Influence of preoperative left ventricular function on results of homograft replacement of the aortic valve for aortic stenosis

The effect of preoperative left ventricular function on early and late prognosis was assessed in 103 patients with aortic stenosis who underwent left ventricular cineangiography before homograft replacement of the aortic valve. The patients were separated into two groups: Group A (58 patients) with an ejection fraction of 0.46 or more and Group B (45 patients) with an ejection fraction of 0.45 or less. The two groups were compared with respect to clinical and hemodynamic data as well as operative result. There was poor correlation between clinical data and left ventricular function. In Group A there were three early deaths (5.2 percent) and three late deaths (5.2 percent) compared with no early and six late deaths (13.3 percent) in Group B during the follow-up period of 12 to 102 months (mean 43 months). Most patients in Group B showed considerable symptomatic improvement but less than that observed in Group A. Forty-two patients (13 in Group A and 29 in Group B) underwent repeat cardiac catheterization and coronary angiography. Improvement in left ventricular function as assessed by radial analysis of segmental wall motion and ejection fraction was observed in 20 of the 29 patients in Group B. Failure of left ventricular function to improve was associated with additional coronary artery disease in the majority of patients. It is concluded that poor left ventricular function does not increase the risk of aortic valve replacement for aortic stenosis and that improvement in left ventricular function can be expected in the majority of patients.

Influence of preoperative left ventricular function on results of homograft replacement of the aortic valve for aortic regurgitation

The effect of preoperative left ventricular function on eraly and late prognosis was assessed in 69 patients with aortic regurgitation who underwent homograft replacement of the aortic valve. Patients were divided into two groups: Group A (38 patients) had an ejection fraction of 0.46 or more and Group B (31 patients) had an ejection fraction of 0.45 or less. Clinical data, hemodynamic data, and operative results were compared in the two groups. In Group A there was one early death (2.6%) and there were two late deaths (5.3%) compared to two early deaths (6.5%) and seven late deaths (22.6%) in Group B during a follow-up period of 13 to 98 months (mean, 49 months). Actuarial analysis showed a 94% survival at 6 years in Group A compared to 80% in Group B. Twenty-four patients were reinvestigated by repeat cardiac catheterization and coronary angiography at a mean time of 38 months following valve replacement. Left ventricular function was assessed by computerized quantitative radial analysis of segmental wall motion. Improvement in left ventricular function occurred in eight of the 14 patients reinvestigated in Group B, and appeared to be closely related to the etiology of the initial valve lesion. Despite the higher mortality rate in patients with poor left ventricular function, most derived considerable benefit from operation.

Characterization of a retrovirus isolated from normal mink cells co-cultivated with a dog mammary tumour

A retrovirus antigenically distinct from known type C, B and D viruses was isolated from normal mink (Mustela vison) lung cells that had been co-cultivated with 5-iododeoxyuridine- and dexamethasone-treated dog mammary tumour cells. Cytogenetic studies of the virus-releasing co-culture showed mitotic figures identical to the normal mink cell line (MvlLu) with the exception of a low frequency of cells with extensive chromosomal breakage and uncoiling. The new virus bands at a buoyant density of 1.16 g/ml, contains 60S RNA and a reverse transcriptase which prefers Mn2+ over Mg2+ for the synthesis of DNA. This enzyme utilizes poly(rA).oligo(dT) more efficiently than poly(dA).oligo(dT) and is also able to synthesize DNA copies from the endogenous RNA. Morphologically, it is a typical type C virus. Filtered virus readily infects mink, dog and other mammalian cells indicating the amphotropic nature of its cell growth requirement. Hybridization studies showed that normal mink DNA contains multiple copies of proviral sequences of this newly isolated virus. Serological analyses indicate that the mink endogenous virus contains in its core protein, in addition to the interspecies type-C determinant, an antigenic component related to one of the determinants found in the feline leukaemia virus p30 protein. This determinant is not present in the Rauscher leukaemia virus, RD114 virus or simian sarcoma virus.

