O6-alkylguanine-DNA alkyltransferase depletion and regeneration in human peripheral lymphocytes following dacarbazine and fotemustine

O6-Alkylguanine-DNA alkyltransferase (ATase) levels were measured in peripheral blood lymphocytes of 13 patients with advanced malignant melanoma treated with sequential dacarbazine (DTIC) and fotemustine. Wide interindividual variation in the pretreatment levels and in depletion and regeneration of ATase activity was noted. Depletion of ATase was seen within the first h after DTIC administration with values ranging from 44 to 92% of pretreatment levels. In 10 patients, progressive depletion of ATase activity occurred with nadir activity occurring at about 4 to 6 h with values ranging from 0 to 67% of pretreatment activity; at 18 h after DTIC infusion. ATase activity varied from 6 to 81%. No significant difference was seen between the rates of ATase depletion or regeneration between the two groups of patients receiving either 500 or 800 mg/m2 of DTIC with the same dose of fotemustine (100 mg/m2). In one patient, maximum depletion occurred within 1 h and no ATase activity was detectable over the next 18 h. In another patient, maximum depletion occurred at 2 h after DTIC followed by recovery of ATase activity to 71% at 18 h. In 2 patients who returned for subsequent cycles of chemotherapy, an increase in pretreatment ATase activity was seen. Overall, the extent of depletion of ATase following DTIC/fotemustine was directly proportional to the initial ATase level.

Dietary fish oil enhances renal hypertrophy in experimental diabetes

Renal hypertrophy occurs early in the natural history of human and experimental diabetes and may be a manifestation of the same pathophysiological process which ultimately results in diabetic nephropathy. The precise biological events which stimulate and regulate this growth process remain incompletely understood. We postulated that renal eicosanoids contribute to the development of renal hypertrophy in diabetes. We elected to test the effects of suppression of dienoic eicosanoid metabolism (arachidonic acid metabolism) on renal hypertrophy in diabetic rats by feeding fish oil. Diabetic rats fed fish oil had markedly reduced insulin requirements compared to control rats pair-fed a beef tallow-rich diet. The concentrations of prostaglandin E2, 6-keto-prostaglandin F1 alpha, and thromboxane B2 were depressed in the renal cortex of diabetic rats fed fish oil. This alteration in eicosanoid metabolism was associated with a substantial enhancement of diabetic renal hypertrophy. These results indicate that dietary fish oil has profound effects on renal eicosanoid metabolism in experimental diabetes and that these autocoids may participate in the biological events which regulate diabetic renal hypertrophy.

Treatment of small cell lung cancer with cyclophosphamide, adriamycin and vincristine (CAV) combination therapy: experience at University Hospital, Kuala Lumpur, Malaysia

Seventeen patients with small cell lung cancer (SCLC) were treated with cyclophosphamide, adriamycin and vincristine (CAV) combination chemotherapy. The overall response rate was 76.5% with 47% achieving complete response and 29.5% partial response. In limited and extensive stage disease, complete response was achieved in 67% and 36.5% respectively. Chinese were the predominant ethnic group affected (82%). Six patients presenting with superior vena cava obstruction responded significantly to CAV chemotherapy alone. Median survival for patients with extensive disease was 7.4 months. All patients with limited disease were still alive. Two relapsed patients with limited disease achieved significant response to VP-16/Cisplatin combination chemotherapy.

Preliminary experience with mitomycin, vinblastine and cisplatin (MVP) combination chemotherapy in the treatment of advanced non-small cell lung cancer at University Hospital, Kuala Lumpur

Twelve patients with advanced inoperable non-small cell lung cancer (NSCLC) were treated with mitomycin, vinblastine and cisplatin (MVP) combination chemotherapy. The overall response rate was 33% (4 partial responses and no complete response) with a median survival of seven months. One responder above subsequently achieved complete remission following successful resection of his tumour and is still alive 14 months after initial chemotherapy. Responses were observed in patients with good performance status and limited disease. Side-effects were generally well tolerated and manageable. MVP is an effective regimen and the low response rate achieved here as compared to other centres is also discussed.

Structural and functional repetition in a marine mussel adhesive protein

The DOPA-rich polyphenolic protein secreted by the marine mussel Mytilus edulis establishes key chemical linkages in a water-resistant adhesive. Molecular cloning of the gene for this remarkable protein reveals its primary structure as one of the most repetitive proteins identified in the animal kingdom. Expression and purification of polyphenolic proteins from recombinant yeast have provided sufficient material to demonstrate adhesivity of these polypeptides in the laboratory. Adhesive tests reveal a water-resistant bonding capacity of the protein that is dependent on in vitro modification of tyrosine residues to DOPA and the subsequent oxidation to quinone.

