c-erbB2 protein overexpression in breast cancer as a target for PET using iodine-124-labeled monoclonal antibodies. ICR 12, one of a panel of rat monoclonal antibodies recognizing the external domain of the human c-erb B2 proto-oncogene product, (Styles, 1990) was chosen as a candidate for radiolabeling with 124I for positron emission tomography of selected patients with breast cancer. By using N-bromosuccinimide (NBS), optimal labeling conditions were established using 125I. The labeling efficiency was determined using instant thin-layer chromatography (ITLC) and gel filtration (HPLC). The antibody was then labeled with the positron emitter 124I, and a labeling efficiency of 96% and immunoreactivity of 80%-90% was obtained. The product was stable, with less than 5% of the radiolabel being eluted after six days storage in plasma at 37 degrees C. Immunolocalization studies were performed in athymic mice bearing human breast carcinoma xenografts overexpressing the c-erb B2 gene product using as controls 125I labeled isotype-matched rat antibody, and antigen-negative tumors. Good uptake of 124I-labeled ICR12 was obtained in c-erb B2 expressing tumors (up to 12% injected dose per gram at intervals up to 120 hr), with localization indices of 3.4-6.2. Tumor xenografts of 6 mm diameter were successfully imaged with high resolution at 24, 48 and 120 hr using the RMH/ICR MUP-PET camera. We suggest that 124I-labeled ICR12 is a suitable agent to image and quantify immunolocalization in patients whose tumors overexpress the c-erb B2 proto-oncogene product.


Significance of secondary ion mass spectrometry microscopy for technetium-99m mapping in leukocytes. Secondary ion mass spectrometry (SIMS) microscopy is the only method potentially capable of mapping all the elements in the periodic table including stable and radioactive isotopes. We used this method to study 99mTc distribution by detecting and localizing of 99Tc, a daughter product which has the same mass and the same chemical properties. It was combined with albumin macroaggregates or with Hexamethylpropylene-amine oxime (HMPAO) in leukocytes. The efficiency of 99Tc ionization under Cs+ bombardment was higher than with an O2+ beam. By using high mass resolution we succeeded in detecting and localizing 99Tc in cell sections by eliminating polyatomic ions that arise from this biological matrix. The 99Tc specific signal was obtained with a mass resolution of 2000 for labeled albumin macroaggregates, and 5000 for HMPAO-labeled leukocytes. In the latter, the labeling varied from one cell to another and 99Tc was present in both the nucleus and the cytoplasm. The results indicate that SIMS microscopy can provide new insights into 99mTc dosimetry.


Plasmapheresis in radioimmunotherapy of micrometastases: a mathematical modeling and dosimetrical analysis. The feasibility of combining plasmapheresis with a large administration of radiolabeled antibody in order to overcome the "binding-site" barrier to antibody penetration in targeting hematologically distributed micrometastases is examined. In such a strategy, intravenous administration of excess radiolabeled antibody, to saturate antigen sites on the cell cluster periphery, is followed by removal of unbound antibody from the plasma, by plasmapheresis, to reduce the absorbed dose to the red marrow. Plasma antibody kinetics are simulated by a non-linear compartmental model representing free and antigen-bound antibody. This provides the boundary condition for a model of antibody diffusion, saturable binding to and dissociation from antigen sites within a 200 microns diameter cluster of tumor cells. Using these models, the absorbed dose to the red marrow and the absorbed dose profile across the cell cluster are calculated. Changes in marrow and cell cluster absorbed dose from alterations in the onset time and rate of plasmapheresis are illustrated for antibody labeled with 123I, 125I and 131I. The results demonstrate that the "binding site" barrier may be overcome, yielding a 2- to 100-fold improvement in the cell cluster absorbed dose for a given bone marrow absorbed dose.


Development of a monoclonal antibody specific for beta/A4 amyloid in Alzheimer's disease brain for application to in vivo imaging of amyloid angiopathy. We evaluated the efficacy of murine monoclonal antibodies (Mabs) targeted to beta/A4 amyloid for development of procedures for the in vivo identification of amyloid angiopathy (AA) in Alzheimer's disease (AD). Mabs to beta/A4 amyloid were prepared and screened for effectiveness in visualizing AA and senile plaques in postmortem AD brain sections. They were assessed again after enzymatic cleavage to produce Fab fragments and after labeling with 99mTc using a diamide dimercaptide ligand system. Modified and radiolabeled Fab fragments retained activity and specificity towards amyloid-laden blood vessels and senile plaques. A highly specific murine Mab, 10H3, was identified and characterized that fulfills criteria necessary for the development of a diagnostic imaging agent. Expansion and adaptation of these strategies may provide the methods and materials for the noninvasive analysis of AA in living patients, and permit assessment of the contribution of AA to the clinical and pathological features of AD.


Synthesis and renal excretion of technetium-99m-labeled organic cations. Organic cations are excreted more efficiently than organic anions in uremia suggesting superiority as renal imaging agents. In this study, three 99mTc-labeled cationic cyclam complexes were synthesized and their renal clearance quantified in rats. The complexes are cleared at a rate of about 2.5-3 times that of inulin and about 60% that of p-amino-hipurate. Inhibition of 99Tc-cyclam excretion by quinine indicates transport by the organic cation process. Comparative in vivo imaging experiments demonstrated that in normal rats 99mTc-cyclam reached peak renal activity 1.8 +/- 0.6 min after injection, a value intermediate between that for [131I]OIH (1.0 +/- 0) and 99mTc-MAG3 (2.8 +/- 0.6). In rats injected with the acute nephrotoxin cisplatin, the times to peak were lengthened with the relative order being 99mTc-cyclam > 99mTc-MAG3 > [131I]OIH. The results demonstrate that cationic complexes may be useful for renal imaging diagnostic applications.


Radiotoxicity of some iodine-123, iodine-125 and iodine-131-labeled compounds in mouse testes: implications for radiopharmaceutical design. In this work, spermhead survival in mouse testis was used to investigate the radiotoxicity of several intratesticularly localized radioiodinated pharmaceuticals. Radioiodines that decay by electron capture and/or internal conversion (123I, 125I) as well as by beta- decay (131I) were coupled to pharmaceuticals that selectively localize in different cell compartments. Dose response curves yield D37 values of 62 cGy, 75 cGy, 61 cGy and 7.7 cGy for 123IMP (N-isopropyl-p-iodoamphetamine), 131IdU (iododeoxyuridine), H131IPDM (N,N,N'-trimethyl-N'-(2-hydroxyl-3-methyl-5-iodobenzyl)-1,3-propanediami ne) and 125IdC (iododeoxycytidine), respectively. At 37% survival, the relative biological effectiveness (RBE) of these radiochemicals, when compared to the pure gamma-emitting radiochemical 7Be-chloride (D37 = 65 cGy), are 1.0, 0.89, 1.1 and 8.4, respectively. Intratesticular 7Be, with an effective half-life of 430 hr in the organ, was used as the source of reference radiation to determine the RBE values because it solely emits 477 keV gamma rays, and the dose to the testis is delivered chronically, as in the case of the other radiocompounds. Subcellular distribution studies show that all of the cellular activity is localized in the cytoplasm in the cases of 123IMP and H131IPDM, while virtually all of 131IdU and 125IdC were bound to DNA in the cell nucleus. In agreement with our earlier in vivo studies, these data show that subcellular distribution plays a key role in the radiotoxicity of Auger electron emitters such as 123I and 125I, and has no role for beta emitters such as 131I. These findings may have implications in the design of radiopharmaceuticals for both diagnosis (localize Auger emitter in cytoplasm of cell) and therapy (localize Auger emitter in cell nucleus).


Noninvasive detection of hypoxic myocardium using fluorine-18-fluoromisonidazole and positron emission tomography. Fluoromisonidazole (FMISO) is metabolically trapped in viable cells as a function of reduced cellular pO2. Therefore [18F]-FMISO is potentially useful for evaluating patients with hypoxic but viable myocardium. The goal of this study was to investigate [18F]FMISO uptake in ischemic myocardium non-invasively using positron emission tomography (PET). Studies were performed in 10 open-chest dogs subjected to either complete (Group 1, n = 5) or partial (Group 2, n = 5) occlusion of the left anterior descending coronary artery. The tracer was administered by intravenous bolus following the onset of ischemia and serial PET images were acquired for the next 4 hr. In Group 1, viability was assessed using histochemical staining (nitroblue tetrazolium, NBT) and 99mTc-pyrophosphate (Tc-PYP). In Group 2, viability was assessed using measurements of regional wall motion, histochemical staining and histology (two animals). In each study, PET images obtained at times between 2 and 4 hr postinjection showed specific enhancement of tracer activity in the distal anterior wall and apex of the left ventricle. At 4 hr, the tissue-to-blood pool count ratio was significantly higher in ischemic regions; 1.8 +/- 0.4 for Group 1 and 1.6 +/- 0.2 for Group 2 versus 1.0 +/- 0.1 in nonischemic regions. Postmortem tissue sampling of Group 1 hearts showed significant FMISO retention in samples without evidence for infarction, either by NBT or Tc-PYP deposition, as well as in more severely ischemic regions. In Group 2 animals, FMISO was retained in myocardial regions with reduced blood flow (microspheres), which exhibited improved contraction following reperfusion. We conclude that PET imaging of [18F]FMISO is a promising technique for the noninvasive identification of viable hypoxic myocardium.


Technetium-99m-HMPAO cerebral perfusion scintigraphy: considerations for timely brain death declaration. The lipophilic cerebral perfusion agent 99mTc-hexamethylpropylene amine oxime (HMPAO) is increasingly used to demonstrate the absence of blood flow for the declaration of brain death. We report a case that illustrates how the timing of such studies is important when organ harvesting is the underlying emergent indication. If performed too early, a study showing the presence of cerebral perfusion may not expedite the declaration of brain death, but instead may complicate patient assessment and unnecessarily delay the process.


An assessment of factors which influence the effectiveness of the modified in vivo technetium-99m-erythrocyte labeling technique in clinical use. This study assessed factors which may contribute to suboptimal image quality when the modified in vivo erythrocyte labeling technique is used with standard clinical 99mTc activities. For each assessment duplicate or triplicate blood specimens were withdrawn from > or = 10 patients, into syringes containing 700-900 MBq 99mTc as pertechnetate. After incubation the percent of 99mTc which was not bound to erythrocytes at blood re-injection time (%Unbound 99mTc), was measured and compared when one of four factors was varied. The most significant results, in descending order of measured effect were: [table: see text] Our data suggest that the requirements for optimal erythrocyte labeling with standard clinical 99mTc activities are: (A) Erythrocyte tinning time between 10 and 30 min; (B) blood volume > or = 3 ml; (C) blood incubation time > or = 20 min; and (D) Generator ingrowth time < or = 24 hr.


