Alterations in hemodynamics and Kf,c during lung mass resection

The effects of progressive lung mass reduction on total pulmonary vascular resistance (RT), compliance (CT), arterial (Pa), venous (PV), and capillary (Pc) pressures, and the capillary filtration coefficient (Kf,c) were evaluated in whole isolated dog lungs perfused with autologous blood. RT increased (P less than 0.05) in a nonlinear fashion when mass was reduced by greater than 35% in zone 3 lungs (Pa greater than PV greater than airway pressure) perfused at constant pressure (CP, n = 9), a finding predicted by a model of rigid parallel flow channels subjected to loss of cross-sectional area. Furthermore, these findings were not altered by pretreatment with ibuprofen or diphenhydramine (n = 7). In contrast, in zone 3 lungs perfused with constant flow (CF, n = 4), RT did not increase until at least 60-75% of mass was removed. Since Pa and Pc were constant in the former group, but increased in the latter group (P less than 0.05), the attenuation of RT by CF is best explained by vascular distension. This is supported by the finding that microvascular C, as a fraction of CT, decreased significantly with CF, but not with CP. Kf,c and CT (referenced to the initial lung mass) decreased linearly with reductions in lung mass % delta Kf,c = 1.26-0.98% mass removed (r = 0.90, P less than 0.01) and % delta CT = -3.99-0.98% mass removed (r = 0.82, P less than 0.01) relationships that were not altered by blocker pretreatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Diamide stimulates calcium-sodium exchange in dog red blood cells

Calcium influx can be stimulated in dog red blood cells by preexposure to diamide under certain conditions. Diamide-activated calcium influx resembles swelling-induced Ca2+-Na+ exchange in several respects. These include saturation of calcium influx at external calcium levels greater than 0.5 mM, suppression of calcium influx by external sodium, and inhibition by quinidine. The ability of diamide to stimulate this transport pathway depends critically on the ionic composition of the medium in which the cells are bathed at the time of diamide exposure. The effect is greatest if the diamide preincubation is conducted in a hypotonic lithium chloride medium containing at least 1 microM calcium. Stimulation of Ca2+-Na+ exchange is seen at diamide concentrations (0.10-0.33 mM) that are lower than those reported to cause major spectrin cross-linking, glutathione depletion, Ca2+-ATPase inhibition, or ion channel formation. The results suggest that dog red cells have a large latent capacity for Ca2+-Na+ exchange.

Risk assessment and oncodynamics of ethylene oxide as related to occupational exposure

Two rat inhalation bioassays have been integrated into the risk assessment on the carcinogenicity of ethylene oxide (EO). The carcinogenic findings as well as relevant metabolism and pharmacokinetic data are reviewed. Brain tumors were selected as the endpoint for the assessment of risk because of the indication that adverse effects on the nervous system, related to EO exposure, were consistent across species. Two methods, time-exposure concentration product and area under the plasma concentration-time curve (AUC) are used as a basis for calculating effective dose. Scaling of the dose to man from both rat and dog is explored based on pharmacokinetic studies. Two different mathematical risk extrapolation models, the probit and the multi-stage, are used to estimate the cancer risk for daily exposures to EO of 1.8 microgram/liter over a working lifetime. The use of AUC as a basis for dose from a daily exposure of 1.8 microgram/liter over a working lifetime gives the higher risk rates (90-142/10,000 workers). The implication of the simulated dose using plasma concentrations versus the time-concentration product approach is discussed in relation to threshold effects.

Nontraumatic clavicle lesions in children

Sixteen children (average age 7.4 years) with nontraumatic lesions of the clavicle were reviewed. There were six cases of neoplasms, six cases of infection, and four developmental anomalies. The patients with infections all had pain at presentation, with elevated white blood cell counts and erythrocyte sedimentation rates. Tissue biopsy was an important diagnostic tool.

