Expression of genes coding for antioxidant enzymes and heat shock proteins is altered in primary cultures of rat hepatocytes

The expression of genes for heat shock proteins in the HSP70 family and genes for antioxidant enzymes was studied in rat hepatocytes cultured in either L-15 or Williams E media on a collagen matrix for up to 48 hours. The mRNA transcripts for the heat shock proteins hsp70, hsc70, and grp78 were induced dramatically when hepatocytes were cultured in L-15, and to a lesser extent when cultured in Williams E. The increase in hsp70 and hsc70 mRNA levels in the cultured hepatocytes was correlated with an increase in the nuclear transcription of these two genes and the binding activity of the heat shock transcription factor to the heat shock element. Culturing rat hepatocytes in either L-15 or Williams E resulted in a decrease in the levels of the mRNA transcripts for catalase and glutathione peroxidase and the activities of these two enzymes. However, the expression of Cu/Zn-superoxide dismutase, i.e., the level of the mRNA transcript or the enzymatic activity, did not change appreciably when hepatocytes were cultured for up to 48 hours. The decline in catalase and glutathione peroxidase expression in the cultured hepatocytes was correlated with a decrease in the GSH/GSSG ratio and an increase in lipid peroxidation. These data show that the expression of several genes involved in cellular protection change when hepatocytes are placed in primary cultures. Therefore, one must be careful in extrapolating from primary cultures to the liver in vivo, especially when studying processes that might be affected by heat shock proteins or antioxidant enzymes.

Role of surfactant protein A in the pathogenesis of tuberculosis in subjects with human immunodeficiency virus infection

Human immunodeficiency virus (HIV)-infected subjects are at increased risk for tuberculosis even before there is a significant loss of CD4 lymphocytes. A factor was found to be present in the bronchoalveolar lavage (BAL) of HIV-infected subjects that promoted the attachment of M. tuberculosis (MTB) organisms to alveolar macrophages (AMs). Using 51Cr-labeled MTB organisms, BAL from control subjects resulted in MTB attachment to AMs at 11.6% +/- 1.0%; in contrast, BAL from HIV-infected subjects increased attachment to 33.1% +/- 3.8% (P < 0.001). Surfactant protein A (SP-A) levels in BAL of normal controls was 1.9 +/- 0.3 micrograms/ml and was 5.5 +/- 0.4 micrograms/ml in the BAL of HIV-infected subjects (P < 0.01). When SP-A was removed by immunoprecipitation from the BAL of HIV-infected subjects, MTB attachment decreased from 33.1% +/- 3.8% to 11.3% +/- 0.4% (P < 0.001), a value identical to control levels. Exogenous human SP-A (5 micrograms/ml) was added back to the immunoprecipitated BAL and the enhanced attachment of MTB was restored. These data suggest that BAL from HIV-infected subjects contain a factor that facilitates MTB attachment to AMs, the first critical step in the establishment of infection. This factor appears to be SP-A.

Richter hernia: a rare complication of laparoscopy

A case of Richter hernia in the umbilical trocar site following laparoscopic cholecystectomy is presented. The fascia was not specifically closed after the laparoscopic cholecystectomy. The Richter hernia presented 2 days later, suffered a delay in diagnosis because of persistence of bowel function and required bowel resection 9 days later. A total of four known postoperative umbilical trocar site hernias, two of which were Richter hernias, have been reported following 1,979 laparoscopic cholecystectomies in two large community hospitals in Colorado: Saint Joseph Hospital in Denver and North Colorado Medical Center in Greeley. Thus, periumbilical trocar site incisional hernias following laparoscopic cholecystectomy are rare but potentially dangerous because of the susceptibility to Richter hernia.

Antineoplastic agents 337. Synthesis of dolastatin 10 structural modifications

New structural modifications of the marine shell-less mollusk peptide constituent dolastatin 10 (1) have been synthesized, and evaluated against a variety of cancer cell lines and for their ability to inhibit tubulin polymerization. A number of useful structure-activity relationships were uncovered. The most important observation was that the dolaphenine unit of dolastatin 10 could be satisfactorily replaced with a phenethylamine. Peptide 11C, designated auristatin PE, was found to exhibit inhibition of cancer cell growth and tubulin assembly comparable to that of dolastatin 10.