Spatially dependent deadtime losses in high count rate cardiac PET. Cardiac PET scans result in nonhomogeneous distributions of activity within the body, which might lead to great variations in singles rates around the detector ring. Conventional deadtime correction algorithms assume that the singles rates are uniform. This paper investigates singles nonuniformities during several typical cardiac scanning protocols (bolus injections of 15O-water and 82Rb, slow infusion of 18F-FDG and static imaging with FDG) and estimates how such nonuniformities might affect quantitative data. Nonuniformity was observed in all studies and was described by an asymmetry index which increased to 58% during bolus water injection, the most inhomogeneous study. These results are valid for any scanner with a ring diameter of approximately 78 cm and are independent of the amount of activity injected. Deadtime losses depend on the amount of activity and on the scanner type. Nonhomogeneities in singles can be shown to produce spatially dependent deadtime correction factors; for our scanner, these were seen to differ by up to 16% from the mean deadtime correction during bolus water injection. To demonstrate the distortions generated by average deadtime correction, the activity distribution during a clinical cardiac study was simulated using a phantom. A simple local deadtime correction and its implementation on our system are described, and the resulting improvements in both absolute and relative quantitation of the phantom study are shown.


SPECT quantification: a simplified method of attenuation and scatter correction for cardiac imaging. The quantitative and visual interpretation of SPECT myocardial perfusion images is limited by physical factors such as photon attenuation, Compton scatter, and finite resolution effects. A method of attenuation correction is described for use in nonhomogeneous media and applied to cardiac SPECT imaging. This method, termed multiplicative variable attenuation compensation (MVAC), uses tissue contours determined from segmentation of a transmission scan to assign a priori determined attenuation coefficients to different tissue regions of the transaxial images. An attenuation correction map is then constructed using a technique inspired by Chang's method that includes regionally dependent attenuation within the chest cavity and is applied after reconstruction by filtered backprojection. Scatter correction using the subtraction of a simultaneously acquired scatter window image enables the use of narrow beam attenuation coefficients. Experimental measurements to evaluate these methods were conducted for 201Tl and 99mTc SPECT using a homomorphic cardiac phantom. Finite resolution effects were included in the evaluation of results by computer simulation of the three-dimensional activity distribution. The correction methodology was shown to substantially improve both relative and absolute quantification of uniform and nonuniform regions of activity in the phantom's myocardial wall.


Simultaneous acquisition of emission and transmission data for improved thallium-201 cardiac SPECT imaging using a technetium-99m transmission source. Transmission computed tomography (TCT) data provides useful complementary information to single-photon emission computed tomography (SPECT) reconstructions, especially for cardiac studies. In particular, TCT data has been used to correct for nonuniform attenuation in the chest. Typically the transmission data are acquired in a separate acquisition, but simultaneous acquisition is preferable both to save time and to avoid difficulties involved with registration. In this work, we present a technique for simultaneously acquiring 201Tl SPECT and TCT data using a 99mTc sheet source that requires only minor equipment modifications. The use of these isotopes results in cross-contamination of the emission and transmission data. We present a practical technique to compensate for this contamination using post-acquisition image processing. This technique was evaluated by performing phantom and patient studies. The resulting images compare well with data obtained from separate emission and transmission studies.


No-bridge of Drosophila melanogaster: portrait of a structural brain mutant of the central complex. The mutant no-bridge (nobKS49) has its name from a structural defect in the protocerebral bridge of the central complex. This rod-shaped neuropil in nobKS49 has a large gap at the sagittal midplane, with some of the missing material accumulated more laterally. Mutant nob flies have a reduced maximal and average walking speed. Leg coordination is disturbed during turning but not while walking straight. Motivation for walking is low and steps are small due to slow forward swinging of the legs. Flies spontaneously may pass into an autistic (and possibly spastic) state in which they can move their legs and even perform cleaning movements but do not walk or fly. They spontaneously recover if left undisturbed. Gynandromorph experiments place the focus of the walking defects into the head. Mutant flies have a reduced tendency to escape when mechanically stimulated. In a brightly lit arena they do not avoid a black square above the horizon and they are negatively phototactic. In tethered flight optomotor responses are normal but the amplitude of spontaneous torque modulations as well as the number of torque spikes are reduced. If a single black bar is slowly rotated around the fly, the normal response pattern is observed. It vanishes, however, at moderately fast angular velocity at which the wild type still is fully responsible. The behavioral defects support the notion that the protocerebral bridge is part of a higher center for the regulation of behavior.


The Yolo County Midwifery Service. A descriptive study of 496 singleton birth outcomes, 1990. The Yolo County Midwifery Service was begun in January 1989 to serve pregnant low-income women who were denied care by local obstetricians. In 1990, 58% of women served were Latina and 33% were Anglo-white. Their mean age was 24.5 +/- 5.5 years, and their mean level of education was 9.9 +/- 3.5 years. Thirty-seven percent were nulliparous. All deliveries were at the only hospital in the county with a maternity service. To evaluate the effectiveness of nurse-midwifery care in this sample, a prospective study of the service's 496 singleton birth outcomes during 1990 was undertaken. Although the cesarean rate in 1990 for the obstetricians not associated with the midwifery service at this hospital was 20.6%, the midwifery clients experienced a primary cesarean birth rate of 3.7% and a total rate of 6.7%. Instrument-assisted deliveries took place for 1.0% of births. The success rate for women attempting vaginal birth after cesarean was 87.2%. Delivery over an intact perineum occurred for 51.8%. Preterm birth was experienced by only 1.0% of the women. A newborn birth weight of < 2,500 g occurred in 2.4% of births. Occult cord prolapse preceded a single neonatal death, resulting in a perinatal and neonatal death rate of two per 1,000. These data add to the growing body of information about nurse-midwifery in which that care is found to be a safe, well-accepted, and cost-effective adjunct to existing obstetric care services.


A mammalian homologue of a transcript from the Drosophila pecanex locus. The Drosophila pecanex locus contains a maternal-effect neurogenic gene. A homologue of this gene has not yet been described in mammals or other organisms. We report here a partial complementary DNA clone from rat brain mRNA that encodes sequences which are very similar (83% over 189 amino acids) to a portion of sequence encoded by a transcript from the Drosophila pecanex locus [LaBonne, S.G., Sunitha, I and Mahowald, A.P. (1989) Dev. Biology 136: 1-161].


Evaluation of research studies. Part II: Observational studies. Clinical practice is often based on the results of research. Critical evaluation of research studies is important if appropriate conclusions are to be drawn. In this series of columns, we review principles of research methodology and statistical analysis. Our intent is to assist certified nurse-midwives in understanding the relative merits of the research they read and use. This paper, the second of the series, will review issues pertinent to observational study design.


Hematocrit values during pregnancy in a nurse-midwifery caseload. This article reviews the normal hematologic changes in pregnancy and the kinetics of iron metabolism. The differences between iron depletion and anemia are described. The hematocrit levels of a nurse-midwifery caseload in a tertiary-care setting are described and compared with recently published population norms. Hematocrits of the sample compared favorably to the population hematocrits until 24 weeks' gestation, when the sample hematocrit mean became statistically lower and remained that way throughout pregnancy. Further analysis was done on the sample hematocrits, comparing differences in parity, age, pregnancy spacing, and AS versus AA hemoglobin. Parous women with a pregnancy interval > 12 months had a higher mean hematocrit than nulliparous women. Mean hematocrits of age groups varied significantly only at the 29-32-week interval, with women younger than 18 having lower mean hematocrits than those > or = 18. A trend of women with AS hemoglobin having higher hematocrits than women with AA hemoglobin was identified, reaching statistical significance at the 29-32-week interval.


KiS1--a novel monoclonal antibody which recognizes proliferating cells: evaluation of its relationship to prognosis in mammary carcinoma. Immunohistochemical staining with a novel monoclonal antibody, KiS1, which recognizes a cell cycle-associated antigen, was investigated in 142 cases of stage I and II invasive breast carcinoma. KiS1 staining indices were compared with disease-free interval, overall survival, and post-relapse survival. Using a semi-quantitative method of assessment, we found that tumours with a high level of staining (34/142, 24 per cent) had a significantly worse prognosis than those with a low level of staining (108/142, 76 per cent). Significant correlations were found between KiS1 staining and disease-free interval (P < 0.001), overall survival (P < 0.001), and post-relapse survival (P = 0.008). A more time-consuming, quantitative method of assessment gave similar results. Cox multivariate analysis showed these results to be independent of nodal status, histological type, and grade of tumour (P = 0.01). We conclude that KiS1 is a valuable new antibody which affords useful prognostic information in breast carcinoma. As it can be used in formalin-fixed, paraffin-embedded material, it may be of particular use in the study of small lesions such as those identified in the Breast Cancer Screening Programme.


The National Birth Center Study. Part III--Intrapartum and immediate postpartum and neonatal complications and transfers, postpartum and neonatal care, outcomes, and client satisfaction. This is the final article of the three-part report of the National Birth Center Study. Eight percent of the mothers or infants had serious complications; 16% were transferred, 12% before and 4% after the deliveries. Fifteen percent of transfers were emergencies. Nulliparous women were much more likely than parous women to experience dystocia, be transferred, or have cesarean sections. Seventy-five percent of the nulliparous women gave birth in the centers, compared with 95% of the parous women. Eighty-four percent of the women had at least one postpartum home or office visit. There were 11,814 mothers, no maternal deaths, and 15 intrapartum/neonatal deaths (1.3/1,000 births, 0.7 excluding congenital anomalies). Postterm deliveries with macrosomic infants, placental abruption, sustained fetal distress, and thick meconium were associated with high mortality. Mortality was very low for those not transferred and much lower for transfers during labor as compared with those after the delivery. Women with no medical/obstetric risk factors had the lowest rates of transfers and serious complications. Except for postterm pregnancies, the intrapartum/neonatal mortality rate for birth center clients was not higher than rates from studies of low-risk hospital births, and the cesarean section rate was lower. There is no evidence that hospitals are a safer place for low-risk births.


