Sensitivity of veiled (dendritic) cells to cyclosporine

The effect of cyclosporine (CsA) on dendritic cell function was tested by pulsing rabbit veiled cells (VC, the "dendritic" cells from the afferent lymph) with the drug. This treatment inhibited their capacity to enhance proliferative responses of autologous peripheral blood lymphocytes to the mitogen concanavalin A. The concentration of CsA required to produce inhibition varied from one rabbit to another and ranged from 5 to 100 ng/ml. The degree of inhibition was greater under conditions in which the normal VC were more effective. Addition of further untreated VC restored the response, but this restoration was incomplete under some culture conditions. Pulsing peripheral blood mononuclear cells (PBM) with CsA also produced a reduction in the stimulation by Con A, and the response was not restored by addition of normal VC. The experiments did not distinguish whether the effect of CsA was directly on dendritic cell function or via a secondary effect of "presentation" of CsA to lymphocytes by the dendritic cells.

Extra intestinal influences on exhaled breath hydrogen measurements during the investigation of gastrointestinal disease

During the clinical investigation of patients with gastrointestinal disease by exhaled breath hydrogen measurement, the occurrence of inexplicable variations in recorded hydrogen values led to a search for extra intestinal factors which were capable of adversely influencing breath hydrogen concentration and impairing the diagnostic accuracy of the test. Serial breath samples were collected from normal subjects under a variety of conditions which might occur during routine clinical study, including, hyperventilation, exercise, cigarette smoking, and carbohydrate ingestion. Breath hydrogen concentrations were consistently reduced by hyperventilation (p less than 0.01) and exercise (p less than 0.05). Cigarette smoking, in contrast, caused a marked rise in measured breath hydrogen (p less than 0.01), as did oral carbohydrate (p less than 0.05). Prior bactericidal mouthwash abolished this carbohydrate associated rise, suggesting that the hydrogen was the result of fermentation by oropharyngeal bacteria. Because, in all instances, the changes in breath hydrogen were of sufficient magnitude to interfere with data interpretation, it is recommended that these factors are eliminated, whenever possible, from conditions of study.

Acylmorphinans. A novel class of potent analgesic agents

A series of novel 2- and 3-acylmorphinans (8-14) was synthesized in our search for a potent analgesic agent with low addiction potential. The compounds were evaluated for antinociceptive potency and receptor binding affinity. Among these compounds, the levorotatory 3-acetyl-N-(cyclopropylmethyl)morphinan (12) was found to be an orally active analgesic, comparable in potency to morphine (1), yet only weakly able to substitute for morphine (1) in morphine-dependent rats.

Inhibition of rat liver glutathione S-transferases by piriprost: kinetics of the inhibition and preliminary evidence that piriprost may be a poor alternative substrate for these enzymes

The administration of tritiated piriprost, an inhibitor of leukotriene formation, to rats resulted in its rapid excretion. Some 90 percent of the initial dose was excreted in the feces and only five to six percent were recovered in the urine, regardless of the route of administration of the compound. The finding of significant, though low, residual activity in the liver even seven days after dosing (0.016 and 0.072% of dose in orally and iv-treated animals, respectively) suggested that piriprost may be bound by proteins in liver which play a role in detoxification. The finding that piriprost is a potent inhibitor of several partially purified cytosolic liver glutathione S-transferases ( EC 2.5.1.18) is consistent with this suspicion. Kinetic studies indicate that the inhibition may be competitive with the chromogenic substrate, chloro-2,4-dinitrobenzene (Ki 1-2 microM) and non-competitive with respect to glutathione when the second substrate was present at saturating concentration. Incubation of one to four micromolar radiolabeled tritiated piriprost with glutathione resulted in the gradual formation of a series of products which could be detected by high pressure liquid chromatography. The formation of these products was stimulated by the presence of glutathione S-transferase although the same products were also formed in the absence of the enzyme.