Motorcycle spoke injury

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A model for short term drug absorption studies; comparison of sulphadiazine tablets

The four parameter equation, applicable to drug absorption kinetics over a limited time period, has been used to interpret plasma concentration, time results following oral dosage with three different formulations of sulphadiazine tablets, to each of five subjects. Assessment parameters for the formulations, the time for ten percent absorption, the time interval between 10-90% absorption and the plasma concentration with no disposition (relative availability) have been estimated. Intersubject variation obscured many of the differences between formulations. To blank off this variation, plasma concentrations at each time were averaged and then random variation corresponding to the error of the assay method was applied so as to generate a number of sets of data which including the mean concentrations was equal to the number of sets in the original measurements. Kinetic analysis of these sets indicated a number of significant differences between the formulations.

A study on the evaluation of local shati starch as a substitute of polysaccharides used in the preparation of capsules and tablets of antibiotics

Local shati starch was extracted, purified and used as an excipient for the preparation of capsules and tablets of oxytetracycline and chloramphenicol. The weight variation test, disintegration time and hardness test of these dosage forms were done and compared with the conventional maize starch containing tables and capsules of the antibiotics. The results in respect of their potency test were found to conform to official pharmacopoeias (B.P. and U.S.P). Stability study for over one year of both varieties of tablets and capsules revealed that they retained their potencies equally well.

The use of "fresh" unstented homograft valves for replacement of the aortic valve: analysis of 6 1/2 years experience

Between August 1969 and January 1976, 561 patients underwent homograft replacement of the aortic valve (AVR). Isolated AVR was performed in 339 patients, ranging in age between 18 months and 74 years. The valves were sterilized in antibiotic solution and preserved at 4 degrees C in tissue culture medium. There were 11 early deaths (3.2%) and 23 late deaths (6.8%). Actuarial analysis showed 88% survival at 5 years and 85% at 6 years. Valve failure occurred in 13 patients (3.8%) due to prolapse of one cusp in five patients (1.5%), infective endocarditis in three and degeneration of the graft in five (1.5%). Degenerative valve failure was encountered after the fourth year with an incidence of 3.5% of patients at risk, and occurred only in grafts from donors over the age of 70 years. Diastolic murmurs were present in 22% of patients followed up for more than one month and increased very slightly with time. The clinical result was judged to be good or excellent in approximately 90% of the surviving patients.

Production of antiserum to the reverse transcriptase of Mason-Pfizer monkey virus

The reverse transcriptase of Mason-Pfizer monkey virus (M-PMV) has been isolated and partially purified by ion exchange chromatography. Sera from rabbits immunized with the partially purified enzyme have been shown by microimmunodiffusion analysis to be immunologically specific for the M-PMV polymerase. The immune serum also specifically inhibits M-PMV polymerase activity and this inhibitory activity has been shown to reside in the IgG fraction of the serum. The application of these reagents to examining virus identity and investigating the possible viral aetiology of human breast cancer is discussed.

Expression of Mason-Pfizer and simian type C viruses in the presence of 5-iododeoxyuridine and dexamethasone

Production of infectious Mason-Pfizer monkey virus (M-PMV) was enhanced after treatment of the CMMT cell line with 2.5 x 10(-5) M dexamethasone phosphate (DXM). The reverse transcriptase (RT) activity and infectivity titers of treated culture fluids were enhanced by five- and tenfold, respectively. Along with stimulation of M-PMV synthesis, a simian type C virus (SCV) was also detected by electron microscopic and RT analyses. The SCV was serologically related to the endogenous baboon type C virus. 5-iododeoxyuridine (IUDR) also activated the SCV in the CMMT cell line while significantly inhibiting the production of infectious M-PMV. The activation of endogenous SCV by IUDR or DXM was transitory, since removal of these compounds from the growth medium resulted in the disappearance of SCV buds and the related RT activity; however, low levels of specific viral structural proteins continued to be synthesized intracellularly. Similarly, the enhancement of M-PMV production seen with DXM was lost when the treated cells were subcultured for 2 weeks in the absence of the hormone.