Production of a monoclonal antibody (IND.64) identifying a cell cycle-associated antigen using spleen cells from nude mice bearing Ichikawa tumour. Using spleen cells from athymic nude mice grafted with Ichikawa tumour, we have generated the monoclonal antibody IND.64, which detects a proliferation-associated nuclear antigen. Immunoblotting analysis with IND.64 showed a double band with apparent molecular weights of 395 and 345 kD. In normal human tissues, the antigen detected by IND.64 was expressed only by the nuclei of proliferating cells, such as germinal centre cells of reactive lymph nodes, cortical thymocytes, the basal layer of the skin, and proliferative compartments of the stomach, small intestine, and colon. IND.64 did not react with cells known to be non-proliferative or to show only a low turnover, such as cells of the kidney, liver, smooth muscle, cardiac muscle, and brain. The expression of this antigen during the cell cycle was determined using two approaches: IND.64 immunostaining of synchronized adult bovine aortic endothelial cells and flow cytometric analysis of double-labelled PHA-stimulated peripheral mononuclear blood leucocytes with a DNA marker and IND.64. The antigen recognized by IND.64 was found to appear in the late G1 phase, and persisted in phases S, G2, and M, but was absent in the G0 and early G1 phases. IND.64 was further investigated in different tumour types to evaluate the correlation between the percentage of IND.64-positive cells (IND.64 index) and the histological grade. In non-Hodgkin's lymphomas, an excellent correlation was found between the percentage of IND.64-positive cells and the cytomorphological grade. In nodular sclerosis and mixed cellularity Hodgkin's disease, a high number of Reed-Sternberg cells were positive with IND.64. The non-lymphoid neoplasms investigated showed a variable percentage of positive cells. IND.64 appears to be a promising tissue marker to complement the evaluation of prognosis in human cancer.


Morphometry of gastric carcinoma: its association with patient survival, tumour stage, and DNA ploidy. Morphometric image analysis of nuclear features was performed on tissue from 46 patients who had had curative resections for gastric cancer. Clinical, pathological, flow cytometric, and follow-up data were available for these patients, which were drawn from a larger, previously reported series. The morphometric data were compared with patient survival, clinico-pathological status, and DNA ploidy. Univariate survival analysis revealed that morphometric parameters were not significantly related to survival, but examination of clinico-pathological data showed lymph node involvement, involvement of the resection margin, and lymphatic invasion to be significantly associated (P < 0.01) with patient prognosis. Multivariate survival analysis using the Cox model found only lymph node and resection margin involvement to be independently related to survival. Comparison of morphometric results with the clinico-pathological parameters showed various features, relating to nuclear size, and its variation to be significantly associated (P < 0.01) with the presence of lymphatic invasion, resection margin involvement, and tumour pattern (intestinal/diffuse). A comparison of morphometry with flow cytometric analysis in these cases showed that nuclear size was not significantly related to either DNA aneuploidy or the DNA proliferative index.


Adhesion receptors of intimal and subintimal cells of the normal synovial membrane. The distribution of cell adhesion molecules (CAMs) and matrix proteins in the normal synovium of four subjects was studied by immunohistology in order to determine the factors governing the cellular and tissue organization of the intimal and subintimal compartments. Basement membrane proteins, laminin, and collagen type IV, as well as vitronectin and fibronectin, were identified in the intima and there was corresponding expression of integrin and non-integrin receptors (e.g., CD29, CD49b, CD49d, CD49e, CD49f, CD51, CD61, CD44) for these matrix proteins. There were notable differences in CAM expression between intimal, subintimal, and vascular compartments of the synovial membrane. Phenotypic heterogeneity for CAMs involved in cell-cell interactions, particularly CD11a, CD11b, ICAM-1, and HLA-DR, was also present. The range of CAMs expressed by synovial and endothelial cells not only indicates a structural role for these antigens, but also suggests that they may control leucocyte traffic into the membrane, including recruitment of cells into the synovial lining.


Heparin causes partial removal of glomerular antigen deposits by a mechanism independent of its anticoagulant properties. We have previously reported that heparin can enhance the removal of antigen from the glomeruli of rats with chronic serum sickness glomerulonephritis. We have performed two studies to investigate the relevance of anticoagulation to this effect. The first experiment was essentially a repeat of those described before, but instead of using heparin, anticoagulation was achieved using Ancrod, which causes depletion of fibrinogen. The amount of antigen in the glomeruli of these rats at the end of the experiment did not differ from controls. In the second experiment, both kidneys were excised from rats with glomerulonephritis induced by a radiolabelled cationic antigen. Of each pair of kidneys, one was perfused for 30 min at 5 ml/min with Hank's balanced salt solution (HBSS) at 37 degrees C. The other was perfused with HBSS to which a total of 4500 units of heparin had been added. The antigen content of isolated glomeruli was subsequently measured. In every case, the kidney perfused with heparin had less antigen per glomerulus than the control contralateral kidney. The ability of heparin to enhance removal of glomerular immune complex deposits is therefore not mediated by anticoagulation.


Isologous monoclonal antibodies can induce anti-GBM glomerulonephritis in rats. Injection of isologous monoclonal antibodies (SR2, SR3) caused anti-glomerular basement membrane antibody-induced glomerulonephritis (anti-GBM nephritis) in WKY/NCrj rats. The antibodies were obtained from hybridoma cells derived from fusion of the spleen of a nephritic WKY/NCrj rat injected with rat solubilized renal basement membranes with adjuvant, and mouse SP2-myeloma cells. They belonged to the rat IgG2a subclass and bound to rat kidney in a linear pattern along the glomerular and tubular basement membranes. Histological changes in glomeruli were detected at day 1 after the injection; proteinuria with haematuria appeared on day 2; and proteinuria became severe and reached a plateau by day 5. These results demonstrate that anti-GBM nephritis can even be induced by an isologous monoclonal antibody and that the rat IgG2a subclass is at least nephritogenic. The experimental model of anti-GBM nephritis with isologous monoclonal antibodies makes it possible and easier to analyse further the mechanism of anti-GBM nephritis.


Structure, function and organization of antenna polypeptides and antenna complexes from the three families of Rhodospirillaneae. Comparative primary structural analysis of polypeptides from antenna complexes from species of the three families of Rhodospirillaneae indicates the structural principles responsible for the formation of spectrally distinct light-harvesting complexes. In many of the characterized antenna systems the basic structural minimal unit is an alpha/beta polypeptide pair. Specific clusters of amino acid residues, in particular aromatic residues in the C-terminal domain, identify the antenna polypeptides to specific types of antenna systems, such as B880 (strong circular dichroism (CD)), B870 (weak CD), B800-850 (high), B800-850 (low) or B800-820. The core complex B880 (B1020) of species from Ectothiorhodospiraceae and Chromatiaceae apparently consists of four (alpha 1 alpha 2 beta 1 beta 2) or three (2 alpha beta 1 beta 2) chemically dissimilar antenna polypeptides respectively. There is good evidence that the so-called variable antenna complexes, such as the B800-850 (high), B800-850 (low) or B800-820 of Rp. acidophila, Rp. palustris and Cr. vinosum, are comprised of multiple forms of peripheral light-harvesting polypeptides. Structural similarities between prokaryotic and eukaryotic antenna polypeptides are discussed in terms of similar pigment organization. The structural basis for the strict organization of pigment molecules (bacteriochlorophyll (BChl) cluster) in the antenna system of purple bacteria is the hierarchical organization of the alpha- and beta-antenna polypeptides within and between the antenna complexes. On the basis of the three-domain structure of the antenna polypeptides with the central hydrophobic domain, forming a transmembrane alpha helix, possible arrangements of the antenna polypeptides in the three-dimensional structure of core and peripheral antenna complexes are discussed. Important structural and functional features of these polypeptides and therefore of the BChl cluster are the alpha/beta heterodimers, the alpha 2 beta 2 basic units and cyclic arrangements of these basic units. Equally important for the formation of the antenna complexes or the entire antenna are polypeptide-polypeptide, pigment-pigment and pigment-polypeptide interactions.


Core mutations of Synechococcus sp. PCC 7002 phycobilisomes: a spectroscopic study. Three cyanobacterial strains harboring mutations affecting phycobilisome (PBS) cores were studied using steady state absorption and fluorescence and time-resolved fluorescence. The apcF mutant, missing beta 18, and the apcDF mutant, missing both alpha APB and beta 18, showed only small spectroscopic differences from the wild-type strain; their PBS emission was blue shifted by 10 nm, whereas their absorption spectra and time-resolved fluorescence kinetics were virtually unchanged. The third mutant studied was the apcE/C186S mutant in which the chromophore-binding cysteine-186 in the LCM99 polypeptide has been substituted with serine. The apcE/C186S mutant contained a modified chromophore which significantly changed the spectroscopic properties of the PBS complex. The apcE/C186S PBS absorbed more than the wild-type strain at 705 nm, and the emission spectrum gave two peaks at 660 nm and 715 nm. The time-resolved kinetics of the apcE/C186S mutant PBS were also significantly altered from those of the wild-type strain.


Effect of volatile thiol compounds on protein metabolism by human gingival fibroblasts. The levels of volatile sulphur compounds (VSC) in periodontal pockets and mouth air have been found to correlate with severity of the disease process. The purpose of this study was to examine the influence of hydrogen sulphide and methyl mercaptan on protein metabolism of human gingival fibroblasts. The incorporation of labelled amino acids into protein was used to evaluate effects on total protein content. Changes in collagenous protein concentration were monitored by release of radioactivity following collagenase digestion as well as direct analysis of hydroxyproline. Both thiols were found to reduce total protein synthesis, with mercaptan exerting a greater adverse effect. In cultures exposed to mercaptan, total protein was reduced by 35%. The changes in total protein were accompanied by a corresponding decrease in collagenase-digestible protein. Hydroxyproline analysis of CH3SH-exposed cultures confirmed the changes associated with collagenous proteins. It indicated that in comparison to the controls the CH3SH-exposed cultures had a 70% reduction in collagen which resulted from a combined effect of suppressed synthesis and increased rate of collagen degradation. The possibility of thiol reaction with collagen was determined using in vitro systems in which type I collagen was reacted with varying concentrations of [35S]-H2S. The carboxymethyl (CM) cellulose assays of resulting reaction mixtures indicate that [35S]-radioactivity was incorporated directly into alpha 1, alpha 2, beta 11, beta 12 peptide chains. Furthermore, upon exposure of collagen to elevated H2S concentrations, the H2S converted some of the acid-soluble collagen to a more soluble product which could be extracted in neutral salt and analyzed by CM-cellulose chromatography.(ABSTRACT TRUNCATED AT 250 WORDS)


Fine structure of adrenergic nerve fibers in human periodontal ligament. The presence of adrenergic nerve fibers was demonstrated ultrastructurally in the human periodontal ligament obtained from extracted premolar teeth from 8 young patients. The nerve endings were located close to arterioles. The results suggest that they seem to control blood flow in the human periodontal ligament.


