Antigenic characterization of the oligosaccharide portion of the lipooligosaccharide of nontypable Haemophilus influenzae

Monoclonal antibodies (MAbs) directed against epitopes in the oligosaccharide portion of the lipooligosaccharide (LOS) of nontypable Haemophilus influenzae (NTHI) were used to characterize the LOS of this pathogen. Western blot (immunoblot) analysis with four LOS-specific MAbs and proteinase K-derived LOS preparations from 69 NTHI strains allowed the classification of these strains into nine LOS antigenic groups. The use of these MAbs in a more sensitive colony blot radioimmunoassay system together with these same NTHI strains identified 14 LOS antigenic groups. Extensive cross-reactivity was detected between the LOS epitopes of these NTHI strains and the LOS of H. influenzae type b. The epitopes recognized by these MAbs were not accessible to antibody on the surface of every strain. These LOS epitopes were also not stably expressed by NTHI growing in vitro; the observed frequency of LOS antigen variation ranged from 1 to 24% when large numbers of colonies of NTHI strains were screened for reactivity with the LOS-directed MAbs in the colony blot radioimmunoassay. This LOS antigenic variation was sometimes associated with alterations in the profile of the LOS molecule as resolved by dodecyl sulfate-polyacrylamide gradient gel electrophoresis followed by staining with silver. These data indicate that considerable antigenic diversity exists among NTHI strains with regard to the oligosaccharide epitopes in their LOS molecules.

Palliative retreatment of locally-recurrent lung cancer after radical radiotherapy

Twenty-two patients who had received high-dose radiotherapy (50-60 Gy) for non-small-cell lung cancer were retreated with palliative radiotherapy for symptoms that were due to locally recurrent disease. Twelve of the 23 (one patient was retreated twice) repeat courses produced symptomatic benefit. One patient developed spinal-cord injury after retreatment, but this was probably not related to the second course. There were no other serious complications, even though total tumour doses as high as 120 Gy were achieved. This experience demonstrates that repeated courses of radiotherapy can be given successfully and safely in spite of previous radical dosage.

The role of diet in prostate cancer

This is a one-to-one, age- and race-matched case-control study involving 55 histologically confirmed black prostate cancer patients and 55 controls who were seen at three major hospitals in Washington, DC from 1982 to 1984. Personal interviews were conducted to obtain the number of times food items of specified serving size were consumed per week by cases and controls; the subjects were grouped according to the age periods 30-49 and 50 years and older. We then calculated the average daily consumption of each of 18 nutrients per 1,000 calories. There was a significant negative association between linoleic acid (p less than 0.04) for the 50 years and older group, thiamin (p less than 0.05) for those 30-49 years old, riboflavin (p less than 0.03) for the 50 and older group, and iron (p less than 0.05) for those 30-49 years old. The results of this study suggest that the intake of thiamin and iron (in subjects 30-49 years old), linoleic acid and riboflavin (in subjects 50 years and over) could be protective because control subjects consumed more of these nutrients than did the cases.

Comparison of piperacillin vs. ticarcillin plus tobramycin in the treatment of acute pulmonary exacerbations of cystic fibrosis

During a 22-month period 35 children with cystic fibrosis received 52 courses of antibiotic therapy for acute pulmonary exacerbations, including 26 cases of therapy with piperacillin and 26 courses with ticarcillin plus tobramycin. Groups were similar in age (5 vs. 5.4 years), disease severity based on Schwachman scores and presenting symptoms. Pseudomonas aeruginosa was the most common organism isolated in 90% of sputum cultures. Mean minimal inhibitory concentrations for piperacillin, ticarcillin and tobramycin were 8, 64 and 1 microgram/ml, respectively. Piperacillin pharmacokinetic data revealed an average half-life in serum of 36 minutes. Peak serum concentrations averaged 144 micrograms/ml, and after 4 hours serum concentrations continued to exceed the P. aeruginosa 90% minimal inhibitory concentration in 50% of children. The dosage requirement for tobramycin was quite variable, necessitated monitoring of aminoglycoside serum concentrations and in most cases resulted in at least one dosage adjustment. Emergence of resistant bacteria was not seen in 26 courses of piperacillin therapy. Both regimens were effective and well-tolerated. Single agent therapy has the advantage of providing reliable serum concentrations and, in contrast to the standard therapy, does not necessitate monitoring of serum drug concentrations.