Histiocytosis X and compulsive water drinking: report of a case

We describe a patient with histiocytosis X and compulsive water drinking. The association of diabetes insipidus with histiocytosis X is well recognized, and this patient was initially considered to have diabetes insipidus. It was only after further testing that the proper diagnosis was made.

Postprandial plasma glucose, insulin, glucagon and triglyceride responses to a standard diet in normal subjects

Postprandial plasma glucose, insulin and triglyceride responses were determined in 12 normal subjects (7 male and 5 female) fed a standard diet composed of typical American foods; the three meals were identical for each subject. A significant postprandial rise in glucose and insulin was observed. They were closely related temporally in the early postabsorptive period. However, in the late post-absorptive phase insulin decline was generally slower than the glucose decline. A considerable difference in the glucose and insulin response was observed between males and females. Fasting plasma glucose and insulin concentrations were lower in the women. Following each meal the peak plasma glucose was lower in the women, but the difference was significant only following breakfast (p less than 0.02). The area under the glucose curve following breakfast was also lower (p less than 0.01) in the women. In the men the maximal postprandial glucose concentration and the postprandial glucose area remained stable throughout the day, but there was an increase in peak insulin concentration and insulin area after dinner. In contrast, in the women the maximal postprandial glucose concentration and the postprandial glucose area increased throughout the day, but the peak insulin concentration and insulin area did not change. Plasma trigylcerides increased with breakfast and remained elevated throughout the day. Both fasting and postprandial mean triglycerides were higher in the men, but this did not reach statistical significance. The circulating pancreatic glucagon concentration, determined in 4 subjects, was unaffected by meals and remained stable throughout the day.

Practical considerations in the development of a human cancer vaccine

Factors involved in the development of a human oncornavirus vaccine are discussed. The isolation and purification of subviral gp69/71 antigenic components enhance the feasibility of developing safe vaccine. The recent isolation of a C-type virus (the HL-23) from a human leukemic patient and its similarity to the simian sarcoma virus presents us with a unique opportunity to test the safety and potency of a vaccine in nonhuman primates.

Extraction of digoxin and its metabolites from urine and their separation by Sephadex LH-20 column chromatography

The efficiency with which serveral solvent systems extract digoxin and its metabolites from urine has been studied and column chromatography using Sephadex LH-20 has been used to separate digoxin and its metabolites. These procedures have been evaluated and used to study the excretion of 3H-digoxin-12alpha and its metabolites in urines collected serially in 7 patients and in bile in one. The percentage of the radioactivity excreted as metabolites in urine and bile was found to reach a peak within the first day and then to gradualy decline to minimal amounts in patients with advanced renal failure as well as those with good renal function. The maximum percentage measured as metabolites in 4 patients with the most advanced renal failure was 10%.

Pathologic hypofunction of the renin-angiotensin-aldosterone system

The literature now contains reports of many cases of aldosterone deficiency. Usually, the presenting features are persistent hyperkalemia and tendencies to serious urinary sodium loss and hypotension. A classification of defects leading to pathologic hypofunction of the renin-angiotensin-aldosterone system (RAAS hypofunction) is presented, with emphasis on idiopathic hyporeninemia (probably the most common). Criteria for diagnosis are (1) normal adrenal glucocorticoid function, (2) low aldosterone excretion under basal and stimulated conditions, and (3) renal tubular responsiveness to exogenous mineralocorticoid. The condition is effectively managed with mineralocorticoid replacement therapy and should be considered in the presence of unexplained persistent hyperkalemia, hyponatremia, or postural hypotension.

Detection of simian type-C particles in Mason-Pfizer virus infected cultures

A simian type-C virus has been detected in cultures chronically infected with Mason-Pfizer monkey virus (M-PMV). Simultaneous budding of M-PMV and type-C virus particles from the same cells was observed in cultures incubated at 37 or 40 degrees C. However, the frequency of such cells was greater in cultures grown at 40 degrees C. Although clusters of type-C viral buds were seen at the surface of the cells, extracellular mature type-C particles in cell pellets or concentrated virus preparations were very rarely found. The increase in frequency of type-C buds was found to be transitory since cultures adapted to growing at the high temperature demonstrated budding type-C particles only occasionally. Cultures producing type-C buds were found to contain, in addition to M-PMV antigens, serological activity with polyvalent antisera produced against multiple structural components of endogenous baboon virus (BV) or simian sarcoma virus (SiSV). The reactivity, however, was found not to be serologically related to the major SiSV P28 core protein.

