Primary cardiac paraganglioma. Case report and review of surgically treated cases

A 58 year old man with an infiltrating non-resectable left atrial paraganglioma was diagnosed by sternotomy and open biopsy. The patient remains symptom free 16 months after the operation. No evidence of an increase in the size of the tumour has been detected by echocardiography. The literature regarding surgically treated patients with cardiac paragangliomas is reviewed.

Glycoinositol phospholipids from American Leishmania and Trypanosoma spp: partial characterization of the glycan cores and the human humoral immune response to them

The glycoinositol phospholipid (GIPL) profiles of American Leishmania spp. (L. mexicana and L. braziliensis), Leishmania donovani, and American Trypanosoma spp. (T. cruzi and T. rangeli) were compared. The major GIPLs in these parasites include tetraglycosyl-, pentaglycosyl-, and hexaglycosylphosphatidylinositol. These were partially identified by their comigration by high-performance thin-layer chromatography with purified L. major GIPLs, gas-liquid chromatography of the monosaccharides released after aqueous HF treatment, N-acetylation and methanolysis, sensitivity to exoglycosidases, and antibody absorption on several specific natural haptens. Members of the genus Leishmania have two other highly polar glycolipids, while the T. rangeli glycolipid profile was quite different from those of other kinetoplastids that were studied. On a weight basis, the glycan core of L. major GIPL-1 is the most reactive, followed by GIPL-3 and GIPL-2. Antibodies to the core glycans of GIPL-1, GIPL-2, and GIPL-3 were present at a low titer in the serum of every normal individual studied, while elevated GIPL-2 antibody levels were present in 80 to 100% of T. cruzi-, T. rangeli-, or L. donovani-infected patients, with lower values being found for GIPL-3 (30 to 60%) and GIPL-1 (30 to 50%). Except for GIPL-2 antibodies, which were mainly located on immunoglobulin G (IgG) and IgM, GIPL-1 and GIPL-3 antibodies were mainly distributed in IgM, with lower reactivity present in IgG. Antigen-antibody binding was very selectively blocked with Gal(alpha 1-3)Man, or Gal(beta 1-4)Man, Gal(alpha 1-3)Gal, and Gal(alpha 1-6)Gal for GIPL-1, GIPL-2, and GIPL-3 antibodies, respectively.

[Hematologic changes in rats treated with high doses of vitamin K3 (menadione)]

The present study describes the effect of high doses of vitamin K3 (8-30 mg/kg) administered daily by intramuscular injection during seven days; on blood smear, red blood cells (RBC) and concentration of hemoglobin (Hb) counts, value of hematocrit (Ht), mean corpuscular hemoglobin concentration (MCHC), reticulocyte and erythroblast counts, total and differential counting of leukocytes (WBC) and total and fractionated serum bilirubin concentration of albino male rats. Results were then compared with findings in normal rats treated with the same doses of sodium bisulfite. In animals treated with vitamin K3 a statistically significant decrease in the number of erythrocytes and in the concentration of Hb, Ht and MCHC was found together with a concomitant increase of erythroblast and reticulocyte counting. In regard to the blood smear, it was observed that erythrocytes vary in their hemoglobin content, size, shape and in their staining properties (polychromatophilia) where as the leukocytes were found to be morphologically normal, but in an increased number. Lymphocytes occasionally showed azurophil granules. Platelets assumed irregular shape and in normal amounts. The leukocytes count showed leukocytosis with marked neutrophilia, eosinophilia, lymphocytosis and monocytosis. Also, the presence of clinical jaundice with an increase of the serum "indirectly-reacting" bilirubin was also observed. These findings indicate that hypervitaminosis K3 induces a marked hemolytic microcytic hypochromic anemia and changes in the white blood cells count. Further studies will be pursued in order to obtain a better understanding of the causes and/or the mechanisms that induce these alterations in the blood cells.

