Human cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis in Santiago del Estero, Argentina: identification of parasites by monoclonal antibodies and isoenzymes

Diagnostic and parasite characterization and identification studies were carried out in human patients with cutaneous leishmaniasis lesions in Santiago del Estero, Northern Province of Argentina. Diagnostic procedures were biopsies of lesions for smears and inoculations in hamster, needle aspirations of material from ulcers for "in vitro" cultures. Immunodiagnostic techniques applied were IFAT-IgG and Montenegro skin test. Primary isolation of eight stocks of leishmanial parasites was achieved from patients with active lesions. All stocks were biologically characterized by their behaviour in hamster, measurements of amastigote and promastigotes and growth "in vitro". Eight stocks were characterized and identified at species level by their reactivity to a cross-panel of sub-genus and species-specific Monoclonal Antibodies through an Indirect Immunofluorescence technique and a Dot-ELISA. We conclude from the serodeme analysis of Argentina stocks that: stocks MHOM/AR/92/SE-1; SE-2; SE-4; SE-8; SE-8-I; SE-30; SE-34 and SE-36 are Leishmania (Viannia) braziliensis. Three Leishmania stocks (SE-1; SE-2 and SE-30) did not react with one highly species-specific Monoclonal Antibody (Clone: B-18, Leishmania-(Viannia) braziliensis marker) disclosing two serodeme group patterns. Five out of eight soluble extracts of leishmanial promastigotes were electrophoresed on thin-layer starch gels and examined for the enzyme MPI, Mannose Phosphate Isomerase; MDH, Malate Dehydrogenase; 6PGD, 6 Phosphogluconate Dehydrogenase; NH, Nucleoside Hydrolase, 2-deoxyinosine as substrate; SOD, Superoxide Dismutase; GPI, Glucose Phosphate Isomerase and ES, Esterase. From the isoenzyme studies we concluded that stocks: MHOM/AR/92/SE-1; SE-2; SE-4; SE-8 and SE-8-I are isoenzymatically Leishmania (Viannia) braziliensis. We need to analyze more enzymes before assigning them to a braziliensis zymodeme.

Pelvic inflammatory pseudotumor with predominant macrophagic reaction

We describe the clinical and pathological features of a case of inflammatory pseudotumor of the pelvis, exceptionally reported in the female genital tract. Macroscopically the lesion consisted in several yellowish nodules, one on the uterus fundus, others along the ureteral serosa and the urinary bladder suggesting a multifocal pelvic malignancy during the surgical intervention. The histological examination of the nodules showed a total lack of malignant cell proliferation and a macrophagic reaction, enclosing numerous non birefringent heterogeneous crystal structures. In the patient file no colonic diverticulosis or previous pelvic surgical excision was recorded. The differential diagnosis in particular malignant tumors is discussed.

Dual function of a human immunodeficiency virus (HIV)-specific cytotoxic T-lymphocyte clone: inhibition of HIV replication by noncytolytic mechanisms and lysis of HIV-infected CD4+ cells

CD8+ T cells may play a beneficial role in human immunodeficiency virus (HIV)-infected patients by two mechanisms. HIV-specific cytotoxic activity and secretion of a soluble mediator(s) that inhibits HIV replication in vitro. Here we characterized both activities mediated by an HIV p24gag-specific cytotoxic T lymphocyte (CTL) CD8+ clone derived from an HIV-infected patient. When the CTL clone was mixed with HIV-infected autologous CD4+ T cells, viral replication was suppressed. This viral inhibition was observed in heterologous CD4+ T cells and when CD8+ and CD4+ populations were separated by a semipermeable membrane, demonstrating the involvement of a diffusible factor(s). The lysis of autologous HIV-infected T cells was also detected. However, HIV suppression was more efficient when CD4+ and CD8+ T cells shared major histocompatibility complex alleles and were in direct contact. Thus, one and the same CD8+ T cell population can mediate both lysis of HIV-infected targets and nonlytic suppression of HIV replication. These results underline the multiple roles of CD8+ T lymphocytes in the suppression of HIV-infected cells.

Quantitative immunocytochemical assays on frozen sections of p53: correlation to the follow-up of patients with breast carcinomas

A series of 222 tumor samples stored at -80 degrees C in the authors' tumor library were investigated with anti-p53 (PA 1801) and streptavidin-biotin-peroxidase complex. The p53 immunoprecipitates were quantified by densitometry assessed by image analysis of digitized microscopic images. Two parameters, percentage of positive surface and mean optical densities, were compared with the patient's outcome (follow-up = 96.8 months) (life table method, Mantel Cox test, BMDP statistical software). The p53 expression significantly correlated with a poor overall survival (P = .0063), metastasis-free survival (P = .024), and recurrence-free survival (P = .022) at a 20% cutoff point of positive immunoreactive tumor surface. A strong prognostic significance was observed in the node-positive subset of patients but not in the node-negative subset, except for recurrence-free survival (P = .047). The results indicate the clinical relevance p53 evaluated by quantitative immunocytochemistry.

A western surgical experience of peripheral cholangiocarcinoma

The aim of this retrospective study was to analyse outcome in 31 European patients operated on for peripheral cholangiocarcinoma between 1988 and 1995 (hilar cholangiocarcinoma was excluded). Before 1992, in addition to conventional resection, patients with irresectable tumour and with no extrahepatic metastasis underwent total hepatectomy with liver transplantation. Mild abdominal pain was the most frequent presenting clinical sign (11 of 31 patients) and jaundice was present in only four patients. Preoperative histological findings were available for 20 patients but the diagnosis was correct in only eight of these. Nineteen patients had curative surgery: 17 underwent conventional resection and two had total hepatectomy with liver transplantation. Major hepatectomy was performed in 12 of 17 cases, extended to the caudate lobe in five, to the bile duct confluence in four and to the retrohepatic vena cava in one. Postoperative mortality and morbidity rates were three and seven of 19 patients respectively, median survival was 15 months, and actuarial 1-, 2- and 5-year survival rates were 67, 40 and 32 per cent respectively. Twelve patients had only exploratory laparotomy because of the presence of extrahepatic metastasis or irresectable tumour. The invasive nature of peripheral cholangiocarcinoma can explain the limited number of resectable cases and the particularly unfavourable prognosis. Total hepatectomy does not provide survival benefit. Conventional surgery remains the only effective treatment, even for patients with advanced stage tumours.