Band 3 tyrosine kinase in avian erythrocyte plasma membrane is immunologically related to pp60c-src

We have identified in the plasma membrane of the chicken erythrocyte a 60-kDa tyrosine-specific protein kinase immunologically related to the transforming protein pp60v-src of Rous sarcoma virus. The erythrocyte protein kinase phosphorylated heavy chains of tumor-bearing rabbit (TBR) antibodies reactive with pp60c-src at tyrosine in immune complex protein kinase assays. The kinase was identified as a 60-kDa protein by [35S]methionine labeling of erythrocytes and by autophosphorylation in immune complexes. The kinase migrated on two-dimensional gel electrophoresis with an apparent pI and molecular mass similar to pp60c-src. A plasma membrane-enriched fraction isolated from chicken red cells contained the majority of the kinase activity. The kinase was solubilized from the plasma membrane by the detergents 0.5% (wt/vol) Na-deoxycholate and 1% (vol/vol) Nonidet P-40. One molar NaCl was much less effective, indicating a strong association of the kinase with the plasma membrane. Incubation of the plasma membrane fraction with [32P]ATP resulted in tyrosine phosphorylation of the anion transport protein band 3. Band 3 phosphorylation was blocked by TBR antibodies, indicating that the kinase recognized by pp60c-src antibodies was responsible for band 3 phosphorylation. These results demonstrate that the avian erythrocyte plasma membrane contains a tightly bound tyrosine-specific protein kinase identical or closely related to pp60c-src and that this kinase is responsible for band 3 phosphorylation in vitro.

Interactions of sodium-proton exchange mechanism in dog red blood cells with N-phenylmaleimide

Dog red blood cells (RBC) have a Na-H exchanger that is reversibly activated by cell shrinkage. The Na-H exchanger can be fixed in the on or off mode by treating the cells with N-phenylmaleimide. This action depends on the volume of the cells at the time of exposure to N-phenylmaleimide and also on the concentration of the reagent per number of cells. If the cells are swollen in hypotonic media during N-phenylmaleimide exposure, the Na-H exchanger becomes irreversibly inactivated, so that on subsequent shrinkage of the cells, no amiloride-sensitive Na flux is seen. This effect is maximal at N-phenylmaleimide concentrations of greater than 20 mumol/g hemoglobin. If the cells are shrunken in hypertonic media during N-phenylmaleimide exposure, the response of the Na-H exchanger depends critically on the concentration of the reagent. At N-phenylmaleimide concentrations of less than 20 mumol/g hemoglobin, the Na-H exchanger is fixed in the activated state, so that even when the volume stimulus is removed by subsequent cell swelling, an amiloride-sensitive flux is seen. Higher concentrations of N-phenylmaleimide applied to shrunken cells inhibit the Na-H exchanger. The results are accounted for in a model that envisions a volume-responsive switching mechanism for Na-H exchange that has two functional groups capable of reacting with N-phenylmaleimide. The accessibility of these groups is determined by cell volume.

Analysis of altered capillary pressure and permeability after thermal injury

In order to investigate the effects of thermal injury on microvascular hemodynamics and permeability, hindpaw arterial (PA), venous (PV), and capillary (PC) pressures, blood (QB) and lymph (QL) flows, and lymph (CL) and plasma (CP) total protein concentrations were measured before and for 3 hr after a 10-sec 100 degrees C scald burn in 11 dogs. Prior to injury in eight experiments (Group I--permeability analysis) venous pressure was elevated by outflow restriction until the minimal CL/CP was obtained. In three experiments (Group II--hemodynamic analysis) outflow was not restricted. Lymph and plasma protein fractions ranging in size from 37 to 120 A were measured using gradient gel electrophoresis and capillary equivalent pore sizes were calculated. In the early postburn period, PC increased from 24 +/- 2 (mean +/- SE) to 47 +/- 5 mm Hg (P less than 0.05) and precapillary resistance (RA) decreased from 6.6 +/- 0.2 to 2.5 +/- 0.2 mm Hg/ml/min/100 g (P less than 0.05) while postcapillary resistance (RV) remained unchanged. Pre- to postcapillary resistance (RA/RV) fell by 74%. The reflection coefficient for total proteins (calculated as sigma = 1 - CL/CP) decreased from 0.87 +/- 0.01 to 0.45 +/- 0.02 (P less than 0.01). Permeability of the postburn capillary endothelium was described by using two populations of equivalent pores. Preburn pore radii were 50 and 300 A with 13% of the capillary filtrate passing through the large pores. Pore radii increased after injury to 70 and 400 A with 49% of the filtrate passing through the large pores. The postburn total tissue filtration coefficient (Kf) increased to 2.4 times the control. Over the first 3 hr postburn, 53% of the increase in capillary filtration was attributable to increased capillary pressure and 47% to increased permeability. We conclude that the early rapid edema formation following thermal injury is the result of marked increases in both capillary filtration pressure and filtration through large nonsieving pores.