Number and ultrastructure of epithelial cells in crypts and villi along the streptozotocin-diabetic small intestine: a quantitative study on the effects of insulin and aldose reductase inhibition

This study has quantified the effects of insulin treatment with and without aldose reductase inhibitor (ponalrestat) on intestinal epithelial cell morphology in streptozotocin-diabetic rats. Epithelial volumes, villous and microvillous surface areas and mean volumes of cells (and their nuclei) in crypts and villi were estimated in each of four segments and in the entire intestine. We derived total numbers of cells, quantified the ultrastructural features of average cells and explored variation along the intestine and between experimental groups. In crypts, insulin and ponalrestat had significant effects on cell number (reduced towards normal values) and size (volume and apex area increased beyond normal values). There were interaction effects between insulin and ponalrestat for cell volume and apex area (insulin producing more exaggerated effects when given without ponalrestat). On villi, insulin and ponalrestat returned cell numbers towards normal values but neither treatment normalised cell size or the number and area of microvilli per cell. Indeed, ponalrestat increased microvillous number and area beyond values found in untreated diabetic animals. Again, there were interaction effects between insulin and ponalrestat. Patterns of segmental variation seen in crypts of normal rats (values tending to be higher in proximal or mid-intestinal regions) were not preserved, and only some of the segmental differences seen on villi (higher values at proximal or mid-intestinal sites) were maintained during therapy. Apart from reducing the abnormally high numbers of cells in untreated diabetic rats, these results show that insulin and ponalrestat treatment fail to restitute epithelial cell morphology in the small intestines of experimental diabetic rats.

Antineoplastic agents, 325. Isolation and structure of the human cancer cell growth inhibitory cyclic octapeptides phakellistatin 10 and 11 from Phakellia sp

The two new marine sponge (Phakellia sp., western Pacific Ocean) constituents, phakellistatin 10 [1] and 11 [2], were found to be cyclic octapeptides that significantly inhibited growth of the murine P-388 lymphocytic leukemia (ED50 values of 2.1 and 0.20 micrograms/ml, respectively) and human cancer cell lines. The structures were established based on results of extensive tandem ms/ms and high-field (500-MHz) 2D 1H- and 13C-nmr analyses. All of the amino acid units (except Trp, not determined) were found to correspond to the (S)-configuration.

Using the CAGE to screen for drinking-related problems in college students

OBJECTIVE

As a brief alcohol screening instrument the CAGE has demonstrated a high degree of accuracy in identifying problem drinkers among adults. However, some studies have questioned its screening accuracy within a college population. The research presented in this article contains the results of two additional studies that examined the ability of the CAGE to identify problem drinkers within a college student population.

METHOD

In both 1988 and 1992 a questionnaire of various drinking practices, including CAGE items, was mailed to a random sample of 1,000 students at a large midwestern university (response rate: 58.2%, 1988; 49.8%, 1992). Using identical problem-drinking criteria, sensitivity, specificity and positive predictive values at various cutoff scores of the CAGE were calculated for both sets of data and for gender.

RESULTS

At the recommended CAGE cutoff score of > 2 for a positive test the sensitivity and positive predictive values (PPV) were slightly higher for the 1992 sample. The PPV values at that cutoff score were 46% (1988) and 49% (1992) and 48% for the combined data. In both samples the screening values were lower for women.

CONCLUSIONS

These data from both surveys do not support the CAGE as a screening measure for problem drinking with this population. It appeared to be less accurate with women although that conclusion should be tempered by the fact that there was a relatively low percentage of problem drinkers found among women.

Interaction of dolastatin 10 with tubulin: induction of aggregation and binding and dissociation reactions

We have prepared [3H]dolastatin 10 and examined its interactions with tubulin. Binding kinetics appeared to be biphasic, with a rapid initial reaction that could not be accurately measured, followed by a slower second reaction. Bound drug was stable in centrifugal gel filtration, column gel filtration, and high performance liquid chromatography gel filtration, but the bound drug could be displaced by an active isomer of dolastatin 10. Scatchard analysis of binding data was consistent with two classes of binding sites. However, dolastatin 10 induced an aggregation reaction upon binding to tubulin, complicating analysis of the data, and incorporation of [3H]dolastatin 10 into large aggregates was readily demonstrated. The chromatographic properties of the smallest radiolabeled species that could be documented were most consistent with a complex consisting of two molecules of alpha/beta-tubulin dimer and two molecules of [3H]dolastatin 10. The coexistence of an aggregation reaction with a binding reaction at a single site probably underlies the biphasic binding kinetics and the biphasic Scatchard plot. Of peptides that strongly inhibit tubulin polymerization (dolastatin 10, dolastatin 10 isomers, segments, and analogs, dolastatin 15, and phomopsin A), only those previously shown to be strong inhibitors of vinblastine binding and nucleotide exchange also strongly inhibited [3H]dolastatin 10 binding and induced tubulin aggregation (dolastatin 10 itself, two chiral isomers of dolastatin 10, and phomopsin A). The morphology of dolastatin 10-induced aggregates was compared with that of vinblastine-induced aggregates under a variety of reaction conditions. With both drugs the aggregates had a more organized appearance when microtubule-associated proteins were included in the reaction.