Toxicity of particles emitted from combustion of waste crankcase oil: in vitro and in vivo studies

The ever-rising cost of energy provides incentives for the utilization of low-cost waste crankcase oil (WCO) for space heating. Although WCO is known to contain toxic heavy metals, the potential health hazards of emissions and waste products resulting from the combustion of WCO are unknown. Thus, the toxicity of the emission particles and waste products from two different types of burners, a Dravo atomizing oil burner (AOB) and a Kroll vaporizing oil burner (VOB), is evaluated using automotive WCO. Samples are characterized by performing elemental analysis and scanning electron microscopy. Both burners emitted fine (less than or equal to 3 microns), respirable particles. The AOB emission particles contained high concentrations of toxic heavy metals, especially Pb, which showed concentrations as high as 7.5%. The VOB retained a significant amount of heavy metals in the burner residue and emitted a much smaller quantity into the air. The toxicity of AOB emission particles, VOB emission particles, and VOB waste residue is evaluated in three bioassay systems, including a rabbit alveolar macrophage (RAM) cytotoxicity in vitro assay, an intratracheal injection infectivity assay, and a peritoneal irritancy test in mice. The emission particles from both burners and leachate from VOB residue produce a dose-related reduction in viability and cellular adenosine triphosphate (ATP) in alveolar macrophages following 20-hr exposure. Acidity of the RAM medium due to the presence of VOB emission particles and waste leachate contributes to its toxicity.(ABSTRACT TRUNCATED AT 250 WORDS)

Nitropyrene: DNA binding and adduct formation in respiratory tissues

Binding of 1-nitro (14C)pyrene (NP) or its metabolites to cellular DNA and protein in cultures of rabbit alveolar macrophages, lung tissue, and tracheal tissue was examined. DNA binding in tracheal tissue (136 +/- 18.3 pmole NP/mg DNA) was four to five times the levels measured in either lung tissue (38 +/- 9.4 pmole NP/mg DNA) or macrophages (26 +/- 7.5 pmole NP/mg DNA). Adduct analysis of DNA isolated from lung tissue incubated with 1-nitro[H3]pyrene in vitro resulted in the identification of 2 to 5% of the NP adducts as C8-deoxyguanosine 1-aminopyrene. NP was also bound to cellular protein in tracheal tissue and lung tissue, and at a lower level in macrophages. Cocultivation of the macrophages with lung and tracheal tissue decreased the DNA binding in tracheal tissue by 45%. Following intratracheal instillation of diesel particles (5 mg) vapor-coated with 14C-NP (380 ppm, 0.085 muCi/mg) particles into rats, 5-8% of the radioactivity remained in the lungs after 20 hr. Most of the diesel particles were also deposited in the lung. Examination of DNA and protein binding in this tissue showed 5 to 12% of the pulmonary 14C bound to protein and no detectable levels of 14C bound to DNA.

Ductal spread in prostatic carcinoma

The histologic appearances of ductal invasion were studied in 139 cases of prostatic adenocarcinoma diagnosed in the Department of Pathology, Howard University Hospital, during the period January 1980 through October 1983. Intraductal spread was found in almost half (48%) of the prostatic glands examined. Ductal spread was associated with the local extent (P less than 0.001) rather than with the grade of the tumor (P less than 0.01). Three distinct patterns of ductal penetration were recognized. The duct wall was completely destroyed in microinvasion. In foci of ductal permeation the integrity of the basement membrane was generally preserved, and the duct wall was infiltrated mainly by solitary tumor cells. When the tumor spread was by extension in continuity within the duct wall, the neoplastic cells appeared to grow between the pre-existing epithelial layers. It was concluded that prostatic carcinoma cells have the ability to penetrate the wall of benign ducts and progressively replace the normal epithelial elements. In this process the general framework of the affected duct appears to be preserved.