Evidence for an in vivo superantigenic activity in human immunodeficiency virus-infected individuals

In a previous study, we reported the existence of a specific anergy affecting selectively the V beta 8 subset in both CD4 and CD8 T cells from human immunodeficiency virus (HIV)-infected persons. Because this observation gives evidence for a previous in vivo activation of this subset by a superantigen, we further characterize, in the present study, this V beta 8-anergy associated with HIV infection. Molecular T cell receptor analysis indicates that the V beta 8-anergized T cells are polyclonal. Furthermore, we show the dependence of this anergy on the expression of allelic forms of HLA class II DRB1 molecules. These observations explain the frequency of anergic persons among HIV-infected donors (56%) and are consistent with a previous in vivo superantigenic activity. Comparative analyses of disease evolution between V beta 8 responder and anergic persons do not show any clear relation between the V beta 8 status and acquired immunodeficiency syndrome pathogenesis. However, the stability of the V beta 8 status, the absence of correlation with previous microbial infections, and the previously reported precocity of V beta 8 anergization are in favor of a strong association between the in vivo existence of a V beta 8-specific superantigen and HIV infection. Finally, the functional dichotomy we observe for all anergized donors between blood and lymph node T cells raises the question of the in vivo localization of the superantigenic activity.

[Tumor markers in the cytodiagnosis of thyroid nodules. Detection of dipeptidyl aminopeptidase IV (DAP IV) activity]

Dipeptidyl-aminopeptidase IV (DAP IV), an exopeptidase involved in T-cell activation is absent from normal thyroid tissue but highly expressed by malignant thyroid cells. It has been suggested to be a useful adjunct for the diagnosis of malignant thyroid tumors on fine needle aspirates (FNA). To assess this assumption DAP IV activity was demonstrated by histochemical staining on FNA performed on 102 thyroid nodules at the time of surgery (60 macrofollicular adenomas, 15 microfollicular adenomas. 7 Hashimoto's thyroïditis, 3 Graves' disease. 13 papillary carcinomas and 4 follicular carcinomas). A staining score based on the percentage of positive epithelial cells and staining intensity was established for each case and results were compared to histological diagnosis. Most cells in malignant tumors were deeply stained except in one case of papillary carcinoma. Null or very low scores resulting from light or medium staining of less than 40% of the cells were obtained in 78/85 benign nodules. In 6 macrofollicular adenomas and in 1 case of thyroiditis staining score was as as high as in carcinomas. DAP IV staining was correlated to malignancy in all follicular tumours (4 malignant tumours were positive and 15 benign were negative). The sensitivity for diagnosis of malignancy was 94.1% and the specificity 91.7%. This study brings confirmation that DAP IV activity detection could be an useful adjunct to cytological examination for the distinction between benign and malignant thyroid nodules, especially in cases of follicular tumors.

Giant chylous cyst. An unusual presentation of intestinal duplication

Duplications of the digestive tract are very unusual entities that can be located in any other part of the Gastrointestinal tract. However the most frequent location is the jejunoileal one. We report the case of a giant chylous intestinal cyst duplication, located in the ileum, diagnosed in a 41 year-old man.

Ultrastructural characterization of the acetylcholine innervation in adult rat neostriatum

The ultrastructural features of acetylcholine axon terminals (varicosities) in adult rat neostriatum were characterized by electron microscopy after immunostaining with a sensitive monoclonal antibody against rat choline acetyltransferase. Several hundred single sections from these varicosities were analysed for shape, size and content, presence of a synaptic membrane specialization, and composition of the microenvironment. An equivalent number of unlabeled varicosities selected at random from the same micrographs were similarly examined. The immunostained varicosity profiles were relatively small and seldom showed a junctional membrane specialization. Stereological extrapolation to the whole volume of these varicosities indicated that less than 10% were synaptic. Far fewer dendritic spines were juxtaposed to these predominantly asynaptic profiles than to their unlabeled counterparts. This difference seemed imputable to the low synaptic incidence of the acetylcholine varicosities and was consistent with the view that these are randomly distributed in relation to surrounding elements. The bulk of the data was suggestive of volume transmission. This raised the possibility that, in such a densely innervated area, a basal level of acetylcholine is permanently maintained around all cellular elements, contributing to the modulatory properties of this transmitter. This basal level of acetylcholine could also serve as a regulatory signal controlling the expression of different receptor subtypes in neurons, glia and blood vessels.

In vitro influence of Mycoplasma penetrans on activation of peripheral T lymphocytes from healthy donors or human immunodeficiency virus-infected individuals

Mycoplasma penetrans is a mycoplasma species newly isolated from the urine of human immunodeficiency virus (HIV)-infected individuals and presents the only case in which an association has been found between antibodies against a mycoplasma and HIV infection. To further explore the effects of M. penetrans on the immune system, we studied the influence of this mycoplasma on peripheral blood mononuclear cells (PBMCs) from healthy donors and HIV-infected individuals. M. penetrans induced, in addition to blastogenesis of PBMCs, a significant proliferative response associated with the expression of some activation markers such as CD69, HLA-DR, and CD25. This M. penetrans-dependent lymphocyte activation was observed not only in healthy donors but also in HIV-infected persons at different stages of the disease. In addition, our study revealed that both CD4+ and CD8+ T lymphocytes were responsive to M. penetrans. Interestingly, the mitogenic activity of M. penetrans was associated with mycoplasma cells but not with the supernatants of mycoplasma culture. The potent stimulating activity of M. penetrans on T lymphocytes from HIV-infected individuals is of particular interest in view of the supposed contribution of immune activation to HIV replication and disease progression.