Further evidence for coupling of sodium and proton movements in dog red blood cells

Using 4,4'-diisothiocyanostilbene-2,2'-disulfonate (DIDS) and tributyltin the sodium transport pathway activated by shrinkage in dog red blood cells is shown to behave as expected for an electroneutral Na+/H+ exchanger. When the driving forces for sodium and protons are equal, flow through the pathway stops. Amiloride inhibits the shrinkage-induced Na+/H+ exchange.

Interstitial distribution of charged macromolecules in the dog lung: a kinetic model

A mathematic model was constructed to investigate conflicting physiologic data concerning the charge effect of continuous capillaries to macromolecules in the lung. We simulated the equilibration kinetics of lactate dehydrogenase (MR 4.2 nM) isozymes LDH 1 (pI = 5.0) and LDH 5 (pI = 7.9) between plasma and lymph using previously measured permeability coefficients, lung tissue distribution volumes (VA) and plasma concentrations (CP) in lung tissue. Our hypothesis is that the fixed anionic charges in interstitium, basement membrane, and cell surfaces determine equilibration rather than charged membrane effects at the capillary barrier, so the same capillary permeability coefficients were used for both isozymes. Capillary filtration rates and protein fluxes were calculated using conventional flux equations. Initial conditions at baseline and increased left atrial pressures (PLA) were those measured in animal studies. Simulated equilibration of isozymes over 30 h in the model at baseline capillary pressures accurately predicted the observed differences in lymph/plasma concentration ratios (CL/CP) between isotopes at 4 h and equilibration of these ratios at 24 h. Quantitative prediction of isozyme CL/CP ratios was also obtained at increased PLA. However, an additional cation selective compartment representing the surface glycocalyx was required to accurately simulate the initial higher transcapillary clearances of cationic LDH 5. Thus experimental data supporting the negative barrier, positive barrier, and no charge barrier hypotheses were accurately reproduced by the model using only the observed differences in interstitial partitioning of isozymes without differences in capillary selectivity.

Segmental vascular resistances and compliances in dog lung

The segmental distribution of vascular resistances and compliances were evaluated in isolated blood perfused lung lobes using arterial, venous, and double-occlusion pressures and were compared with filtration midpoint capillary pressures (Pc,f). We separated total vascular resistance (RT) and compliance (CT) into large artery (Ra, Ca), large vein (Rv, Cv), and microvascular compartments (Rmc, Cmc) at base-line and increased vascular pressures and during infusions of histamine, serotonin, and norepinephrine. In control lobes, double-occlusion pressure (Pdo) closely approximated Pc,f at all vascular pressures. Pre- and postcapillary resistance were approximately equal when referenced to either Pc,f or Pdo. Although Rmc comprised 42% of RT and Cmc constituted 76% of CT, a twofold increase in base-line Pc,f caused RT to decrease to 67% and Rmc/RT to 29% of control values, whereas CT decreased to 87% and Cmc/CT decreased to 88% of control values over the same Pc,f range. Mean static CT was 2.25 +/- 0.09 ml X cmH2O-1. 100 g-1, whereas dynamic CT was 1.54 +/- 0.08 ml X cmH2O-1. 100 g-1, or only 68% of static vascular compliance. Drug infusions increased mean RT from 4.2- to 5.3-fold and significantly decreased both static and dynamic CT. Although all vascular segments were constricted, histamine affected primarily large veins, serotonin increased Ra greater than Rv, and norepinephrine constricted upstream and downstream vessels about equally. Increased Pc,f in the presence of these drugs decreased RT significantly in every case primarily through attenuation of the drug vasoconstrictor effect on Rmc and decreased CT primarily due to a decrease in Cmc, but increased Cmc/(Ca + Cv). Thus the microvascular compartment appears to be the major site of both fluid filtration and vascular compliance and contributes significantly to total vascular resistance. Drug infusions constricted large and small vessel compartments as defined here, but increased Pc,f attenuated microvascular vasoconstriction and to a lesser extent large vessel vasoconstriction resulting in a reduced microvascular resistance in both drug-treated and control lobes. This effect can be attributed to recruitment and/or distension of microvessels and distension of larger vessels.