Use of adjuvants for enhancement of rectal absorption of cefoxitin in humans

The biological availability of cefoxitin administered rectally in the form of suppositories was examined in six human subjects by a cross-over design. Four different suppository systems containing adjuvants expected to enhance the absorption of the drug were studied. The presence of sodium salicylate and a nonionic surface-active agent, Brij 35, gave increased bioavailability as high as 20% compared with 3% for a system without adjuvants. The quantity of sodium salicylate was found to have an influence on the quantity of cefoxitin absorbed, and the salicylate was absorbed over an extended period of time from the rectum. The suppositories were well tolerated, and there were no adverse effects on bowel flora.

Effects of anthrax toxin components on human neutrophils

The virulence of Bacillus anthracis has been attributed to a tripartite toxin composed of three proteins designated protective antigen, lethal factor, and edema factor. The effects of the toxin components on phagocytosis and chemiluminescence of human polymorphonuclear neutrophils were studied in vitro. Initially, it was determined that the avirulent Sterne strain of B. anthracis (radiation killed) required opsonization with either serum complement or antibodies against the Sterne cell wall to be phagocytized. Phagocytosis of the opsonized Sterne cells was not affected by the individual anthrax toxin components. However, a combination of protective antigen and edema factor inhibited Sterne cell phagocytosis and blocked both particulate and phorbol myristate acetate-induced polymorphonuclear neutrophil chemiluminescence. These polymorphonuclear neutrophil effects were reversible upon removal of the toxin components. The protective antigen-edema factor combination also increased intracellular cyclic AMP levels. These studies suggest that two of the protein components of anthrax toxin, edema factor and protective antigen, increase host susceptibility to infection by suppressing polymorphonuclear neutrophil function and impairing host resistance.

T-cell chronic lymphocytic leukaemia: anomalous cell markers, variable morphology, and marked responsiveness to pentostatin (2'-deoxycoformycin)

4 men with an unusual variant of T-cell chronic lymphocytic leukaemia are reported. The clinical features differed from the virus-associated T-cell disease reported from Japan, the Caribbean, and the southeastern United States. Cytology was pleiomorphic: cells with cerebriform nuclei resembling Sézary cells and lymphocytes with cytoplasmic granules resembling T-suppressor cells occurred in the same patients. Immunofluorescence studies with monoclonal antibodies suggested that the leukaemia cells expressed determinants of both helper- (OKT4+) and suppressor-(OKT8+) related antigens. The cells were TdT-negative. In all patients the disease was very refractory to conventional cytotoxic agents, but there was prompt and extensive response to the adenosine deaminase inhibitor pentostatin (2'-deoxycoformycin). This agent merits further study in the treatment of T-cell chronic lymphocytic leukaemia.

Amylase excretion after exercise

Increase in amylase excretion in the urine in response to 8 days of aerobic running is delayed until after the athletes have rested for 24-48 h. In contrast, the amylase creatinine ratio is increased immediately after intense short-term exercise. The mechanism for these differences is unknown, but the timing of the amylase excretion pattern after long- and short-term exercise is similar to the urinary amylase after continuous and single bolus intravenous glucagon.

Dipyridamole-thallium-201 scintigraphy in the prediction of future cardiac events after acute myocardial infarction

To evaluate the safety and usefulness of serial thallium scanning immediately after intravenous dipyridamole, we studied 51 patients recovering from acute myocardial infarction. Eight patients experienced angina during the procedure, but there were no serious complications. Patients were followed for a mean period of 19 months after hospital discharge. Eleven of 12 patients who died during follow-up or had another infarction had shown transient defects (redistribution) on their predischarge scan, as had 22 of the 24 patients who needed readmission for management of angina. Among all the other clinical or scintigraphic criteria tested, the presence of redistribution on the dipyridamole-thallium scan was the only significant predictor of these serious cardiac events. Twenty-six patients were also given a submaximal exercise test before discharge, of whom 13 subsequently had serious cardiac events. The exercise test had been positive in only 6 of these 13 patients, whereas the dipyridamole-thallium scan had shown a redistribution pattern in 12 (P less than 0.001). We conclude from this preliminary study that dipyridamole-thallium scintigraphy after myocardial infraction is relatively safe. It appears to be a more sensitive predictor of subsequent cardiac events than a submaximal exercise test and may therefore prove useful in evaluating patients after recovery from a myocardial infarction.