Clinical indices to predict simple and mixed acid-base disturbances

We propose that in any acid-base disturbance there is a predictable mathematical relationship between the changes in the individual serum anionic concentrations of chloride, bicarbonate and the unmeasured anion gap. Two indices were developed, from the ratios of the changes in these anionic concentrations, that are useful in predicting the presence of an acid-base disturbance. Based on recent experimental evidence we determined the mathematical values of these 2 indices, alpha and beta, in 17 acid-base disturbances. By utilizing the paired values of these indices, the 17 disturbances including simple, metabolic plus respiratory and triple disorders were subcategorized into 7 groups. It is suggested that the use of these indices will facilitate the diagnosis of complicated mixed acid-base disorders.

L-asparaginase from Erwinia carotovora. An improved recovery and purification process using affinity chromatography

A large-scale process was developed to purify L-asparaginase from submerged cultures of Erwinia carotovora. Cells from 880 L of fermentation broth were harvested and washed using a plate and frame type filter press. A cellular acetone powder was prepared from the washed cells by suspending the cells twice in acetone and the residual acetone was removed by washing the acetone powder in the filter press with 10 mM phosphate buffer (pH 7.0). The cellular acetone powder was extracted with 10 mM borate buffer at pH 9.5. The enzyme-rich borate extract was recovered by filtration and clarified by an in-line bag filter. The filtrate was adjusted to pH 7.5 and filtered through a 1-micron bag filter precoated with Celite and then through a 0.22-micron cartridge filter. The cell-free extract, containing 21 x 10(6) IU of enzyme and 448 g of total protein, was applied to an L-asparagine Sepharose 6 Fast Flow affinity column (9 L) using a bag filter loaded with Cell Debris Remover as an in-line prefilter. The affinity gel was prepared by coupling L-Asn at pH 9.0 to epoxy-activated Sepharose 6 Fast Flow beads. A total of 14 x 10(6) IU of enzyme (35 g protein) was eluted at pH 9.0 in 10.5 L. The eluted enzyme was determined to be greater than 90% pure using sodium dodecyl sulfate polyacrylamide gel electrophoresis. The total process time from whole broth to affinity column elution was 68 h and the enzyme yield was 38%. This improved process for the 880 L fermentation broth produced a cell-free extract of high specific activity, shortened the process time, increased the column capacity, and yielded a product with high purity.

Rapid identification and typing of herpes simplex virus by a new enzyme immunoassay with peroxidase-labeled complement C1q

A new enzyme-linked immunoassay system (TC-ELISA) was developed for the rapid, specific detection and typing of herpes simplex virus (HSV) using anti-HSV immune sera and enzyme-labeled complement component C1q (P*-C1q). The method is based on viral antigen produced in HSV-infected cells being detected by simultaneous addition of immune serum and P*-C1q (ELISA-CF). With this assay, it was found that HSV was detected with anti-HSV immune serum and P*-C1q and that HSV type 1 and HSV type 2 could be differentiated with anti-HSV-1 and anti-HSV-2 immune sera and P*-C1q. The TC-ELISA test was HSV specific and not reactive with measles virus, cytomegalovirus, mumps virus or varicella-zoster virus. The whole assay procedure can be completed within 3 hours, as long as HSV-inoculated cell cultures with more than 10% cytopathic effect are used. These results suggest that TC-ELISA is useful in the diagnosis of viral infections.

Are we missing portal vein thrombosis?

We report a case of portal vein thrombosis which was misdiagnosed as tropical splenomegaly syndrome. This is the first documented case confirmed radiologically at Universiti Hospital, Kuala Lumpur. A discussion on the management of portal vein thrombosis is also described.

Viscerotropic Rocky Mountain spotted fever in southeastern Texas: report of a survivor with atypical manifestations and multiple organ failure

A 32-year-old black man from rural southeastern Texas had headache, fever, chills, bronchopneumonia, and an atypical rash, complicated by hypotension, lethargy, confusion, liver dysfunction, thrombocytopenia, and acute renal failure. The diagnosis of Rocky Mountain spotted fever (RMSF) was not suspected until eight days after the onset of symptoms. He was subsequently treated with chloramphenicol, followed by hemodialysis and aggressive supportive therapy. He recovered uneventfully with complete return of renal function. This case emphasizes that RMSF should be considered in the differential diagnosis of any obscure febrile illness even in nonendemic areas.