Diagnosis and treatment of the febrile child following hepatic portoenterostomy

We report a retrospective analysis of 75 children with hepatic portoenterostomies hospitalized because of fever. Bacterial cholangitis was the most commonly defined cause of fever within 3 months of surgery. Pneumonia and upper respiratory infections were more common 3 months to 2 years following the procedure; however, cholangitis continued to occur during this time period. Twenty percent of hospitalizations were associated with bacteremia or fungemia. Streptococcus pneumoniae was the most common pathogen isolated from the blood. Three children with presumed cholangitis continued to have fever until effective antipseudomonal antibiotic coverage was implemented. The findings in this study lead to the following suggestions: vaccinate all children with pneumococcal vaccine at 2 years of age; a chest radiograph and dental evaluation should be obtained when evaluating the febrile child; empiric treatment for possible cholangitis should include an antipseudomonal penicillin derivative with an aminoglycoside; and if signs of peritonitis are present antibiotic treatment should also include antimicrobials effective against Haemophilus influenzae.

Nutrition and prostate cancer: a case-control study

This one-to-one, age- and race-matched case-control study involved 181 histologically confirmed black prostate cancer patients and 181 controls seen at three major hospitals in Washington, DC, during the period 1979-1982. Personal interviews were conducted to obtain the number of times food items of specified serving size were consumed per week by cases and controls during the age periods 30-49 and 50 years and older. Then the average daily consumption of each of 18 nutrients per 1,000 calories was calculated. There was risk enhancement associated with increased intake of proteins, total fat, saturated fat, oleic acid, and vitamin A during the age period 30-49 years. The association was highly significant for vitamin A and approached statistical significance for the other four nutrients. A hypothesis based on disturbance of the zinc-retinol binding protein-vitamin A axis was put forward to explain the relative risk enhancement effect of vitamin A on prostate cancer.

Non-neonatal infection due to Listeria monocytogenes

In the period from 1969 through 1983, four cases of non-neonatal Listeria monocytogenes meningitis were encountered in Dallas, representing an incidence rate of 0.3%. Three cases occurring in immunocompetent patients are the subject of this report. A review of the literature since 1945 produced 87 cases of Listeria infections in patients who were from 2 months to 20 years of age. Of these, 54% occurred in immunocompetent persons. The case-fatality rate was 15% in the immunocompetent patients, compared with 42% in immunocompromised patients and with 35% in patients with other underlying illnesses. The diagnosis of listeriosis causes concern about the possibility of an underlying occult malignancy or disorder of T cell function, but on the basis of our review these underlying abnormalities are usually clinically apparent at the time of infection. A rational approach to the child with Listeria infection, who is not known to be a compromised host, would be to examine the history and patient carefully to consider documenting normal numbers of T lymphocytes and assessing delayed hypersensitivity by skin testing.

Relatively penicillin-resistant pneumococcal infections in pediatric patients

Two hundred fifty-eight isolates of Streptococcus pneumoniae obtained from 232 infants and children at Children's Medical Center, Dallas, from November 1, 1981, to March 31, 1983, were screened for susceptibility to penicillin. On 1-microgram oxacillin disks 21 strains (8%) had zones of inhibition of 17 mm or less, and the tube-dilution minimal inhibitory concentrations of penicillin were from 0.125 to 0.5 micrograms/ml. These strains were designated as relatively resistant S. pneumoniae (RRSP). Prior therapy with a beta-lactam agent had occurred in 56% of patients with RRSP disease compared with 14% of randomly selected children with infections due to susceptible strains of S. pneumoniae (P = 0.009). Fifteen children (6%) had diseases due to RRSP ranging from sepsis or meningitis to otitis media or conjunctivitis. Four children, including the two patients with meningitis, had unsatisfactory responses to therapy with a beta-lactam antibiotic. Vancomycin or chloramphenicol is preferred for therapy of disease due to RRSP.