Relationship between bacterial counts, microbial vitality and the accumulation of supragingival dental plaque in humans. Comparisons between plaque index (PlI) and bacterial counts have been made already; however, these did not take into account the area used for plaque sampling. The objective of the present study was to determine the correlation between the PlI score, the number of bacteria and the bacterial plaque vitality when dental plaque was repeatedly sampled from the same area in each subject during early plaque accumulation. Between intervals of optimal oral hygiene, 10 participants refrained from all oral hygiene measures for periods of 1, 2, 3, 4 and 5 days. The PlI was recorded on the vestibular surface of all first premolars as local PlI:LS. For statistical reasons, the scores of the independent variable LS were added for each subject giving LS* values ranging from 0 to 8. The plaque sampled from this specific surface was circumscribed by the marginal gingiva and an acrylic splint, giving reproducible areas for plaque collection. Total microscopic bacterial counts (BC), colony forming units of anaerobes (CFUan) and aerobes (CFUae), and proportions of vital bacteria (VF) were compared with LS* values. BC and LS* values were strongly correlated. CFUan and CFUae increased significantly with LS*, but this increase was higher for LS* 0 to 4 than for LS* 4 to 8. The ratio between vital and dead microorganisms, assessed by two different methods, was low when an LS* of 0 was recorded, with higher ratios registered for LS* values 4 and 8.


Influence of temperature and foil hardness on interocclusal tactile threshold. Determinations of interocclusal tactile threshold levels so far have involved neither appropriate psychophysical approaches nor an assessment of the mechanical and thermal properties of the foils used. Twenty subjects (12 females) aged 18 to 50 (mean age 35) were tested for their absolute threshold level (RL). Both the method of limits and the staircase method were applied to determine the active or passive RL. For the active RL assessment, foils of different thicknesses were placed between edge-to-edge opposed incisors during gentle biting. Inner ear receptors of the blindfolded subjects were blocked by broad band noise applied through earphones, because vibrations induced by occlusal contact and conducted through bone might be perceived by these receptors. The foils presented were aluminum (Al), tin (Sn), polyester (PE) and calibrated steel (St) (thickness ranging from 8 to 50 microns) which offer different physical and thermal properties. The range of RL of the group varied between 8 microns for aluminum to 46 microns for polyester for 50% correct assessments. Increasing the foil temperature from room temperature (20 degrees C) to body temperature (35 degrees C) significantly increased the RL for conducting materials (one-way blocked ANOVA). These results indicate that temperature exchange takes place while presenting conducting foils at 20 degrees C (cold stimulus) interocclusally, which influences the RL by activating thermosensitive receptors. The passive RL determination with classical von Frey-hairs resulted in a mean axial RL of 3.0 g. Both psychophysical RL assessments (method of limits, staircase method) gave reproducible and similar results as ascertained by ANOVA. Furthermore, a positive correlation was established between active and passive RL (Pearson correlation test).(ABSTRACT TRUNCATED AT 250 WORDS)


The mechanisms of Eikenella corrodens aggregation by salivary glycoprotein and the effect of the glycoprotein on oral bacterial aggregation. The mechanism of aggregation of Eikenella corrodens 1073 with E. corrodens aggregating factor (EcAF) which was purified from submandibular-sublingual (SM-SL) saliva was investigated. Heating (100 degrees C, 10 minutes) or protease treatment of E. corrodens cells abolished the aggregating activity. The aggregation was inhibited by adding N-acetyl-D-galactosamine (GalNAc) and saccharides which contain a galactose residue at the non-reducing end. The aggregating activity was sensitive to EDTA and was restored by Ca2+ but not by Mn2+ or Mg2+. Neuraminidase treatment of EcAF increased their ability to aggregate. E. corrodens, suggesting that the sialic acids on EcAF interfere with aggregation. These data suggest that the aggregation of E. corrodens 1073 with EcAF is mediated by specific interactions between a bacterial cell surface lectin-like substance and a complementary GalNAc-like receptor. EcAF also aggregated 16 strains of oral bacteria including periodontopathic bacteria such as Porphyromonas (Bacteroides) gingivalis 381 and Actinobacillus actinomycetemcomitans ATCC29522; however, those aggregations were not inhibited by GalNAc. Therefore, EcAF appears to have more than two types of bacterial binding site and plays important roles in accumulation of dental plaque by forming a complex network of plaque bacteria including periodontopathic strains.


Tetracycline administration increases protein (presumably procollagen) synthesis and secretion in periodontal ligament fibroblasts of streptozotocin-induced diabetic rats. Streptozotocin-induced, insulin-deficient diabetic adult rats were daily administrated either minocycline or a chemically-modified non-antimicrobial tetracycline (CMT) by oral gavage for a 3-week time period; untreated diabetic and non-diabetic rats served as controls. On day 21, all rats received an intravenous injection of 3H-proline followed by perfusion fixation with an aldehyde mixture at 20 minutes and 4 hours after isotope injection. The upper and lower mandibles of these rats were dissected and processed for quantitative electron microscopic autoradiography to study 3H-proline utilization by fibroblasts in the periodontal ligament (PDL) of molars. In the non-diabetic controls, at 20 min after 3H-proline injection, radioprecursor was incorporated by the Golgi-RER system of PDL fibroblasts. At the 4-h time period, most of the label was present over the collagen fibers around these cells. In contrast, PDL fibroblasts in the untreated diabetic rats showed marked abnormalities ultrastructurally and minimal uptake (20 min) and secretion (4 h) of labeled proline. At both time periods, in both minocycline- and CMT-treated diabetic rats, fibroblasts were structurally more normal and the radioprecursor was localized in the fibroblasts and the PDL matrix in a pattern similar to that seen in the control rats. These results suggest that the diabetes-induced structural abnormalities and suppression of synthesis and secretion of protein (presumably collagen and its precursor) by PDL fibroblasts can be restored to near-normal by administration of a tetracycline and that this effect is mediated by a non-antimicrobial property of this family of antibiotics.


Living arrangements and nutrient intakes of healthy women age 65 and older: a study in Manhattan, Kansas. One hundred healthy women over age 65 were recruited for a study to determine differences in nutrient intakes by living arrangement and to examine the effect of demographic characteristics, health habits, and social contacts on nutrient intakes. There were significant differences (p < 0.05) in the mean intakes for calcium and riboflavin between women living alone and women living with a spouse. There were no significant differences in health habits by living arrangement, but women living alone were more likely to have fewer social contacts than women living with a spouse (x2 = 38.25; p < 0.001). Education, physical activity, and smoking were the most important predictors of nutrient intakes.


Nutrition promotion for mature adults: a case study in peer education. The peer education model, which enables trained learners to instruct their peers, was tested in a case study involving senior citizens in a nutrition education program. The case study approach, using action research, was chosen because the project involved the description and analysis of a unique group of 32 mature adults. Topics selected for presentation in the three two-hour sessions were selected by open consensus of the entire participating body. Six members of the group volunteered to engage in a preliminary training program. These individuals became known as volunteer peer educators (VPE), who subsequently took full responsibility for disseminating the nutrition information to their peers. Educational materials to meet the goals of the program were compiled by the researcher in a resource manual for each of the volunteer peer educators. Techniques of participant observation for data collection and qualitative analysis were used. The satisfactory implementation of the program was due in great part to group selection of the learning episode; to a relaxed atmosphere; to enthusiasm on the part of the VPE; to the availability of a good resource manual and a facilitator who provided a strong organizational framework. The peer education model was found to be a particularly useful tool in providing nutrition information to a much broader sector of the senior population than can be currently reached via public health programs.


Project director characteristics in the Elderly Nutrition Program. The federally funded Elderly Nutrition Program (ENP) began in 1972, authorized under Title 7 of the Older Americans Act. Its purpose was to serve elders, targeting those in greatest social and economic need. This article describes the characteristics of the Nutrition Project Directors in the ENP through data gathered by a questionnaire completed by a random sample of 430 directors across the nation. One important finding was that directors of programs serving large numbers of low-income or minority elders tended to have less education and commanded lower salaries than directors serving fewer poor and minority elders. In addition, while a higher proportion of these directors were minority members, numbers of nonwhite Nutrition Project Directors remains low.


Sous vide processed foods: are they safe for the elderly? Demographic trends and market analyses indicate that Americans' interest in convenience foods that are nutritious, safe, and high quality will influence the food industry into the next century. The increase in individuals over 55 plus working women, and the changing family have caused the food industry to develop a new generation of foods. One of the processes, sous vide, is an advanced method where fresh foods are vacuum sealed in impermeable plastic, cooked at low temperature in circulating water, and chilled and held at refrigerator temperature for up to three weeks. Nutritionists and food scientists have concerns about the food safety of sous vide products and the possible increase in food borne illnesses. Continued research is needed for the food industry to deliver safe, nutritious foods, particularly to the elderly.


Affect, personality, and social activity. These studies examined relations between social activity and state and trait measures of Positive and Negative Affect. In Study 1 Ss completed scales relevant to 3-factor models of personality and a weekly mood and social activity questionnaire for 13 weeks. In Study 2 Ss completed measures of the 5-factor model of personality and a daily mood and social activity survey for 6-7 weeks. In within- and between-Ss analyses, socializing correlated significantly with state measures of Positive Affect and with trait measures of Extraversion/Positive Emotionality. These relations were relatively general across various types of positive affect and social events; however, specific types of social events also were differentially related to affect. In contrast, social activity had no consistent association with measures of Negative Affect or the other personality dimensions. The results support a temperamental view of Extraversion.