[The hematological manifestations in 111 patients with systemic lupus erythematosus]

Hematologic alterations are frequent in SLE. The hematologic changes of 111 patients diagnosed as suffering from SLE are described, associating them to 89 clinical, biological and hystological variables. The most frequent alteration was normocytic and normochromic anemia. Coombs positive hemolytic anemia appeared in 10% of the cases. Approximately 20% of patients had leukopenia. Lymphopenia was observed during the active period of the disease. Mild thrombocytopenia is common, as well as quality changes of the platelets. The sedimentation rate is high in nearly all patients with SLE and this is a non-specific index of the disease activity. These changes have seldom been described in our area.

Defect in the tissue cellular immune response: experimental visceral leishmaniasis in euthymic C57BL/6 ep/ep mice

In BALB/c mice, successful defense against visceral leishmaniasis is T cell dependent, expressed by tissue granuloma formation, and probably mediated by macrophages activated by cytokines, including gamma interferon (IFN-gamma). C57BL/6 ep/ep (pale ear) mice, which reportedly exhibit impaired IFN-gamma production, were challenged with Leishmania donovani to determine the outcome of infection in a euthymic host with an apparent defect in lymphokine secretion. In BALB/c and normal C57BL/6 mice, L. donovani liver burdens peaked at 2 weeks and were largely eliminated by 4 weeks. In contrast, in pale ear mice, infection progressed until after 4 weeks and persisted at high levels at 8 weeks. The failure to resolve hepatic infections was not related to deficiencies in (i) Thy-1+, L3T4+, or Lyt-2+ T cells; (ii) IFN-gamma secretion; (iii) liver tissue Ia expression; (iv) macrophage antimicrobial capacity; or (v) antileishmanial antibody production. However, despite the anticipated influx of mononuclear cells into livers, these cells were not properly focused on the parasitized Kupffer cells, the inflammatory infiltrate receded prematurely, and mature granulomas failed to develop. These results suggest that there is a cellular immune defect at the tissue level and emphasize the critical role of granuloma formation in successful resolution of systemic intracellular infections.

Antagonistic and agonistic properties of saccharide moieties in the hemizona assay

The hemizona assay (HZA) was used to evaluate the effects of different sugars on human sperm-zona pellucida interactions. In each controlled assay, sperm binding from men of known fertility with/without preincubation with different carbohydrate constituents was compared. We used human prophase I oocytes obtained from surgically removed ovaries; these oocytes were stored in salt solution and later bisected by micromanipulation. Preincubation of sperm (1 hour) with fucoidin (1.0 mg/mL) significantly inhibited binding by more than 85% as compared with controls. Similarly, lesser fucoidin concentrations of 0.5, 0.25, and 0.01 mg/mL were markedly inhibitory. In addition, preincubation times of 60, 30, and 15 minutes were not different in their degree of inhibitory effect. On the other hand, preincubation of the hemizonae with fucoidin before HZA inhibited binding by 43% compared with controls. Here, the fucoidin effect was significantly less inhibitory than the sperm preincubation effect of fucoidin. Preincubation of sperm with d-fucose had no measurable effect on binding, whereas d-glucose (1.0 mg/mL) and 1-fucose (1.0 mg/mL) increased binding. These results indicate: (1) that the HZA provides a unique internally controlled homologous bioassay to evaluate the effects of simple and complex carbohydrates on sperm zona interactions; (2) that fucoidin is an immediate (less than 15 minutes) inhibitor of human sperm binding to the human zona pellucida under HZA conditions.

Fertilizing potential of acrosome-defective sperm following microsurgical injection into eggs

Ejaculates from three infertile men were examined ultrastructurally and found to include a high number of amorphous acrosomeless spermatozoa. Two of the patient's spermatozoa exhibited the typical characteristics of round-head syndrome--spherical-shaped heads completely absent of acrosome and postacrosomal sheath. The semen of the third patient was found to contain a mixture of round-headed and irregularly shaped acrosomeless sperm and a small percentage of normal acrosome-intact sperm. Previous studies have shown that acrosomeless sperm do not have the ability to bind or penetrate zona-free hamster eggs (Weissenberg et al., Syms et al.). In an attempt to determine if such amorphous sperm are capable of decondensation and pronuclear formation, sperm of all three men were microsurgically injected into zona-intact hamster eggs. All of the sperm injected were found to be capable of decondensation or pronuclear formation, suggesting that if the inability to penetrate an egg is bypassed, the sperm of these infertile men are capable of participating in the early events of fertilization.

