Inosiplex therapy in subacute sclerosing panencephalitis. A multicentre, non-randomised study in 98 patients

Inosiplex was administered to 98 patients with subacute sclerosing panencephalitis (SSPE) in the United States and Canada for variable periods of time up to 9.5 years. Survival data from these 98 patients were compared by life-table analysis with survival in three SSPE control groups drawn from SSPE patients contracting the disease in Israel, Lebanon, or the United States at about the same time as the inosiplex-treated patients but treated differently or not at all. In the inosiplex-treated patients the actuarial probability of survival at 2, 4, 6, and 8 years from onset of SSPE was 78%, 69%, 65%, and 61%, compared with 38%, 20%, 14%, and 8% in a composite control group (p less than 0.01 for all four comparisons). Statistical adjustments for time-to-treatment bias did not affect this result: a modified logrank procedure demonstrated that the risk of dying in the treatment group was 43% of that in the controls. Inosiplex seems to be able to prolong life in patients with SSPE.

Protective effect of chronic versus acute cardiac denervation on contractile force during coronary occlusion

The effects of acute coronary artery (CA) occlusion on myocardial contractile force were studied in mongrel dogs with (1) chronically denervated hearts (n = 10), (2) acutely denervated hearts (n = 5), and (3) normally innervated hearts (n = 6). Contractile force was measured in ischemic and nonischemic areas using Walton-Brodie strain gauge arches sutured to the epicardium. Coronary occlusion was accomplished by ligating several small branches of the left anterior descending and the circumflex arteries supplying the apical region on the left ventricle. Following occlusion, contractile force in the ischemic area decreased by 66.8% in the control group, by 73.6% in the acutely denervated group, but only by 21.6% (P less than 0.001) in the chronically denervated group. These results demonstrate that chronic cardiac denervation protects from the severe loss of contractile force in the ischemic area. This salutary effect is not seen with acute cardiac denervation.

Origin of handicap in young children

A survey was carried out of all infants born in Southampton and South-west Hampshire Health District in 1975 to assess the incidence and cause of handicapping conditions at age 2-3 years. Twenty-four infants were identified with major handicap. A prenatal cause was identified in 15 cases, a perinatal cause in 5 cases, and a postnatal cause in 2 cases. No cause was identified in 2 cases. The incidence of cerebral palsy was 1.2 per 1000 live births. There was some evidence for a perinatal cause in half of them.

Relaxation of the isolated coronary artery by inosine: noninvolvement of the adenosine receptor

The relaxation responses to adenosine and its analog inosine were compared in isolated canine coronary arterial rings (1-2 mm o.d.). The rings were contracted with prostaglandin F2 alpha (PGF2 alpha) and relaxed by progressively increasing the nucleoside concentration in the bathing medium. The maximal relaxation (Rmax) was expressed as a percentage of the increase in isometric tension caused by PGF2 alpha. All 15 rings responded to inosine, but only 10 responded to adenosine. In the 10 rings responding to both nucleosides, the ED50 (geometric mean with 95% confidence limits) for adenosine and inosine was 0.89 (0.76-1.26) and 224 (166-302) microM, respectively (p less than 0.001). However, in these 10 rings, the Rmax for adenosine was much less than that for inosine (p less than 0.05); thus, the mean ratio of adenosine Rmax/inosine Rmax was only 0.56 +/- 0.15 (SE). In further experiments, the methylxanthine aminophylline completely abolished the relaxation response to adenosine but did not affect the response to inosine. These results suggested that inosine relaxes the coronary artery by stimulation of a site distinct from the vascular adenosine receptor.

Fluorescent enzyme immunoassay for antibody to single- or double-stranded DNA

Fluorescent enzyme immunoassays have been developed for antibody to either single-stranded (ssDNA) or double-stranded (dsDNA) DNA. Preliminary testing of several clinically distinct groups of persons is consistent with the suggestion that the former assay (anti-ssDNA antibody) has sufficient sensitivity and specificity to be used as a generalized test for the detection of possible systemic lupus erythematosus in a heterogeneous clinical population. Further evaluation may ultimately establish its utility in the diagnosis of other related disorders. The sensitivity and specificity of the anti-dsDNA antibody fluorescent enzyme immunoassay are compatible with its use as a confirmatory test in the laboratory diagnosis of systemic lupus erythematosus. Qualitative comparisons between both assays and the more classic laboratory procedures involved in the diagnosis and treatment of systemic lupus erythematosus were quite favorable. The enzyme immunoassay method appears to be acceptably reproducible, and rheumatoid factor has neither a suppressive nor an enhancing effect on test values.