Interactions between endogenous baboon type-C virus and oncogenic viruses. I. Syncytium induction and development of infectivity assay

Cells releasing the endogenous baboon virus (BV) can interact with human KC cells containing the Rous sarcoma virus (RSV) genome, resulting in cell fusion and syncytium formation. This interaction has been utilized in the development of a sensitive infectivity assay for BV. The titration pattern is of a one-hit type, demonstrating a linear relationship between virus concentration and number of syncytial plaques obtained in the KC co-cultivation assay. Endpoint titration comparisons indicate that the KC test is as sensitive as the immunofluorescence or the RNA-directed DNA-polymerase assays. Attempts to develop an XC test for BV failed, indicating that while BV can interact with the RSV genome it will do so in the human KC cells and not in the rat XC cells. Syncytia are also induced when KC cells are directly exposed to cell-free BV; however, a linear dose relationship is not obtained. When syncytium-positive KC cultures are passaged, the syncytia disappear and a chronic BV infection is established. These KC-BV cells then lose the ability to interact with either the endogenous cat RD-114 virus or the Mason-Pfizer virus which are known to form syncytia with KC cells.

Jaundice due to carbimazole

On three occasions, a 63 year old housewife with hyperthyroidism developed a reaction which included fever, pruritus, malaise, and, on one occasion, jaundice one to 17 days after taking carbimazole. Challenge with carbimazole was followed within 12 hours by abdominal pain, pruritus, and increased serum transaminase levels. Light microscopy of a liver biopsy showed increase of portal zone cellularity over the control and the electron microscopy revealed fine structural changes compatible with drug-related liver injury.

Late results of aortic homograft reconstruction of the right ventricular outflow tract in infants and children

33 infants and children between 4 months and 14 years have undergone successful reconstruction of the right ventricular outflow tract with adult sized fresh aortic homografts. The late results have been analysed and it is concluded that satisfactory results can be obtained even in infants and that the operation should be performed early to prevent secondary changes in the heart and lungs.

Competition radioimmunoassay for mason-pfizer monkey virus: comparison with recent isolates

The major core protein of Mason-Pfizer monkey virus was purified by DEAE ion exchange column chromatography and shown to be 27,000 daltons (p27). Following the characterization of monospecific antisera prepared against p27, a radioimmunoassay was developed with these reagents and competition experiments were done with come of the recent M-PMY-like isolates as well as with other oncornaviruses. Results suggest that three of the viruses tested, AO, X-381 and FTP-1, are similar to M-PMV while J-96 virus is related, but not identical, to M-PMV. It is also shown that competition RIA can be used successfully to detect the presence of viral proteins in tissue homogenates and cell extracts.

Functional rectal carcinoid tumour and ocular myopathy

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Degradation of polychlorinated biphenyls by two species of Achromobacter

Two species of Achromobacter were isolated from sewage effluent using biphenyl (BP) and p-chlorobiphenyl (pCB) respectively as sole carbon sources. Achromobacter BP grown on biphenyl accumulated a product with an ultraviolet absorption maximum at 257 nm which could not be identified. Washed cell suspensions of both isolates oxidized biphenyl, o-phenylphenol, phenylpyruvate, catechol, p-chlorobiphenyl, m-chlorobiphenyl, o-chlorobiphenyl, o,o′-dichlorobiphenyl, and p,p′-dichlorobiphenyl. Both isolates produced meta cleavage products by fission of the benzene ring. However, spectral characteristics of degradation products from respective substrates were different between the two isolates, indicating divergent degradation pathways. Benzoic and p-chlorobenzoic acids were produced from the degradation of BP and pCB, respectively, by Achromobacter pCB. Chloride was not produced by either isolate during the degradation of all chlorobiphenyls tested including the growth of Achromobacter pCB on p-chlorobiphenyl.