle

Cysteine-proteinase activities were measured in extracts of pre- and post-fusion populations of rat myogenic line L6 cells and in extracts of whole rat muscle. Activities of cathepsins B, L and H were compared. The substrates used included Z-Phe-Arg-NMec (cathepsins B and L), Z-Arg-Arg-NMec (cathepsin B), and Arg-NMec (cathepsin H) (where Z = benzyloxycarbonyl, and NMec = 4-methyl-7-coumarylamide); the enzyme activities were more specifically differentiated by appropriate concentrations of the inhibitors Z-Phe-Phe-CHN2 (CHN2 = diazomethane), bestatin and E-64 [L-trans-epoxysuccinyl-leucylamido(4-guanidino)butane]. These experiments have demonstrated the feasibility of determining the cysteine-proteinase activities of myoblasts from a single (60 mm-diameter) Petri dish, with enzyme concentrations in the range of 5-20 ng/ml. Specific activities of the enzymes in L6 cells increased 2-20-fold after fusion. Concentrations of cysteine proteinases in extracts from cultured myoblasts were two orders of magnitude greater than those in muscle-tissue extracts. Cultured-cell extracts contained endogenous inhibitor(s) to purified rat cathepsins B, L and H.

Linked pools of processed alpha-mannosidase in Dictyostelium discoideum

We are studying the fate of alpha-mannosidase, a lysosomal enzyme, in Dictyostelium discoideum. alpha-Mannosidase is synthesized as a 150,000-dalton precursor which becomes proteolytically cleaved to mature (56,000-62,000 dalton) forms. When cells are shifted into starvation buffer (5 mM phosphate, pH 6.5), the enzyme is secreted. We compared the kinetics of secretion of newly processed alpha-mannosidase with that of bulk forms. After 2 h in phosphate buffer less than 20% of the newly processed forms but as much as 50% of the bulk enzyme activity was secreted. During the course of the experiments, the total alpha-mannosidase activity remains constant, cells remain viable, and there is no evidence of degradation of enzyme. Furthermore, a 4-h chase period prior to starvation is required before the newly processed forms are secreted to the same extent as the bulk forms. On the basis of these results we propose that the enzyme is present in at least two pools and that it is transferred from a newly processed to an efficiently secreted pool.

Comparison of the lipid composition of breast milk from mothers of term and preterm infants

Milk was collected from mothers of 18 very premature (26 to 30 wk gestation age), 28 premature (31 to 36 wk), and six term (37 + wk) infants on day 2 to 3 (colostrum), and at 1, 3, 6, and 12 wk postpartum. Fat content for 154 milk samples was 2.80 g/dl gravimetrically and 2.66 g/dl by quantitative thin-layer chromatography. Fat content increased during lactation, whereas phospholipids and cholesterol declined. Concentrations of medium-chain fatty acids increased from colostrum to mature milk and were highest in preterm milk. Compensatory decreases were observed in very premature and premature oleic acid. Long-chain polyunsaturated fatty acids were highest in colostrum and reduced in mature milk. Long-chain polyunsaturated fatty acids were also higher in very premature and premature milk than in term milk. These elevated levels of readily absorbed medium-chain fatty acids and long-chain polyunsaturated fatty acids in preterm milk may be of special benefit for the needs of premature infants.

White cell and platelet component support in human bone marrow transplantation

Bone marrow transplantation is the preferred form of treatment for patients with severe acute aplastic anaemia and immunodeficiency disease. The procedure has also been used in the treatment of patients with refractory or relapsed acute leukaemia and may result in further disease-free periods in excess of two years in approximately 15% of such individuals.

The patient exhibiting episodic violent behavior

This case presentation describes a 21-year-old white male patient seen for episodic violent behavior. The case is seen as relevant for primary care physicians because of the frequency of violent acting out in the general population, the importance of making an accurate diagnosis, and the many medical, psychological, and social implications involved in diagnosing such disorders. In such cases it is important that the physician keep an open mind and include within the differential diagnosis a variety of psychiatric disturbances such as paranoid schizophrenia, antisocial personality disorder, drug abuse syndromes including a variety of hallucinogens as well as prescription medication, organic diseases affecting the central nervous system, including encephalitis and temporal lobe epilepsy, and a variety of interpersonal difficulties, including spouse abuse and spousal rape. The case presentation method demonstrates how the psychiatric interview and a judicious use of biochemical and physiological testing can lead the practitioner to a correct diagnosis.

Comparison of ranitidine and cimetidine in the treatment of chronic gastric ulcer. A double-blind trial

The aim of the study was to compare the effectiveness of ranitidine and cimetidine in accelerating the healing of chronic gastric ulcer. 44 outpatients with endoscopically proven gastric ulcer whose duration of symptoms was greater than 4 weeks and who were without major systemic disease were studied. Patients were randomly allocated to receive either ranitidine, 150 mg twice a day or cimetidine, 200 mg three times a day and 400 mg at night for 4 weeks. If the ulcer had not healed, treatment was continued for a further 4 weeks, when patient assessment and endoscopy were repeated. By 4 weeks, 13 of 22 patients taking ranitidine (59%) and 14 of 22 patients taking cimetidine (64%) had healed (p2 = 1.0, 95% confidence interval - 20%, 38%). At 8 weeks, 91% on ranitidine and 91% on cimetidine had healed (p2 = 1.0, 95% confidence interval - 18%, 18%). Symptomatic improvement was similar with both drugs. Smoking did not influence healing rates. There were no major side effects with either medication. It is concluded that ranitidine and cimetidine are of similar efficacy in accelerating the healing of chronic gastric ulcer.

Red cell phospholipids in schizophrenia

Phospholipids in red blood cells (RBCs) of schizophrenics and controls were determined. Three different RBC preparations and two different extraction methods were used. Phospholipids were separated by thin layer chromatography and by high pressure liquid chromatography, and were quantified by phosphorus analysis and by ultraviolet absorption. Findings were consistent with values previously reported for normals. However, in contrast to recent reports of elevated phosphatidylserine levels in schizophrenics' RBCs, we observed no differences between populations.