The Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments

Environmental health remains a niche topic in bioethics, despite being a prominent social determinant of health. In this paper we argue that if bioethicists are to take the project of health justice as a serious one, then we have to address environmental injustices and the threats they pose to our bioethics principles, health equity, and clinical care. To do this, we lay out three arguments supporting prioritizing environmental health in bioethics based on bioethics principles including a commitment to vulnerable populations and justice. We also highlight and advocate for environmental law efforts that align with these priorities, focusing specifically on the need for a right to a healthy environment. Our intention is to draw attention to the legal and ethical concepts that underlie the importance of a healthy environment, and urge bioethicists to prioritize both legal and ethical advocacy against environmental injustices in their practice.

Kinetics of chemical degradation of isoxaflutole: influence of the nature of aqueous buffers (alkanoic acid/sodium salt vs phosphate)

A kinetic study of the chemical degradation of isoxaflutole (5-cyclopropyl-1,2-oxazol-4-yl alpha alpha alpha-trifluoro-2-mesyl-p-tolyl ketone) into its diketonitrile derivative (DKN), which is its active herbicide principle, in organic buffers at different pH values was carried out using a HPLC/UV detection method. The values of the pseudo-first-order rate constants Kobs for the reaction were calculated and compared with those previously obtained in inorganic buffers. In both cases, Kobs was found to be dependent on pH and temperature, but at pH 5.2 the degradation of isoxaflutole in CH3COOH/CH3COONa buffers was considerably faster than in KH2PO4/Na2HPO4 buffers, indicating that the compound was sensitive to the nature of the reagents used to prepare buffered solutions. The influence of phosphate and acetate concentrations and the influence of the R-substituent in RCOOH/RCOONa buffers were investigated. For the HA/A- buffers studied, the values of Kobs were linearly dependent on HA and A- concentrations, which meant that the degradation of isoxaflutole was subject to general catalysis. The values of Kobs were also found to be dependent on the number and the position of the CH3 groups of the R-substituent. The known degradation product of DKN (a benzoic acid derivative) was not detected throughout this study.

Fate of a phenylpyrazole in vegetation and soil under tropical field conditions

The fate of fipronil, a phenylpyrazole insecticide, and its metabolites under tropical conditions was studied in soil and in vegetation after treatment for locust control. Two different plots were treated with a formulation of fipronil at doses of 5 and 10 g of active ingredient ha(-)(1), respectively. Vegetation and soil at depths of 0-5 and 5-20 cm were sampled for up to 2 months after treatment. After extraction and purification on fipronil immunoaffinity cartridges, residues were analyzed by gas chromatography using electron capture and mass detectors. In soil, a rapid initial decrease of fipronil was observed with a rapid formation of the sulfone and the photodegradate; the amide and the sulfide were not detected. In vegetation, a rapid initial decrease of fipronil was also observed with a rapid formation of mostly the sulfone; the photodegradate and the sulfide were also detected but at much lower concentrations. The metabolites resulting from the degradation of fipronil were similar in both soil and vegetation, but their relative concentrations were different.

Kinetics of abiotic hydrolysis of isoxaflutole: influence of pH and temperature in aqueous mineral buffered solutions

A kinetic study of the chemical hydrolysis of isoxaflutole [5-cyclopropyl-4-(2-methanesulfonyl-4-trifluoromethylbenzoyl)is oxazol e (IFT)], a new herbicide recently developed by Rhône-Poulenc Agro, in buffered, sterile aqueous solutions was carried out in the dark at 295, 308, and 323 K and at nine pH values between 1.8 and 10.1. Samples were analyzed by HPLC-UV. The decrease in IFT concentration was accompanied by an increase in the concentration of its diketonitrile derivative (DKN). Obeying pseudo-first-order kinetics, isoxaflutole hydrolysis increased with increasing pH and temperature: for 295 K and pH 9.3 the rate of degradation was 100-fold faster than at pH 3.8. Using the Arrhenius equation, the rate constants K(obsd), activation energies E(a), and entropies DeltaS() were calculated, and plotting log(K(obsd)) against pH showed that the effect of pH varied with temperature. According to DeltaS() values the mechanism of the reaction was found to be different with respect to pH range. The benzoic acid derivative, known as a degradation product of DKN in plants, was not detected in the present study.