Biological basis for extrapolation across mammalian species

The rationale for extrapolation or "scaling" across species is founded in the commonality of anatomic characteristics and the universality of physiologic functions and biochemical reactions. The development of the allometric equation, Y = aWn, relating species body size (W) with various morphological, physiological, biochemical, pharmacological, and toxicological characteristics, as the fundamental basis for extrapolation of biological data from laboratory animals to man is outlined. The familiar methods of extrapolation on the basis of "milligrams per kilogram body weight" and "body surface area" are simply examples, W1.0 and W0.67, respectively, of this equation. The experimental observations used to support these two, and other extrapolation bases, are reviewed. Criteria for the selection of an appropriate base for transfer of specific biologic data from laboratory animals to man, and the expected reliability of the extrapolation, are discussed with the enunciation of four guiding principles. The application of these principles to the extrapolation to man of dose-tumor incidence data from carcinogenicity bioassays of laboratory animals is discussed. The components are identified, and illustrative examples are given.

Paralytic hip instability in poliomyelitis

A retrospective study was made of the results of surgical treatment of subluxation or dislocation of the hip in patients who had suffered from poliomyelitis. Good results were achieved in 46% and satisfactory results in 24%. The key factors for success are muscle balance, the femoral neck-shaft and anteversion angles, and the acetabular geometry. Iliopsoas transfer can augment the hip abductor power by an average of one MRC grade. Varus derotation femoral osteotomy is important to re-establish a normal neck-shaft angle and anteversion. The results of pelvic osteotomy are variable and the importance of a posterior acetabular defect is emphasised.

Validation of double vascular occlusion method for Pc,i in lung and skeletal muscle

Capillary pressures in isogravimetric lung and skeletal muscle measured with the double vascular occlusion technique (Pdo) were compared to those measured using the traditional gravimetric technique (Pc,i). Pressures were measured using both techniques in isolated blood-perfused canine lungs (n = 18), blood-perfused rat hindquarters before (n = 8) and after (n = 6) maximal dilatation with papaverine and in rat hindquarters perfused with an artificial plasma (n = 6). In both organs, regardless of vascular tone, the double vascular occlusion isogravimetric pressure was the same as the gravimetric Pc,i, and the two measurements were highly correlated. Lung: Pdo = -0.22 + 1.06 Pc,i (r = 0.85, P less than 0.01); hindquarter: Pdo = -1.03 + 0.99 Pc,i (r = 0.91, P less than 0.01). In addition, Pdo was the same at every combination of isogravimetric arterial and venous pressures tested. The results indicate that the more rapidly applied double vascular occlusion pressure yields an accurate measure of isogravimetric capillary pressure in isolated organs over a wide range of isogravimetric pressures.

Transvascular clearance and distribution of charged macromolecules in ANTU lung injury