The Fitness to stand trial Interview Test: how four professions rate videotaped fitness interviews

The results of this study provide some preliminary support for the use of the FIT as a method for providing structure to interviewers. The FIT may be particularly useful as a guide for making initial decisions about fitness. It was suggested that a screening evaluation based on the FIT could be completed by any properly trained individual with some professional background. The more difficult cases can be referred for lengthier evaluations. Of course, further research on the use of the FIT with actual defendants in real assessments will need to occur before such a procedure can be used as a matter of routine. Finally, the FIT promises to be an effective research tool for isolating professional group differences in definitions of fitness and the importance of different aspects of it, from both a legal and a mental health perspective.

Cellular toxicity in Chinese hamster ovary cell cultures. II. A statistical appraisal of sensitivity with the rabbit alveolar macrophage, Syrian hamster embryo, BALB 3T3 mouse, and human neonatal fibroblast cell systems

Chinese hamster ovary, rabbit alveolar macrophage, Syrian hamster embryo, BALB 3T3 mouse, and human neonatal fibroblast cells were employed in a statistical evaluation of the relative sensitivity of the cells to toxic substances. The cells were exposed to 1,2,4-trichlorobenzene, 2,4-dimethylphenol, Aroclor 1248, cadmium chloride, lead sulfate, nickel nitrate, lead oxide-coated fly ash, and a fine particulate from coal combustion. A filter-disk technique was used to measure the inhibition of protein and DNA synthesis. A quantitative ranking of cell-system sensitivity was determined from comparisons of statistically significant differences (P less than or equal to 0.01) in protein and DNA synthesis expressed as a percentage of control. An overall ranking of sensitivity showed that rabbit alveolar macrophages, Syrian hamster embryo cells, and Chinese hamster ovary cells were more sensitive than another of the five cell systems in 75, 68, and 62% of the experiments, respectively. The corresponding values for BALB 3T3 mouse and human neonatal fibroblast cells were 38 and 28%, respectively, under our experimental conditions. Detailed data on the control cell cultures are also presented.

Treatment of occult bacteremia: a prospective randomized clinical trial

Antibiotic therapy for children without foci of infection and at risk for bacteremia is controversial. A prospective randomized clinical trial was conducted using expectant antibiotic therapy in children at risk for bacteremia. A total of 96 children (aged 6 to 24 months) with temperature of more than 40 degrees C, no identifiable source of infection, and a leukocyte count greater than or equal to 15,000/microL and/or sedimentation rate greater than or equal to 30 were enrolled. The following tests were performed on all children: blood culture, chest roentgenogram, urinalysis, and urine culture. A lumbar puncture was performed if a child was 12 months or less. Patients were randomized to receive either no antibiotic therapy or Bicillin C-R, 50,000 U/kg intramuscularly, followed by penicillin V, 100 mg/kg/d, orally four times a day for three days. Patients were examined at 24 and 72 hours. Fifty patients were treated expectantly and 46 received no antimicrobial therapy. Ten of the 96 patients were bacteremic (nine had Streptococcus pneumoniae, one had Haemophilus influenzae). Four of the five children treated for bacteremia showed improvement at the first follow-up visit (afebrile and no obvious focus of infection). The five untreated patients showed no improvement; four patients developed focal infections (two had meningitis, two had otitis media) (P less than or equal to .05, Fisher exact test). No complications of expectant therapy were detected. Thus, expectant antibiotic therapy for children who have no obvious source of infection and who meet these criteria associated with occult bacteremia is warranted.