An investigation of the spatial variations of the energetic trapped electrons at low altitudes

We have analyzed the trapped electron data (0.19-3.2 MeV) taken by the Japanese OHZORA satellite operated at 350-850 km altitude in polar orbit during 1984-1987 near solar minimum. The electron observations reveal all the global attributes of the quiet-time electron radiation belts, such is the South Atlantic Anomaly, the electron "slot", and the outer radiation belt regions. The electron data are in general agreement with the NASA AE-8 electron model, but there are differences, particularly with respect to distinctive local-time variations in the slot region. In this paper, we present results from analyses of variations of the electron pitch angle distributions with local time, L-shell and altitude.

The impact of non-endotoxin LAL-reactive materials on Limulus amebocyte lysate analyses

Limulus amebocyte lysate (LAL) is activated by bacterial endotoxins and certain glucans (beta-D-glucan, LAL-RM). The potential for conflicting inter-laboratory results for LAL tests exists because commercial LAL reagents are highly variable in response to LAL-reactive glucans. The nature of beta-D-glucan activation of LAL and means for rendering LAL non-responsive to glucan are reviewed to provide a background for resolving conflicting data. Kinetic LAL methods are particularly useful for screening materials potentially contaminated with glucan. The presence of beta-D-glucan in parenterals is uncommon and is likely limited to products exposed to microbial or cellulosic materials. A scheme is suggested for identifying LAL-reactive glucans and for LAL release-testing without glucan interference.

Endogenous colonization by gentamicin-resistant gram-negative bacilli elaborating aminoglycoside (3)-5-acetyltransferase

Members of the family Enterobacteriaceae that elaborate aminoglycoside 3-5-acetyltransferase [AAC(3)-5] caused a nosocomial outbreak at the Vanderbilt University Medical Center and have persisted. To see whether the gene for AAC(3)-5 was present in the community, stool cultures of newly admitted patients and ambulatory persons were examined with a specific gene probe. AAC(3)-5-positive strains were present in the intestinal flora examined.

Resolving LAL Test interferences

A greater understanding of the nature of LAL-Test interferences and the use of permissible dilution have minimized inhibition problems. Common interference mechanisms include suboptimal pH, endotoxin aggregation or adsorption, container effects, unbalanced cation concentration, enzyme or protein modification, and non-specific LAL activation. Dilution is the best approach to resolving interferences because over 90% are concentration dependent and are solved by the 1:40 dilution with LAL Reagent Water. Other problems are approached by using dilution plus a specific pretreatment procedure designed to neutralize the offending mechanism.

Mycobacterium chelonae: a cause of nodular skin lesions with a proclivity for renal transplant recipients

PURPOSE

Infections due to Mycobacterium chelonae are uncommon. Several renal transplant recipients at our medical center have developed M. chelonae infections during the past several years, so we decided to review our recent experience with M. chelonae infections.

PATIENTS AND METHODS

The clinical microbiology laboratory records of four Vanderbilt University Affiliated Hospitals were reviewed. Ten patients with M. chelonae tissue or blood infections were identified between 1982 and July 1988.

RESULTS

All infections involved the skin and subcutaneous tissue. Three infections developed at the sites of medical injections. The remaining seven infections occurred in renal transplant recipients and produced a clinically distinctive syndrome. All were indolent tender nodular lesions on the extremities, usually the lower legs. Systemic symptoms were absent, and white blood cell counts were within normal limits. Diagnosis required tissue biopsy and cultures that were incubated for a month. Therapy consisted of surgical excision combined with long-term antibiotics. Even so, some patients had a chronic, relapsing course.

CONCLUSION

Although other diagnoses must be considered, the presumptive diagnosis of M. chelonae infection is suggested by the appearance of nodular erythematous lesions on the legs of a renal transplant recipient.

Recurrent meningitis in a black man

A 43-year-old black man had recurrence of acute bacterial meningitis caused by Neisseria meningitidis. He had had three previous episodes of acute meningitis, starting at age 27 years. The patient's serum was found to have an undetectable level of the sixth component of complement. Congenital absence of one of the terminal proteins in the complement system impairs a patient's ability to eradicate bacteria, and increases susceptibility to recurring infections caused by meningococci and other Neisseria species. Though the serum of complement-deficient patients promotes normal opsonization of bacteria, it is unable to kill meningococci directly. The currently available meningococcal vaccine may augment type-specific antibody, but it does not correct the underlying complement deficiency. The role of self-administered antibiotics in preventing recurrent Neisseria infection remains uncertain.

