Mucormycosis in patients with multiple-organ failure

Mucormycosis in two patients with multiple-organ failure appeared as a cutaneous lesion and spread rapidly. In the first case, wet mounts and potassium hydroxide preparations were unhelpful, but a punch biopsy specimen established the diagnosis. Prompt and extensive debridement and amphotericin B administration arrested the infection. In the second case, virulent progression of the lesion occurred despite limited amputation, debridement, transfer factor, and amphotericin B, but finally responded to further amputation. Diagnosis was made by histologic examination of infected tissue. Both patients shared the following predisposing factors: sepsis, low blood flow, acidosis, multiple-organ failure, and multiple-antibiotic therapy. Although the mucormycosis was controlled, as confirmed in the first case at autopsy and in the second case by clear margins following reamputation, the outcome was fatal in both cases due to other features of multiple-organ failure.

Technetium-99m pyrophosphate in diagnosis of acute cardiac rejection in the rat with effect of cyclosporine: concise communication

Tc-99m pyrophosphate (PPi) uptake has been measured in a rat model of heterotopic heart transplant at 5 days after transplantation. comparison of tracer uptake, as a ratio between the heterotopic transplanted heart and the recipient's native heart, was made in four groups of animals. Group 1, with transplants between animals of isogeneic strain showed a lower ratio, significantly different from the ratio in Group 2 in which transplants were between nonisogeneic animals. The ratio of uptake after transplantation between nonisogeneic animals treated with 10 mg/kg-day of cyclosporine (Group 3), was not significantly different from Group 1. In contrast, the ratio of uptake between nonisogeneic animals treated with subtherapeutic doses of cyclosporine (Group 4), was not significantly different from Group 2. In Groups 1, 2, and 3 there was a correlation between the histology of the transplanted hearts, graded 1 to 5 according to the severity of rejection, compared with the uptake of Tc-99m PPi. This agent can therefore be used to diagnose cardiac rejection in a rat model, and the results correlate well with the severity of rejection as assessed histologically.

Recurrent use of disposable syringe-needle units in diabetic children

Fourteen insulin-dependent diabetic children reused their disposable syringe-needle units an average of 6.3 times per needle. Between uses, the needle was wiped with alcohol and stored in the refrigerator. There were no infections reported during the study for an average duration of 94 days. Dullness of the needle was the major reason for changing to a new one. Recurrent use of disposable needles for insulin injections appears safe in children and may be advised. It will help decrease some of the high cost of the daily care of a person with diabetes.

Use of cyclosporin A in allotransplantation of rat limbs

An experimental model for limb transplantation as a composite tissue transfer has been developed using two genetically well defined strains of rats, BUF and LEW. The study shows that cyclosporin A (CyA) is very effective as an immunosuppressive agent in preventing rejection of transplanted limbs in rats. It is found to suppress rejection of the homotransplants as long as treatment is continuous. No untoward side effects have been noted at the current experimental dosage of the medication. CyA is superior to the conventional agents, such as azathioprine and prednisolone, which allow rejection of the limbs while treatment is in progress. There is a period of immune tolerance following CyA treatment; however, this period becomes shorter as the length of the treatment is increased. This may indicate that CyA treatment should be continuous and not pulsed at the dosage used in this experimental model. Additional experiments are underway to further elucidate this phenomenon.

Spontaneous hepatic hemorrhage during pregnancy

Spontaneous rupture of the liver during pregnancy seems to represent an extreme vascular complication of toxemia. The very high mortality rate has generally been attributable to uncontrolled hemorrhage. However, control of the hemorrhage may not be sufficient to achieve recovery. Hepatic dysfunction may proceed to necrosis associated with multiple organ failure, even after successful hemostasis. Although ligation of the hepatic artery has been successful in controlling hemorrhage in hepatic trauma, this maneuver may contribute to injury in patients with this lesion in whom there is a preexisting hepatic abnormality. In this brief review, the relationship of the underlying pathology to a variety of therapeutic measures in the context of a catastrophic complication of pregnancy are discussed.