Antineoplastic agents, 326. The stereochemistry of bastadins 8, 10, and 12 from the Bismarck archipelago marine sponge Ianthella basta

An investigation of cancer cell-growth inhibitory constituents of the Papua New Guinea marine sponge Ianthella basta led to isolation of the C-6 hydroxybastadins 8 [1] 10 [2], and 12 [3]. The absolute stereochemistry (6S) of each bastadin (or its tetramethyl ester derivative) was determined by means of the Mosher-Trost method. Bastadins 10 [2] and 12 [3] were found to significantly inhibit the growth of a selection of human cancer cell lines. Bastadins 8, 10, and 12 inhibited growth of the Gram-positive opportunists Staphylococcus aureus and Enterococcus faecalis.

Antineoplastic agents 320: synthesis of a practical pancratistatin prodrug

Owing to its sparingly soluble properties, the potential anticancer drug pancratistatin (1) resisted conventional drug formulation procedures and the synthesis of a water-soluble prodrug became necessary. That important objective for further pre-clinical development was met by devising a route to a disodium phosphate derivative (5). The key step in the synthesis of the phenolic phosphate was phosphorylation of 1,2,3,4-tetraacetoxy-pancratistatin (2) with dibenzyloxy(N,N-diisopropylamido)-phosphine. Subsequent oxidation with m-chloroperbenzoic acid afforded phosphate 4a. Hydrogenolysis of the benzyl esters followed by base-catalysed hydrolysis of the acetate groups led to the water-soluble prodrug 5 in high yield.

Criterion variability in problem-drinking research on college students

A persistent issue confronting research on problem drinking (PD) and heavy drinking (HD) among college-age adults is the lack of a consistent, valid definition and criteria for either of the two conditions. This article presents a review and analysis of the criteria used in a selected group of studies on college students' PD and HD from 1974 to 1993. All studies within the time period that employed a random sample of students were analyzed for variations in criteria used to define either PD or HD. Sample characteristics, the specific criteria used, and data on prevalence rates found with those criteria are described. Areas of uniformity and inconsistency were identified and effects of criterion variations were described for the 23 studies reviewed. Of particular note was the lack of differential criteria for gender.

Diarrhea and weight loss after bone marrow transplantation in children

To define the determinants of diarrhea after bone marrow transplantation (BMT) and its nutritional sequelae, the medical records of 20 consecutive children (median age, 9 years; 13 boys and 7 girls) undergoing BMT at Children's Hospital in Birmingham, UK were surveyed. All patients who received total body irradiation (TBI) required parenteral nutrition (PN). Seventy-eight percent of TBI patients and 73% of children who received allografts developed diarrhea compared with only 27% of non-TBI patients and 22% of those who received autografts (P < 0.05). Ninety percent of children with diarrhea required PN. Duration of PN in these children was longer than in those without diarrhea who requested PN (P < 0.05). Despite PN, weight loss at discharge was still greater in the study group (P < 0.05). Diarrhea was associated with a significant fall in serum albumin (P < 0.005). Diarrhea and weight loss occur in children after BMT despite active PN support. Pretransplant TBI and the use of allografts are important determinants of these complications.

Laparoscopic appendectomy, is it worth it?

The recent experience with open appendectomy was compared to our initial experience with laparoscopic appendectomy. Thirty-eight patients had open appendectomy for acute appendicitis. Two major and four minor complications occurred. Concurrently, 39 patients had laparoscopic appendectomy. There was one major and one minor complication. Of the laparoscopic patients, 69% received less than 24 hours of parenteral postoperative analgesia, compared to 44% of the patients in the open group. Fifteen of 39 laparoscopic patients (38%) were discharged within 24 hours of operation versus 3 of 38 (8%) in the open group. Total mean hospital cost for the laparoscopic group, $7,500, was significantly greater than for the open group, $5,700, because of increased laparoscopic equipment charges. Both open and laparoscopic appendectomy procedures were performed with minimal morbidity. The benefits of laparoscopy were earlier hospital discharge and less parenteral analgesic use, but it was significantly more expensive.

Glutathione S-transferase-sspA fusion binds to E. coli RNA polymerase and complements delta sspA mutation allowing phage P1 replication

Bacteriophage P1 is unable to form plaques on E. coli hosts lacking a functional sspA gene. However, sspA mutants can be infected by P1, resulting in the synthesis of P1 early gene products and accumulation of P1 DNA, but without P1 late gene product formation or host lysis. Overexpression of the stringent starvation protein (SspA) as a glutathione-S-transferase fusion results in complementation of the sspA mutation and production of viable viral particles as in sspA+ strains. This suggests that the GST-SspA protein functions in vivo in a similar manner as native SspA with respect to P1 replication. Here, evidence is presented that shows that SspA binds to RNA-polymerase. This supports the notion that SspA is involved in P1 replication since it is known that P1 requires host RNA-polymerase activity to replicate and this suggests a mechanism by which P1 redirects E. coli RNA-polymerase specificity from P1 early to P1 late genes.