Effect of patient positioning on distribution of tetracycline in the pleural space during pleurodesis

Thoracostomy tube drainage with tetracycline (TCN) instillation is an effective technique for management of recurrent, symptomatic, malignant pleural effusions. Although patient rotation through various positions after instillation of TCN has been advocated empirically, it has not been shown scientifically to be necessary and is often uncomfortable for the patient and time-consuming for personnel. Five patients with symptomatic, malignant pleural effusions were studied during pleurodesis using radiolabelled TCN. Scintigraphic imaging was done immediately after TCN instillation prior to patient rotation. Patients were rotated through six positions and multiple images were obtained at 30 and 120 minutes. Tetracycline dispersed throughout the pleural space within seconds. Patient positioning had no effect on the intrapleural distribution of TCN in four of the five patients. In one patient with loculated hydropneumothorax and trapped lung, rotation minimally improved distribution of TCN to the apex. Rotation during pleurodesis does not appear to be necessary in patients with a relatively normal pleural space. However, patient rotation enhances distribution of TCN when the lung is separated substantially from the chest wall, as with trapped lung. Possibly, in this situation the properties of fluid mechanics and capillary action no longer apply.

Symptomatic sclerosing cholangitis in patients with a normal alkaline phosphatase: two case reports and a review of the literature

The diagnosis of sclerosing cholangitis is usually not considered in the absence of an elevation of serum alkaline phosphatase. The purpose of this paper is to report two symptomatic cases of primary sclerosing cholangitis (PSC) which presented with a normal alkaline phosphatase, and to review the literature regarding alkaline phosphatase in PSC. A total of 172 patients with PSC were identified in the literature; six of these patients (3%) presented with a normal alkaline phosphatase. Patients with diseases known to be associated with primary sclerosing cholangitis and having a compatible clinical presentation should be considered for evaluation with endoscopic retrograde cholangiography, even in the presence of a normal level of serum alkaline phosphatase.

Energetic Charged Particles in the Uranian Magnetosphere

During the encounter with Uranus, the cosmic ray system on Voyager 2 measured significant fluxes of energetic electrons and protons in the regions of the planets magnetosphere where these particles could be stably trapped. The radial distribution of electrons with energies of megaelectron volts is strongly modulated by the sweeping effects ofthe three major inner satellites Miranda, Ariel, and Umbriel. The phase space density gradient of these electrons indicates that they are diffusing radially inward from a source in the outer magnetosphere or magnetotail. Differences in the energy spectra of protons having energies of approximately 1 to 8 megaelectron volts from two different directions indicate a strong dependence on pitch angle. From the locations of the absorption signatures observed in the electron flux, a centered dipole model for the magnetic field of Uranus with a tilt of 60.1 degrees has been derived, and a rotation period of the planet of 17.4 hours has also been calculated. This model provides independent confirmaton of more precise determinations made by other Voyager experiments.

Comparison of several control standard endotoxins to the National Reference Standard Endotoxin--an HIMA collaborative study

A collaborative study, initiated under the auspices of the Health Industry Manufacturers Association (HIMA), was designed to establish the relationship of Escherichia coli O55:B5 endotoxin (the control standard endotoxin of HIMA and the Food and Drug Administration's Office of Medical Devices) to the U.S. National Reference Standard Endotoxin and to two internationally used control standard endotoxins. By using two Limulus amoebocyte lysate test systems, it was established that the E. coli O55:B5 endotoxin lot originally used by HIMA and the Office of Medical Devices to establish Limulus amoebocyte lysate release test criteria for pyrogen testing of medical devices contains approximately 4.5 endotoxin units (EU) per ng. Thus, the 1.0-ng/kg endotoxin dose limit currently established for medical devices is approximately the same as the 5.0-EU/kg endotoxin limit (on an activity basis) established by several other Food and Drug Administration agencies for human and animal parenteral drugs and biological products.

Identification of structural and secretory lectin-binding glycoproteins of normal and cancerous human prostate

We have utilized the technique of lectin-loading of SDS gels with iodinated concanavalin A and wheat germ agglutinin to identify glycoproteins in prostatic and seminal fluids as well as in prostate tissue fractions. The following subunits which bound both lectins were detected: (a) 50, 43 and 38 kDa subunits common to prostatic and seminal fluids, and an additional 55 kDa subunit which predominates only in prostatic fluid; (b) 78, 55, 50 and 43 kDa subunits in prostatic tissue cytosol and (c) 195, 170, 135, 116 and 95 kDa subunits present in the particulate fractions of prostatic tissue. Immunoblotting using specific rabbit antibodies revealed the 50 kDa band to be prostatic acid phosphatase and the 38 kDa band to be prostate-specific antigen. Interestingly, antibodies directed toward prostatic acid phosphatase were found to cross-react with the 43 kDa band. Fractionation on sucrose gradients showed that several of these particulate glycoproteins were associated with a vesicle fraction enriched in adenylate cyclase activity, implying that they are plasma membrane glycoproteins. Comparison of soluble and particulate fractions of normal and cancerous tissue homogenates was made by densitometric scanning of autoradiograms of lectin-loaded gels. Similar relative intensities of lectin-binding were obtained for corresponding proteins in normal and cancerous tissue fractions. Also, immunoblotting showed no differences in prostatic acid phosphatase or prostate-specific antigen between normal and cancerous soluble homogenate fractions. Our results suggest that major lectin-binding proteins are conserved in the transition from normal to cancerous tissue. These results may be useful in developing a multiple-marker profile of metastatic prostate cancer and for the design of imaging agents, such as monoclonal antibodies, to prominent soluble and particulate prostate glycoproteins.