Peripheral nerve damage facilitates functional innervation of brain grafts in adult sensory cortex

The neural pathways that relay information from cutaneous receptors to the cortex provide the somatic sensory information needed for cortical function. The last sensory relay neurons in this pathway have cell bodies in the thalamus and axons that synapse on neurons in the somatosensory cortex. After cortical lesions that damage mature thalamocortical fibers in the somatosensory cortex, we have attempted to reestablish somatosensory cortical function by grafting embryonic neocortical cells into the lesioned area. Such grafts survive in adult host animals but are not innervated by thalamic neurons, and consequently the grafted neurons show little if any spontaneous activity and no responses to cutaneous stimuli. We have reported that transection of peripheral sensory nerves prior to grafting "conditions" or "primes" the thalamic neurons in the ventrobasal complex so that they extend axons into grafts subsequently placed in the cortical domain of the cut nerve. In this report we present evidence that the ingrowth of ventrobasal fibers leads to graft neurons that become functionally integrated into the sensory circuitry of the host brain. Specifically, the conditioning lesions made prior to grafting produce graft neurons that are spontaneously active and can be driven by natural activation of cutaneous receptors or electrical stimulation of the transected nerve after it regenerates. Furthermore, oxidative metabolism in these grafts reaches levels that are comparable to normal cortex, whereas without prior nerve cut, oxidative metabolism is abnormally low in neocortical grafts. We conclude that damage to the sensory periphery transsynaptically stimulates reorganization of sensory pathways through mechanisms that include axonal elongation and functional synaptogenesis.

Female immigrants and labor in colonial Malaya: 1860-1947

"The role of Chinese and Indian women as immigrants and workers in colonial Malaya is examined using data from censuses, immigration records, official reports and secondary sources. The article discusses the main types of work of female immigrants and their contribution to the economic development of colonial Malaya during the late nineteenth and early twentieth centuries in an attempt to redress the neglect of female immigrants' economic role in Malaya's history. Comparisons between male and female immigrants' labor and between Chinese and Indian immigrants, are drawn to highlight the different conditions of migration and labor for the different groups of immigrants."

Single-chain antigen-binding proteins

Single-chain antigen-binding proteins are novel recombinant polypeptides, composed of an antibody variable light-chain amino acid sequence (VL) tethered to a variable heavy-chain sequence (VH) by a designed peptide that links the carboxyl terminus of the VL sequence to the amino terminus of the VH sequence. These proteins have the same specificities and affinities for their antigens as the monoclonal antibodies whose VL and VH sequences were used to construct the recombinant genes that were expressed in Escherichia coli. Three of these proteins, one derived from the sequence for a monoclonal antibody to growth hormone and two derived from the sequences of two different monoclonal antibodies to fluorescein, were designed, constructed, synthesized, purified, and assayed. These proteins are expected to have significant advantages over monoclonal antibodies in a number of applications.

Effect of dietary protein on cholesterol homeostasis in diabetic rats

Normal and streptozotocin (STZ)-diabetic rats were studied in order to examine the effects of altering the type of dietary protein on cholesterol homeostasis. Rats were fed a non-purified or a purified diet containing either casein or soybean protein. The results obtained on the specific aspects of lipid metabolism were remarkably similar in control rats fed the non-purified (Purina Lab Chow) diet or the purified diet with the soybean protein. However, most of the findings obtained with the above two groups were different from those obtained with rats fed the purified diet containing casein. In the latter group, plasma cholesterol was elevated following a 15-day feeding period as compared to the other two dietary groups. The excess plasma cholesterol in the casein-fed group was found in two lipoprotein fractions with densities of 1.023-1.045 g/ml and 1.045-1.086 g/ml, respectively. The latter lipoprotein fraction was also enriched with apolipoprotein E. The casein-fed animals also showed a lower fractional rate of plasma cholesterol esterification and an abnormal accumulation of cholesterol in the body despite inhibition of cholesterol synthesis in the liver and in the intestines. Twelve to 15 days after the induction of diabetes, plasma cholesterol increased to a similar extent in the rats on all three diets. However, the distribution of cholesterol among the lipoprotein fractions was markedly different. The percentage of cholesterol in fractions of d less than 1.086 g/ml was increased while that carried in the fraction of d 1.086-1.161 g/ml decreased in the rats fed the nonpurified diet and the casein diet. In contrast, there was no change in the distribution of lipoprotein cholesterol between the diabetic and the control rats fed the soybean protein diet. The hepatic synthesis of cholesterol was unaltered in diabetic rats fed the nonpurified diet and the purified diet with soybean protein, but was increased 2.4-fold in diabetic rats fed casein. Intestinal cholesterol synthesis was increased in all three dietary groups. The increase was highest in the rats fed casein and lowest in rats fed soybean protein. The rate of sterol synthesis in the kidneys was not significantly affected by the diet or diabetes. In all three dietary groups diabetes led to an abnormal accumulation of cholesterol in the body. This accumulation was highest in the casein-fed rats and lowest in those fed the soybean protein diet. The cholesterol content of the kidneys was markedly increased by dietary casein.(ABSTRACT TRUNCATED AT 400 WORDS)