Polycythaemia rubra vera transforming to acute lymphoblastic leukaemia with a common immunophenotype

Lymphoblastic transformation of polycythaemia rubra vera is an extremely rare phenomenon. A case of a 76 year old man with polycythaemia rubra vera who developed acute lymphoblastic leukaemia (ALL) 16 years after his initial diagnosis is reported. Membrane markers showed a CD10 positive (common ALL) immunophenotype. To our knowledge this association has not been previously recorded. The rare occurrence of ALL in polycythaemia rubra vera may indicate that in a minority of patients clonal expansion of an abnormal pluripotent haemopoietic stem cell is responsible for the polycythaemia rubra vera disease phenotype.

Starvation-induced expression of SspA and SspB: the effects of a null mutation in sspA on Escherichia coli protein synthesis and survival during growth and prolonged starvation

Maxicell labelling and two-dimensional gel electrophoresis (2-D PAGE) have identified the proteins encoded by sspA and sspB (SspA, SspB) as proteins D27.1 and A25.8, respectively, in the Escherichia coli gene-protein database. SspA expression increases with decreasing growth rate and is induced by glucose, nitrogen, phosphate or amino acid starvation. The promoter, Pssp, is similar to gearbox promoters. Inactivation of SspA (sspA::neo) blocks sspB expression. [35S]-methionine-labelled proteins synthesized during growth and during stationary phase are different in delta sspA strains compared to sspA+ strains. This difference is enhanced during extended stationary phase (24-72 h). Long-term (10 d) viability of arginine-starved isogenic strains shows that sspA+ cultures remain viable significantly longer than delta sspA mutants. 2-D PAGE of proteins expressed during exponential growth shows that expression of at least 11 proteins is altered in delta sspA strains. A functional relA gene is required for sspA to affect protein synthesis.

Isolation and structure of cephalostatins 10 and 11

Further investigation of antineoplastic constituents from the marine worm Cephalodiscus gilchristi, employing a 450 kg re-collection from the Indian Ocean (Southeast Africa), has led to isolation and structural determination of two previously undetected members of the cephalostatin series, designated cephalostatins 10 [4] and 11 [5]. Structural analyses were conducted primarily employing high field 2D nmr and high resolution mass spectral techniques. All the stereochemical assignments were deduced using the original X-ray crystal structure of cephalostatin 1 and ROESY 2D nmr methods. Both cephalostatins 10 and 11 strongly inhibited growth of a series of important human cancer cell lines.

Laparoscopic cholecystectomy produces less postoperative restriction of pulmonary function than open cholecystectomy

This study was undertaken to determine whether laparoscopy produces less postoperative decrease in pulmonary function than does open operation. Ten elective laparoscopic cholecystectomy patients (LC group) were compared to 10 elective open cholecystectomy patients (OC group). Spirometry was performed preoperatively and then postoperatively as soon as each patient was awake and cooperative. The two groups were similar with respect to age, gender, and preexisting medical illness. No patient had underlying cardiopulmonary disease. Postoperatively, forced vital capacity, forced expiratory volume in 1 s, and maximum forced expiratory flow decreased to 56%, 55%, and 43% of preoperative values in the OC group and to 72%, 76%, and 81% of preoperative values in the LC group. These decreases were significantly greater in the OC group as compared to the LC group, P values < or = 0.05. Cholecystectomy had a significant restrictive effect on immediate postoperative pulmonary function. Laparoscopic cholecystectomy produced significantly less restriction.

Tumor necrosis factor-induced mortality is reversed with cyclooxygenase inhibition

OBJECTIVE

The authors hypothesized that TNF would induce eicosanoid synthesis, and a cyclooxygenase inhibitor would attenuate both eicosanoid synthesis and improve survival in an LD90 TNF-induced (150 ng/kg/i.v./5 min) mortality model.

SUMMARY BACKGROUND DATA

Tumor necrosis factor is a cardinal mediator in sepsis; however, little is known about its effects on arachidonate metabolism.