[Morphometry by analysis of microcalcifications and histopathological diagnosis: a new approach to the diagnosis of impalpable lesions of the breast detected by mammography]

A series of 104 impalpable breast lesions detected by mammograms containing microcalcifications was studied. Intraoperative radiographs of intact and sliced specimens were assessed, followed by microscopic diagnostic on frozen sections of areas containing microcalcifications. Microcalcification detected on mammograms and on radiographs of the specimens were digitized and evaluated according morphometric parameters including the mean surface, shape factor, bend energy, the envelope surface and the total surface, the total number and the concentration of the microcalcifications. Benign disorders, atypical hyperplasia and carcinomas accounted for 47.2%, 4.8% and 48% of the tissue lesions respectively, but disorders were most often heterogeneous and mixed. Most but not all parameters were significantly correlated in the three types of radiographs, although radiographs of the sliced specimens provided for images of the best quality. Only two parameters, the mean size and the bend energy were significantly (p = 0.008, p. = 0.036) different in benign and malignant lesions. It is concluded that image analysis of digitized microcalcifications in radiographs may provide a quantitative basis helpful for mammograms interpretation.

A survey of drug treatment and outcomes in diabetic patients with acute myocardial infarcts

Sixty-four diabetic patients suffering an acute myocardial infarct were retrospectively matched, by age, gender and smoking habit, to non-diabetic controls. The two groups were compared for cardiovascular risk factors, pre-admission and discharge drug treatment, in-hospital drug treatment, and complication and mortality rates. Hypertension was more prevalent in the diabetic (63%) than in the control (42%) group. When comparing drugs on admission to those at discharge, there was a significant increase in antiplatelet and nitrate usage in both groups (P < 0.001), in beta-blocker usage in the control group (P < 0.001) and in loop diuretic usage in the diabetic group (P < 0.001). The usage of angiotensin converting enzyme inhibitors was low: 16% of diabetic patients and 5% of controls at discharge. Thrombolytic therapy was used in 29 diabetics and 37 controls. There was a significantly higher complication rate in the diabetic group than in the control group (P < 0.006), the most common being congestive cardiac failure (59% vs 30%, P < 0.001). Four controls and 13 diabetic patients died; three of the latter had their diabetes diagnosed during the admission. This study did not clearly demonstrate any underlying risk factors or treatment variables to account for the increased morbidity or mortality in diabetic patients with acute myocardial infarct, when compared to a matched non-diabetic population. However, modest associations not detected by this relatively small study are still possible.

Empathic accuracy in a clinically relevant setting

This study addressed 3 questions regarding empathic accuracy in a clinically relevant setting. First, does the empathic accuracy of a perceiver improve with increased exposure to a target individual? Second, can empathic accuracy be enhanced by providing the perceiver with feedback about the target's actual thoughts and feelings? Third, are there stable individual differences in empathic accuracy that generalize across different targets? The results indicated that although absolute performance levels varied from 1 target to another, empathic accuracy generally improved with increased exposure to the target. In addition, feedback concerning the target's actual thoughts and feelings accelerated the rate at which the perceivers' empathic accuracy improved. Finally, cross-target consistency in responding (alpha = .86) revealed stable individual differences in the perceivers' empathic ability. Implications of these findings for clinical training and practice are discussed.

Carbohydrate-deficient transferrin levels in a female population

Female college students (n = 49) from a small southwestern United States university participated in the 9-month study. Data collected included the assessment of drinking habits and other related substance use habits and serum levels of carbohydrate-deficient transferrin (CDT). Each subject provided an interview and blood sample on three occasions at 90-day intervals. Appended to the interview were a series of questions regarding stage of menstrual cycle and the diagnoses of certain diseases. The CDT values obtained were consistent with those obtained in other studies. Moderate-drinking subjects had significantly higher CDT values than did the abstainers and light drinkers. Females using oral contraceptives had significantly higher CDT values than those who were not taking oral contraceptives. Finally, although CDT values varied over time, they did not appear to vary as a function of menstrual cycle stage.

Relational features of acetylcholine, noradrenaline, serotonin and GABA axon terminals in the stratum radiatum of adult rat hippocampus (CA1)

In a well-defined sector of adult rat hippocampus (CA1, stratum radiatum), the ultrastructural features of acetylcholine (ACh), noradrenaline (NA), serotonin (5-HT) and GABA axon terminals (varicosities) were compared by electron microscopy after immunostaining with antibodies against choline acetyltransferase, NA, 5-HT and glutamic acid decarboxylase. Approximately 100 sectional profiles of each type were analyzed for size, presence of a synaptic membrane specialization (synaptic incidence) and composition of the microenvironment. An equivalent number of immunonegative varicosity profiles selected at random from the same micrographs were similarly examined. ACh, NA and 5-HT varicosity profiles were of comparable size, and significantly smaller than GABA profiles. They exhibited a low frequency of junctional specialization, amounting to 7%, 15% and 21%, respectively, when extrapolated to the whole volume of these terminals. In contrast, GABA varicosities appeared entirely synaptic. The ACh, NA and 5-HT varicosities also differed from their GABA counterparts in being juxtaposed to a greater number of unlabeled axonal varicosities and a lower number of dendritic branches. In addition, the microenvironment of immunostained terminals showed a much lower number of dendritic spines than that of immunonegative varicosities. This latter finding was viewed as another indication that predominantly asynaptic varicosities do not maintain particular relationships with their immediate surround. It was also concluded that volume transmission represents a major mode of transmission for ACh, NA and 5-HT in adult rat hippocampus, thus contributing to the properties and functions assigned to these transmitters in this part of brain.

Isolation and characterization of bovine follistatin cDNA

Seven bovine follistatin (FS) cDNA clones were isolated from a bovine ovarian follicle cDNA library. The predicted amino acid sequences revealed that six of the cDNA clones represented an FS precursor of 344 amino acids which corresponded to a mature FS of 315 amino acids (FS 315), with one cDNA clone containing the entire coding sequence including 180 nucleotides of 5' untranslated sequence. The predicted amino acid sequence of the seventh cDNA clone, which differed in the 3' coding sequence, represented a precursor protein of 317 amino acids, corresponding to a mature FS of 288 amino acids (FS 288). This clone encoded an identical amino acid sequence to the other six cDNA clones except that the C terminal of FS 315 was truncated by 27 amino acids. The sequence of bovine FS was found to contain 36 cysteine residues and 2 potential N-linked glycosylation sites. The predicted amino acid sequence of bovine FS has overall sequence homologies of 98% with ovine FS and 97% with human FS.