Isolation and characterization of a tomato cDNA clone which codes for a salt-induced protein

The cDNA clone (pNP24) coding for a protein induced by exogenous NaCl has been isolated from a tomato root cDNA library with the use of an inosine containing synthetic oligomer. The authenticity of the clone has been established by comparing the sequence of the clone to the NH2-terminal sequence of the protein which has been purified to homogeneity by HPLC. The nucleotide sequence of pNP24 reveals a 5' signal sequence, an open reading frame of 718 nucleotides, a 3' AT rich untranslated region containing a probable polyadenylation signal sequence, and a poly A stretch. The mature polypeptide sequence as deduced from the nucleotide sequence reveals a protein with a molecular weight of 24226. This protein has been named NP24. It is slightly basic and has an unusually high number of cysteines (15). Northern blot analyses reveal that the abundance of mRNA for NP24 is at least 100-fold greater in tomato suspension cells in log phase grown in medium with NaCl than in cells grown in the control medium. The mRNA for NP24 is below the level of detection in roots of young control tomato plants until several weeks after germination but it is induced earlier and to higher levels in roots stressed by 0.171 M NaCl. Thus salt stress accelerates the accumulation of message in tomato roots. A comparison of the steady state levels of mRNA for NP24 to the accumulation of NP24 by immuno analyses indicates that the accumulation of this protein is determined by its mRNA level. The protein is not secreted and is localized within the cytoplasm or the soluble fraction of the nucleus, vacuole, or microbodies. NP24 has a high degree of homology (58%) with thaumatin, a protein which has considerable value as an artificial sweetener.

Metastatic islet cell tumour with clinical manifestations of insulin and glucagon excess: successful treatment by hepatic artery embolization and chemotherapy

A patient with a metastatic islet cell tumour with clinical features of both insulin and glucagon excess is reported. This appears to be only the third such case in the literature and the first in whom the initial symptoms were of the glucagonoma syndrome. Radiologically and biochemically defined complete remission was induced within 9 months of hepatic arterial embolization and cyclical chemotherapy with 5-fluorouracil and streptozocin; complete remission has been maintained for a further 23 months without therapy.

Exertional heat stroke and acute renal failure in a young woman

Strenuous exercise leading to heat stroke is known to cause rhabdomyolysis and acute renal failure in men, but there are no reports of this environmental illness in otherwise healthy women. We report the first case of heat and exercise induced acute renal failure in a young nonacclimated adult female following intense exertion in the Grand Canyon. This individual displayed the typical clinical features of exertional heat stroke including hyperpyrexia, CNS disturbance, rhabdomyolysis, oligoanuric acute renal failure, and disseminated intravascular coagulopathy. The pathophysiology is discussed as well as sexual differences in response to heat and exercise. The specific factors that may have predisposed this young woman to heat stroke from exertion are identified.

Effects of glucagon on physiologic and compensatory renal growth in the rat

Glucagon has been implicated as a growth-promoting hormone in the kidneys of diabetic animals, but its role in the nondiabetic state is unknown. We evaluated the effect of subcutaneous glucagon administration on renal growth in intact rats with two kidneys and after 50% reduction in renal mass. The relative kidney weight was increased in intact rats treated with a glucagon infusion for 7 days (p less than 0.01), but decreased in uninephrectomized rats treated with glucagon (p less than 0.05). Absolute kidney weight gain and rates of renal DNA synthesis were also significantly blunted by glucagon infusion in uninephrectomized rats. These data suggest that 'physiologic' and 'compensatory' renal growth are governed by separate processes. Furthermore, the observation that glucagon promotes renal growth in intact nondiabetic animals supports its possible role as a growth factor in the early stages of diabetes.

The effects of subtotal pancreatectomy on renal growth in streptozotocin diabetic rats

Increases in kidney size and function are characteristic features of the early stages of Type I diabetes mellitus, and may contribute to the pathogenesis of diabetic nephropathy. Other studies have shown that the relative circulating concentrations of insulin and glucagon may be regulatory to renal growth and function. In order to elucidate the role of pancreatic glucagon in diabetic renal growth, subtotal pancreatectomy was performed prior to administration of streptozotocin to rats. Glycosuria and kidney weight were significantly reduced by subtotal pancreatectomy, although creatinine clearance and blood glucose levels were not different from diabetic controls. These data suggest that hyperglucagonemia may be an important mediator of renal growth in insulinopenic diabetes mellitus.