Distribution of prostatic acid phosphatase isoenzymes in normal and cancerous states

We have studied the IEF (isoelectric focusing) profiles and the sedimentation characteristics of intracellular and secretory prostatic acid phosphatase (PAP) in normal and cancerous states. IEF studies show a similar relative distribution of tartrate inhibitable pI 4.9 (approximately 80%) and 5.6 (approximately 20%) forms of this enzyme in normal as well as cancerous prostate. The same IEF profile is obtained regardless of whether an enzymatic or RIA method is utilized for detection of PAP. Of these two isoenzymes, only the form of pI 4.9 predominates in prostatic and seminal fluids and in Stage IV serum. Sedimentation analysis shows that the purified enzyme is exceptionally stable since it retains an S020,w value of 5.7 at low concentrations (ng/ml). While only the 5.7S form is observed in normal and cancerous tissues as well as in prostatic fluid, analysis of Stage IV serum reveals an additional form at 8.7S. Control experiments suggest that the 8.7S form is not induced by non-specific association with normal serum proteins or by the inhibitor tartrate. Our results suggest that: (a) of the two major isoenzymes in tissue, only the pI 4.9 isoenzyme predominates in secretion, (b) this relationship of intracellular to secretory forms is unaltered in the transition from normal to cancerous tissue, and (c) the utility of PAP as a tumor marker is derived at least in part by the intrinsic stability of the 5.7S form. The significance of the 8.7S form is unknown at the present time, but it does not distort the clinical (RIA) measurement of PAP in serum.

Purification of acetylcholine receptors from the muscle of Electrophorus electricus

Muscle from the electric eel Electrophorus electricus contains acetylcholine receptors at 50 times the concentration of normal mammalian muscle and fully one-tenth the concentration of receptors in its electric organ tissue. Receptor is organized much more diffusely over the surface of Electrophorus muscle cells than is the case in normally innervated mammalian skeletal muscle. Receptor was purified from Electrophorus muscle by affinity chromatography on cobra toxin-agarose and found to contain subunits which correspond immunochemically to the alpha, beta, gamma, and delta subunits of receptor from electric organ tissue of Torpedo californica. Receptor purified from Electrophorus muscle appears virtually identical with receptor purified from Electrophorus electric organ tissue.

Radiotherapy for prostatic carcinoma: post-irradiation prostatic biopsy and recurrence patterns with long-term followup

From 1968 through 1975, 159 patients with stages A, B and C adenocarcinoma of the prostate were treated with supervoltage radiation therapy. A median dose of 7,200 rad was given. The influence upon survival of grade, stage and a positive biopsy result after irradiation is analyzed. Over-all survival is a patently imprecise test of local treatment because patients die of intercurrent disease and are alive with metastases for significant intervals. The classification of survival with no evidence of recurrent disease excluded those patients dying of intercurrent disease. Therefore, the rate of survival free of disease always will be greater than the over-all survival rate in these patients, and a certain percentage of the patients without evidence of cancer will harbor subclinical disease. The 5 and 10-year survival rates free of disease were 80 and 69 per cent, respectively, in 51 patients with stages A and B cancer, and 66 and 47 per cent, respectively, in 108 with stage C disease. The 5 and 10-year over-all survival rates were 72 and 56 per cent, respectively, in the former and 68 and 39 per cent, respectively, in the latter patients. Survival free of disease and death of prostatic carcinoma were influenced adversely by advancing grade and stage (p less than 0.05), while over-all survival was influenced adversely by grade (p equals 0.02) but not by stage (p greater than 0.05). A positive biopsy result after irradiation did not predict survival free of disease, over-all survival or death of prostatic cancer in patients followed for 10 years (p greater than 0.05).

The morale-productivity relationship: how close?