Sequence of a phosphorylation site in nucleolar protein B23

The sites of phosphorylation in protein B23, a silver-staining preribosomal ribonucleoprotein particle protein, were analyzed by tryptic peptide mapping. Three 32P peptides were found using in vitro labeling of nucleoli. An additional unlabeled phosphopeptide was identified by amino acid analysis. The sequence of the latter was Asp-Thr(P)-Pro-Ala-Lys. These results suggest that protein B23 contains one class of site labeled rapidly in vitro and another type of site phosphorylated only in vivo.

Evidence for increased protein synthesis in myocardial microvessels after chronic sympathectomy in the dog

Using histochemical methods, evidence of increased protein synthesis was observed in microvessels (diameter less than 100 micrometers) from dog hearts which had been sympathectomized 2 weeks earlier when compared to controls. Such evidence consisted of increased staining intensity for the enzyme glucose-6-phosphate dehydrogenase and for the nucleic acids RNA and DNA. Increases in reaction intensities were noted in approximately 30% of the microvessels examined from the sympathectomized hearts, and may imply a vascular proliferation in these hearts. However, since no increase in capillary density was observed in sympathectomized hearts, a vascular proliferation, if it occurred, may have been involved in development of the coronary collateral circulation. These data support previous results indicating that collateral resistances are reduced following chronic cardiac sympathectomy while resistance of the coronary vascular bed itself is not altered.

Carotid artery surgery without a temporary indwelling shunt. 1,917 consecutive procedures

One thousand nine hundred seventeen consecutive carotid artery operations were performed in which the carotid artery was clamped for as long as necessary to accomplish a revascularization procedure. Those patients adversely affected by failure to use a shunt were identified. Results of a statistical analysis of stroke morbidity when compared with the literature show that the use of an intraoperative temporary shunt does not offer improved results in carotid artery surgery.

Phosphodipeptide analysis of nonhistone nuclear proteins from Novikoff hepatoma ascites cells

To study the sites of phosphorylation in nuclear proteins a simple method was developed for the isolation and analysis of phosphodipeptides. Partial acid hydrolysates of unfractionated nonhistone nuclear proteins were subjected to Dowex-1 column chromatography followed by paper electrophoresis at pH 1.8. Phosphoserine- and phosphothreonine-containing dipeptides each had characteristic mobilities in the latter system. By subtractive Edman degradation these peptides were identified as having the general structure, X-PSer or X-PThr, where X is a nonphosphorylated amino acid. The two groups of phosphodipeptides were further purified into unique peptides by two-dimensional paper electrophoresis at pH 3.6 and 6.5. Amino acid analysis, and thus nearest neighbor analysis, of phosphodipeptides from nonhistone nuclear proteins revealed that a heterogeneous group of amino acids was on the amino terminal side of phosphoserine residues. In contrast, phosphothreonine residues were predominantly preceded by proline.

Nonmetabolically coupled coronary vasodilatation during inosine infusion in dogs

Left ventricular contractile force (LVCF), dP/dt, arteriovenous oxygen difference [(a-v)O2], circumflex blood flow (CBF), and myocardial oxygen consumption (MVo2) were determined in dogs during intravenous infusion of inosine at various rates. LCVF and maximal dP/dt increased progressively with increasing infusion rates. CBF increased by 100% at the highest infusion rate, but (a-v)O2 was reduced by 30%. At each infusion rate the increase in MVo2 was only 40% the increase in CBF (P less than 0.05), indicating a nonmetabolically coupled vasodilatation. To further demonstrate this action, the effects of isoproterenol on CBF and (a-v)O2 were compared with those of inosine. During isoproterenol infusion, the increase in CB paralleled the increase in MVo2, and (a-v)O2 showed no change. Intracoronary infusion experiments showed that a 100% increase in flow was caused by an arterial inosine level of about 150 micro M. At inosine levels over 400 micro M, the increase in flow was equal to the maximal increase seen with adenosine infusion.

Reduced coronary collateral resistances after chronic ventricular sympathectomy

Previous work has suggested that chronic ventricular sympathectomy causes a reduction in coronary collateral resistances. In the present experiments an isolated dog heart procedure was used to directly measure directional collateral resistances in 12 acutely denervated controls and 8 hearts that had undergone ventricular sympathectomy 2 wk earlier. In the procedure, the major coronary arteries were perfused separately but simultaneously during maximum vasodilation, and collateral resistances supplying the vascular beds of the arteries were determined by the double retrograde flow method. In the sympathectomized hearts, all collateral resistances were 47--65% less than in the controls (P less than 0.05). Also, in all hearts, minimum antegrade coronary resistances were determined from pressure-flow relationships in the major coronary arteries. Minimum coronary resistances in the 2 groups were not significantly different (P greater than 0.05). These results indicate that 2 wk of ventricular sympathectomy indeed causes a reduction in coronary collateral resistances, but has no effect on coronary resistances.