Kinetic immunonephelometric determination of protein concentrations in follicular fluid

Nonsteroidal biochemical markers of oocyte maturity could presumably aid in oocyte selection and in the timing of insemination for in vitro fertilization. We assessed the usefulness of six potential markers found in follicular fluid. We used kinetic immunonephelometry to measure concentrations of alpha 1-antitrypsin, alpha 2-macroglobulin, antithrombin III, ceruloplasmin, fibrinogen, and plasminogen in 53 fluids and the corresponding plasma from 20 women undergoing in vitro fertilization. Specimens were obtained from both mature and immature follicles from each woman. The respective protein concentrations in follicular fluid could be assayed with a between-assay CV of 1.5% to 3.2%. Analytical-recovery studies indicated that only fibrinogen and antithrombin III concentrations were altered (by 120% and 75%, respectively) during aspiration of the follicle into saline. All protein concentrations were significantly increased in mature follicles, as were the follicular fluid:plasma concentration ratios for alpha 1-antitrypsin, antithrombin III, and ceruloplasmin.

Kinetic immunonephelometric determination of protein concentrations in follicular fluid

Nonsteroidal biochemical markers of oocyte maturity could presumably aid in oocyte selection and in the timing of insemination for in vitro fertilization. We assessed the usefulness of six potential markers found in follicular fluid. We used kinetic immunonephelometry to measure concentrations of alpha 1-antitrypsin, alpha 2-macroglobulin, antithrombin III, ceruloplasmin, fibrinogen, and plasminogen in 53 fluids and the corresponding plasma from 20 women undergoing in vitro fertilization. Specimens were obtained from both mature and immature follicles from each woman. The respective protein concentrations in follicular fluid could be assayed with a between-assay CV of 1.5% to 3.2%. Analytical-recovery studies indicated that only fibrinogen and antithrombin III concentrations were altered (by 120% and 75%, respectively) during aspiration of the follicle into saline. All protein concentrations were significantly increased in mature follicles, as were the follicular fluid:plasma concentration ratios for alpha 1-antitrypsin, antithrombin III, and ceruloplasmin.

Monitoring of serum levels of imipramine and desipramine and individualization of dose in enuretic children

The serum levels of imipramine (IMI) and its active metabolite desipramine (DMI) were monitored in 90 children with primary nocturnal enuresis. Ages ranged between 5 and 14 years. Serum concentrations were determined in 21 children at 24 h after administration of a dose of 75 mg and once when steady state had been reached, 12 h after the last dose; a good correlation was seen between the total levels (IMI + DMI) on those two occasions (r = 0.81; p less than 0.01). This serves as a basis to predict the steady-state levels of IMI + DMI reached in an individual patient. In the remaining patients the serum levels of IMI + DMI were determined at steady state. Dosage regimens were adjusted individually to obtain a favorable response with regard to the frequency of enuresis and to the possible occurrence of side effects. Good correlation was established between the serum concentrations of IMI + DMI at steady state and the frequency of enuresis, with a favorable response being obtained for levels greater than 80 ng/ml. Monitoring of serum levels leads to better compliance with the regimen throughout treatment.

Iron absorption from typical Latin American diets

The availability and daily absorption of iron was determined by the extrinsic label method in typical lower middle to lower class diets consumed in regions of Argentina, Brazil, Chile, Mexico, Peru, and Venezuela. Differences in iron absorption from meals up to 7-fold, could be attributed to the varying contents of absorption enhancers, eg, in meat, and of inhibitors in tea, vegetables, and wheat or maize bread. The total iron available in the diets from four countries did not meet the physiological requirements for normal subjects but deficient subjects fulfilled their requirements absorbing from 1.0 to 2.1 mg/day. In five diets heme iron (6 to 24% of the total) provided 34 to 73% of the iron absorbed. These data suggest that such absorption and utilization studies may be used to correlate the prevalence of iron deficiency in a population with certain diets and to guide fortification programs.