Is there a direct relationship between morale and productivity? According to Robert H. Garin, professor of secondary and higher education at East Texas State University and John F. Cooper, dean of instruction at Patrick Henry Community College, the traditional view that the individual whose morale is high will be highly productive, or vice versa, is not a necessarily valid one. The authors analyzed the historical development of the major representative research studies and concepts concerning the morale-productivity relationship and found that the relationship evolved from one of simple direct correlation to the present viewpoint that a variety of factors--such as the environment, motivation, job levels, and so on--must be taken into consideration before any positive conclusion can be drawn. Because of the national concern over the decline in American productivity standards, Garin and Cooper believe that the morale-productivity relationship is an area ripe for further experimental research.

The radioimmunochemical measurement of prostatic acid phosphatase: current state of the art

A novel radioimmunochemical method for the measurement of human prostatic acid phosphatase in serum and bone marrow has demonstrated distinct biochemical advantages over the standard enzymatic techniques that are currently utilized in the clinical laboratory. The promising nature of the immunochemical assay now in clinical assessment for prostatic cancer may lend itself particularly to more sensitive confirmation of the presence of prostatic neoplasia as well as significantly more precision in the clinical staging of the disease process. In its present form, utilization of the technique as a reliable screening test for early prostatic cancer is patently inappropriate from a biochemical and biostatistical point of view. Continuing research on the antigenic nature of the human prostatic acid phosphatase molecule and the development of antibody with enhanced specificity may somewhat resolve the current screening problem. However, the essentially insoluble problem of the relatively low prevalence rate for prostatic cancer in males in the United States will persist and will probably limit the clinical application of enzymatic and radioimmunochemical screening techniques for early prostatic cancer.

Current experience with radioimmunoassay techniques for prostatic acid phosphatase

Data are presented demonstrating that radioimmunoassay techniques for measurement of serum prostatic acid phosphatase are more sensitive than enzymatic methods in the detection of all stages of prostatic cancer. The possibility of using a solid phase RIA technique to screen for prostatic cancer is considered. Sixty-three hundred and twenty men over age 45 entering a clinical laboratory for any indication were evaluated using the RIA test for PAP. In this group 444 (7%) had elevated test values. Clinical recall and urologic review of the patients with elevated test results yielded 67 who were suspect for prostatic cancer, of whom 59 (88%) were confirmed by prostatic needle biopsy. These data suggest that the RIA for prostatic acid phosphatase as an isolated clinical procedure is not sufficiently specific to be used for screening due to the large number of false-positive results. However, the RIA-PAP test in combination with a follow-up urologic examination is quite specific and deserves further consideration as a screening method for prostatic malignancy.

Combined serum and bone marrow radioimmunoassays for prostatic acid phosphatase

Combined serum and bone marrow radioimmunoassays for prostatic acid phosphatase provide a unique means for the early diagnosis and more accurate clinical staging of prostatic cancer. The combined screening technique appears to be helpful, particularly in providing a clinical assessment of the presence or absence of early, subclinical lymphatic and bone marrow metastases. Low titer elevations of bone marrow prostatic acid phosphatase by radioimmunoassay have been observed commonly in clinically understaged C prostatic cancer with normal technetium bone scans, indicating the presence of unrecognized stage D disease with bone metastases. The combined screening method also is of distinct clinical value in the early diagnosis of prostatic cancer and in monitoring the effects of specific therapy. In therapeutically responsive patients marked suppression of serum and bone marrow prostatic acid phosphatase is observed regularly with the radioimmunochemical method under study.

A radioimmunoassay for prostatic acid phosphatase

A solid phase radioimmunoassay for human prostatic acid phosphatase has demonstrated substantially greater biochemical sensitivity than a standard enzymatic method for which p-nitrophenylphosphate was used as substrate. Preliminary data indicate that the radioimmunochemical approach can precisely classify 43% stage I-II and 94% stage III-IV prostate cancers. In contrast, the standard enzymatic methods correctly classified only 9% stage I-II and 46% stage III-IV cancers. It is clinically apparent that a radioimmunochemical approach for the measurement of human prostatic phosphatase may have distinct potential in the clinical diagnosis of prostate cancer.

Measurement of prostatic acid phosphatase in various cell lines

In the last few years, we have developed a radioimmunoassay for the measurement of human prostatic acid phosphatase. This method, which requires samples of the patient's serum, has been proved to be more accurate than the conventional enzymatic assay for the detection of early stages of carcinoma of the prostate. We used the enzymatic assay and radioimmunoassay for the quantitation of prostatic acid phosphatase in cultured prostatic cell lines. We were unable to show any difference in the concentration of prostatic acid phosphatase between prostatic and any other established cell lines.