METHODS

Conscious male rats with carotid arterial and jugular venous catheters were randomized for mortality: group I, TNF alone (150 kg/i.v./15 min, n = 30); group II, ibuprofen (30 mg/kg/i.v. at t = -20 and +240 min), plus TNF, (n = 28); and for hemodynamics, eicosanoid synthesis, blood gases: group III, TNF alone, (n = 8); group IV, ibuprofen + TNF (n = 8); group V, monoclonal antibody to TNF plus TNF (n = 8). Mortality was determined at 4-72 hr. Other parameters determined over 4 hours (0, 5, 60, 120, 240 min).

RESULTS

TNF stimulated synthesis of (a) TXB2 (71 +/- 30 pg/ml, mean +/- SE at base vs. 117 +/- 18 at 4 hr, p < 0.02); (b) PGE2 (70 +/- 6 pg/ml at base vs. 231 +/- 68 at 4 hr, p < 0.02); (c) 6PGF (52 +/- 6 pg/ml at base vs. 250 +/- 80 at 4 hr, p < 0.02). Ibuprofen significantly (p < 0.05) inhibited eicosanoid synthesis from TNF. TNF-induced mortality (87%, 26/30) was dramatically decreased with ibuprofen (11%, 3/28), at 4, 24, and 72 hr (p < 0.01). Monoclonal antibody to TNF prevented all abnormalities and had 100% survival. Hemodynamic events were similar in both groups, but metabolic acidosis was attenuated with ibuprofen.

CONCLUSIONS

TNF stimulates arachidonic acid metabolism in vivo. A cyclooxygenase inhibitor attenuates eicosanoid synthesis and dramatically improves survival. TNF appears to have different effect on tissues that synthesize certain eicosanoids. Hypotension from TNF is not mediated via the eicosanoids. TNF-induced mortality, like endotoxemia/sepsis may be mediated, in part, via arachidonic acid metabolites. These new findings support the notion that cyclooxygenase inhibitors may be used as adjunctive therapy in clinical sepsis.

Hirschsprung's disease complicating colon atresia

An infant with the rare association of colon atresia, total colonic Hirschsprung's disease, and tetralogy of Fallot is presented. While Hirschsprung's disease associated with atresia of the colon has been reported five times previously, this is the first case with associated congenital cardiac disease. As in previous reports, initial operations to relieve obstruction due to the colon atresia failed because of the unrecognized aganglionosis. This infant initially had an ileostomy performed as a newborn and then two failed attempts at closure of the ileostomy. In this case, as in four previously reported cases, histological examinations of resected colon from the initial operations were first reported as normal and only under the pressure of increasing clinical evidence was the pathology reviewed and the absence of ganglion cells appreciated. We stress the importance of suspecting the coexistence of Hirschsprung's disease and colon atresia when a functional obstruction is present after repair of the atresia.

Management of Service Personnel with a History of Penicillin Allergy: Discussion Paper

A false label of penicillin allergy may have important consequences for wartime medical evacuation. This article outlines the antibiotic protocol for war wounds, the current status of tests to diagnose true penicillin allergy and suggests a strategy for the management of personnel with a history of such allergy.

Isolation and structure of the marine sponge cell growth inhibitory cyclic peptide phakellistatin 1

A new cell growth inhibitory (P-388 murine leukemia ED50 7.5 micrograms/ml) cycloheptapeptide designated phakellistatin 1 was isolated from two Indo-Pacific sponges, Phakellia costata and Stylotella aurantium. Structural elucidation was accomplished utilizing high field nmr, amino acid analyses, and mass spectral techniques (fab, tandem ms/ms), followed by chiral gas chromatographic procedures for absolute configuration assignments (all S-amino acid units). By these methods phakellistatin 1 [1] was found to be cyclo (Pro-Ile-Pro-Ile-Phe-Pro-Tyr), and this assignment was finally confirmed by an X-ray crystal structure determination.

Laparoscopic insufflation of the abdomen depresses cardiopulmonary function

Recently we have used the laparoscope to remove the gallbladder in critically ill patients in order to spare them the operative trauma of laparotomy. However, increased intraperitoneal pressure may have deleterious cardiopulmonary effects. This was investigated in a dog model. Insufflation of the abdomen with carbon dioxide decreased the mean cardiac output to less than 80% of baseline (P < 0.004). This was aggravated by the reverse Trendelenburg position and partially alleviated by the Trendelenburg position. Mean arterial PCO2 and mean peak airway pressure significantly rose. These effects are of doubtful clinical significance in the majority of patients. However, to extend the benefits of laparoscopy to patients with decreased cardiopulmonary reserve, hemodynamic and carbon dioxide monitoring should be used because measures to improve venous return, augment cardiac output, and counteract the increase in PCO2 and peak airway pressure may be required.