Fine-needle aspiration of thyroid follicular neoplasm: diagnostic use of thyroid peroxidase immunocytochemistry with monoclonal antibody 47

BACKGROUND

We previously demonstrated that thyroid peroxidase (TPO) immunocytochemistry with monoclonal antibody 47 can help to differentiate benign (staining score, 80% or more) from malignant (staining score, less than 80%) thyroid nodules on fine-needle aspiration (FNA) samples. In the present study we assessed the use of TPO immunocytochemistry in the cytologic diagnosis of thyroid follicular neoplasms.

METHODS

A total of 109 histologically proven follicular tumors were studied. There were 60 microfollicular adenomas, 23 atypical adenomas, 17 oncocytic adenomas, and 9 follicular carcinomas. Adequate preoperative FNA samples were available in all cases. TPO immunocytochemistry was performed on one half of the slides.

RESULTS

The staining score was less than 80% in all follicular carcinomas, whereas it was 80% or more in 68 of 100 benign tumors. There was no false negative and 32 false positives for diagnosis of malignancy. The false positives were 10 microfollicular adenomas, 13 atypical adenomas, and 9 oncocytic adenomas. TPO immunocytochemistry has a sensitivity of 100% and a specificity of 68% for screening of follicular cancer.

CONCLUSIONS

TPO immunocytochemistry with monoclonal antibody 47 on FNA samples is a highly sensitive and fairly specific method to distinguish benign from malignant follicular neoplasms. This technique can help to reduce the number of surgical procedures for benign thyroid nodules without increased risk of overlooking malignancy.

Thyroid peroxidase immunodetection as a tool to assist diagnosis of thyroid nodules on fine-needle aspiration biopsy

In a previous work we have reported the presence in 96.9% of malignant and 4.2% of benign thyroid tumors of an immunological abnormality of the enzyme thyroid peroxidase, impeding the fixation of the anti-thyroid peroxidase monoclonal antibody termed "MoAb47". The present study has been designed to establish the ability of thyroid peroxidase immunodetection to assist the diagnosis of malignancy in fine-needle aspiration of thyroid nodules. The fixation of anti-thyroid peroxidase monoclonal antibody was investigated by immunohistochemistry on fine-needle aspirates of 150 surgically removed thyroid nodules (20 papillary carcinomas, five follicular carcinomas, 90 colloid adenomas, nine fetal adenoma, 13 atypical adenomas, five oncocytic adenomas, six Hashimoto's thyroiditis and two Graves' disease). The percentage of positive cells has been compared to the final histological diagnosis. In samples from 113/125 benign nodules 80-100% cells presented a positive immunoreaction, whereas all samples from malignant tumors yielded less than 80% positive cells. Benign nodules exhibiting less than 80% positive cells corresponded to three degenerative colloid nodules, five atypical follicular adenomas, two oncocytomas and two thyroiditis. According to results obtained in this series, with the value of 80% as the limit for discrimination between benign and high-risk nodules, the sensitivity of thyroid peroxidase staining for diagnosis of malignancy would be 100%, its specificity 90% and its overall accuracy 92%. Thyroid peroxidase staining with monoclonal antibody MoAb47 on fine-needle aspirates is a useful adjunct to conventional cytology for the investigation of patients with thyroid nodules.

In vitro activities of enoxacin, enrofloxacin, sparfloxacin, and ciprofloxacin against Escherichia coli strains isolated from diarrheic lambs and kids

The in vitro activities of four fluoroquinolone compounds were tested against 92 Escherichia coli strains of ovine and caprine origin under aerobic and anaerobic incubation conditions. The four fluoroquinolones proved to be highly effective against the E. coli isolates tested. When bacteria were cultured anaerobically, at least fourfold increases in the MICs of enoxacin for the strains occurred and no detectable changes in enrofloxacin, sparfloxacin, and ciprofloxacin MICs occurred.

Thyroperoxidase immunodetection for the diagnosis of malignancy on fine-needle aspiration of thyroid nodules

We have previously demonstrated that in 95.6% of malignant thyroid tumors the enzyme thyroid peroxidase (TPO) presents antigenic changes detectable by a monoclonal antibody termed MoAb47. The aim of this study was to investigate the interest of TPO immunodetection for the diagnosis of malignancy on fine-needle aspiration biopsy (FNAB) of thyroid nodules. The study was performed on 300 patients. Slides of FNAB aspirate were air-dried and stained by anti-TPO-MoAb47. According to the percentage of TPO-positive epithelial cells, patients were divided into two groups: benign (> 80%) and malignant (< 80%). In 279 cases additional slides were available for Giemsa stain and standard cytology. All the patients were operated on, and the final diagnosis was recorded as benign in 248 cases (183 macrofollicular nodules, 23 microfollicular adenomas, 18 atypical adenomas, 11 oncocytomas, 11 thyroiditis, 2 Graves' disease) and malignant in 52 cases (44 papillary carcinomas and 8 follicular carcinomas). Samples from 215 of 248 benign nodules yielded 80% to 100% TPO-positive cells, whereas samples from all malignant tumors yielded less than 80% positive cells. The sensitivity of TPO staining for diagnosis of malignancy was thus 100%, its specificity 86.7%, and its overall accuracy 89%. With conventional cytology, sensitivity, specificity, and accuracy were 91.6%, 79.2%, and 81.0%, respectively. We conclude from this study that TPO staining with MoAb47 should become an essential adjunct in the preoperative cytologic diagnosis of thyroid nodules.