Comparative study of home blood glucose monitoring devices: Visidex, Chemstrip bG, Glucometer, and Accu-Chek bG

Visidex (Ames Company, Elkhart, Indiana) and Accu-Chek bG (Bio-Dynamics, Boehringer Mannheim, Indianapolis, Indiana), two new devices for determining blood glucose at home, were compared with two older devices, Chemstrip bG (Bio-Dynamics) and Glucometer (Ames Company), and the standard laboratory glucose-oxidase method (Beckman autoanalyzer, Beckman Instruments, Fullerton, California). Laboratory serum glucose values up to 400 mg/dl had excellent overall correlation with Accu-Chek bG (r = 0.974), Glucometer (r = 0.974), Chemstrip bG (r = 0.963), and Visidex (r = 0.955). For glucose values less than or equal to 180 mg/dl, Glucometer had the best correlation (r = 0.921). For glucose values of 181-400 mg/dl, Accu-Chek bG had better correlation (r = 0.907) although Glucometer had closer mean value. Visidex was just as accurate as Chemstrip bG. Although the four devices tested tended to give lower values than the lab method, they are sufficiently accurate to be of clinical use in home monitoring of blood glucose. Meticulous care in running the tests is mandatory for accuracy. Individual differences among the four methods are discussed.

Survival of primates following orthotopic cardiac transplantation treated with total lymphoid irradiation and chemical immune suppression

Fractionated total lymphoid irradiation (TLI) has been used for attempts at induction of a donor-specific tolerant-like state in allograft recipients and for immunosuppressive effects. Cyclosporin A (Cy A) has been shown to suppress rejection of organ grafts in many species including man. The present study was designed to test the effectiveness of TLI in combination with either CY A or rabbit anticynomolgus thymocyte globulin (ATG) and azathioprine. Thirty-one orthotopic cardiac allografts were performed using surface cooling and total circulatory arrest in outbred cynomolgus monkeys. TLI was administered preoperatively in fractions of 100 rad until a total of 600 or 1800 rad was achieved. Cy A was administered 17 mg/kg/day. All treatment groups demonstrated extended survival. Myocardial biopsies as early as 4 weeks were consistent with mild rejection in all treatment groups. No significant synergistic effect upon survival could be demonstrated utilizing TLI plus Cy A when compared with using Cy A alone. TLI (1800 rad) plus ATG and azathioprine was associated with a high incidence of early death attributable to leukopenia and infection. Cy A alone or in combination with TLI was associated with the development of lymphoid malignancy.

The detection of messenger ribonucleic acid sequences in heterogeneous nuclear ribonucleic acid fractions of the oestrogen-stimulated rat uterus

cDNA (complementary DNA) complementary to the abundant sequences of mRNA isolated from oestrogen-stimulated uterus was hybridized to polyadenylated and non-polyadenylated uterine hnRNA (heterogeneous nuclear RNA). High-molecular-weight polyadenylated hnRNA, isolated under denaturing conditions, was able to saturate the cDNA, but complementary sequences were low abundance when compared with homologous mRNA. The mRNA sequence content of the polyadenylated hnRNA increased considerably during oestrogen-induced growth of the uterus. Non-polyadenylated hnRNA also contained sequences complementary to the cDNA.

Cyclosporin A initially as the only immunosuppressant in 34 recipients of cadaveric organs: 32 kidneys, 2 pancreases, and 2 livers

34 patients treated with cyclosporin A received 36 cadaveric organ allografts (32 kidneys, 2 pancreases, and 2 livers), 26 kidneys are still supporting life, 3 after more than a year; the pancreases and livers are also functioning. 20 patients are not receiving steroids, and 15 of these have not had any additional immunosuppressive agents. In these patients infectious complications have not been severe, but a gastroduodenal lymphoma has developed in 1 patient. 6 patients were given 'Cytimum' (a cyclophosphamide derivative) and steroids in addition to cyclosporin A: 5 of these died of infections and 1 also had a lymphoma. 11 patients received additional steroids: 1 of these died from septicaemia and lymphoma. Nephrotoxicity can be avoided by perioperative hydration and forced diuresis. Cyclosporin A is effective on its own and is a very potent immunosuppressive drug. Additional immunosuppressive agents may lead to severe complications.