"Headbanging" and carotid dissection

Images

A rapid technique for estimating DNA binding, used to evaluate 1-nitropyrene adduct formation

A simple and rapid procedure for estimating binding of radio-labelled material to DNA and protein is described. Protein was extracted from lysed rabbit alveolar macrophages with chloroform: iso-amyl-alcohol:phenol extraction. Nucleic acids were precipitated from the lysate, and hydrolysed with protease and NaOH to remove residual protein and RNA respectively. Bound radioactivity was quantitated by precipitation of DNA onto glass fiber filters. Protein labelled with 3H-leucine and DNA and RNA adducts formed from 1-nitro[14C]pyrene by xanthine oxidase were used to define this procedure. 14C was shown to be bound to endogeneous protein and DNA isolated from rabbit alveolar macrophages that had been incubated with 1-nitro[14C]pyrene.

The nature and consequences of forensic psychiatric decision-making

Data collected from the Metropolitan Toronto Forensic Service (METFORS) were examined to determine factors affecting psychiatric assessments completed for the courts. Psychiatric history is found to be a salient factor for fitness to stand trial decisions; prior violence and the type of charge influence dangerousness to others determinations. Variables affecting whether or not a patient is recommended for further assessment include fitness: 78% of those found fit and 100% of those for whom fitness was unclear were recommended for further assessment in 68% of the cases. Patients who were threatening or acting out were not for the most part hospitalized. Relatively high correlations between psychiatric recommendations derived from these assessments and the actual judicial dispositions suggest that knowledge of the extra legal factors and biases which enter into the decisions should be more widely considered in the legal setting.

Pseudomonas aeruginosa septicemia in childhood cancer patients

Twenty-three pediatric cancer patients developed Pseudomonas aeruginosa septicemia during an 11-year period. Typically the patients had advanced neoplasia and were receiving immunosuppressive therapy. Severe myelosuppression was almost always present and antibiotic therapy during the prior 2-week period for proven or suspected sepsis was common. Disruption of the skin and mucosa in the anogenital regions was evident in the majority of patients, and the gastrointestinal tract represented the most common portal of entry. Patients who developed sepsis while relapsed had the highest case-fatality rate, and use of synergistic antibiotic combinations did not affect outcome in this group.

Peroneus longus tendinitis: a possible biomechanical etiology

Tendinitis of the foot and ankle is becoming increasingly common, or at least more commonly recognized, with the recent widespread interest in running. In runners seen in our clinics we have encountered several cases of peroneus longus tendinitis. The authors present a case report and possible biomechanical etiology for peroneus longus tendinitis.

Cancer of the prostate and aging: an autopsy study in black men from Washington, DC, and selected African cities

Age-related changes of arteries, veins, glands, and stroma in the prostate of black men from Washington, DC, and from Ibadan, Nigeria, and Accra, Ghana, West AFrica, were studied in a total of 795 consecutive, unselected prostate specimens removed at autopsy during a 7-year period (1973-1980). Except for age group 80 and over, aging changes in the prostate were more severe in all age groups in black men from Washington, DC, than in black men from Ibadan and Accra (P less than 0.01). However, when the intensity of age-dependent alterations was compared in either US or African black men with carcinoma and with no carcinoma, no significant differences were found. These findings do not support the idea that the aging process per se increases susceptibility to cancer.

Blood hormone profiles in prostate cancer patients in high-risk and low-risk populations

Epidemiologic data reveal that the incidence rate of prostate gland carcinoma among the black population in the United States (US) is several times higher than among Nigerians. A collaborative study between the two countries was undertaken, and blood hormone (testosterone [T], dihydrotestosterone [DHT], estrone [E1], estradiol [E2], and prolactin [P1]), total acid phosphatase (TP), and prostatic acid phosphatase (PAP) profiles in the two population groups were compared. In the US groups (patients and controls) there were significantly higher levels of T (P less than 0.01) and E1 (P less than 0.05) compared with the Nigerians. Also, the US patients had significantly higher levels of T (P less than 0.05) and E1 (P less than 0.01) compared with their matched controls. In the Nigerians T but not E1 levels were significantly lower (P less than 0.05) in patients compared with controls. DHT, E2, and P1 were not significantly different in patients and controls between and within the populations. Nigerian patients had higher levels (P less than 0.001) of TP and PAP compared with US patients. It is concluded that differences in blood hormone profiles in the two population groups are based on factors other than the genetic makeup of the populations.