Repression at encoding: discrete appraisals of emotional stimuli. In previous research, the emotions associated with repressors' memorial representations were found to be more discrete than those associated with nonrepressors'. In each of the 3 experiments reported here, repressive discreteness was apparent in repressors' appraisals of emotional stimuli at the time they were encoded. In 1 experiment, Ss appraised individual facial expressions of emotion. Repressors judged the dominant emotions in these faces as no less intense than did nonrepressors, but they appraised the blend of nondominant emotions as less intense than did nonrepressors. In the remaining 2 experiments, Ss appraised crowds of emotional faces as well as crowds of geometric shapes. In both crowd experiments, the repressive discreteness was evident in appraisals of crowds of emotional faces but not in appraisals of crowds of geometric shapes. The repressive discreteness effect did not appear to reflect a general repressor-nonrepressor difference in the appraisal of stimulus features. Rather, the results suggested that repressive discreteness may be constrained to appraisals of emotions.


Intergenerational continuity of parental rejection and depressed affect. Using survey and observational data from a sample of 451 intact families, this study used structural equation modeling to examine the intergenerational continuity of depressed mood and rejecting parenting. The model partially replicated the intergenerational model of Elder, Caspi, and Downey (1986) that indicates a cyclical transmission process by which parents' personality traits affect parent-child interaction, which, in turn, increases the propensity for developmental problems among offspring. The results indicated a pattern of intergenerational transmission of depressed mood through parental rejection of offspring. Multiple reporters and multiple indicators strengthen previous intergenerational findings by reducing some of the method variance biases that have been problematic in prior studies.


Thinking is for doing: portraits of social cognition from daguerreotype to laserphoto. From the outset, perspectives on social cognition have taken an emphatically pragmatic stance, as evident in early writing by James, Allport, Bruner, Asch, Heider, Tagiuri, and Jones. After a hiatus, during which social cognition research neglected its proper attunement to social behavior, researchers again are emphasizing that thinking is for doing, that social understanding operates in the service of social interaction. Early and recent (but not intermediate) theories have reflected a pragmatic orientation in 3 recurring themes: People are good-enough social perceivers; people construct meaning through traits, stereotypes, and stories; and people's thinking strategies depend on their goals. The pragmatic viewpoint again opens up new areas for research and theory in social cognition.


Memory accessibility and probability judgments: an experimental evaluation of the availability heuristic. Consistent with Tversky and Kahneman's (1973, 1974) availability heuristic hypothesis, the current study found a negative correlation between recall latency for past events and the perceived future probability of similar events. Furthermore, when the relative accessibility of memories of positive and negative events was experimentally manipulated using the Velten mood-induction procedure, the perceived future probabilities of similar events also changed in a manner consistent with the availability heuristic account. Reductions in recall latencies resulting from the mood manipulations were, as predicted, related to increases in perceived probability, and vice versa. Partial correlations indicated that this association between the observed patterns of changes in recall latencies and probability judgments could not be accounted for by the existence of independent associations between each of these effects and the magnitude of mood change.


Why do people need self-esteem? Converging evidence that self-esteem serves an anxiety-buffering function. Three studies were conducted to assess the proposition that self-esteem serves an anxiety-buffering function. In Study 1, it was hypothesized that raising self-esteem would reduce anxiety in response to vivid images of death. In support of this hypothesis, Ss who received positive personality feedback reported less anxiety in response to a video about death than did neutral feedback Ss. In Studies 2 and 3, it was hypothesized that increasing self-esteem would reduce anxiety among individuals anticipating painful shock. Consistent with this hypothesis, both success and positive personality feedback reduced Ss' physiological arousal in response to subsequent threat of shock. Thus, converging evidence of an anxiety-buffering function of self-esteem was obtained.


Controlling the uncontrollable: effects of stress on illusory perceptions of controllability. Individuals' failure to exercise actual control over an event might be compensated for by trying to bolster a generalized, subjective sense of control. Control might then be sought by undertaking acts the effect of which on the environment is illusory. This observation led to the hypothesis that stress, which undermines persons' sense of control, would engender illusory perceptions of controllability. The hypothesis was tested in 3 experiments that required Ss to choose between 2 gambling forms. Although the 2 forms were essentially identical, 1 was designed to instill an illusion of control. The results showed that highly stressed Ss, compared with those who experienced low stress, preferred gambling forms that heightened perceptions of controllability.


The impact of mothers' gender-role stereotypic beliefs on mothers' and children's ability perceptions. The focus of this study is the relation between mothers' gender stereotypic beliefs, their perceptions of their children's abilities, and their children's self-perceptions in 3 activity domains. Approximately 1,500 mothers and their 11- to 12-year-old children responded to questions about the children's abilities in the math, sports, and social domains. It was predicted that mothers' beliefs about their children would be moderated by their gender stereotypic beliefs about the abilities of female and male people in general. As predicted, path analyses revealed that mothers' gender stereotypic beliefs interact with the sex of their child to influence their perceptions of the child's abilities. Mothers' perceptions, in turn, mediate the influence of past performance on children's self-perceptions in each domain.


Social facilitation and inhibition of emotional expression and communication. Does the presence of others facilitate or inhibit emotional expression? Female "senders" (n = 45) viewed 12 emotionally loaded slides either alone or with another sender while responses were secretly videotaped. In Study 1, 14 "receivers" guessed the type of slide viewed by dyads more accurately (eta = .366). In Study 2, 42 receivers viewed 10 senders with friends, 10 with strangers, and 10 alone. One dyad member was covered so that only 1 sender was visible. Analysis revealed significant effects of condition (alone, friend, or stranger; eta = .456), slide type (sexual, scenic, unpleasant, or unusual; eta = .325), and the Condition x Slide Type interaction (eta = .350). Strangers had overall inhibitory effects on communication accuracy, whereas friends had facilitative effects on some slides and inhibitory effects on others. Thus, both social facilitation and inhibition of expression occurred on the basis of the emotional stimulus and personal relationship involved.


Fishy-looking liars: deception judgment from expectancy violation. To explain how people judge that others are lying, an expectancy-violation model is proposed. According to the model, deception is perceived from nonverbal behavior that violates normative expectation. To test the model, 3 experiments were conducted, 2 in the United States and 1 in India. In each experiment, people described acquaintances while exhibiting weird nonverbal behaviors, such as arm raising, head tilting, and staring. Other Ss watched the videotapes of the descriptions and made deception judgments. Consistent with the expectancy-violation model, both American undergraduates and Indian illiterates inferred deception from weird behaviors. Implications of the model are discussed.


Disclosure and anxiety: a test of the fever model. According to the fever model of Disclosure, the relationship of Disclosure (utterances that reveal subjective information) to psychological distress is analogous to the relationship of fever to physical infection: Both are indicators of some underlying disturbance and part of a restorative process. High and moderate trait anxious university students (but not the low trait anxious students) used higher percentages of Disclosure when speaking about an anxiety-arousing topic than when speaking about a happy topic. With topic order counterbalanced, students tended to use more Disclosure during their 1st presentation than during their 2nd. These results support the fever model's suggestion that people tend to Disclose when they are distressed.


Modeling cognitive adaptation: a longitudinal investigation of the impact of individual differences and coping on college adjustment and performance. Drawing on cognitive adaptation theory, optimism, psychological control, and self-esteem were explored as longitudinal predictors of adjustment to college in a sample of 672 freshmen. Although a direct effect of optimism on adjustment was found, most of the predicted effects were mediated by coping methods. Controlling for initial positive and negative mood, the beneficial effects of optimism, control, and self-esteem on adjustment were mediated by the nonuse of avoidance coping, greater use of active coping, and greater seeking of social support. Alternative models of the causal relations among these variables did not fit the data as well as the a priori mediational model. The results of a 2-year follow-up indicated that self-esteem and control predicted greater motivation and higher grades, controlling for college entrance exam scores. Implications for cognitive adaptation theory and for interventions with populations under stress are discussed.


Susceptibility of a line of dolphin kidney cell culture to several herpesviruses. A cell line was established from cell cultures of kidney cortex of a pantropical spotted dolphin, Stenella attenuate. The replication of 6 strains of herpesviruses was studied in the cells. Five strains of them, herpes simplex virus type I and type II, equine rhinopneumonitis virus, infectious bovine rhinotracheitis virus and Aujeszky's disease virus, were grown fairly well in showing clear cytopathic effects and plaques under agar overlay medium.


Metabolism of gallate in Penicillium simplicissimum. The pathway for the degradation of gallate (3,4,5-trihydroxybenzoate) by a new strain of Penicillium was examined by in vivo and in vitro cell-free systems. The organism was identified as P. simplicissimum (Oud) Thom. It grew optimally at pH 5.5 and 27 degrees C, with 11.75 mM (0.2%) gallate added to the basal salt media. Mycelia grown on gallate accumulated protocatechuate in the medium, and had inducible activity for protocatechuate 3,4-dioxygenase as determined by spectrophotometric and oxygen electrode studies. A NADPH-dependent reductase in the cell-free extract reduced gallate to dihydrogallate. Maleylacetate reductase was also detected in the gallate induced cell-free extract, while beta-ketoadipate was detected as the product produced. The possible steps in the degradation of gallate are discussed.


Fungal contamination, natural occurrence of mycotoxins and resistance for aflatoxin accumulation of some broad bean (Vicia faba L.) cultivars. Using glucose-Czapek's and 10% NaCl glucose-Czapek's agar media incubated at 28 +/- 2 degrees C, nine genera and 18 species were identified from 10 different cultivars seed of broad bean. Aspergillus and Penicillium were the most common genera on the two types of media used. The most common fungal species were Aspergillus flavus, A. niger, A. tamarii and Penicillium chrysogenum. Thin-layer chromatographic analysis indicated that seeds of one cultivar only was naturally contaminated with aflatoxins B1, B2, G1 and G2. Nine mycotoxin-free cultivars of broad bean were examined for resistance or susceptibility for aflatoxin production when inoculated by Aspergillus flavus IMI 89717. Results obtained revealed that seeds of two cultivars were highly resistant, two cultivars showed partial resistance and the remaining were susceptible to the establishment of A. flavus and aflatoxin accumulation. The results did not show any relationship between morphological characters (colour, shape and size) and the amount of aflatoxin produced on the different broad bean seed cultivars. Also the results reveal absence of significant variation in the total nitrogen of the highly susceptible, partially resistant and highly resistant groups of broad bean seeds examined. Mean values of calcium, total phosphate and potassium of both seed coat and seed kernel of the susceptible seeds were low as compared to those of partially and highly resistant seed cultivars. The susceptible seeds contained higher levels of magnesium, zinc and sodium while the resistant seeds contained lower ones.