Continuous arteriovenous hemodiafiltration: an aggressive approach to the management of acute renal failure

Continuous arteriovenous hemodiafiltration (CAVHD) offers a modified therapeutic approach to the patient with acute renal failure. The system employs a hollow-fiber dialyzer, whose perfusion is dependent on the patient's BP. Peritoneal dialysis solution is infused through the dialysate ports in a direction countercurrent to blood flow at a rate of 500 to 1,500 mL/h. Five complex patients with acute renal failure were treated with CAVHD for periods ranging from two to 40 days. Urea clearances approached 37 L/d, and in stable patients, the BUN was maintained at 40 to 60 mg/dL and serum creatinine 1.4 to 4.0 mg/dL. Ultrafiltration up to 1 L/h could be obtained without difficulty. CAVHD is a safe and technically simple procedure that is particularly suitable for hemodynamically unstable patients with ongoing needs for fluid removal.

L-dopa in uremic patients with the restless legs syndrome

Restless legs syndrome (RLS) is a poorly understood, often distressing condition that is particularly prevalent among patients with chronic renal failure. A wide variety of medications have been used to treat RLS with variable results. In order to evaluate the efficacy of carbidopa/levodopa therapy, eight consecutive uremic patients with RLS on maintenance hemodialysis were treated with doses ranging from 25/100 to 25/250 twice daily. Six of eight patients obtained satisfactory relief which has continued for 3 months follow-up. Carbidopa-levodopa appears to be an effective opinion in management of RLS in patients with chronic rental failure.

Chronic effects of an alpha-glucosidase inhibitor (Bay o 1248) on intestinal disaccharidase activity in normal and diabetic mice

Bay o 1248 is a potent alpha-glycosidase inhibitor that reduces postprandial hyperglycemia when administered p.o. with sucrose or maltose. The compound binds to and competitively inhibits the alpha-disaccharidases and is also readily absorbed across the intestinal mucosa. To evaluate its effect on the activity of disaccharidases and on metabolic control, groups of obese diabetic mice (C57BLKsJ db/db) were given the drug for periods of 3, 7 and 84 days as a drug food mixture (5 or 10 mg/100 g of food). Nondiabetic mice of the same strain were dosed for 3 and 7 days. The drug did not influence body growth, food intake or fasting blood glucose. However, urine glucose excretion was significantly decreased at the higher dose in the diabetic mice. The drug had no effect on the protein content of jejunum (proximal and middle thirds) or ileum (distal third) of the small intestine. The activity of sucrase and maltase was significantly decreased in practically all segments of the small intestine in both diabetic and nondiabetic mice. These changes were evident after 3 days of drug administration. Lactase was not affected by the drug. The mechanism underlying these changes, although unclear, is of significant interest and deserves further investigation.

Magnification radiography in osteomyelitis

Osteomyelitis often eludes early diagnosis because plain film radiography is too insensitive and radionuclide bone scanning is nonspecific. In this study, 90 diabetic patients were studied with plain film and magnification radiographs of their feet. Among the 24 patients with osteomyelitis, plain radiographs suggested the diagnosis in 14 patients and magnification radiography was diagnostic in 18 of these patients. Thus, magnification radiography offers some diagnostic advantage in patients suspected of having osteomyelitis.

Effect of tripamide on glucose tolerance in patients with hypertension

The effects of tripamide and hydrochlorothiazide on blood pressure and glucose tolerance were studied in 20 hypertensive patients, half of whom had type II diabetes mellitus. Each patient underwent intravenous glucose tolerance testing before and after 4 weeks of treatment with tripamide, 10 mg, and, at a separate time, hydrochlorothiazide, 50 mg. Both tripamide and hydrochlorothiazide lowered blood pressure; for both drugs, the magnitude of the reduction in mean arterial pressure was positively correlated with the pretreatment mean arterial pressure. Hydrochlorothiazide produced a greater fall in serum potassium than did tripamide. In the nondiabetics, neither drug produced a significant change in the glucose disappearance curve or the plasma insulin response. In the diabetics, hydrochlorothiazide produced an increase in serum glucose levels, but the plasma insulin response, which was blunted in comparison to the nondiabetics, did not change. Tripamide did not affect serum glucose or plasma insulin levels in either group of patients. Tripamide at a dose of 10 mg daily does not affect glucose tolerance in either nondiabetic hypertensive patients or patients with type II diabetes mellitus.