Excessive proliferation of peripelvic fat of the kidney

Excessive proliferation of the peripelvic fat of the kidney (EPPF) is a benign process with an innocuous effect on the patient. However, this condition may assume major clinical significance by producing pyelocalyceal deformities that may be mistaken for true renal masses. Rarely, EPPF may masquerade as a renal pelvic tumor. We present the second reported case of EPPF simulating a renal pelvic tumor and review the history as well as the characteristic radiographic and sonographic features of this condition.

The natural history of papillary transitional cell carcinoma of the bladder and its treatment in an unselected population on the basis of histologic grading

Between 1950 and 1965, 365 patients were treated for transitional cancer of the bladder at our hospitals. A retrospective study was done, using clinical records and a histopathologic review to determine the long-term natural history of this population when treated conservatively. The natural history of 3 separate patient populations was discovered, based solely on the grading of the transurethrally resected fragments. Based on the grade on initial presentation these patients were divided into grades I, II and III. Of the patients 5 per cent in grade I, 16 per cent in grade II, 28 to 35 per cent in grade III not involving muscle and 83 per cent in grade III involving muscle died of bladder cancer. Ninety-seven patients (26 per cent) died of bladder cancer, 110 (31 per cent) died of other causes and 158 (43 per cent) have been alive more than 5 years (104 more than 10 years). Grade I tumors that progressed to a higher grade did so within 2 years of the initial diagnosis. Of the bladder cancer deaths 83 per cent occurred within 2 years of the initial diagnosis. Of 64 patients dying more than 5 years after presentation only 7 died of bladder cancer.

A solid phase radioimmunoassay for prostatic acid phosphatase

The sensitivity of a recently developed solid phase radioimmunoassay for human prostatic acid phosphatase was compared to that of an enzymatic method using p-nitrophenylphosphate as substrate. In 109 histologically verified untreated stages I to IV prostatic cancers and 200 men without such cancer the solid phase radioimmunoassay method demonstrated substantially greater sensitivity and specificity than the enzymatic technique. In the 109 prostatic malignancies the immunochemical method correctly classified 80 (73 per cent) versus 34 (31 per cent) for the p-nitrophenylphosphate enzymatic technique (p less than 10(-6). In 44 stages I and II cancers confined to the prostate the radioimmunoassay was abnormally elevated in 19 (43 per cent) with only 4 (9.1 per cent) enzymatic elevations (p less than 10(-3). In 65 stages III and IV extraprostatic cancers correct classifications were noted in 61 (94 per cent) of the radioimmunoassays and 30 (46 per cent) enzymatic tests (p less than 10(-6). The radioimmunoassay in 200 male controls yielded 11 (5.6 per cent) and the p-nitrophenylphosphate enzymatic test yielded 7 (3.5 per cent) falsely positive results. In 90 non-prostatic human cancer sera 85 (94.5 per cent) were correctly classified as negative by the radioimmunoassay for prostatic acid phosphatase versus 66 (73 per cent) as negative by the enzymatic method. These data are discussed in terms of the merits of a radioimmunochemical approach for the measurement of human serum prostatic acid phosphatase.

Experimental use of fluoroalkyl cyanoacrilate in ureteral anastomosis

A fluorinated tissue adhesive Fluoroalkyl Cyanoacrilate has been used in end-to-end ureteral anastomoses as an adjunct to suture material to avoid urinary extravasation in seven dogs. A similar number of dogs served as controls. The urinary tracts were evaluated grossly, radiographically, and histologically after 3 to 12 months. Better anatomical results and less inflammatory reaction and fibrosis were found in the group submitted to the tissue adhesive.

Radioimmunochemical measurement of bone marrow prostatic acid phosphatase

Human acid phosphatases are ubiquitous phosphohydrolases that are present in most respiring tissues and cells. Specifically, human prostatic acid phosphatase is a unique enzyme within a vast family of acid phosphatases concerned with catabolic processes in cellular metabolism. The majority of serum and bone marrow acid phosphatases are of non-prostatic origin and are present chiefly in erythrocytes, leukocytes, platelets and other maturing cells in the bone marrow. The specific concentration of prostatic acid phosphatase in serum and bone marrow is normally relatively low compared to non-prostatic acid phosphatases. Many falsely positive assays for total serum acid phosphatases and bone marrow acid phosphatases have been reported, particularly after traumatic marrow biopsy procedures and mishandling of blood samples in the clinical laboratory and in hematologic disease states. The disruption and lysis of whole blood and marrow cells can liberate non-specific acid phosphatases into the serum. Since standard enzymatic assays do not discriminate accurately prostatic acid phosphatase from non-prostatic acid phosphatase present in the serum spurious results can be realized. A preliminary experience with a promising radioimmunoassay for the specific measurement of prostatic acid phosphatase in bone marrow and serum is presented.