Tissue uptake, extravascular distribution volumes, and plasma-lymph equilibration of two isozymes of lactate dehydrogenase (LDH) were labeled with radioiodine and studied in dogs with either normal or injured lungs. Cationic LDH 5 [isoelectric point (pI) = 7.9] was initially cleared from plasma by lung tissue at a rate 1.61 times higher (9.3 vs. 5.8 X 10(-3) ml X min-1 X g-1 extravascular wet wt) than anionic LDH 1 (pI = 5.0). LDH 5 also had a significantly higher extravascular distribution volume but equilibrated more slowly between plasma and pulmonary lymph (t1/2 = 120 min) than LDH 1 (t1/2 = 78 min) in normal lungs. Respective lymph-to-plasma ratios were 0.53 and 0.43 for LDH 1 and LDH 5 after 4 h of infusion. Infusion of the isozymes 2 h after injection of alpha-naphthylthiourea (ANTU) resulted in larger initial tissue plasma clearances for both isozymes compared with control, but greater relative tissue plasma clearances and extravascular distribution volumes for LDH 5 compared with LDH 1. Plasma-lymph equilibration half times of LDH 5 and LDH 1 were reduced after ANTU to 50 min and 41 min, respectively, whereas the respective alveolar fluid-to-plasma ratios of the two isozymes at termination of the ANTU experiments were 0.56 and 0.84. These data suggest that the fixed anionic charges on endothelial cell surfaces, intercellular junctions, basement membranes, and interstitial structures act much like a cation exchange gel to rapidly take up cationic proteins and retard the plasma-lymph equilibration of these proteins relative to anionic proteins of the same size.(ABSTRACT TRUNCATED AT 250 WORDS)

Interactions of lithium and protons with the sodium-proton exchanger of dog red blood cells

Passive movements of Li in dog red blood cells (RBC) ar like those of Na and protons in being stimulated by osmotic cell shrinkage and inhibited by amiloride. Li and protons have similar asymmetrical effects on Na-H exchange. When the intracellular fluid is made rich in Li or protons, Na-H exchange is stimulated. When the extracellular fluid is enriched in Li or protons, Na-H exchange is inhibited. In the case of protons, these effects can override alterations in driving force that are created by the experimental conditions. For example, acidification of the cytoplasm stimulates outward Na movements, while acidification of the medium inhibits Na efflux. Thus, protons (and, by analogy, Li) can interact with the Na-H exchanger not only as substrates but also as modulators. In previous experiments, the only way to activate the Na-H exchanger in dog RBC was to shrink the cells in hypertonic media. The influences of Li or protons, however, are so strong as to preempt the volume effects, so that the pathway can be activated even in swollen cells and deactivated in shrunken ones.

Empirically derived pain-patient MMPI subgroups: prediction of treatment outcome

Fifty-seven male chronic pain patients admitted to an inpatient multimodal pain treatment program at a Midwestern Veterans Administration hospital completed the MMPI, Profile of Mood States (POMS), Tennessee Self-Concept Scale (TSCS), Rathus Assertiveness Schedule (RAS), activity diaries, and an extensive pain questionnaire. All patients were assessed both before and after treatment, and most also were assessed 2-5 months prior to treatment. No significant changes occurred during the baseline period, but significant improvements were evident at posttreatment on most variables: MMPI, POMS, TSCS, RAS, pain severity, sexual functioning, and activity diaries. MMPI subgroup membership, based on a hierarchical cluster analysis in a larger sample, was not predictive of differential treatment outcome. Possible reasons for comparable treatment gains among these subgroups, which previously have been shown to differ on many psychological and behavioral factors, are discussed.

Fluid filtration and protein clearances through large and small pore populations in dog lung capillaries

Solvent drag reflection coefficients (sigma f) for six protein fractions with hydrodynamic radii ranging from 37 to 120 A were determined using dog lung lymph CL/CP data over a range of lung lymph flows (QL). Two equivalent pore populations with effective radii of 75-85 A and 200-325 A were determined for the pulmonary capillaries over a range of mean lymph flows for 1.8 to 6.3 times control. Fractional fluid clearance through the large pore population was observed to decrease from 0.28 to 0.16 as QL increased. These data indicate that lymph flow (filtration) increased primarily by an increased filtration through small pores with relatively little increase in filtration through the large pore population. The shift to small pore filtration at high filtration rates accounts for the dependence of the homoporous estimate of total protein sigma f on lymph flow previously observed using lung lymph (Parker et al., 1981). If capillary membrane heteroporosity is present then there should be a net convective clearance of protein across the capillary caused by a volume circulation between large and small pore populations. Minimal estimates of 6-10% of protein clearance are attributed to this mechanism even in the absence of net fluid movement across the capillary. The optimal solute radius for clearance due to volume circulation is about 60 A, based on the membrane pore sizes determined for lung capillaries. Although convective transport of macromolecules is generally acknowledged to account for most transcapillary protein clearance at high filtration rates, the inclusion of a volume circulation component suggests that convection may also be the dominant mode of macromolecular transport at low filtration rates.