Overexpression of a Rhodococcus erythropolis protein in Escherichia coli with immunological identity to the Rhodococcus steroid 1-dehydrogenase. Immunoelectron microscopic localization and electrophoretic studies. The recombinant Escherichia coli K-12 strain chi 6060 harbouring the plasmid pYA 1201 with a gene from Rhodococcus erythropolis IMET 7030 overexpressed a protein which reacts with a monospecific antiserum against the steroid 1-dehydrogenase (Sdh) from the same Rhodococcus strain. It was shown previously that this recombinant protein exhibits no enzymatic activity. By immunogold labelling the protein was localized on ultrathin sections of the recombinant E. coli strain. After cultivation at 37 degrees C it was found within large cytoplasmic compartments (inclusion bodies). The inclusion bodies occupied 40% to 75% of the sectioned cell area. The highest amount of protein was observed after induction of the culture with isopropyl-beta-D-thiogalactopyranoside. Approximately 20% of the induced cells became enlarged (up to 5-fold of the normal size) and deformed; multiplication of the Rhodococcus protein producing cells was inhibited. After ultrasonic cell disintegration the inclusion bodies were found only in the fraction of the sedimented cell debries and did still react with anti-Sdh. When recombinant E. coli cells were cultivated at 28 degrees C, inclusion bodies appeared very seldom and the immunoreactive protein was distributed throughout the whole cytoplasm.


Perspectives on entry level residency training in podiatric medicine. The author presents information related to the structures of medical and podiatric residency training and statistical information regarding entry level residency positions in approved podiatric residency programs. The results of surveys of residency directors (1989 and 1990) and the residency community of interest (1990) conducted by the Council on Podiatric Medical Education are reported. Specific findings from the surveys indicated the desirability of establishing training sequences consisting of rotating podiatric residencies followed by specialty training programs but identified significant difficulties related to implementation.


The residency in podiatric medicine. A brief historical overview. The author provides a general overview of the development of postgraduate residency training in podiatric medicine since 1956. The evolution of residency standards and requirements of the Council on Podiatric Medical Education are discussed. Integration of specialty organizations in the residency evaluation process also are reviewed. The author notes that the current positive number of entry level residency positions available to graduates of colleges of podiatric medicine may be a dubious facade in view of increasing college enrollments and the potential conversion of rotating podiatric residencies to residencies in primary podiatric medicine. He cautions the profession not to overlook these events as it considers the development of the PGY-1 concept in the restructuring of entry level residency training.


Primary care podiatric medicine and entry level residency. The new millennium. The author presents the perspective that the nation's health care initiatives demand that greater attention be given to primary care providers. Inasmuch as the credibility of the podiatric medical profession must function in a health care environment dominated by allopathic and osteopathic physicians, the podiatric primary care initiative must be pursued within the guidelines and definitions for primary care that are present in all of mainstream medicine. The author argues that primary care podiatric medicine must establish itself as a specialty that stands as an equal along side of the other recognized specialties in podiatric medicine. Also, in keeping with the essential educational needs for specialty training, the development of residencies in primary podiatric medicine is crucial to assuring a credible area of special practice.


Postgraduate podiatric medical educational resources in the Department of Veterans Affairs. The existing podiatric medical residencies in the Department of Veterans Affairs are reviewed. The suitability of these residencies to fill a potential need for entry level programs is discussed. The financial implications of providing such training are reviewed and a plan for implementation is presented. Ninety-eight rotating podiatric residency positions currently available in Department of Veterans Affairs hospitals are prime candidates to serve as entry level PGY-1 positions. Assurances will need to be given that implementation of the PGY-1 concept must serve the best interests of the veteran patient population, and that funds will need to be allocated to pay faculty salaries and resident stipends. Congressional review of student loan forbearance policies affecting podiatric medical residents is also needed.


Experience with the rotating podiatric residency/podiatric surgical residency-12 model. Twenty-four months of integrated training. The author describes the positive experiences of Cranston General Hospital, Osteopathic in establishing a 24-month program, combining an entry level rotating podiatric residency and a podiatric surgical residency. The program grew from a 12-month surgical program to become a 24-month program, using expanded training opportunities available in Brown University teaching hospitals. An improved quality of care and a greater fund of knowledge for the residents are two results of the 24-month training program. Recommendations and views about developing entry level residency programs are presented.


An alternative approach to the mandatory year of clinical residency training. The author takes the position that a mandatory fifth postgraduate year to serve as a uniform period of clinical education for podiatric medical graduates is unnecessary. A need exists to define primary podiatric medicine as the entry level podiatric medical field of practice. The colleges of podiatric medicine are urged to deemphasize podiatric surgery while placing greater emphasis on primary podiatric care. The author believes that the colleges are responsible for preparing primary podiatric medical practitioners. Residency programs should focus on specialty training in podiatric surgery and podiatric orthopedics.


The entry level residency curriculum. Proposal for discussion. The author discusses the curriculum proposed for the PGY-1 residency program. The author briefly describes the activities resulting from the March 1992 residency forum that have led to a national survey of residency program directors to ascertain opinions about the critical elements of the PGY-1 residency. The elements proposed as part of the PGY-1 curriculum, including specific training experiences for 13 clinical rotations, are presented. Results of the survey will be used as a basis for discussion at a second residency forum to be held in December 1992.


Primary prevention trial of oral cancer in india: a 10-year follow-up study. Oral cancer is caused by chewing and smoking of tobacco. To assess the feasibility of primary prevention of oral cancer, two cohorts were studied in base-line surveys and then followed up annually for 10-yr in Ernakulam district of Kerala state. The intervention cohort consisted of 12212 tobacco users aged 15 yr and over, who were exposed to a concentrated program of education against tobacco use. The control cohort was a non-concurrent cohort of 6075 tobacco users studied using similar methods but with a minimal amount of advice against tobacco use. The stoppage of tobacco use increased and the incidence rate of leukoplakia decreased significantly and substantially in the intervention cohort compared to the control cohort. The decrease in the incidence of leukoplakia was indicative of the decrease in the risk of oral cancer since the two were intimately related. This study demonstrated feasibility of primary prevention of oral cancer.


Melanin depigmentation of the palatal mucosa in reverse smokers: a preliminary study. The melanin pigmentation in the palate of Indian reverse smokers was histologically studied in 80 biopsies, which were compared with corresponding tissue from 49 nontobacco users. The morphology of epithelium containing melanin in its basal part was normal in smokers and nonsmokers, in contrast to areas with a local melanin depigmentation of the epithelium found in some of the reverse smokers. Here an epithelial thinning, inflammation in the underlying connective tissue, and eventually a cancer was found. The histologic appearance was in accordance with the theory that as long as a smoker's melanosis or a genetic melanin pigmentation is present, melanin functions as a defence against toxic agents penetrating into the oral mucosa.


Langerhans cell distribution and keratinocyte expression of HLADR in oral lichen planus. Keratinocyte expression of the Class II major histocompatibility complex antigen HLADR, is seen in several inflammatory disorders of skin and mucosa, including lichen planus. The purpose of this study is to determine whether the distribution of Langerhans cells and their expression of CD4 in oral lichen planus is related to keratinocyte HLADR. The numbers of CD1- and CD4-positive Langerhans cells were compared in areas of keratinocyte HLADR and areas showing no expression in oral lichen planus and with normal oral mucosa. Cells were identified using an immunoalkaline phosphatase technique and numbers were expressed per mm epithelial surface length. In lichen planus, an increase both in the number of Langerhans cells and the numbers expressing CD4 were found in areas of keratinocyte HLADR expression compared with HLADR negative areas and with normal oral mucosa. There was no difference in the numbers of Langerhans cells or their expression of CD4 between HLADR-negative areas in LP and normal oral mucosa. These results show that the distribution of Langerhans cells is related to keratinocyte expression of HLADR and suggest that Langerhans cell entry may be enhanced in these areas. Whilst it is possible this enhancement is mediated by CD4/HLADR interaction, other molecules are also likely to be important in controlling Langerhans cell entry into oral mucosa.


Relative efficacy of fluocinolone acetonide compared with triamcinolone acetonide in treatment of oral lichen planus. Twenty patients with oral lichen planus and topically treated with fluocinolone acetonide in orabase 0.1% (FAO) were compared with 20 treated with triamcinolone acetonide in orabase 0.1% (TAO). During 4 wk of treatment the lesions in 13 of 19 patients could be effectively cured with FAO whereas only 8 of 19 patients were cured with TAO. These differences were statistically significant. There were no differences in blood pressure, plasma cortisol or number of circulating lymphocytes after treatment with FAO, but the number of eosinophils was reduced in every case after treatment for 6 months. There was no permanent adrenal cortical suppression after treatment for 6 months. Acute pseudomembranous candidiasis during the treatment was common but could be cured with antifungal drug in every case. This study shows that FAO in a majority of cases is an effective treatment of oral lichen planus without any serious clinical side effects apart from treatable candidiasis.


Transamidase and collagenase activity in healthy and diseased human gingival tissues. Transamidases are a class of calcium-dependent mammalian enzymes which cross-link proteins by catalyzing the formation of (gamma-glutamyl)-epsilon-lysine bonds. It is possible that these enzymes play an important anabolic role in tissue healing. This study was to quantitate transamidase activity in human gingival tissue and examine the relation between transmidase activity and degree of inflammation. Forty-four out of a total 120 collected human gingival specimens from healthy and diseased patients were selected based on histometric and microbiologic criteria. Specimens were minced and homogenized in 10 mM CaCl2 and then extracted for 30 min, in 50 mM tris-HCl buffer (pH 7.5) containing 100 mM CaCl2. Following low speed centrifugation at 4 degrees C, the supernatant solution was assayed for both transamidase and collagenase activities by radioactive amine incorporation, and digestion of tritiated collagen, respectively. Appreciable levels of transamidase and collagenase activities in healthy gingivae were found. These enzyme activities were significantly elevated in the diseased and healing tissues. Unlike other transamidases, calcium was required in the enzyme extraction process.