A correlational study of carbohydrate-deficient transferrin values and alcohol consumption among Hispanic college students

One hundred and forty-eight U.S. college students from a small southwestern university were asked to provide or complete the following: the Michigan Alcoholism Screening Test (MAST), a structured alcohol-use interview, and a 10-ml blood sample to be assayed for carbohydrate-deficient transferrin (CDT) levels and gamma-glutamyl-transpeptidase (GGTP) activity. Using the data obtained in the interview, only 2 females and 5 males were identified as heavy drinkers. Conclusions regarding the efficacy of the biochemical markers are therefore limited. It was found that CDT levels were significantly and positively correlated with various measures of alcohol consumption among males. There was no similar association between CDT, or GGTP, and alcohol consumption within the female sample.

Selective anergy of V beta 8+ T cells in human immunodeficiency virus-infected individuals

We have analyzed the V beta usage by CD4+ and CD8+ T cells from human immunodeficiency virus (HIV)-infected individuals in response to an in vitro stimulation with the superantigenic erythrogenic toxin A (ETA) of Streptococcus pyogenes. ETA amplifies specifically CD4+ and CD8+ T cells from control donors expressing the V beta 8 and the V beta 12 elements. When peripheral T cells from asymptomatic HIV-infected individuals were stimulated with ETA, there was a complete lack of activation of the V beta 8+ T cell subset, whereas the V beta 12+ T cell subset responded normally to the superantigen. This V beta-specific anergy, which was also observed in response to staphylococcal enterotoxin E (SEE), affected both CD4+ and CD8+ T cells and represented an intrinsic functional defect rather than a specific lack of response to bacterial superantigens since it was also observed after a stimulation with V beta 8 monoclonal antibodies. The V beta 8 anergic T cells did not express interleukin 2 receptors (IL-2Rs) and failed to proliferate in response to exogenous IL-2 or IL-4, suggesting that this anergy was not a reversible process, at least by the use of these cytokines. The unresponsiveness of the V beta 8 T cell subset is frequent since it was found in 56% of the patients studied, and comparison of the clinical status of responder vs. anergic patients indicated that the only known common factor between them was HIV infection. In addition, it is noteworthy that the anergy of the V beta 8 subset may be a very early phenomenon since it was found in a patient at Centers for Disease Control stage I of the disease. These data provide evidence that a dominant superantigen may be involved in the course of HIV infection and that the contribution of HIV has to be considered.

Cellular mechanism of the conduction abnormalities induced by serum from anti-Ro/SSA-positive patients in rabbit hearts

In this study, IgG fractions from sera of SLE patients with anti-Ro/SSA or anti-Ro/SSA and anti-La/SSB activity were tested in Langendorff preparations of adult rabbit hearts, aiming to reproduce the cardiac manifestations observed in neonatal lupus in an experimental model. The hearts were perfused with normal Tyrode's solution for 30 min, followed by perfusion with Tyrode's containing 0.3 mg/ml of anti-Ro/SSA- (or anti-Ro/La-) positive IgG (nine sera), anti-ribonucleoprotein (RNP)-positive IgG (five sera), or IgG fractions from normal donors (five sera). In one third of the experiments done with anti-Ro/La-positive IgG, heart block was observed. With the remaining fractions, a decrease in heart rate of 17.1% was observed, but normal sinus rhythm was maintained. The IgG fractions with anti-RNP activity (five experiments) and from normal sera (six experiments) reduced heart rates by 12.9 and 3.3%, respectively, but heart block was not observed. To further characterize the cellular mechanisms involved in the conduction disturbances observed in the whole rabbit hearts, we conducted experiments with ventricular myocytes isolated from young rabbit hearts, studied by whole cell patch-clamp technique. In these experiments, the slow inward currents were analyzed during the superfusion of the cell with normal Tyrode's solution and 5 min after superfusion with Tyrode's solution containing 0.3 mg/ml of anti-Ro/SSA- (or anti-Ro/La-) positive IgG (five sera), anti-RNP-positive IgG (three sera), or IgG from normal donors (four sera). Resting and action potential amplitudes were not affected by any of the sera used. The anti-Ro/SSA IgG fraction induced a mean reduction in the peak slow inward current of 31.6%. IgG fractions with anti-RNP activity reduced slow inward current by 4.4%, whereas IgG fractions from normal donors increased this current by 3.3%. IgG-free fractions from sera of patients with anti-Ro/SSA activity did not alter the peak slow inward current. These results show, for the first time, that the presence of anti-Ro/SSA or anti-Ro/SSA and anti-La/SSB antibody activity in IgG fractions from lupus patients' sera can induce cardiac conduction disorders similar to those observed in neonatal lupus.

[Hepatic angiomyolipoma. 2 case reports and review of the literature]

We report two cases of hepatic angiomyolipoma. The first tumor was disclosed at the time of resection of a cardia carcinoma, and temporarily regarded as a possible metastasis. The second tumor was an enormous necrotic mass of the right liver in a young woman mimicking a sarcoma.

Effects of a job-simulated exercise programme on employees performing manual handling operations

This study investigated the effects of physical training on employees performing manual handling operations in three manufacturing plants. Employees from two plants were trained using progressive resistance exercise (PRE) while employees in the third plant were trained using PRE and trunk flexibility exercises (TFE). The results were: (1) a combined TFE and PRE programme significantly improved muscular endurance (124%), dynamic (86%) and static (back: 59%; arm: 25%; shoulder: 23%) muscular strength, and trunk flexibility (low back flexibility: 11%; total trunk rotation: 48%); (2) a dynamic PRE programme did not improve static strength (arm: 3%; shoulder: 8%; back: 14%; composite: 7%) as much as dynamic strength (71%); (3) endurance time at a fixed workload increased without changing job demand perception, but daily operations were performed more easily.

Enzymatic DNA amplification (PCR) in the diagnosis of extrapulmonary Mycobacterium tuberculosis infection

A polymerase chain reaction able to amplify Mycobacterium tuberculosis DNA from clinical samples of extra-pulmonary origin is described. The PCR amplified a 294 base pair DNA fragment spanning positions 5'-782 to 3'-1075 of the 65 kDa M. tuberculosis antigen gene. The procedure enables amplification of target DNA at quantities as low as 1 pg of purified material and less than 1000 mycobacteria present in clinical samples. The reaction amplifies M. tuberculosis DNA as well as Mycobacterium bovis BCG DNA. In 34 extra-pulmonary clinical samples studied, 18 rendered positive results and two false-negative results; compared to classical diagnostic procedures, the sensitivity was 90% and specificity 100%. The PCR approach to diagnosis of tuberculosis of extra-pulmonary origin is a valid diagnostic alternative to classical procedures.