Arterial embolisation of a facial haemangioma

Non-invasive investigations in the diagnosis of highly vascular lesions are without doubt a sound principle. A case is presented however, in which the clinical diagnosis of a haemangioma was confirmed by ultrasound and magnetic resonance imaging (MRI) but required further investigation by angiography to facilitate treatment. Embolisation is a well established technique available in most large radiology departments, but may not be well known by general dental practitioners.

Carotid body tumor

To better define the management and behavior of carotid body tumors, a 34-year surgical experience with 33 tumors in 30 patients was reviewed. There were 20 women and 10 men with an age range of 20 to 78 years. All but one presented with a neck mass. Arteriography was performed on 21 patients and was diagnostic in every case. There was no surgical mortality. Complications occurred in eight patients (27%), and one long-term neurologic deficit occurred. Three of 33 tumors were malignant, and aggressive resection of all approachable disease with radiotherapy for unresectable metastases led to prolonged survival in each case. Carotid body tumors present with neck mass. Arteriography is diagnostic and surgery is indicated. Even for malignant tumors and metastases, aggressive resection and radiotherapy are indicated.

Laser power beams obtained by the dynamic selection of emitting elements in an array

A method for partially correcting the spatial coherence of an array of laser beams is described. The method trades far-field intensity for simplistic implementation and array lifetime extension, resulting in a quasicoherent array with features of adaptive optics. An algorithm for implementing the method is described and feasible options for improvement are presented. A computer experiment used the algorithm and fast Fourier transforms to calculate typical far-field intensity distributions of such arrays. The far-field distributions illustrate beam power concentration, beam steering, and (indirectly) extended lifetime of the array.

Anemia in pregnancy

In evaluating pregnant women with anemia, it is essential to do a complete history and physical examination, as well as a complete blood count with indices and a blood smear examination. Based on these findings, other tests such as ferritin and serum or red cell folate may be ordered. Because of the normal physiologic changes in pregnancy that affect the hematocrit, indices, and some other parameters, diagnosing true anemia, as well as the etiology of anemia, is challenging. Because of the increased nutritional requirements of the mother and fetus, the most common anemias are iron deficiency anemia and folate deficiency megaloblastic anemia. These anemias are more common in women who have inadequate diets and who are not receiving prenatal iron and folate supplements. Other less common causes of acquired anemia in pregnancy are aplastic anemia and hemolytic anemia associated with preeclampsia. In addition, congenital anemias such as sickle cell disease can impact on the health of the mother and fetus. Obviously, severe anemia has adverse effects on the mother and the fetus. There is also evidence that less severe anemia is associated with poor pregnancy outcome. The cause of this association has yet to be elucidated. It is important, however, to diagnose and treat anemia in pregnancy to provide for optimal health of the mother and infant.

Steroid use is associated with pneumonia in pediatric chest trauma

A review of pediatric trauma focused on pediatric chest injuries was performed at a trauma center specializing in neurologic trauma. Eighty of 342 (23%) pediatric trauma patients admitted to the center had chest injuries. Age, gender, mechanism of injury, magnitude of injury, incidence of pulmonary infection, chest tube usage, endotracheal intubation, steroid or antibiotic usage, morbidity, and mortality data were reviewed. Sixteen of 78 children (20%) with chest injuries developed pulmonary infections and were compared with the noninfected group. Patients with pneumonia had a higher morbidity with significantly longer mean hospital stay (43.0 vs. 12.7 days; p = 0.001), duration of intubation (8.4 vs. 1.5 days; p = 0.001), and total days with chest tubes, (2.2 vs. 1.4 days; p = 0.02). Pneumonia was significantly associated with longer mean duration of steroid usage (6.4 vs. 0.8 days; p = 0.0001). Duration of steroid administration for the treatment of concomitant brain injury was a significant independent risk factor for the occurrence of pneumonia.

The significance of neopterin and biopterin concentrations at presentation in haematological malignancies

Urinary neopterin and biopterin concentrations were measured in 32 healthy controls and 53 patients with newly diagnosed haematological malignancies classified and staged by accepted criteria. The neopterin concentrations were only significantly raised in chronic lymphocytic leukaemia at stages III-IV. Total biopterin concentrations after oxidation with iodine at acid pH were decreased in chronic lymphocytic leukaemia stages O-II, multiple myeloma, and acute myeloid leukaemia but not in chronic lymphocytic leukaemia stages III-IV. Although of research interest, neopterin concentrations proved of little prognostic value at presentation, but taken with the biopterin concentration they may be useful for the assessment of tumour activity.