[Current treatment of poisoning by ingestion of caustic substances]. Lesions by ingestion of corrosive substances had so far been treated at the time of sequelae. In the seventies several events modified deeply the epidemiology and the early care of these poisonings. At that time household products like highly concentrated basic and acid substances and oxidizing agents were distributed and led to an increase of the number and the severity of these intoxications. In the same time, fiberoptic endoscopy of the digestive tract played a leading part to evaluate the diagnosis and the prognosis of these poisonings at an early stage, and thus, with accurate intensive care and digestive surgery contributed to generate appropriate guidelines, according to the severity. The first step of the treatment is fasting, fluid replacement and analgesic if required. A full examination must be performed, especially in the throat even if there is no strong correlation between early clinical signs and the severity of the lesions; blood samples must be obtained to look for metabolic acidosis, hyperleukocytosis hemolysis and consumption coagulopathy which could be better indicators of the severity. Fiberoptic endoscopy of the upper digestive tract should be performed as soon as the physical and psychological patient's condition is stable; if possible before the twelfth hour and no more late than the twenty-fourth hour. It should determine the lesions: type, range and grade according to Quincy's classification modified by Mongon and Di Constanzo. Survival and healing of "extremely severe" grade intoxication can only be obtained through a surgical intervention within the first hours; a laparotomy will indicate the depth of the lesions, which is not determined by endoscopy, and will consist of Celerier's stripping method and if necessary a gastrectomy, more seldom a cephalic duodeno-pancreatectomy. Only the surgical excision of necrotic tissues can prevent the occurrence of lethal complications like oesophageal or gastric perforations and septic shocks. The analysis of the literature from 1975 up to now gives us information on the methods and the results of these different therapeutic approaches.


[Current status of poisoning by ingestion of caustics: apropos of a series of 49 cases]. The authors report the history of 49 patients, admitted to an intensive care unit after a caustic or corrosive ingestion. This series follows a similar one, related in 1979. An update is made for early evaluation and management, based on patients classification in three groups: severe cases, moderate cases, mild cases. Clinical and biological data, treatment and outcome for the three groups are related. The frequency and gravity of these poisonings appear to be the same as in the first series, with poor prognosis for extreme emergencies and high risk of oesophageal or gastric stricture for important forms. In this population, 20% of extreme emergencies have favorable outcome with early major surgical procedure.


[Fatal poisoning involving amitriptyline: toxicologic data]. A fatality involving amitriptyline is described. The drug and its metabolite nortriptyline were separately quantified in various post-mortem samples, including hair. Results are discussed in the light of the existing literature.


[Iodoform poisoning. 3 cases].

[Iodoform poisoning. 3 cases]. Three cases of iodoform poisoning are described following dressings with 10% iodoform gauze (0.10 x 5 m) on extended wounds. Five, ten and sixteen days after the beginning of dressings, the patients became confuse, hallucinated, and one of them was subsequently comatose. Vomiting, fever, tachycardia with premature ventricular beats and shortening of P-R interval, slight increase of transaminases and proteinuria were observed. Within a few days (3 to 8) after the iodoform dressings were discontinued, the signs of iodoform toxicity disappeared. The toxicity of iodoform is probably unrecognized if the rarity of the observations published and the amount of iodoform gauzes annually sold are compared.


Risks of flumazenil in mixed benzodiazepine-tricyclic antidepressant overdose: report of a preliminary study in the dog. This preliminary study evaluates the cardiac and neurological risks associated with the sudden antagonism of benzodiazepine (BZD)--induced sedation in dogs intoxicated with tricyclic anti-depressants (TCA). Twelve dogs were anesthetized with midazolam and ventilated with room air. EEG, ECG, and arterial pressure were continuously recorded. An infusion of amitriptyline (6 dogs) or clomipramine (6 dogs) 1 mg/kg. min was maintained until signs of cardiotoxicity (QRS prolongation, hypotension or arrhythmias) occurred. The effects of a bolus of flumazenil 0.2 mg/kg were then observed until 120 minutes. In amitriptyline poisoning, BZD reversal was associated with development of convulsions in 3 dogs, with severe arrhythmias in 4 and with one death. In clomipramine intoxication, 2 dogs developed sudden fatal arrhythmias. These results show that BZD reversal may unmask the convulsant properties and increase the severity of arrhythmias induced by TCA.


Primary Casualty Reception Ship: the hospital within--Operation Granby. As the build-up of Operation Granby forces developed in the Gulf, casualty estimates indicated the need for a 100-bed hospital facility to care for the possible maritime casualties. RFA Argus, the Air Training Ship, was identified as the potential Primary Casualty Reception Ship (PCRS) and at the end of September 1990 plans were drawn up to convert the forward hangar into a two-storey 100-bed hospital in collective protection (COLPRO). In the three weeks prior to deployment, the hospital was designed, built, equipped and staffed. Argus arrived in the Gulf in mid-November as the PCRS with, all in COLPRO, a 10-bed intensive care unit (ICU), a 14-bed high dependency unit (HDU), a 76-bed low dependency unit (LDU) plus four operating tables in two theatres with full support services. The hospital was staffed by a medical team of 136 personnel and supported by the Air department with four casualty evacuation helicopters, an RN Party and the staff of the RFA. One hundred and five patients were treated of which 78 were returned to duty. Argu as PCRS spent longer in the northern Persian Gulf than any other ship, UK or US.


Naval Party 1036: its role in the Gulf Conflict. With the escalation of the Gulf Conflict in December 1990, there was a greater requirement for medics to support the land forces. In war, BMH Hannover becomes 32 Field Hospital RAMC, a 200 bed third line medical facility. This account describes the contribution made by Naval Party 1036 when it augmented 32 Field Hospital in Saudi Arabia in early 1991 during Operation Granby.


Decrease in enkephalinase A number in kidney membranes from hypercholesterolemic and hypertensive rats. The variation of enkephalinase A number on the hypertensive and hypercholesterolemia rats kidney membranes is studied using the [3H]-acetorphan, a potent inhibitor of enkephalinase A to label the protease in rat kidney. The binding of [3H]-acetorphan to kidney membrane determined in vitro with both equilibrium and kinetic methods is saturable and reversible involving a single class of sites with a dissociation constant of 4-5.3 nM. The [3H]-acetorphan binding capacity is identical, Bmax approximately 51 pmoles per mg of proteins, for kidney membranes from Sprague Dawley and Wistar Kyoto rats. In contrast, the enkephalinase A number is decreased in the pathological states studied: 20% for hypertensive rats and 50% for hypercholesterolemic rats. Such pharmacological results provide a great deal of information about the modification appeared in the metabolism of peptidic substrates of enkephalinase A in hypercholesterolemia and hypertension.


Characterization of muscarinic receptor subtypes in canine left ventricular membranes. The pharmacological characteristics of muscarinic receptor (mAChR) subtypes in canine left ventricular membranes (LVM) were determined using [3H] quinuclidinyl benzilate ([3H]QNB) and [3H]N-methyl scopolamine ([3H]NMS) as ligands. Binding of [3H]QNB and [3H]NMS was saturable with respect to the radioligand concentrations. Analysis of binding isotherms by Scatchard plot showed that [3H]QNB and [3H]NMS bound to an apparently homogeneous population of mAChRs in LVM, with KD values of 390 +/- 100 and 285 +/- 34 pM and Bmax values of 240 +/- 20 and 133 +/- 9 fmol/mg protein, (n = 6), respectively. The Hill coefficients for [3H]QNB and [3H]NMS binding were 0.95 +/- 0.02 and 0.99 +/- 0.01, respectively. Based on the competitive inhibition of [3H]ligand binding, atropine and NMS as well as the selective M1 antagonist PZ revealed no selectivity for these mAChRs. PZ competed with [3H]QNB or [3H]NMS for a single binding site with a Ki value of 0.23 +/- 0.03 microM and 0.62 +/- 0.10 microM, (n = 6), respectively, which is close to the values of M2 or M3 receptors. The data indicate that the M1 receptor subtype did not exist in canine LVM. Competition of [3H]ligand binding with selective M2 antagonists, AF-DX 116 and methoctramine and the selective M3 antagonists, 4-DAMP and hexahydrosiladifenidol, gave a best fit for a two-binding site model. The inhibition of carbachol-mediated phosphoinositide hydrolysis by PZ, AF-DX 116 and 4-DAMP, generated an affinity profile for this response also dissimilar to that described for the classical cardiac M2 response. Although no other muscarinic receptor mRNA has been detected in this tissue, these data suggest the presence of a second population of muscarinic sites, which may signify an M2 receptor diversity.


LPS-induced decrease of specific binding of 3H-dexamethasone to peritoneal macrophages of C57BL/6 mice. The effect of LPS on the specific binding of 3H-dexamethasone to peritoneal macrophages of C57BL/6 mice was studied. Scatchard plot of the specific binding of 3H-dexamethasone to the macrophages indicated that the Kd and Ro of glucocorticoid receptor was approximately 3.0 nM and 5,500 binding sites per cell, respectively. LPS, at the concentration of 10 ug/ml, caused a decrease in the specific binding of 3H-dexamethasone to macrophages after it interacted with the macrophages for different times. Con A, a mitogen for lymphocytes, did not significantly cause a decrease of glucocorticoid receptor in the macrophages at the concentration of 10 ug/ml. Our results indicated that the effect of LPS on the specific binding of 3H-dexamethasone to macrophages was different from the effect of Con A, which might be significant in the interaction of immune system and neuroendocrine system.


Modulatory effect of nonesterified fatty acids on structure and binding characteristics of estrogen receptor from MCF-7 human breast cancer cells. Arachidonic, docosahexaenoic and oleic acids were found to produce a dose-dependent cytotoxic effect on MCF-7 cells; palmitic and stearic acids were totally ineffective in this regard suggesting that solely unsaturated fatty acids were able to arrest mammary tumor cell growth. Similarly, only former acids were able to decrease the binding capacity and affinity (increase Kd value) of the cells for 3H-E2 in a dose-dependent manner. In the case of arachidonic acid (the reference fatty acid), this decrease was associated with a slight cleavage of the native 67 KDa estrogen receptor (ER) into 50 and 25-30 KDa peptides as demonstrated by sequential labeling of high-salt cell extracts with 3H-tamoxifen aziridine, specific immunoadsorption with H-222 anti-ER monoclonal antibody, SDS-PAGE and fluorography. Both, modifications in binding characteristics of ER and cleavage of the native 67 KDa receptor were found to be extremely marked when unsaturated fatty acids were directly added to the high-salt cell extracts. This clear influence on the ER structure was reflected on enzyme immunological assay (EIA) by a reduction of ER immunoreactivity of approximately 50% in presence of arachidonic acid. Our observations are discussed in terms of possible interference of unsaturated fatty acids either through transmembrane modulation of phosphokinases and/or phospholipases implicated in ER mechanism of action, or through an intracellular interaction between ER and these acids acting as second messengers in regulation of cellular functions.