The effect of glucagon on urine amylase in various animal species

Glucagon effects on the kidney include increased water, creatinine, and amylase clearance. We have compared these effects in several laboratory animal species. Although every species responded to glucagon, 1 mg iv, by some alteration in renal function there were differences in the degree and direction of the changes. Glucagon caused an increase in amylase clearance in four of the six species studied and an increase in creatinine clearance in four. An increase in urine flow tended to occur in all species. An increased amylase clearance is a feature of acute pancreatitis, and raised glucagon levels have been found during attacks. It is possible that the two are causally related. In the experimental situation, timing of urine collections and species differences were found to be of critical importance in exploring this possibility.

Role of veiled cells in lymphocyte activation

Peripheral blood lymphocytes from normal rabbits or from rabbits hyperimmunized with human immunoglobulin were cultured in 20-microliters hanging droplets. The cultures were stimulated with concanavalin A or, in the case of cells from sensitized animals, with human immunoglobulin. The addition to the cultures of small numbers of autologous or allogeneic veiled cells separated from afferent lymph increased the responses to low doses of the stimulants, particularly when the cells were cultured at low cell densities or for short periods of time. At high cell densities or at longer periods of culture, stimulation occurred in the absence of added veiled cells and was associated with clumping of the lymphoid cells and development of cells which morphologically resembled veiled cells found in afferent lymph. The enhanced responses upon addition of small numbers of veiled cells were also correlated with the formation of lymphoid aggregates which were frequently held together by the elongated processes of a single veiled cell. The observations support the view that the veiled cells are lymph-borne precursors of dendritic cells in the lymph nodes. This may provide an in vitro model for the cellular relationships which occur in paracortical cords of lymph nodes following antigenic stimulation.

Assessing methods for measuring compliance with a fat-controlled diet

This study assessed the relative validity of the following non-laboratory measures of compliance with a fat-controlled diet by hypercholesterolemic males: quantitative and qualitative measures of compliance derived from three-day food records and structured interviews, and summary ratings by nutritionists and interviewers. The quantitative measures of consumption referred to: saturated fat, linoleic acid, polyunsaturated fat, P/S ratio and cholesterol. The non-laboratory measures were assessed using the following two laboratory measures as criteria of validity: serum cholesterol concentration and the proportion of linoleic acid among the fatty acids of the serum cholesteryl esters. The results showed that, with respect to quantitative measures, the food record and interview manifested approximately equal validity, with the former marginally more valid. However, under certain conditions qualitative measures, such as patients' self-ratings, were about as valid as the more rigorous and expensive quantitative measures. Characteristics of the patient influenced the validity of the various measures. Validity was enhanced by the simultaneous use of certain combinations of measures.

Metastable creatine kinase MM and complexes of creatine kinase BB and immunoglobulin G, "atypical" isoenzymes with similar electrophoretic mobility

Metastable creatine kinase MM isoenzyme was isolated and partially purified from homogenates of myocardium and skeletal muscle by gradient elution on carboxymethyl cellulose. This variant isoenzyme migrated between the MM and MB isoenzymes on agarose electrophoresis, accounted for 3.5% of the total creatine kinase activity in each tissue, was not a macromolecule, and had stable electrophoretic mobility only in borate buffer (0.02 mol/L). By comparison, the creatine kinase isoenzymes with similar "atypical" electrophoretic mobility in serum specimens were complexes of the BB isoenzyme and immunoglobulin G. These complexes were measured by a radioimmunoassay specific for the creatine kinase B-subunit and eluted predominantly with the MB isoenzyme in a commercial anion-exchange reagent system.