The myocardium and its vasculature: a histochemical comparison of the normal and chronically sympathectomized dog heart

Using histochemical techniques, the reactivities of selected enzymes and other metabolic components were examined in the myocardium, coronary arteries, and coronary arterioles of normal, two-week-sympathectomized, and sham-operated canine hearts. There were no differences in the histochemistry of coronary arteries in any of the hearts, but important differences were noted in the myocardium and especially in the arterioles. The reactivities of the enzyme glucose-6-phosphate dehydrogenase and the nucleic acids were increased in arterioles of the sympathectomized heart, possibly indicating an increased protein synthesis. The reactivities of succinate dehydrogenase, NAD-isocitrate dehydrogenase, and cytochrome oxidase were reduced in myocardium and arterioles of sympathectomized hearts as well as in arterioles of sham-operated hearts; the changes were greater in the sympathectomized arterioles where there was also observed an increase in reactivity of lactate dehydrogenase. These findings suggest a depression in aerobic metabolic capacity and, in the case of the sympathectomized arteriole, imply a possible shift in adaptation from aerobic to anaerobic metabolism.

Quantitation of rheumatoid factor activity by nephelometry

Rheumatoid factor activity can be quantitated by use of nephelometric assay system. The data presented show a good correlation between this new method and the older quantitative latex tube rheumatoid factor test. In addition, the nephelometric and latex tube testing of sera from normal, rheumatoid and non-rheumatoid patients yielded similar results, suggesting the two procedures share a similar immunologic specificity. The new nephelometric test for rheumatoid factor is simple to perform, endpoints are objectively determined, and test data are highly reproducible.

Further definition of antibiotic use and abuse in the surgical setting

Surveys of the use of antimicrobial agents were conducted at three university-affiliated teaching hospitals to ascertain the current use of antibiotics associated with surgery and to compare this use to the presently accepted standards. The survey included 300 consecutive surgical patients representing three surgical specialities. Evaluation was based on accepted therapeutic criteria with respect to the presence of an infection, appropriate in vitro antibiotic sensitivity testing, and recognized forms of prophylaxis. The results of our survey disclosed that although nonuse was usually appropriate, more often than not use of antibiotics was inappropriate. Errors, in order of frequency, included (1) misjudgments in attempted prophylaxis of operative wound infection, such as failure to use preoperative administration or use in clean operations without implanted foreign bodies, such as prosthesis, and (2) attempted treatment of undefined and undiagnosed fever.

Effect of inosine on ventricular regional perfusion and infarct size after coronary occlusion

In 16 dogs inosine was infused at 0.5 mmol/min i.v. for 5 min beginning 15 min after coronary occlusion. Tracer microspheres were used to estimate flow in subepicardium and subendocardium of nonischemic, central ischemic, and borderline ischemic muscle. Estimates of flow before occlusion, 5 min after occlusion, during inosine infusion, 30 min after infusion and 60 min after infusion were obtained. Coronary occlusion reduced flow in the central ischemic regions by 75-95%. The reduction in flow was greatest in subendocardium. In the borderline regions subendocardial flow was reduced by 30% while subepicardial flow was unaffected. The major effects of inosine were seen in nonischemic and borderline ischemic regions. Flow in borderline subendocardium returned to its pre-occlusion value, and flow in nonischemic myocardium increased by approximately 60-80%. However, only in the ischemic regions was the increase in flow sustained for the entire 60 min. In 20 dogs infarct size was determined using nitro blue tetrazolium stain. In 10 controls infarct size was 20.1%, while in 10 inosine-treated dogs infarct size was 15.2% of left ventricular weight (p less than 0.01). Thus, following coronary occlusion inosine infusion was associated with an increase in perfusion of ischemic myocardium and a reduction in infarct size.

Laryngeal tuberculosis: a case report

A case of laryngeal tuberculosis, in a 21-year-old female, is presented. The pathophysiology and natural course of the disease are discussed. The incidence of apical tuberculosis and associated laryngeal spread is noted.