Covalent cross-linking of radiolabeled N-formylated hexapeptide to its specific receptor on rat and human neutrophils: evidence for a ligand induced complex formation. The structure of the rat and human neutrophil receptor for N-formylated chemotactic peptides was characterized using 125I-labeled N-formyl-Nle-Leu-Phe-Nle-Tyr-Lys hexapeptide as a ligand and an affinity cross-linking technique. 125I-hexapeptide bound to purified rat peritoneal neutrophils was time, temperature and pH-dependent. The average receptor number per cell was about 67,000 and dissociation constant (Kd) 0.41 nM. Formyl-MLLP, fMLP, fNLP, were 750%, 15%, 8.6% respectively and Boc-MLP, Boc-NLP, and MLP 0.6% as potent as the hexapeptide in inhibiting the binding of 125I-hexapeptide to rat neutrophils. The same correlation was found between these peptides in their potency to induce chemotaxis. This indicates that the rat neutrophil chemotactic receptor is like human receptor also a highly stereoselective and requires a N-formylated ligand for high affinity binding. Affinity cross-linking of 125I-hexapeptide to rat and human neutrophil chemotactic receptor with glutaraldehyde revealed on SDS-PAGE a 85-kDa and 62-kDa major complex and a 170-kDa and 120-kDa minor complex, respectively. The 120-kDa complex was absent in human neutrophils if the cells were treated with glutaraldehyde prior to cross-linking of 125I-hexapeptide to its receptor. Likewise, the larger complex was absent if neutrophils were exposed to heterologous ligand (C5a) prior to glutaraldehyde treatment and cross-linking of 125I-hexapeptide to its specific receptor. These results demonstrate that the rat neutrophils possess a functional high-affinity receptor for N-formylated chemotactic peptides and that the size of the monomeric receptor is 85-kDa and about 23-kDa larger than that of the human receptor. Upon homologous ligand binding the receptor seems to form a larger complex.


Could the fasting plasma glucose assay be used to screen for gestational diabetes? The fasting plasma glucose assay was compared with the one-hour post-glucose test as a screening test for identification of gestational diabetes. Of 4,561 consecutive patients screened with a 50-g glucose test, 968 (21.2%) had results > or = 135 mg/dL; 141 (14.6%, or 3.1% of the total) were found to have diabetes. In the 968 patients, the area under the fasting plasma glucose receiver operating characteristic curve was greater than that under the glucose screening test curve, indicating greater discriminatory value of the former test. Of the 116 patients who had sequential glucose screening tests and fasting plasma glucose assays performed twice during pregnancy, a significant correlation was found for fasting plasma glucose values, but not for glucose screening test values. We conclude that the fasting plasma glucose assay may perform better than the one-hour post-glucose test as a screening test for gestational diabetes. Based on these data, a population-based prospective study seems justified.


Creatine kinase and its MB isoenzyme in the third trimester and the peripartum period. Forty-nine normal pregnant women were recruited late in the third trimester for serial determinations of creatine kinase (CK) and its MB isoenzyme fraction (CK-MB) at four different times: (1) on recruitment between 36 and 40 weeks' gestation, (2) on admission in active labor, (3) immediately after delivery, and (4) on the first postpartum day. In the patients with vaginal delivery (n = 43) total CK was significantly elevated at time 4 compared with times 1, 2 and 3 (P value < .0001). CK-MB fraction was also significantly elevated at time 4 compared with times 1, 2 and 3 (P value < .0001). In 35.7% of the patients at time 4, CK-MB was sufficiently elevated to give the laboratory interpretation of "borderline" or "consistent with a myocardial infarction," even though none of the patients had cardiac symptoms or complications. A review of the literature shows that CK-MB is found not only in myocardium but also in uterus and placenta. The implication of this study is that elevations in total CK and CK-MB should be used with caution during the peripartum period to diagnose myocardial ischemia or infarction.


Ultrasonic surgical aspirator in cytoreduction of splenic metastases to avoid splenectomy. The Cavitron Ultrasonic Surgical Aspirator (Cavitron) was used to reduce the volume of splenic metastases in seven patients. Six patients had epithelial carcinoma of the ovary, and one had peritoneal mesothelioma. All patients had stage IIIC disease. Initially, six patients had malignant disease > 15 mm in diameter (of any single nodule), and one had disease 6-15 mm in diameter. In order to avoid resection of the spleen, cytoreduction could not be performed by standard means. After using the Cavitron, three patients had no gross residual disease, and four patients had disease 1-5 mm in diameter. No complication resulted from cytoreduction of splenic disease using the Cavitron, and splenectomy was not performed in any case. The Cavitron is invaluable in obtaining minimal residual disease of splenic metastases without performing splenectomy.


Laparoscopy using a simplified open technique. A review of 585 cases. Laparoscopy was carried out using a simplified open method on 585 patients. In the group, 173 (29.5%) had undergone a previous laparoscopy or laparotomy, 28 (4.8%) suffered from gross obesity and 1 patient had a large umbilical hernia. Laparoscopy was diagnostic in 216 (37%) patients and operative in 369 (63%). In this series there were no technical failures or major complications; the incidence of minor complications was 2.7%. The above results seem to suggest that open laparoscopy compared to the closed method may offer the advantage of a lack of contraindications secondary to previous surgery, no risk of failure with unintended laparotomy and, possibly, decreased postoperative discomfort. A larger, randomized series to settle the controversy between closed and open laparoscopy regarding the safety differences between the two approaches may result in more widespread use of the open technique.


Diagnosis of intrauterine growth retardation as a two-step process with morphometric ultrasound and Doppler umbilical artery velocimetry. Ultrasound and Doppler umbilical artery velocimetry have been used to diagnose the small-for-gestational-age (SGA) fetus. Both techniques are relatively inefficient for this diagnosis. The aim of the present study was to see whether their serial use improved diagnostic accuracy. Forty women with an ultrasound diagnosis of SGA within three weeks of delivery were studied with velocimetry, and the outcome was evaluated. Diagnostic accuracy was improved from 65% by ultrasonography alone to 92% by the addition of an abnormal umbilical artery waveform (P < .02). An abnormal waveform was associated with an adverse outcome in 62%, compared to 14% with normal velocimetry (P < .01). The majority of small fetuses have a normal outcome. The combination of ultrasonography and velocimetry improved diagnostic accuracy and identified those small fetuses truly at risk.


Does douching promote ascending infection? Despite the fact that vaginal douching is practiced regularly by approximately 20 million American women, little is known about who douches, why or its associated risks or benefits. Recent studies of douching collectively suggest a possible association with ectopic pregnancy and pelvic inflammatory disease. These findings, however, are difficult to interpret because of the small number of studies, conflicting findings and methodologic weaknesses, reflecting both the early stage of interest and difficulties inherent to studies of intimate behaviors. Further information is needed to differentiate between douching as a causal factor or as an indicator for behaviors that increase the risk of sexually transmitted diseases and their complications. The central issue is whether other risk factors and/or markers for sexually transmitted diseases, which are more common among women who douche, have been reasonably excluded as a source of bias. Few, if any, criteria for establishing a causal link between douching and adverse outcomes are satisfied, but this reflects a paucity of data rather than data that refute such a conclusion.


Splenic artery aneurysm rupture in pregnancy with maternal and fetal survival. A case report. A splenic artery aneurysm occurred at 30 weeks, 3 days' gestation. Both the mother and fetus survived.


Ultrasound diagnosis of a twin gestation with concordant body stalk anomaly. A case report. Concordant body stalk anomaly in an 18-week twin gestation was diagnosed by ultrasound and confirmed by pathologic examination after elective termination of pregnancy. The ultrasonographic presentation of this rare anomaly and its embryogenesis are discussed.


Roseola infantum in pregnancy. A case report. Roseola infantum (exanthem subitum) was first described as a specific syndrome by Zahorsky in 1913. It is a benign disease that occurs almost exclusively in infants and young children (six months to three years of age). We report a case of roseola in a pregnant woman. We were unable to find any prior reports of roseola in pregnancy. The classic presentation of roseola is characterized by high temperatures (103-105 degrees F) that last 3-5 days and resolve by crisis followed by the appearance of a morbilliform rash that lasts a few hours to a few days. The infectious agent is human herpesvirus-6. We recommend the addition of roseola to the differential diagnosis of rashes that occur in pregnancy. The potential danger to the fetus from this virus is unknown.


Distribution of the Lyme disease vector, Ixodes dammini (Acari: Ixodidae) and isolation of Borrelia burgdorferi in Ontario, Canada. Ixodes dammini Spielman, Clifford, Piesman & Corwin was confirmed at Long Point, Lake Erie, Ontario, on small mammals and white-tailed deer and by dragging for ticks. Mean intensities of up to 16.2 larvae and 2.1 nymphs were found on Peromyscus leucopus (Rafinesque), with an overall prevalence of infestation up to 92%. Adult I. dammini (101.6 +/- 77.63) (mean +/- SD) were found on 8 white-tailed deer, Odocoileus virginianus (Zimmerman). The seasonal pattern of recovery of ticks from hosts and the environment resembled that described elsewhere. I. dammini was not found on 952 small mammals trapped at 25 other localities throughout Ontario, although other ticks (Derma-centor variabilis (Packard), Ixodes angustus Neumann, I. marxi Banks, I. muris Bishopp & Smith) were encountered sporadically. I. dammini is not widespread or common in Ontario other than at Long Point. Borrelia burgdorferi was isolated from 10 of 151 P. leucopus; from larval and nymphal I. dammini; and from nymphal and adult D. variabilis, all from Long Point. B. burgdorferi was not recovered from 116 small mammals from localities other than Long Point. Seropositive P. leucopus (indirect fluorescent antibody test titer > or = 1:20) were common (up to 30% prevalence in July 1988, n = 23) on Long Point. Where I. dammini was not found, the prevalence of seroreactors among Peromyscus was 0 (15 sites), < 12% (5 sites), and 29% (1 site); seroprevalence at 1:20 could not be calculated for a further 4 sites examined in 1987. Antibody to B. burgdorferi was also detected in other small mammals at some sites. Such antibody was interpreted as possibly cross-reacting or caused by direct transmission.