Changes in serum calcium caused by supplementation of low protein diets with keto-acid analogues in patients with chronic renal failure

Six patients with stable end stage chronic renal failure have been studied while receiving keto-acid supplements that provided a daily calcium load of 42 +/- 2 mM. None of the patients had intercurrent illness. All patients showed elevated serum calcium concentration levels while on keto-acid supplements, reaching significance on 5 occasions. Reciprocal falls in serum phosphate concentrations were noted in all patients, and this observation was not due to an anabolic effect of the keto-acids. In 3 patients, the rise in serum calcium concentration was associated with marked clinical manifestations that required curtailment of treatment. The risk of hypercalcemia occurs early and certain high risk categories can be identified. Recommendations about the use of calcium salts of alpha-keto-acid analogues are given and it is suggested that a choice should be made available between calcium and sodium salt analogues.

Characterization of prostatic carcinoma among blacks: a comparison between a low-incidence area, Ibadan, Nigeria, and a high-incidence area, Washington, DC

A comparison of carcinoma of the prostate gland in a low-incidence Nigerian (Ibadan) population and a high-incidence U.S. Afro-American (Washington, D.C.) population was the purpose for this study, initiated in 1973. The frequency of carcinoma (micro- and invasive) was determined in consecutive necropsy cases from hospitals in Ibadan, Nigeria, Accra, Ghana and Washington, D.C. The results of these clinical, epidemiologic and morphologic studies are reported. Clinically, the peak incidence of carcinoma of the prostate in Nigerian males in Ibadan and in American males in Washington, D.C. was in the 65-74 age group. The median age of patients was 66.4 years in Ibadan and 69.2 years in Washington, D.C. Seventy-five percent of Nigerian and 49% of American patients were in stages III and IV. Overall, the distribution by grade of neoplasms in surgical material from Ibadan and Washington, D.C. was similar. Plasma testosterone and estrone levels were significantly higher (p < 0.05 and p < 0.001) in U.S. patients than in U.S. controls and higher (p < 0.001 and p < 0.05) in U.S. patients than in Nigerian patients with prostatic carcinoma. Plasma testosterone levels were significantly lower (p < 0.05) in Nigerian patients than in Nigerian controls. Estrone levels were not significantly different in Nigerian patients than controls. Nigerian patients were more sexually active throughout their lives than American patients; however, they reported a higher incidence of impotence than U.S. patients in the immediate 5 years preceding the diagnosis of prostatic carcinoma. Nigerian respondents (patients and controls) arrived at puberty later than their American counterparts. Within each of the two population groups, the factor with the highest relative risk ratio was lower urinary tract symtoms occurring 10 years or longer before the onset of the present complaints which led to the diagnosis of prostatic carcinoma. Nigerian and U.S. patients were more sexually active than controls. Microcarcinoma (incidental, latent) of the prostate gland occurred with a frequency of 11.8% and at an age-adjusted incidence rate (world standard) of 40.6 per 1000 necropsies in the sampled U.S. black male population. The age-adjusted incidence rate (world standard) for microcarcinoma in the combined West African (Accra and Ibadan) series (36.7/1000) was almost equal to the rate (40.6/1000) in the Washington, D.C. series.

Dietary management of chronic renal failure with oral amino acids

6 patients in end-stage renal failure of varying aetiologies have been studied on low protein dietary regiments according to a P 6 formulation. All patients had part of their daily protein allowance substituted by an essential amino acid capsule also containing histidine and glutamic acid. All patients were maintained in nutritional balance as a result of the regiments prescribed. No toxic effects were noted and patient compliance was good. Our studies suggest the amino acid formulation given is safe and did not cause any fluctuations in patient plasma amino acid profiles. Our studies suggest an improved method of low protein dietary management for chronic renal failure patients together with a greater flexibility and wider range of prescribing possibilities. It is recommended that amino acid supplements according to the formula produced here constitute an improvement on currently prescribed Giovannetti regimens.