Diversity and complexity of uterine mRNA from rats of differing hormonal states

The diversity and complexity of the uterine mRNA population has been compared at two different stages of uterine growth and development in the rat. Analysis by cDNA hybridization to homologous mRNA indicates that there are 8000 different sequences expressed in the immature rat uterus responding to just 4 h of oestradiol-17 beta-induced growth while the fully developed uterus expresses 36 000 sequences. As a check on our results, the complexity is re-analysed by hybridization of mercurated mRNA to total unique DNA. Analysis by this method indicates that the hormone-stimulated immature rat uterus contains 12 000 poly(A)-containing mRNA sequences while the fully differentiated adult tissue contains 53 000 diverse sequences.

Qualitative and quantitative changes in uterine mRNA populations in response to oestradiol treatment of rats

The mRNA population of immature rat uteri, responding to different lengths of oestradiol-induced differentiation, have been compared by the technique of DNA hybridization with heterogeneous RNA. Over the first 4 h of hormone induction there are continuing qualitative and quantitative changes in the poly(A)-containing mRNA such that, by 4 h after oestradiol administration, the population bears little resemblance to that of the unstimulated animal. Between 2 h and 4 h after oestradiol administration, the most striking changes appear to be in sequences of intermediate abundance. The possible significance of these findings is discussed.

Diabetes mellitus with immune complex glomerulonephritis

The present study describes 3 patients with the simultaneous occurrence of diabetic nephropathy and immune-complex mediated glomerulonephritis. Renal manifestation included proteinuria and hematuria which were preceded by or co-existent with an infectious process. Renal manifestation included proteinuria and hematuria which were preceded by or co-existent with an infectious process. Renal histology showed the characteristic change of diabetic nephropathy along with those of immune complex glomerulonephritis. Immunofluorescence studies showed a linear pattern with a superimposed granular pattern of IgG and C3 deposits. Renal function and urinary findings improved in the 2 patients who were followed up.

Characterization of uterine heterogeneous nuclear ribonucleic acid and the effect of oestradiol-17 beta on its synthesis

An early response to the administration of oestradiol-17 beta to immature rats is a dramatic stimulation in the synthesis of uterine hnRNA (heterogenous nuclear RNA). High-molecular-weight fractions of the hnRNA were purified and subfractionated on poly(U)-Sepharose into fractions that differed in their poly(A) content and their size profile on polyacrylamide gels. Oestrogen treatment of the rats stimulated the synthesis of all three fractions of high-molecular-weight hnRNA, but the kinetics of synthesis, degree of stimulation and size distribution of the newly synthesize RNA differed in each fraction.

Effect of cortisone on aspartate and alanine aminotransferases in a desert lizard

1. Liver and serum aspartate aminotransferase (GOT) and alanine aminotransferase (GPT) activities were measured in a hibernating desert lizard, Uromastix hardwickii. The levels of both enzymes were found to be lower in hibernation than during the active period, particularly in the liver. 2. After intramuscular injection of 2 mg of cortisone acetate there was a rapid rise in the levels of these enzymes with a peak of 18 hours (GOT) and 12 hours (GPT). 3. The response of both enzymes to cortisone was much greater during the active period than during hibernation. 4. GOT showed a much more rapid and greater response to cortisone than GPT. This is in contrast to the response of rat liver where GPT is more responsive to this hormone. 5. These studies indicate that the transferase enzymes of this lizard differ from those of the rat in their sensitivity and time of response to cortisone.