Postmortem evaluation of Alzheimer's disease

Postmortem evaluation of ten individuals with a diagnosis of Alzheimer's disease (AD) confirmed the clinical diagnostic accuracy at our institution and showed significant ventricular dilatation with reduced brain mass, increased neuritic plaques, neurofibrillary tangles, vascular amyloid, and Lewy bodies in these individuals. A matched control group had no or fewer cortical neuritic plaques and neurofibrillary tangles, and two of the four control patients with rare neuritic plaques had terminal dementia. Cancer and cardiovascular disease occurred more often in the control group, but pneumonia and respiratory failure were more prevalent in the patients with AD. Thorough clinical assessment can accurately indicate Alzheimer's disease, as shown in this study.

Plasma-lymph exchange and interstitial distribution volumes of charged macromolecules in the lung

The plasma-lymph exchange of two lactate dehydrogenase (LDH) isozymes (4.2 nM) of different molecular charge between plasma (CP) and lung lymph (CL), their initial clearances across the capillary wall, and their extravascular distribution volumes were studied in dog lungs at control and increased left atrial pressures (Pla = 23.3 +/- 2.1 cmH2O). The anionic LDH 1 [isoelectric point (pI) = 5.0] exhibited a more rapid plasma decay compared with cationic LDH 5 (pI = 7.9) after bolus injection but was maintained relatively constant in several experiments using a constant infusion. The mean 10- to 12-min lung tissue clearances were 40% higher for LDH 5 than LDH 1 at control Pla and 120% higher at increased Pla. The CL/CP ratios of the anionic LDH 1 were consistently higher at 4-5 h after simultaneous injection than those of cationic LDH 5. However, the extravascular distribution volumes of LDH 5 were significantly higher in lymph equivalents than those of LDH 1 at 4 h in both Pla groups. Fixed negative charges located on endothelial cells, basement membrane, and interstitial matrix could explain the observed differences between LDH isozymes in CL/CP ratios, tissue uptake, and extra-vascular distribution volumes by the ionic interaction of LDH 5 with these negative change sites which would retard the plasma-lymph transport and enhance the extravascular distribution volume and initial clearance of these cationic macromolecules.

Exclusion of charged macromolecules in the pulmonary interstitium

The polyanionic glycosaminoglycans and glycoproteins of the interstitial ground substance could influence the interstitial distribution volumes (VA) of plasma proteins filtered across the pulmonary capillaries depending upon the molecular charge of the proteins. To determine if such differences occur, two isozymes of lactate dehydrogenase (LDH) were selectively labeled with either 125I or 131I and infused simultaneously at a rate sufficient to maintain constant plasma concentrations for 24 hr. The isoelectric points of LDH 1 and LDH 5 are 5.0 and 7.9, respectively, but they have the same mol wt (140,000) and hydrodynamic radius (42 A). VA values were calculated in lymph equivalents based on the respective activities in prenodal tracheobronchial lymph. We corrected the residual blood in the tissue using either 99mTc-labeled red cells or Dextran 70 washout of blood. At 24 hr the VA for cationic LDH 5 was significantly greater than that of anionic LDH 1 (0.299 vs 0.197 ml/g wet wt) in the lung. Lymph/plasma ratios for LDH 1 and 5 were not significantly different (0.63 vs 0.58) and total extravascular lung water was not significantly different from normal. This indicates the LDH 1 was excluded from a significantly greater portion (47%) of interstitial fluid than LDH 5 (21%), and suggests an interaction of the fixed negative charges on interstitial polysaccharides with cationic proteins.

Ovarian cancer complicated by cerebellar degeneration: a paraneoplastic syndrome

A patient with ovarian carcinoma who subsequently developed the paraneoplastic syndrome of cerebellar degeneration is presented. The literature is reviewed and possible explanations of the phenomenon are discussed.