Incidence of prostatic calcification in blacks in Washington, D.C., and selected African cities. Correlation of specimen roentgenographs and pathologic findings. Cooperative Prostatic Research Group

The incidence of calcification in the prostate gland of black men from Washington, D.C., and from Ibadan, Nigeria, and Accra, Ghana, West Africa, was assessed in a total of 874 consecutive, unselected prostate specimens removed at autopsy during a five-year period (1973--1978). In the combined series there was a significant positive association between prostatic calcification and age (p less than 0.001). The frequency of calcification was significantly higher in the Washington, D.C. series than in the West African series at all age levels (p less than 0.001). This difference most likely reflects the different dietary patterns of the two population groups.

Prevention of amino acid losses during peritoneal dialysis

The addition of amino acid supplements to peritoneal dialysis fluid has been studied in 8 patients with compromised renal function requiring peritoneal dialysis. By the addition of 10 ml of Vamin-glucose solution to each one litre of peritoneal dialysate, amino acid losses were curtailed, no significant alterations occurred in the plasma amino acid concentrations, there were no local complications and no infections were seen. This procedure is recommended as a safe, simple way of keeping a patient in positive amino acid balance during peritoneal dialysis.

Effect of acute smoke exposure on hepatic protein synthesis

In vivo hepatic protein synthesis was monitored in female rats under control and smoke-exposed conditions. During the 15 min period after i.v. administration of [3H]proline protein synthesis was 206 +/- 35 nmol of proline per mg of DNA for sham-control animals. When animals were subjected to acute exposure to cigarette smoke, protein synthesis was inhibited and the extent of inhibition was positively correlated with the dosage of smoke (32%, 15 puffs; 66%, 60 puffs). The inhibitory effect of whole smoke on protein synthesis was unaltered by passing the smoke through either charcoal or cambridge filters. Carbon monoxide in smoke is not removed by either type of filter. At a level comparable to that in cigarette smoke carbon monoxide depressed hepatic protein synthesis to the same extent as did whole or filtered smoke.

Evaluation of a high nitrogen source amino acid solution ('Aminofusin' L Forte)

A new high concentration nitrogen source solution ('Aminofusin' L Forte) was evaluated in 9 patients requiring complete parenteral nutrition regimens. Excellent clinical tolerance was observed and the solution proved capable of maintaining patients in nitrogen balance. Although the non-essential part of the amino acid profile is incomplete, no significant deviations from the normal range in plasma amino acid concentrations were noted. It is concluded that the solution is a useful addition to the range of amino acid preparations available for intravenous feeding.

Comparison of the effects of keto acid analogues and essential amino acids on nitrogen homeostasis in uremic patients on moderately protein-restricted diets

Comparisons of isonitrogenous supplements (1.2 g N) of essential amino acids and five keto acid analogues with four essential amino acids were made in seven patients with stable chronic renal failure (creatinine clearance, 4.6 to 16 ml/min) on moderately protein-restricted diets (4.60 to 7.8 g N per day). Full nitrogen balance data on the four patients who have already completed studies lasting 24 weeks are presented. No benefits of keto acid over amino acid supplements were observed. Two transient episodes of hypercalcemia occurred during keto acid treatment. There was no improvement of renal function with keto acids. Also, no carry-over effects were seen after keto acid treatment. It is concluded that any beneficial effects of keto acids in patients with chronic renal failure are only likely to occur in those taking a diet of less than 30 g protein daily.

Blue nevus of the prostate: ultrastructural study

A case of blue nevus of the prostate in a sixty-five-year-old black patient was studied by light and electron microscopy. In the melanocytes only fully melanized melanosomes were present; melanosomes in early stages of development were entirely absent. It was concluded that the formation of melanosomes within the melanocytes in blue nevus of the prostate is probably under genetic control.