Subacute hepatic necrosis induced by piroxicam

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Large-scale recovery and purification of L-asparaginase from Erwinia carotovora

A large-scale process was developed to purify gram quantities of a therapeutic enzyme, L-asparaginase, from submerged cultures of Erwinia carotovora. Cells were harvested from 150 L of fermentation broth and washed. A cellular acetone powder was prepared and extracted with pH 9.5 borate buffer. After continuous centrifugation and filtration to remove cell debris, the acetone powder extract was adjusted to pH 7.7 and adsorbed onto a 16-L CM-Sepharose Fast Flow column, with a precolumn packed with Cell Debris Remover. The enzyme was desorbed from the catin-exchange column at pH 9.0 and further purified with an affinity column of L-asparagine Sepharose CL-4B. After dialysis-concentration to remove buffer salt, the enzyme was depyrogenated, formulated, sterile filled, and lyophilized as a single-dose final product. The final-product evaluation included analysis of the content of protein, sodium chloride, glycine, sodium, glucose hydrate, phosphate, and endotoxin, as well as reconstitution, potency, pH, specific activity, uniformity of fill, and sterility. The product was further subjected to visual examination, sodium dodecyl sulfate polyacrylamide gel electrophoresis, native gel electrophoresis, isoelectric focusing, amino acid analysis, N-terminal sequencing, peptide mapping, and immunological comparison.

Inhibition of compensatory renal growth by indomethacin

Renal prostaglandins may be important in the modulation of compensatory renal growth. Reductions in renal mass are associated with increased synthesis of these substances by the remaining kidney, and inhibition of prostaglandin synthesis diminishes renal function in partially nephrectomized animals and in patients with reduced functioning renal mass. We examined the effects of uninephrectomy and treatment with indomethacin on renal prostaglandin E2 and 6-keto prostaglandin F1 alpha concentrations in adult male Sprague Dawley rats. The renal content of these prostaglandins was significantly increased in the remaining kidney two days following uninephrectomy (p less than 0.01). Treatment with 5 mg/kg/day of indomethacin over this period abolished the compensatory increase in renal prostaglandin synthesis and significantly attenuated compensatory increases in renal mass, protein and RNA concentrations (p less than 0.05). No alterations in kidney weight, protein or RNA concentrations were found in intact animals treated with the same dose of indomethacin. These findings suggest renal prostaglandins may participate in the biological events leading to compensatory renal growth.

Chemical liver function tests and epidemiologic studies of HBsAg positive blood donors

The HBsAg positivity in age, sex, occupation, blood type, past history and chemical liver function tests were analyzed in 869 cases without symptoms of liver disease and positive testing for HBsAg by RPHA method, who were selected among 11, 197 blood donors of the Red-Cross Blood Bank in Pusan, Korea from August 1, to September 30, 1982. The following results were obtained: 1. The overall HBsAg positivity in random blood donors was 7.76%. 2. The HBsAg positivity of males was 8.36% and females 6.0%; males had a slightly higher positivity than females. 3. The HBsAg positivity of the 16–20 year old age group had the highest frequency (9.05%), 21–25 year old age group 8.23%, 26–30 year old age group 5.72%, 31–35 year old age group 5.76%, 36–40 year old group 5.85%, 41–45 years old age group 4.76%, and 46–50 year old age group 3.7%. HBsAg positivity had decreasing tendency of frequency by increasing age. 4. The HBsAg positivity of the merchant group had the highest frequency (10.26%), and next, the unemployed, salary man, student, soldier, in order of frequency. 5. The HBsAg positivity in cases with blood type A had the highest frequency (8.07%), and next, cases with B type, O type, and AB type in order of frequency. 6. The HBsAg positivity in cases with no past history in liver disease had the highest frequency (75.37%), and next, cases with history of liver diseases among family 12.54%, hepatitis with jaundice 5.06%, admission due to other diseases except liver diseases 3.57%, transfusion 2.42%, hepatitis without jaundice 1.04%. 7. In chemical liver function tests of HBsAg positive blood donors, elevation of SGPT level showed highest frequency (10.70%), SGOT 7.7%, total serum bilirubin 5.29% and elevation of one or more than of SGPT, SGOT, total serum bilirubin 18.99%.

Demonstration of hematobilia using technetium-99m labeled red blood cells

A 75-year-old woman, who presented with obstructive jaundice, was shown by percutaneous transhepatic cholangiography to have a markedly dilated biliary system and stones within the common bile duct. The stones were removed percutaneously using the transduodenal approach, and an internal drainage catheter was placed. Following the procedure, the patient experienced gastrointestinal bleeding manifested by melanotic stools. Blood-tinged bile was withdrawn from the biliary drainage catheter, leading to the suspicion that the bleeding might be originating from the biliary tract. A Tc-99m red blood cell (Tc-99m RBC) scan was performed to try to designate the biliary tract as the site of bleeding, and to determine if there were any other bleeding sites present. The study demonstrated bleeding from the biliary tract, which was confirmed by angiography and endoscopy. The technique for the detection of gastrointestinal bleeding using Tc-99m RBCs is well described. This case suggests that when doing studies to localize occult bleeding, the liver should be included in the field-of-view to exclude bleeding from the liver.