Metastable creatine kinase MM and complexes of creatine kinase BB and immunoglobulin G, "atypical" isoenzymes with similar electrophoretic mobility

Metastable creatine kinase MM isoenzyme was isolated and partially purified from homogenates of myocardium and skeletal muscle by gradient elution on carboxymethyl cellulose. This variant isoenzyme migrated between the MM and MB isoenzymes on agarose electrophoresis, accounted for 3.5% of the total creatine kinase activity in each tissue, was not a macromolecule, and had stable electrophoretic mobility only in borate buffer (0.02 mol/L). By comparison, the creatine kinase isoenzymes with similar "atypical" electrophoretic mobility in serum specimens were complexes of the BB isoenzyme and immunoglobulin G. These complexes were measured by a radioimmunoassay specific for the creatine kinase B-subunit and eluted predominantly with the MB isoenzyme in a commercial anion-exchange reagent system.

Conditions for measuring DNA synthesis in PHA stimulated human lymphocytes in 20 microliters hanging drops with various cell concentrations and periods of culture

We have studied conditions for measuring the uptake of [3H]thymidine ([3H]Tdr) by human lymphocytes in inverted microcultures, varying cell concentrations and periods in culture. Analysis of variance of the log values for [3H]Tdr uptake may be used to separate effects of variables and their interactions. A pulse time of 2 h, a total thymidine concentration of about 1 microgram/ml and a specific activity of [3H]Tdr of 2 Ci/mmole were optimal. Variables such as cell concentration, period of culture, type of serum and dose of PHA were shown to interact, suggesting that these variables should be examined together especially when comparing different samples of lymphocytes. Conditions for doing this simply in small volumes are now available for culturing, thymidine pulsing, harvesting and analysis of data.

A simple technique for harvesting lymphocytes cultured in Terasaki plates

A simple method has been developed for harvesting lymphocytes from Terasaki microplates based on a culture technique where the plates are inverted and the cells grown on the hanging meniscus of the medium in each well. Sixty individual filter discs were prepared in wells in a polycarbonate harvesting plate. A dry Terasaki plate was used to cut these filters with the harvester acting as a die. The inverted culture plate was then lowered onto the harvester to allow the cells on the meniscus from each well to be absorbed on the appropriate filter disc. The culture plate was then discarded and the cells on the filters washed in the harvester. The wash solutions were removed by suction through holes below each filter. The time taken to harvest the cultures from 60 wells of a plate was 3--5 min.

Effect of levamisole on metabolism of phagocytic cells

The effect of levamisole (LMS) on glucose metabolism was studied using a protozoan phagocytic model and human leukocytes. At concentrations of greater than 10 microgram/ml, LMS inhibited glucose metabolism in the protozoan phagocytic model. Glucose metabolism in both the phagocytic model and normal peripheral blood leukocytes was, however, minimally altered when exposed to levels of LMS of less than 10 microgram/ml. In contrast, myeloblasts from a child with leukemia seemed to have increased metabolic activity and 5 microgram/ml of LMS markedly reduced the glucose metabolism. These preliminary studies suggest that LMS can alter glucose metabolism of certain cells and that some malignant cells may be directly inhibited metabolically by LMS.

Reactions and serologic responses after administration of inactivated monovalent influenza A/swine virus vaccines. II. Immunization of children with influenza A/New Jersey/X-53 virus vaccines

Reactivity and immunogenicity of two inactivated, zonally purified, ether-extracted, influenza A/New Jersey/X-53 subunit virus vaccines were studied in 103 children three to 18 years of age. Children aged nine years of younger received doses of 100 or 200 chick cell-agglutinating (CCA) units, and those older than nine years received doses of 200 or 400 CCA units. Vaccines were given intramuscularly. Two doses were given at intervals of four weeks. The vaccines were minimally pyrogenic, causing only two instances of temperatures of greater than 100.0 F. Other systemic reactions were observed infrequently. Tenderness at the site of injection occurred relatively frequently but was of no medical consequence. The geometric mean titers of homologous antibody, which ranged from 1:52 to 1:75 after administration of two doses, were statistically equivalent in all treatment groups. Titers of antibody of greater than or equal to 1:40 to the influenza A/New Jersey/8/76 virus strain were achieved by 88% of the vaccinees. We concluded that two doses of ether-extracted, subunit influenza A/New Jersey/X-53 virus vaccine were well tolerated and, when given at least four weeks apart, were serologically effective for immunization of children aged three to 18 years.