A histochemical study of the microvasculature in the left and right cardiac ventricles of the dog

Subepicardial and subendocardial arteries and arterioles in both the left and right normal canine ventricle were examined histochemically to determine their metabolic profiles. Aerobic metabolic capacity was assessed by determining the reactivities of the enzymes cytochrome oxidase, succinate dehydrogenase and NAD-isocitrate dehydrogenase. Glucose-6-phosphate dehydrogenase was examined to assess activity of the hexose-monophosphate-shunt. The substrate glycogen was determined as an evaluation of anaerobic metabolic capacity, while the amounts of deoxyribonucleic and ribonucleic acid were assessed as an indication of protein synthesis. Results of the present investigation indicate that despite known hemodynamic differences, the metabolic profile of the coronary vasculature is similar in all regions of ventricular myocardium. Reactivities of the enzymes succinate and NAD-isocitrate dehydrogenase and cytochrome oxidase are greater in smooth muscle of arterioles than in arteries. This suggests that arteriolar smooth muscle has a higher capacity for aerobic metabolism than does arterial smooth muscle. The greater reactivity of glycogen in arterial, than in arteriolar smooth muscle, suggests that arterial muscle is more adapted for anaerobic metabolism. Deoxyribonucleic and ribonucleic acids demonstrate a low reactivity in both arteries and arterioles from all regions of ventricular myocardium which conforms to the opinion that under normal conditions, coronary vasculature is quite stable with little cell proliferation. Glucose-6-phosphate dehydrogenase shows little reactivity in all myocardial vessels with implies a low capacity for nucleic acid and protein synthesis.

Effects of coronary ligation of the chromically sympathectomized dog ventricle

The cardiac response to acute coronary occlusion was studied after chronic ventricular sympathectomy. Infarct size was measured using nitro blue tetrazolium. In 11 control dogs, 8 dogs with ventricles sympathectomized 2 wk earlier, and 5 sham-operated dogs, mean infarct size was 20.0%, 8.9%, and 20.4% of the left ventricular weight, respectively. Infarct size in sympathectomized ventricles was significantly less than in control or sham-operated hearts (P less than 0.05). Left ventricular perfusion before and after coronary occlusion was measured in 10 controls and 7 sympathectomized ventricles using tracer microspheres. Preocclusion flow values in chronically sympathectomized ventricles were approximately 30-40% less than in controls even though arterial pressure and heart rate were no different, suggesting an increased efficiency. Furthermore, after coromanary occlusion, collateral perfusions in the central and peripheral ischemic zones of the sympathectomized ventricles were 200-400% of those in nonsympathectomized ventricles. When collateral perfusion was related to the respective preocclusion flows, the difference between control and sympathectomized ventricles was even greater. Thus, chronic ventricular sympathectomy results in reduced infarct size, and this effect may be due to a reduced flow demand as well as to an increased collateral perfusion.

The effect of chronic cardiac denervation on infarct size following acute coronary occlusion

The effect of acute coronary ligation on infarct size was studied in (1) ten acute control dogs, which were non-denervated, (2) in six acutely denervated dogs in which the heart was denervated immediately prior to coronary ligation and in which intra-cardiac reflexes were pharmacologically blocked, (3) in seven chronically denervated dogs in which intrapericardial nerves were cut 2 weeks prior to ligation, and (4) in four dogs which were sham-operated 2 weeks prior to ligation. Infarct size was determined using a nitro blue tetrazolium stain for dehydrogenase activity. Infarct sizes in acute controls, acutely denervated, chronically denervated, and sham-operated hearts were 20.1, 15.0, 3.8, and 21.0 per cent of left ventricular weight, respectively. Infarct sizes in acutely and chronically denervated hearts were significantly less than in acute controls (P less than 0.05). In further studies the fluorescent stain thioflavin S was used to demonstrate that perfusion of myocardium distal to the ligation was substantially greater in chronically denervated hearts than in acute controls.

Perinatal mortality and one-year infant morbidity

Perinatal mortality in Southampton and South-west Hampshire Health District fell from 20.8 per 1000 total births in 1970 to 11.3 per 1000 in 1976. This was atributable mainly to a fall in the stillbirth rate, but also to a recent fall in the neonatal death rate in the first week. All infants born in 1975 who had any problems in the perinatal period were followed up for one year. Of the 12 children identified at one year as having a major handicap, eight suffered from problems of prenatal origin, two from problems associated with preterm delivery, and two from other conditions acquired during the perinatal period. As two-thirds of the major handicaps arose from congenital abnormalities, preterm delivery and low birth weight were not the main causes of major handicap.

Gastrocutaneous fistula: etiology and treatment

Gastrocutaneous fistula is an infrequent but serious surgical complication which has received little attention in the recent literature. The current report analyzes 13 patients with this complication. The fistula most commonly occurs in the fundic portion of the greater curvature of the stomach and is usually a result of unrecognized iatrogenic injury or associated with severe left upper quadrant inflammation and external drainage. Clinical recognition occurs when the patient develops left subphrenic sepsis or drains gastric content. The fistula is best documented by upper gastrointestinal contrast studies and usually responds to wide drainage and supportive treatment in the presence of benign disease. Oral alimentation apparently need not be delayed until complete fistula closure.