Counterimmunoelectrophoresis in determination of prostatic acid phosphatase in human serum

We evaluated counterimmunoelectrophoresis for use in measuring prostatic acid phosphatase in detection of prostatic cancer. After staining for acid phosphatase, we could detect as little as 0.3 ng of purified enzyme standard complexed with antibody by this technique. However, when serum samples were used as antigen, the method was less sensitive (1.5-2.0 ng) because some of the serum proteins migrate with the phosphatase and decrease the intensity of the stain for acid phosphatase. For this reason we could not detect the phosphatase in serum samples of normal persons; only patients with moderately (or greater) increased activity in their serum showed positive results. In contrast, by radioimmunoassay as little as 1.0 ng of the phosphatase can be detected in serum.

Counterimmunoelectrophoresis in determination of prostatic acid phosphatase in human serum

We evaluated counterimmunoelectrophoresis for use in measuring prostatic acid phosphatase in detection of prostatic cancer. After staining for acid phosphatase, we could detect as little as 0.3 ng of purified enzyme standard complexed with antibody by this technique. However, when serum samples were used as antigen, the method was less sensitive (1.5-2.0 ng) because some of the serum proteins migrate with the phosphatase and decrease the intensity of the stain for acid phosphatase. For this reason we could not detect the phosphatase in serum samples of normal persons; only patients with moderately (or greater) increased activity in their serum showed positive results. In contrast, by radioimmunoassay as little as 1.0 ng of the phosphatase can be detected in serum.

Detection of prostatic cancer by solid-phase radioimmunoassay of serum prostatic acid phosphatase

We compared our radioimmunoassay with the standard enzyme assay for prostatic acid phosphatase in the diagnosis of prostatic cancer. Serum samples from 50 controls, 113 patients with prostatic cancer, 36 with benign prostatic hyperplasia, 83 with other cancers, 20 with gastrointestinal disorders and 28 with total prostatectomies were randomized and studied by radioimmunoassay and enzyme assay. When the upper limit was set at 8.0 ng per milliliter (mean + 4 S.D.) the radioimmunoassay diagnosed prostatic cancer in 33, 79, 71 and 92 per cent of the patients with Stage I, II, III and IV disease. In contrast, the enzyme assay detected elevations of enzyme in the serum of 12, 15, 29, and 60 per cent respectively. No false-positive results were detected by either assay in normal controls but the radioimmunoassay test was positive in two patients with benign prostatic hyperplasia, in one patient after total prostatectomy, in nine with other cancers and in one of the group with gastrointestinal disorders. In contrast to the enzyme assay, the radioimmunoassay distinguished over half the cases of intracapsular prostatic cancer.

Isozymes of acid phosphatase in normal and cancerous human prostatic tissue

The supernatants of the homogenates from normal and cancerous human prostatic tissue run on polyacrylamide gel electrophoresis have 2 major electrophoretic bands when stained for prostatic acid phosphatase. The ratios of the electrophoretically distinguishable isoenzymes differ in normal and cancerous tissues. Similar distinctions between isoenzymes in normal and cancerous prostates are observed following column chromatographic separation or isoelectric focusing. The faster electrophoretic band can be separated by diethylaminoethyl cellulose column chromatography or by isoelectric focusing into at least five fractions with different electrophoretic mobilities. We could not find any differences in normal and cancerous tissues among these subfractions of the faster-moving electrophoretic band. Analysis by gel electrophoresis does not show association between these fractions after chromatographic or isoelectric separation of the prostatic acid phosphatase fractions. Quantitative, but no qualitative, differences in prostatic acid phosphatase isozymes occur in normal versus cancerous prostates.

Gamma A myeloma with hyperviscosity and obstructive uropathy

A patient with gamma A myeloma, hyperviscosity and an obstructive uropathy is described. Operation revealed a proteinaceous mass obstructing the right renal pelvis. Immunoprecipitin and immunofluorescent analysis of this mass and concentrated urine demonstrated the presence of gamma A myeloma protein, kappa light chains and albumin. This is the first description of an obstructive uropathy in multiple myeloma owing to a proteinaceous matrix containing paraprotein.