Lecithin/spingomyelin ratio procedure by thin-layer chromatography

We assessed several modifications of thin-layer chromatography for evaluation of amniotic fluid lecithin/sphingomyelin ratios. For a procedure which is reliable, economical, and easy to perform, we preferred laboratory-prepared plates using SI-LICAR TLC-7GF. For spot detection, we preferred the iodine vapor method.

Reactions and serologic responses after administration of inactivated monovalent influenza A/swine virus vaccines. I. Immunization of children and adults with influenza A/Shope virus vaccines

Reactivity and immunogenicity of three inactivated, zonally purified, monovalent influenza A/swine virus vaccines were studied in children and adults. Each dose of vaccine contained either 400 chick cell-agglutinating (CCA) units/0.5 ml or 200 CCA units/0.25 ml. The vaccines contained either whole virus or ether-extracted, subunit virus with or without 1.5 mg of A1PO4/0.5 ml. Children younger than 10 years of age received a half dose. Substantial system reactions, including temperature increases of 2.2 F-4.9 F, were observed in all children who received whole-virus vaccines. In contrast, ether-extracted, subunit vaccines (with or without A1PO4) were minimally pyrogenic in 185 subjects. Two doses of subunit vaccine in subjects younger than 25 years of age were immunologically equivalent to a single dose in older subjects. We concluded that two doses of ether-extracted, subunit virus vaccine with Hsw1N1 antigen, administered at least four weeks apart, are serologically effective for immunization of seronegative subjects of any age and that this dosage regimen should be used in young children in whom whole-virus vaccines are unacceptably reactive.

Limberg flap coverage for axillary defects resulting from excision of hidradenitis suppurativa

After excision of the apocrine gland containing tissue, we advocate wound closure with a Limberg flap. Our results to date suggest that this approach, which combines definitive treatment with surgical economy, warrants an aggressive attitude toward even early cases of axillary "apocrinitis".

HL-A groups in pernicious anaemia

There is a significant association with HL-A3 type and pernicious anaemia. In addition there is a negative association with HL-A2. There is no association between HL-A type and the presence or absence of immunity to intrinsic factor.

Spontaneous laryngeal disease in the canine

This report describes the type and incidence of spontaneous laryngeal disease in the dog. Signs of laryngeal disease are similar to those in other species. Dogs are usually presented with inspiratory obstructive dyspnea or stridor, since earlier signs are often missed. Severe, congenital abnormalities may occur unrecognized due to neonatal death. Subtle anomalies are seldom presented. Congenital paralysis of the laryngeal musculature has been seen in the Bouvier des Flandres and the Siberian Husky. Laryngeal obstruction occurs commonly in brachycephalic dogs (Bulldog, Boxer, Boston Terrier, Pug, Pikingese). The forshortened nasal cavity and pharynx result in reduced airway space. The result is inspiratory obstruction varying from noisy respiration to severe obstruction with cyanosis and syncope. Everted laryngeal ventricles are most common in these dogs. Mild degrees of ventricular edema are common in small breed dogs with lower respiratory disease and in field-trial Beagles due to voice abuse. Traumatic injuries to the larynx and hyoid apparatus are not rare. Bite wounds from dog fights are the most common cause. Compression fractures are rare, but injuries associated with shearing stresses, due to being shcken by the neck cause airway obstruction. These types of injuries include avulsion of the aryepiglottic folds, longitudinal tearing of the epiglottis, arytenoid displacement, hyo-laryngeal separation, and laryngotracheal separation. Delayed signs of recurrent nerve damage are common in severe laryngotracheal injuries.