Null mutation in the stringent starvation protein of Escherichia coli disrupts lytic development of bacteriophage P1

As initial steps toward understanding the regulation and function of the stringent starvation protein (SSP) of Escherichia coli, we have isolated the ssp gene (encoding SSP), defined the operon in which ssp is found, and created insertion-deletion mutations of the ssp gene in recBC, sbc and recD strains by linear DNA transformation. During attempts to move the insertion-deletion structure to other strains by P1 transduction, we found that P1 was unable to form plaques on hosts lacking an intact ssp gene. The delta ssp mutation, however, did not affect transduction of the delta ssp strains and mutant strains were able to support lysogenic P1. When P1 lytic growth was induced, an increase in P1 DNA was detected without lysis or plaque formation. Examination of proteins synthesized in the delta ssp host during induction revealed the absence of P1 late gene products. Also, the apparent continued synthesis of early gene products during late time points was observed in the delta ssp host. The results reported here suggest that the defect in P1 lytic growth brought about by the absence of SSP occurs at the point at which bacteriophage P1 shifts from early to late gene expression. We also report the results of experiments on stable RNA synthesis following amino acid (aa) starvation induced by serine hydroxamate, and experiments on stable RNA synthesis following resupplementation of a limiting aa. These experiments show that SSP is not involved in stable RNA synthesis. Additionally, complementation studies have shown that ssp is identical to the previously described pog gene of E. coli.

Consistently normal CD4+, CD8+ levels in haemophilic boys only treated with a virally safe factor VIII concentrate (BPL 8Y)

Prospective biochemical, virological and selected immunological follow up has been done for up to 32 months on 15 previously untreated haemophilic boys following treatment with an intermediate purity dry heated factor VIII concentrate (BPL 8Y). Tests for liver function and antibodies to blood-borne viruses have been assessed monthly for the first year after starting treatment and thereafter every 2 months. All patients were immunized against hepatitis B and have not developed hepatitis B core antibodies and no boy has shown any rise in alanine transaminase level nor has anyone developed antibodies to hepatitis C (HCV). All patients have remained anti-HIV seronegative. T lymphocyte subsets have been measured approximately every 4 months and in no patient has there been a significant rise in CD8+ cells; one patient showed a significant decrease in CD4+ cells but these and all CD4+ values for the other boys remained within normal age related limits. Changes in CD4+ levels in this one boy were not related to the total amount of treatment received. This group of patients who appear not to have contracted HIV, hepatitis B or non A non B hepatitis following treatment with this intermediate purity factor VIII concentrate have also not shown any consistent changes in CD4+ or CD8+ cells, which have been recorded previously in frequently treated haemophiliacs.

Cardiopulmonary bypass, profound hypothermia, and circulatory arrest for neurosurgery

Six female and 4 male patients (age, 23 to 75 years) underwent operation for difficult intracranial lesions. Preoperative diagnoses included four giant intracranial aneurysms, three base of skull glomus jugulare tumors, two arteriovenous malformations, and one cerebellar hemangioblastoma. All lesions were inoperable or nearly so by standard neurosurgical techniques. All patients were placed on total bypass via groin cannulations. Bypass times ranged from 111 to 269 minutes (mean, 174 minutes) with cooling times of 26 to 83 minutes (mean, 48 minutes) and warming times of 68 to 110 minutes (mean, 83 minutes). Circulatory arrest times ranged from 1.25 to 60 minutes with 1 patient not requiring arrest. The lowest core temperatures recorded varied from 8.4 degrees to 13.7 degrees C. There was one postoperative death and one major complication, both in patients with arteriovenous malformations. Eight patients (80%) have achieved an excellent result. Profound hypothermia with the option of circulatory arrest and exsanguination has been an indispensable adjunct to the safe management of intracranial aneurysm, glomus jugulare tumor, and hemangioblastoma.

Complications in the use of compression plates in the treatment of mandibular fractures

The use of internal rigid fixation with plates in the treatment of facial fractures continues to increase in popularity. The principal advantage is in avoiding the use of maxillary mandibular fixation (intermaxillary fixation), thus enabling early return of function. However, there are clear guidelines for their use and technique of placement. A case is reported that demonstrates several avoidable complications in the use of compression plates and outlines the principles for the correct use of bone plates in mandibular fractures.

Pilomatrixoma: a rare condition in the differential diagnosis of a parotid swelling

Pilomatrixoma is an uncommon tumour arising from hair follicles. It is more common in the hair bearing areas of the upper region of the body, but is relatively rare. A case is presented in which clinical examination, ultrasound and computed tomography suggested the presence of a pleomorphic adenoma arising from the superficial lobe of the parotid gland, but at operation the mass was found to be separate from it and subsequent histological examination revealed a pilomatrixoma.