Molecular typing of thermotolerant species of Campylobacter with ribosomal RNA gene patterns

Ribosomal RNA gene restriction patterns (ribopatterns) of 72 strains representing Campylobacter jejuni (subspecies jejuni and doylei), C. coli, C. upsaliensis and C. lari including the urealytic (UPTC) biovar were determined using four common restriction endonucleases (HaeIII, HindIII, PstI and PvuII). The relative effectiveness of these enzymes for general molecular typing of the thermotolerant campylobacters was assessed. Ribotypes (HaeIII) were defined on the basis of computer-assisted numerical analysis. For C. jejuni, C. coli and C. lari, the HaeIII ribopatterns provided a high level of typability and discrimination, with patterns that were reproducible and easy to code for numerical analysis. There was evidence of diversity within three of the HaeIII types, and PstI ribopatterns proved the most reliable for detecting such differences. C. upsaliensis also could be ribotyped with HaeIII, but HindIII, PvuII and PstI were less satisfactory for this species. For such campylobacters, the HindIII ribopatterns generally were complex and difficult to compare, and the PvuII profiles provided the least discrimination. We conclude that the choice of restriction endonuclease is of critical importance when applying ribotyping to different species of Campylobacter. HaeIII ribopatterns were the most effective means of typing strains of different thermotolerant species of campylobacters and, when combined with PstI ribopatterns, offered a highly discriminatory basis for molecular typing.

Programmed cell death in AIDS-related HIV and SIV infections

One of the difficulties in understanding the complex pathology of human immunodeficiency virus (HIV) infection is to explain the progressive depletion of the CD4 helper T cell population and consequently the destruction of the immune system. Although cytopathic effects of HIV are observed in vitro, they cannot in vivo account for CD4 T cell depletion because relatively few cells are productively infected. Thus immunological mechanisms must be envisaged. We have found that peripheral blood lymphocytes (PBLs) from asymptomatic HIV-infected individuals are primed for a suicide process known as apoptosis or programmed cell death (PCD). DNA fragmentation characteristic of apoptosis was enhanced by stimulation of lymphocytes with ionomycin, a known inducer of apoptosis in suitably primed cells. Identification of the T cell subpopulations programmed for apoptosis indicated that both CD4+ and CD8+ cells died when cultured without stimulation or when polyclonally stimulated with ionomycin. Activation-induced cell death was also observed after stimulation with self-MHC class II-dependent superantigens, namely bacterial toxins from Staphylococcus (SEB), Streptococcus (ETA), and Myocoplasma (MAM) and under these conditions the CD4+ T cells were preferentially affected. To explore whether new macromolecular synthesis were required for apoptosis, various known inhibitors of apoptosis such as cycloheximide, cyclosporin A, Zn2+, or EGTA were tested. Activation-induced apoptosis was found sensitive to these inhibitors, indicating an active mechanism, but apoptosis observed in nonstimulated cultures was not, suggesting that these cells already contained the complete machinery for death. Prevention of apoptosis could be obtained in the presence of a mixture of cytokines and the minimal signal necessary for this prevention was IL-1 alpha and IL-2. Finally, a correlation between PCD and AIDS-pathogenesis was suggested by the comparison of lymphocytes from lentivirus-infected primates suceptible (SIV-infected macaques) and resistant (HIV-infected chimpanzees) to AIDS. Altogether our results suggest that, during HIV or SIV infection, PCD may contribute in vivo to the deletion of reactive T cells after antigenic stimulation.

Thyroglobulin in medullary thyroid carcinoma: immunohistochemical study with polyclonal and monoclonal antibodies

The presence of thyroglobulin (TG) was investigated by immunohistochemistry with one polyclonal and three distinct monoclonal anti-TG antibodies in 19 primary and 15 metastatic medullary thyroid carcinoma (MTC) cases. In two primary tumors possessing a mixed trabecular and follicular growth pattern, a significant number of tumor cells were positive with the four antibodies in all parts of the tumor; these tumors were considered to be genuine mixed follicular and parafollicular tumors. The 17 other primary tumors looked like "classical" (ie, predominantly compact) MTC. Eight contained tubular or microfollicle-like structures that were consistently TG-negative. Eight contained residual entrapped normal follicles positive with the four anti-TG antibodies. In six cases isolated foci of tumor cells reacted with polyclonal antibody or monoclonal antibody 11. In 10 cases circulating TG stained positively with polyclonal antibody in vascular channels, five cases stained positively for TG with monoclonal antibody 11, four cases stained positively for TG with monoclonal antibody 7, and three cases stained positively for TG with monoclonal antibody 1. In metastases TG was found in tumor cells in only one instance, but positive reactions were obtained in vascular channels and macrophages in several cases. We conclude from this study that there is no genuine secretion of TG in classical, compact MTC, which differs morphologically and functionally from mixed follicular and parafollicular tumors secreting both TG and thyrocalcitonin.

Genotoxic potential of crown ethers in mammalian cells: induction of sister-chromatid exchanges

Crown ethers are macrocyclic polyethers which possess ionophoric properties. These compounds are currently being studied for potential use as pharmaceutical agents as well as antibacterials. Though crown ethers have been shown to be highly toxic in prokaryotes and eukaryotes, there have been few investigations into the potential genotoxicity of these compounds. When sister-chromatid exchanges (SCEs) were quantitated after exposure to crown ethers, the results reflected no significant genotoxic effects on Chinese hamster V79 cells at any of the crown ether concentrations utilized. One crown ether, dicyclohexyl 21-crown-7, did appear to possess antigenotoxic activity. The data on the induction of SCEs by crown ethers reported herein suggest that these compounds are not genotoxic in mammalian cells despite their cytotoxicity.