Growth and mineral metabolism in very low birth weight infants. I. Comparison of the effects of two modes of NaHCO3 treatment of late metabolic acidosis

Twenty-six infants weighing less than 1,300 g at birth were divided into pairs according to birth weight (900-1,100 and 1,101-1,300 g) and gestational age ("appropriate" (AGA) = mean 31 weeks; and "small" (SGA) = mean 34 weeks). One member of the pairs was then allocated randomly to one of two treatment regimens with oral sodium bicarbonate. Group A was treated whenever base excess was greater than -8mEq/liter as detected on twice weekly testing and/or when suspected to be acidotic from failure to gain weight. In group B, base excess was maintained within 1 SD of normal (-3.2 +/- 1.7 mEq/liter). The infants received Enfalac 200 ml/kg/24 hr, at 67 cal/100 ml, with vitamin D 400 IU/24 hr added from age 2 weeks. The following measurements were made: daily weight, weekly length, skinfold thickness, head circumference, twice weekly blood pH, PaCO2, base excess, and weekly plasma total calcium, ionic calcium, total magnesium, inorganic phosphorus, and total protein. There were six pairs of each of AGA and SGA infants and two unpaired group A infants. Weekly weight gains did not differ between group A and group B or between AGA and SGA. Length increment was greater in AGA than in SGA babies (0.94 +/- 0.02 vs 0.85 +/- 0.04 cm/week) but not significantly so (P less than 0.1), and in group B babies compared to group A babies (0.973 +/- 0.029 vs 0.83 +/- 0.037 cm/week) (P less than 0.01). Plasma pH was lower in group A (7.23 +/- 0.02) than in group B (7.30 +/- 0.02) and calcium ion activity higher (group A 2.72 +/- 0.04; group B 2.51 +/- 0.06 mEq/liter) between ages 20 and 29 days. Plasma magnesium was higher in group A (1.77 +/- 0.04 mEq/liter) than in group B (1.56 +/- 0.06 mEq/liter) from age 20 to 39 days. Inorganic phosphorus concentrations were consistently higher in group A than in group B, but the differences did not reach significance. Mean total protein concentrations did not rise above 4.5 g/100 ml and tended to be higher in babies of group A than of group B. Bone age was retarded in all babies. Radiographs available for 7 of 13 SGA infants were normal, whereas 6 of 11 radiographs of AGA babies showed some osteoporotic changes.

Intensive immunosuppression in patients with disseminated sclerosis. III. Lymphocyte response in vitro

Lymphocytes from fifteen multiple sclerosis patients gave responses to phytohaemagglutinin (PHA), conconavalin A (con A) and pokeweed mitogen (PWM) which were in the normal range. However, the responses of lymphocytes to stimulation by an allogeneic lymphoid cell line (LCL) were significantly lower in HLA-7-positive than in HLA-7-negative patients (a distinction not found in control groups). Depression of con A, PHA and PWM responses were observed during intensive immunosuppression. Responses to LCL were unaltered or increased during initial azathioprine and prednisone treatment. The depression of this response following antilymphocyte globulin (ALG) treatment was delayed in the HLA-7-positive patients. One week after the end of ALG treatment, most PHA, con A and PWM responses had returned to low normal values. Reduction of azathioprine and prednisone treatment at the end of 1 year resulted in a sharp rise in PHA and con A responses in some patients. Relapses in patients were frequently associated with low responses to LCL cells.

Methyl iodide intoxication. A case report

A 41-year-old chemist developed methyl iodide intoxication. His case is presented with a review of pertinent literature. Characteristics of the poisoning include a delay between exposure and onset of symptoms; early systemic toxicity with congestive changes in the lungs and oliguric renal failure; prominent cerebellar and Parkinsonian neurologic symptoms as well as seizures and coma in severe cases; and psychiatric disturbances that can last from months to years. Although methyl iodide is a rare form of intoxicant, its manifestations are similar to that of poisoning with the other monohalomethanes that are not uncommon.

Adrenoleukodystrophy. Electron microscopic findings

Ultrastructural and neurochemical studies were done on three male patients with adrenoleukodystrophy. In each case, the affected white matter contained enlarged glial cells filled with pathognomic intracytoplasmic inclusions consisting of electron-lucent spicules bounded by 25-Angstrom wide membranes. Similar inclusions were present in adrenocortical cells. These findings and a review of 47 reported cases indicate that adrenoleukodystrophy is a storage disorder caused by a sex-linked recessive error of metabolism.