Characterization of prostatic carcinoma among blacks: a continuation report

A clinical and pathologic comparison of carcinoma of the prostate in a high-risk US (Washington, DC) black population and in a low-risk Nigerian (Ibadan) black population is presented. Fifty-two percent of American patients were in clinical stages I and II, whereas only 10% of Nigerian patients were in the same stages. Testosterone and estradiol blood levels were significantly lower (P less than 0.05) in patients with carcinoma of the prostate from Ibadan compared with American black prostate cancer patients from Washington, DC. Age-standardized incidence rates (world standard) for 1000 autopsies for micro (incidental)-carcinoma were approximately equal in American and African black men. The incidence rate of invasive carcinoma was, however, even after adjustment for age, higher in American black men than in African men.

Trace metal content of cerebral vessels in American Blacks, Caucasians and Nigerian Africans

Trace metal contents of cerebral vessels in age-matched and sex-matched subjects from three population groups were estimated. The trace metals included calcium, manganese, zinc, magnesium, copper and iron. The American blacks in Washington, D.C., who are ethnologically related to Nigerian Africans, have different patterns of trace metal contents in their cerebral vessels and the observed levels also differed in some respects from Minnesota Caucasians living in a similar environment. The greatest amounts of calcium, zinc, and copper were found in the vessels of American blacks while the greatest amount of magnesium was found in vessels of Minnesota Caucasians. There was no statistically significant difference in the manganese content of the cerebral vessels in three population groups. Nigerian Africans had the least amounts of copper and magnesium but had the highest iron content. A similar high level of iron was observed in the vessels of American blacks. Since it has been shown that American blacks have the most extensive and severe degree of atherosclerosis among the three population groups, it would appear that iron, calcium and manganese in the cerebral vessels may not directly relate to the severity of cerebral atherosclerosis. Relatively high levels of copper and magnesium, which were observed in the cerebral vessels of American blacks and Caucasians, may be of significance in the pathogenesis of cerebral atherosclerosis. The low levels of the trace metals in Nigerians may be protective. The possible role of zinc requires further studies.

Epidemiologic association between Gonorrhea and prostatic carcinoma

The curves for death rates from prostatic cancer and gonorrhea incidence rates in Denmark, over a span of thirty years, matched well with a lag period of forty-five years. Moreover, a retrospective study conducted in the United States involving 75 cancer patients and 75 age-matched controls demonstrated a statistically significant association between gonorrheal infection and subsequent development of prostatic carcinoma. Two postulates are presented: the viral-venereal and the chronic infection theories. The recent increase in incidence of prostatic cancer in the United States could be the beginning of an epidemic in which astronomically high rates may be reached.

Malignant tumors in American black and Nigerian children: a comparative study

Results of a study on the relative frequencies of tumors in American black and Nigerian children were compared with data from the Childhood Cancer Registries in Manchester, United Kingdom, and Kampala, Uganda. The American black child living in Washington, D.C. and the Caucasian child living in Manchester had similar high frequencies for leukemia and glioma, whereas the incidence of lymphoma and retinoblastoma was low. African children living in Nigeria or Uganda had the opposite frequency patterns. These differences in frequencies of tumors between two ethnologically related population groups, American black and Nigerian, suggested the influence of environmental factors in the etiology of these tumors, even though exposure to environmental carcinogens was short. The rarity of Ewing's sarcoma and testicular tumors in American black and Nigerian children suggested a genetic influence.

Lipid composition of cerebral vessels in American Negroes, Caucasians and Nigerian Africans: a comparative study

The lipid content of cerebral vessels from American Negroes, Caucasians and Nigerian Africans living in urban areas was chemically quantitated. There are significant differences between the total and free cholesterol content of the vessels among the three population groups. The american Negroes have the greatest amount of cerebral vascular cholesterol compared with American Caucasians and Nigerians. This confirms previous morphological observations that the severity and extent of cerebral atherosclerosis are greater in American Negros than in American Caucasians and aftricans. However, there is no significant difference in the phospholipid content of the cerebral vessels except among the female Negro groups. Chemical quantitation of lipids in vessels may be utilized for assessment of degree of atherosclerosis and may prove to be an acceptable and reliable alternative methodology for epidemiological studies.