Transplacental immunity to varicella-zoster virus in extremely low birthweight infants

Sixteen infants in our intensive care nursery (ICN) were inadvertently exposed to an adult who presented the next day with chickenpox. Since a majority of the patients were extremely premature, we were concerned that they might not have received transplacental varicella-zoster virus (VZV) antibody, and consequently would be at risk for contracting chickenpox. Serum samples were obtained from each infant and examined for the presence or absence of VZV antibody. Fourteen of the 16 infants had antibody levels equal to or in excess of 1:16 by indirect fluorescent antibody, including six of eight infants with birthweights equal to or less than 1000 gm, and eight of ten infants with gestational ages equal to or less than 28 weeks. Passive transfer of immunity to VZV appears to be common in infants as young as 24 to 28 weeks' gestation.

Ultrastructural analysis of the serotonin hyperinnervation in adult rat neostriatum following neonatal dopamine denervation with 6-hydroxydopamine

Serotonin (5-HT) immunocytochemistry was used at the electron microscopic level to characterize the ultrastructural features of 5-HT axon terminals (varicosities) hyperinnervating the neostriatum of adult rats, 3 months after a neonatal destruction of the nigrostriatal dopamine system by intraventricular 6-hydroxydopamine. 5-HT-immunostained terminals from the anterior half of the hyperinnervated neostriatum were examined in single thin sections, and compared to their counterparts in vehicle-injected controls with respect to shape, size, organelle content, presence of a synaptic membrane differentiation and composition of the microenvironment. The intrinsic and relational features of the 5-HT-immunostained varicosities were essentially the same in 5-HT-hyperinnervated and control tissue. In particular, the frequency with which these varicosities made synaptic contacts was similarly low in both conditions (6-8% for whole varicosities), as already described in normal adult rat neostriatum. The distributional frequency of elements juxtaposed to the 5-HT-immunostained varicosities was also comparable in control and 5-HT-hyperinnervated tissue. However, in both conditions, there were much fewer dendritic spines in the microenvironment of 5-HT varicosities than around unlabeled terminals randomly selected from the same thin sections. This difference seemed entirely due to the numerous axo-spinous synaptic contacts made by the randomly selected, unlabeled varicosities. Together with recent observations on the 5-HT-hyperinnervation of adult rat hippocampus after grafts of fetal neurons, these data lead to the suggestion that mostly non-junctional neostriatal 5-HT terminals are not committed to a specific intratissular microenvironment. This might in part explain why they grow in excess when reinnervating adult tissue after a lesion or a graft.

Bilateral distribution of aminopeptidase activities in selected structures of a photoneuroendocrine circuit and other rat brain areas

Provided that soluble aminopeptidases, the most abundant proteolytic enzymes found in brain, are involved in the metabolism of several neuropeptides, their activity could be a reflect of neuropeptide function. Therefore, in order to analyze their rate of participation, we have measured 4 soluble aminopeptidase activities: leucine aminopeptidase, arginine aminopeptidase, aspartate aminopeptidase, and pyroglutamate aminopeptidase, using arylamide derivatives as substrates, in selected structures integrating the photoneuroendocrine circuit related to the melatonin rhythm generating system and other rat brain areas. The regional distribution of all the activities was heterogenous: a 3-fold (leucine-, arginine- and aspartate-aminopeptidase) and 5-fold (pyroglutamate aminopeptidase) difference was observed between the regions with the highest and lowest activity. Significant differences were displayed between the left and right retina for pyroglutamate aminopeptidase and arginine aminopeptidase activities. High levels of pyroglutamate aminopeptidase were evident in the retina and adenohypophysis, which is consistent with a role for thyrotropin releasing hormone in photoreceptive mechanisms, and support its well established role in controlling thyrotropin releasing hormone in anterior pituitary. The presence of a high activity rate of aspartate aminopeptidase in adenohypophysis implies an active participation of angiotensin peptides at this level.

[Indirect ultramicroElisa for the detection of total antibodies against cytomegaloviruses in human blood]

We have standardized an indirect ultramicro ELISA assay for detecting antibodies to human Cytomegalovirus (CMV) using human serum samples (UMELISA CMV). The optimal concentration of coating antigen (30 ug/ml), serum dilution (1:40) and anti-human conjugate working dilution (1:1500), were determined by a check board titration method. The UMELISA CMV was compared with the latex agglutination test for antibodies to CMV (Dupont de Nemours) and with an indirect immunofluorescent method. The results have showed the high coincidence, sensitivity and especificity of the proposed assay regarding the two methods compared with, and supporting its use either for a blood donors screening or in the serological diagnosis of this infection by paired serum samples.

Diurnal variation and left-right distribution of pyroglutamyl peptidase I activity in the rat brain and retina

The thyroliberin and luliberin contents exhibit a diurnal rhythm within the brain and an asymmetrical distribution of both neuropeptides has been demonstrated in the hypothalamus. Since they have been described as substrates of pyroglutamyl peptidase I, this activity was analysed in several rat brain regions and other structures, in order to investigate its putative diurnal variations and changes in relation to the distribution of these neuropeptides and/or other susceptible substrates. Fluorometric activity was assayed in the retina, pituitary gland, superior cervical ganglia, pineal gland, some selected brain regions, and serum of adult male rats at six different time points of a 12:12 h light:dark cycle, using pyroglutamyl-beta-naphthylamide as substrate. A significant circadian rhythm was demonstrated in the retina, the hypothalamus, and the intermediate-posterior pituitary lobe. In addition, a small but significant asymmetrical distribution of this activity, at certain time points, was disclosed: The activity was higher in the left than in the right retina at 10 h of the light period, whereas it was predominant in the right side at 01 h of the dark period. Furthermore, the activity was higher in the left anterior than in the right hypothalamic area at 13 and 01 h. These results could be indicative of a role of this enzymatic activity in the control of the functional status of its endogenous substrates.