Pleomorphic adenoma of the parotid gland

A case of pleomorphic adenoma arising from the deep lobe of the parotid gland is presented. Controversy often surrounds the management of a parotid lump, and many investigations are of little help. The first operation cures most salivary tumours and the patient usually has no residual disability. There is no place for the use of radiotherapy, in the treatment of pleomorphic adenoma.

Trend toward nonoperative management of splenic injuries

Treatment of splenic injuries has evolved over the past decade to reflect more effort to conserve function of the spleen. Records of 169 patients admitted over a 6-year period were identified as documenting the treatment of splenic injuries. We collected data regarding patient age, gender, degree of hemodynamic stability, number of units of blood required, severity of splenic injury, Injury Severity Score, and results of treatment. There were 143 adults (age greater than 16 years) and 26 pediatric patients (age less than 17 years), with mean age in the 2 groups of 31.6 and 11.4 years, respectively. Males comprised 72% of the group, and blunt injury occurred in 154 of the 169 patients. In the adults, splenectomy, splenorrhaphy, laparotomy without operative treatment of the spleen, and nonoperative management were observed 48%, 30%, 14%, and 8% of the time and in the pediatric group 31%, 27%, 19%, and 23% of the time, respectively. By using operative splenic repair techniques and increased use of nonoperative management, the splenic salvage rate has increased in the last 6 years from 41% to 61% without an increase in morbidity and mortality. Incidence of spleen salvage correlated with severity of spleen and overall injury and cardiovascular stability.

Clinical and laboratory evaluation of the treatment of von Willebrand's disease patients with heat-treated factor VIII concentrate (BPL 8Y)

Adequate rises of vWF:activity and satisfactory haemostasis have been obtained in six von Willebrand patients treated with heated 8Y factor VIII concentrate, despite multimeric analysis showing the concentrate to have an alteration in the proportions of the different vWF:Ag multimers including slight loss of the highest molecular weight multimers and an abnormal triplet. As heat-treated concentrates reduce the risk of transmitting blood borne viruses 8Y concentrate should be considered as a possible first line treatment of vWD patients in the U.K. if they do not have mild forms of type I von Willebrand's disease which can be treated with desmopressin (DDAVP) infusions.

Transmission of human parvovirus B19 by coagulation factor concentrates

The prevalence of antibody to human parvovirus B19 was determined in 86 children with congenital bleeding disorders. Forty-seven of 53 boys (89%) receiving non-heat-treated factor VIII or prothrombin complex concentrates were anti-B19 IgG positive compared with 38% of their age-matched controls and 48% of children treated with cryoprecipitate. Acute B19 virus infection occurred in 2 boys 3-4 weeks after they had received the same batch of commercial factor VIII concentrate. Of 11 susceptible children who had only received heat-treated National Health Service factor VIII concentrate (8Y), 1 acquired anti-B19 IgG. This suggests that 8Y heat-treated concentrate has a much reduced risk of transmitting B19 virus and, by implication, other less heat-stable viruses such as human immunodeficiency virus.

Serological evidence that dry heating of clotting factor concentrates prevents transmission of non-A, non-B hepatitis

A new test for antibodies specific for an agent causing non-A, non-B hepatitis (NANBH) was used to screen 45 children with coagulation disorders who received factor concentrates. It was found that the test results correlated with clinical evidence of NANBH and that heat treatment of concentrates (80 degrees C for 72 hours) appears to have prevented transmission of NANBH.

Early treatment of Campylobacter jejuni enteritis

The bacteriologic and clinical effects of early antibiotic treatment of Campylobacter jejuni enteritis were studied. Erythromycin rapidly eliminated C. jejuni from stools, whereas trimethoprim-sulfamethoxazole did not. Despite its bacteriologic effectiveness, erythromycin did not reduce the duration or severity of diarrhea, abdominal pain, or other symptoms.

A prospective study of HIV-infected haemophilic boys and the prognostic significance of immune and haematological abnormalities

Fifty-seven haemophilic boys have been studied prospectively determining T lymphocyte subsets and haematological parameters over a period of 26 months. Clinical follow up of these patients has continued for a further 41 months. At the beginning of the study 21 boys were HIV antibody seropositive and seroconversion was documented in a further 9 during the study period, giving a 52.6% incidence of HIV seropositivity. It has been possible to define a group of patients with persistently falling T4 values and these have shown clinical evidence of HIV infection. Although persistent generalized lymphadenopathy has been observed in 30% of HIV antibody positive boys and some boys have had unexplained fevers, only one boy has progressed to have the acquired immune deficiency syndrome (AIDS) some 5 years and 3 months from HIV seroconversion. This boy had a persistently falling T4 value. The importance of these findings is discussed. To date the abnormalities found in these haemophilic boys irrespective of their age are similar to those already reported in adult haemophiliacs.