The effects of diltiazem and captopril on glycerol-induced acute renal failure in the rat. Functional, pathologic, and microangiographic studies

To evaluate the effects of pharmacologic vasodilatation on glycerol-induced acute renal failure, we studied untreated animals and those given Captopril and Diltiazem at periods ranging from 30 minutes to four weeks after the onset of acute renal failure. At each time frame, comparative coded assessments of renal function, histology, and microangiography were performed. Diltiazem, a calcium channel blocker, significantly reduced the severity of the renal failure, decreased the extent of tubular cell necrosis, and was associated with a more rapid histologic and functional recovery. Captopril, an angiotensin converting enzyme inhibitor, did not influence renal function or pathology throughout the four-week observation period. Microangiography revealed marked differences among the experimental groups. Most notably, there was better visualization of the microvasculature in Diltiazem-treated kidneys at one and two weeks. However, at four weeks, all groups showed similar, severe microangiographic abnormalities. Diltiazem offers significant protection against glycerol-induced acute renal failure in rats. Its mechanism of action in this context remains unknown. Renal function and pathology do not correlate well with microangiographic perfusion patterns in this model of acute renal failure.

Aldose reductase, NADPH and NADP+ in normal, galactose-fed and diabetic rat lens

NADPH and NADP+ levels were measured in rat lens from normal controls, from galactose-fed and diabetic rats during the first week of cataract formation. The level of NADPH in normal rat lens was determined to be 12.3 +/- 0.4 nmol/g wet weight, and that of NADP+ 4.6 +/- 0.2 nmol/g wet weight. In early cataract formation NADPH levels decreased rapidly during the first 2 days and then remained stable at 76% of control for galactose-fed and 84% for diabetic rats. NADP+ levels increased by 38% of control for galactose-fed and 54% for diabetic rats. Calculated NADPH/NADP+ ratios dropped from 3.36 +/- 0.21 to 1.86 +/- 0.16 in galactose fed rats, and from 2.81 +/- 0.15 to 1.61 +/- 0.16 in diabetic rats (P less than 0.001 for both experimental groups). These data are consistent with rapid NADPH oxidation during onset of lens cataracts. No significant changes in aldose reductase enzymatic activity levels were observed in either the galactosemic or the diabetic rats during the times measured.

The protective effect of nitrendipine on gentamicin acute renal failure in rats

Aminoglycoside nephrotoxicity was produced in two groups of Fischer rats by intraperitoneal injection of gentamicin, 40 mg/kg/day for 2 weeks. Beginning 3 days prior to, and continuing throughout the 2-week treatment period, one of the groups (control) received the inert vehicle, polyethylene glycol, while the experimental group was given nitrendipine, a calcium channel blocker, in a dose of 25 mg/kg/day by gavage. Both groups received food and water ad libitum. Gentamicin with vehicle caused a marked decrease in inulin clearance (4.9 ml/min/kg) and paraaminohippurate (PAH) extraction (26%), and extensive renal tubular necrosis. In comparison, the nitrendipine-treated rats had a significantly increased clearance (9.8 ml/min/kg) and PAH extraction (48%), and less histopathologic damage. Renal tissue content of gentamicin was not influenced by nitrendipine after 4 days of dosing. Nitrendipine, a diisopyridine derived calcium channel blocker, offers significant functional and histologic protection against aminoglycoside nephrotoxicity in Fischer rats. Its mode of action in this regard is unknown.

Prevention of the metabolic effects of 2-tetradecylglycidate by octanoic acid in the genetically diabetic mouse (db/db)

2-Tetradecylglycidate is a specific inhibitor of the enzyme carnitine palmitoyl transferase, the rate-limiting step in long chain fatty acid oxidation. We previously showed that chronic administration of TDGA to genetically diabetic mice caused a dose-dependent decrease in blood glucose, retarded the development of renal immunopathologic lesions, and resulted in significant cardiomegaly. The present study was designed to evaluate whether all the observed consequences of chronic TDGA administration resulted from inhibition of long chain fatty acid oxidation or whether the drug exerted other nonspecific effects. To circumvent the effects of LCFAO inhibition, diabetic mice were dosed with TDGA and given a diet containing 9% octanoic acid. Octanoic acid is a medium chain fatty acid, whose oxidation is not dependent on the carnitine transferase system and is not inhibited by TDGA. Administration of the octanoate diet to diabetics receiving TDGA abrogated all the drug effects, including lowering of blood glucose and prevention of renal immunopathology. Cardiomegaly, a consequence of increased protein accretion associated with TDGA dosing, did not occur in the octanoate-fed animals. These results indicate that all the actions of TDGA are mediated via its inhibitory effects on long chain fatty acid oxidation. The cardiac changes resulting from chronic TDGA administration suggest that long chain fatty acid oxidation and its relationship with myocardial energetics may exert a regulatory role on protein synthesis in the myocardium.