Comparison of human prostatic acid phosphatase by measurement of enzymatic activity and by radioimmunoassay

We compared results of measurement of prostatic acid phosphatase activity in serum and various tissues by enzymatic assay and radioimmunoassay. By enzymatic assay, activity in serum is lost rapidly, even at room temperature. In contrast, there was no change in antigenic activity during 48 h by radioimmunoassay. The radioimmunoassay was more specific in 12 tissues and in serum than were several enzymatic assays that make use of inhibitors of the enzyme. The enzymatic assay resulted in 26.6% (24/90) false positives from non-prostatic cancer patients. In contrast, with radioimmunoassay there were only 5.5% (5/90) false positives. We conclude that immunological detection of prostatic acid phosphatase is the more reliable technique.

Comparison of human prostatic acid phosphatase by measurement of enzymatic activity and by radioimmunoassay

We compared results of measurement of prostatic acid phosphatase activity in serum and various tissues by enzymatic assay and radioimmunoassay. By enzymatic assay, activity in serum is lost rapidly, even at room temperature. In contrast, there was no change in antigenic activity during 48 h by radioimmunoassay. The radioimmunoassay was more specific in 12 tissues and in serum than were several enzymatic assays that make use of inhibitors of the enzyme. The enzymatic assay resulted in 26.6% (24/90) false positives from non-prostatic cancer patients. In contrast, with radioimmunoassay there were only 5.5% (5/90) false positives. We conclude that immunological detection of prostatic acid phosphatase is the more reliable technique.

Production of specific antibody to purified prostatic acid phosphatase

Prostatic acid phosphatase may well be a prime antigenic protein in prostatic tissue and fluid. Extraction of the enzyme in highly purified form from prostatic fluid and benign hypertrophic prostatic tissue provides a unique antigen capable of inducing a prompt and specific antibody response in the goat and rabbit as amnifested by immunodiffusion, immunoelectrophoresis, and immunofluorescence techniques. In prostatic cancer patients with elevated serum acid phosphatase levels it is possible to detect humoral circulating PAP antigen by standard immunoelectrophoretic methods and to confirm the existence of the enzyme by radioautography, L-tartrate inhibition, and the Gomori or Burstone staining procedures. Preliminary indirect prostatic immunofluorescence studies consistently demonstrated characteristic fluorescent foci in the paranuclear areas of benign prostatic epithelial cells, the presumed area of synthesis of prostatic acid phosphatase. Consideration has been given to the possibility of the development of a radioimmunoassay for prostatic acid phosphataase utilizing a heterolologous antiserum to the enzyme extracted from human prostatic fluid.

Enhancing effect of surfactant and protein on hydrolysis of thymolphthalein monophosphate by purified prostatic acid phosphatase

Purified prostatic acid phosphatase catalyzes the hydrolysis of thymolphthalein monophosphate 10-fold faster if an optimal concentration of Brij 35 (a wetting agent) or protein (bovine serum albumin or human serum proteins) is present. Results of gel filtration, dialysis, and sucrose density-gradient centrifugation analysis suggest that the substrate must combine with detergent or protein before the enzyme can catalyze its hydrolysis.

A solid-phase radioimmunoassay for human prostatic acid phosphatase

A solid-phase technique for radioimmunoassay of human prostatic acid phosphatase (EC 3.1.3.2) is described. Human prostatic acid phosphatase was purified from prostatic fluid. Monospecific antisera to the purified acid phosphatase were produced in rabbits. Disposable polypropylene tubes were coated with antiserum and used for radioimmunoassay with 125I-acid phosphatase. The nonspecific binding was minimized by saturating the binding sites of the tubes with bovine serum albumin. The working range of the technique was 1 to 30 ng of antigen. The solid-phase radioimmunoassay is rapid, sensitive, and efficient. In preliminary clinical trials it was shown that (a) patients with advanced prostatic cancer had elevated prostatic acid phosphatase levels by both enzymatic assay and radioimmunoassay assays, and (b) patients with other cancers were in the normal range for prostatic acid phosphatase.

Endotoxin as a cause of aseptic meningitis after radionuclide cisternography

The role of pyrogens in aseptic meningitis after radionuclide cisternography was studied by means of the Limulus test, a sensitive detector of endotoxin. During a 15-month period, 39 reactions associated with cisternography were reported. Ten samples of specific lots of the radioactive drugs implicated in 20 of these reactions were tested and all reacted strongly positive to the Limulus test. The less sensitive rabbit pyrogen test was negative for these preparations when tested on a dose-per-weight basis. Our findings apparently provide clinical evidence for the observation made in animals that endotoxin is at least 1,000 times more toxic intrathecally than intravenously. The data implicate endotoxin contamination as a cause of adverse reactions to radionuclide cisternography. We conclude that the USP pyrogen test is insufficiently sensitive for intrathecal injectables and should be supplemented by the Limulus test.