Prophylaxis against infection. Single-dose cefonicid compared with multiple-dose cefamandole

A total of 1489 patients were included in a prospective, randomized study that compared the efficacy of a single dose of cefonicid in 474 patients (Group I) with that of three doses of cefamandole in 510 patients (Group II) and five doses of cefamandole in 505 patients (Group III), for prophylaxis against infection after an operation on bone. The operations involved the insertion of a Moore prosthesis, an Ender and Küntscher nail, a bone-plate, or another device for internal fixation. Patients who had an open fracture or a total joint replacement were not included in the study. The three groups were similar with regard to mean age, sex ratio, duration of preoperative hospitalization, underlying risk factors, and type of operation. The rates of wound infection were not significantly different in the three groups (p = 0.8) or when the rates were stratified according to the type of operation (p greater than 0.3). Staphylococcus aureus and gram-negative bacilli were the most common infecting microorganisms. The rate of mortality related to infection was similar in all three groups (p = 0.2). No adverse side-effects of drugs were encountered. A single preoperative dose of cefonicid, three doses of cefamandole, and five doses of cefamandole were equally effective prophylaxis against infection of the wound in these patients.

[Detection of cytomegalovirus by the immunoperoxidase technique and viral isolation]

An Immunoperoxidase assay was applied to detect early antigens of cytomegalovirus (CMV) in 150 urine samples from immunocompromised patients, using the commercial available monoclonal antibody against CMV E13. The detection of early antigen by IP (IPCMV) is compared to the conventional cell culture isolation regarding specificity and sensitivity in order to evaluate is usefulness in the diagnostic of CMV infections. The IPCMV showed a sensitivity of 89.8% and a specificity of 91.3% when compared to the isolation method. The great advantage of the IPCMV is based on the shorter time results are achieved, since 48-72 Hs can be enough to provide evidence of CMV infection, while in the isolation technique cytopathogenic effect was present around 14 days after sample inoculation.

Heparin-associated thrombocytopenia in a patient with polycythemia vera: the importance of a marked drop in platelet count

The present report describes a patient with polycythemia vera who developed a severe arterial and venous thrombosis caused by systemically administered heparin. An immunologic implication has been proposed as pathophysiological mechanism of this heparin-associated thrombocytopenia and thrombosis syndrome. It is suggested, however, that a strong decrease in platelet count as occurred in this patient leads to a higher chance of developing this complication.

Ultrastructural features of serotonin neurons grafted to adult rat hippocampus: an immunocytochemical analysis of their cell bodies and axon terminals

Serotonin (5-HT) immunocytochemistry was used at the electron microscopic level to examine 5-HT neurons reinnervating and hyperinnervating the hippocampus of adult rat, three to four months after a total 5-HT denervation and subsequent graft of embryonic raphe cells. The study focused on immunostained nerve cell bodies, dendrites and axon terminals (varicosities) in the core of grafts, and on a large single section sampling of axon terminals from a CA3 and a dentate gyrus sector of the outgrowth, which were systematically compared to the endogenous 5-HT innervation of the same regions described in a companion paper. The shape, size and synaptic investment of the grafted 5-HT somata and their dendrites resembled those of in situ 5-HT neurons. Clusters of small, clear vesicles were sometimes seen along these 5-HT dendrites. 5-HT axonal varicosities were fairly numerous in the core. A few were directly apposed to, or made asymmetrical synaptic contact with the immunostained dendrites and perikarya, but the vast majority showed no indication of junctional specialization (synaptic incidence of 19%, as stereologically extrapolated for whole varicosities). Occasional myelinated 5-HT axons were also present in the core of grafts. In the two outgrowth sectors, the graft-borne 5-HT varicosities were similar in size, content, frequency of synaptic contact and identity of junctional and appositional elements, irrespective of their laminar location. Moreover, none of these parameters were significantly different from those of the endogenous innervation. Notably, in spite of their excessive number, the synaptic incidence of the outgrowth 5-HT varicosities remained inferior to 20%. The similarity between the respective microenvironments of the supernumerary, graft-borne 5-HT terminals and of their normal counterparts could only be explained by a random intratissular distribution of these varicosities in both the normal and the grafted hippocampus. Thus, in spite of their transplantation and growth into an abnormal milieu, and the fact that they hyperinnervated the host tissue, the grafted embryonic 5-HT neurons appeared committed to express a particular set of intrinsic and relational morphological features corresponding to their normal adult characteristics.

Mn2(+)-activated aspartate aminopeptidase activity, subcellular localization in young and adult rat brain

The levels of soluble and membrane-bound aminopeptidase activities were assayed in subcellular fractions from young (4 weeks old) and adult (20 weeks old) rat brains, using Asp-2-naphthylamide as substrate. The young rats showed the highest soluble and membrane-bound levels of activity in the microsomal fraction but no differences among fractions were found at 20 weeks of age. The membrane-bound activity was significantly higher than the soluble one in all subcellular fractions of young rats. Soluble activity of the homogenate and the mitochondrial fraction was significantly increased in adult animals when compared to that of younger ones.

In vitro assay for protein digestibility: interlaboratory study

True protein digestibilities of 17 protein sources were estimated by 6 laboratories using an in vitro, 3-enzyme digestion system in a pH stat. Samples from animal, vegetable, and mixed food sources were freeze-dried (if not already dried), ground, mixed, and shipped to each collaborator along with a sodium caseinate standard and trypsin, chymotrypsin, and peptidase. The uptake of titrant during enzymatic digestion was used to calculate estimates of digestibility. Digestibilities ranged from 100% for casein to 89.9% for whole wheat cereal. Mean relative standard deviations for repeatability were 1.4% for rolled oats and less than 1% for the remaining 16 samples. Mean relative standard deviations for reproducibility ranged from 5.0 to 0.8%; values were less than 2.5% for 13 of the 17 samples.

Intrathoracic migration of a Kirschner wire

Migration of Kirschner wires, Rush pins, etc., is well known. Such migrations usually follow a retrograde path and the wires protrude near the entry point. Occasionally migration occurs in another direction. We describe a case in which the Kirschner wire migrated from the shoulder to the thorax. Several factors caused this migration. This complication must be avoided by bending the free end of the wire, removing the osteosynthesis material as soon as possible and following up the patient for a long period.