Relationship between adrenal steroids and renal Na-K-ATPase. Effect of short-term hormone administration on the rat cortical collecting tubule

Mineralo- and glucocorticoids stimulate renal Na-K-ATPase activity if given over a few days, but their immediate effect on the enzyme (i.e. within the time period required to alter electrolyte transport) remains controversial. We evaluated the short-term (3 h) in vivo effect of physiologic and pharmacologic doses of the natural glucocorticoid (corticosterone) and mineralocorticoid (aldosterone), and of a semisynthetic glucocorticoid (dexamethasone) on Na-K-ATPase activity in cortical collecting tubules microdissected from adrenalectomized rats. This nephron segment was chosen because it is a major target site for both classes of corticoids. Neither corticosterone (0.006, 0.6, and 5 mg/100 g body wt, IM), nor dexamethasone (5 mg/100 g body wt, IM) or aldosterone (10 micrograms and 50 micrograms, IV) altered significantly Na-K-ATPase activity in the cortical collecting tubule of these animals 3 h after administration. These results confirm our previous observations in the mouse, and suggest that the enhancing effect of corticosteroids on the renal enzyme seen after longer intervals represents a secondary phenomenon, possibly related to augmentation of the sodium load presented to the pump.

Anaphylactic reaction on subsequent exposure to Cuprophan-Hollow Fiber Dialyzer: a case report

A 55-year-old black female was dialyzed with Cuprophan dialyzers twenty times without complications. Upon re-exposure eight months later she developed a severe anaphylactic reaction characterized by hypotension, shortness of breath and subsequent cardiopulmonary arrest. She did not have significant adverse reactions to Cordis-Dow-Hollow-Fiber dialyzers.

Comparative microangiographic studies of glycerol- and mercuric chloride-induced acute renal failure in rats

Microcirculatory abnormalities may be important in the genesis and/or maintenance of acute renal failure. This work describes the functional, microangiographic, and histopathologic alterations in two experimental models of acute renal failure. Glycerol and mercuric chloride (HgCl2) administration to dehydrated rats produced acute renal failure characterized by a similar degree of renal dysfunction at 24 hours and almost complete functional recovery at one week. Both toxins were associated with early (1/2-1 hour) microangiographically determined perfusion alterations, but in the rats given glycerol, a return to near normal appearance was noted at 2 to 6 hours. Subsequent studies did show mild to moderate residual changes at one week. In contrast, HgCl2 treatment was associated with progressive microcirculatory abnormalities that correlated in part with residual histopathologic alterations. These studies emphasize the discrepancy between functional, circulatory, and pathologic abnormalities in experimental acute renal failure and may improve our understanding of this complex disorder.

Reye's syndrome in the adult: case report and review of the literature

A 22-year-old male presented with a brief history of progressive encephalopathy. One week previously, he had developed an upper respiratory infection that resolved spontaneously and was followed by intractable vomiting. He had taken salicylates for several days during the viral syndrome. The diagnosis of Reye's syndrome was confirmed by hepatic histology. Aggressive conservative management was followed by complete metabolic and neurological recovery. There are fewer than 10 reported cases of Reye's syndrome in adults but this disease may be more common than is generally suspected. The diagnosis should be considered in patients presenting with emesis and obtundation, who have recently had a viral illness and exhibit elevated blood ammonia and transaminases with normal cerebrospinal fluid. Confirmation is achieved by liver biopsy. Therapy is directed toward aggressive reduction of increased intracranial pressure.

Corticosterone binding sites along the rat nephron

Glucocorticoids influence numerous kidney functions but the precise location of glucocorticoid receptors in the nephron is not known. To identify the renal binding sites of corticosterone, the natural glucocorticoid in the rat, we measured the binding of [3H]corticosterone to discrete nephron segments microdissected from adrenalectomized rats. Highest specific binding capacity at 25 degrees C (expressed as fmol X cm-1 +/- SE) was found in the cortical collecting tubule (9.69 +/- 0.77) followed in decreasing order by the distal convoluted tubule (2.70 +/- 0.49), medullary collecting tubule (2.58 +/- 0.64), proximal convoluted tubule (1.09 +/- 0.10), and pars recta (0.57 +/- 0.08). Binding was lowest in the thick ascending limb of Henle's loop, with comparable values in the medullary (0.27 +/- 0.05) and cortical (0.26 +/- 0.05) portions of this segment. The apparent maximal binding capacity of the cortical collecting tubule for corticosterone exceeded by nearly two orders of magnitude that of aldosterone previously measured by us in this structure, which is in agreement with the observations of other investigators in kidney cytosol. Specific binding of corticosterone can be demonstrated along the entire rat nephron, but binding sites are concentrated in the cortical collecting tubule. This segment appears to be the main target site for corticosterone as it is for aldosterone.