In vitro fertilization in Norfolk, Virginia, 1980-1983

Three years of progress of the Vital Initiation of Pregnancy (VIP) Program in Norfolk is reported. No conception resulted from 41 oocyte aspirations during spontaneous menstrual cycles in 1980. An average of 3.7 oocytes per cycle, or a 73.5% recovery rate, resulted in 362 human menopausal gonadotropin/human chorionic gonadotropin-induced cycles from January 1981 to March 1983. Forty percent of the oocytes recovered from these cycles were preovulatory, 35% atretic, and 25% immature. Immature oocytes were often matured in vitro, fertilized, and found to produce pregnancies. A total of 62 pregnancies occurred, which represents a 17 or 23% pregnancy rate, based on laparoscopies or embryo transfers, respectively. There were 11 preclinical and 7 clinical miscarriages. Twenty-nine normal babies have been delivered, including a set of twins. The remainder appears to be normally progressing pregnancies. Polyspermia was observed in 8.8% of the fertilizable oocytes.

The importance of the follicular phase to success and failure in in vitro fertilization

One hundred seventy-five cycles in patients with irreparable tubal disease were stimulated by human menopausal gonadotropin/human chorionic gonadotropin for the purpose of in vitro fertilization. As judged by the height of the peripheral estradiol response, the patients were classified as high, intermediate, or low responders. In addition, the estradiol pattern of the response was found to be separable into six categories. The pregnancy rate was found to be related to the height and to the pattern of peripheral response. The overall pregnancy rate in this consecutive series was 19% but varied according to the height and pattern of response from 40% to 0%.

Long-acting contraceptive agents: norethisterone esters of monoalkenyl and monoalkynyl acids

The synthesis of nine new esters of norethisterone (17 alpha-ethynyl-17 beta-hydroxyestr-4-en-3-one) is described, with the esterifying acids bearing an acetylenic or olefinic function in a chain of eight or nine carbon atoms, for evaluation as long-acting contraceptive agents.

The program for in vitro fertilization at Norfolk

Several aspects of the program of in vitro fertilization (IVF), or, as it is called in Norfolk, the program for the Vital Initiation of Pregnancy (VIP), have been or are in the process of publication. However, because there has been no overall account, it seems appropriate to give a brief report of a general nature covering the period from the beginning of the effort in late February 1980 through December 31, 1981. Although minor changes were constantly made in the protocol, there were two major revisions. Therefore, a discussion of the program during three distinct periods, i.e., 1980, 1981-Phase I, and 1981-Phase II, is necessary. During 1980 and 1981 all patients had either no fallopian tubes or irreparable tubes.

Characteristics of adenylyl imidodiphosphate- and ADP-binding sites insoluble and particulate mitochondrial ATPase. Studies with methanol

The characteristics of the binding sites for ADP and adenylyl imidodiphosphate have been studied in soluble and particulate F1-ATPase from bovine heart mitochondria. ADP, but not electrochemical gradients, removes the inhibitory effect of adenylyl imidodiphosphate on ATPase activity in coupled submitochondrial particles. In soluble F1-ATPase, methanol at 20% concentration diminishes the ability of ATP and adenylyl imidodiphosphate to inhibit ATP and ITP hydrolysis; these findings suggest that ADP and adenylyl imidodiphosphate inhibit hydrolysis by acting on the same site. Methanol at 20% stimulates the hydrolytic activity of soluble F1-ATPase, but fails to stimulate significantly the activity of the particulate enzyme, even though in particulate F1-ATPase methanol markedly diminishes the inhibiting action of added ADP and adenylyl imidodiphosphate on ATP and ITP hydrolysis. This is consistent with the idea that in the particulate system there are two inhibitory binding sites for ADP, one accessible to methanol, and another which is inaccessible to methanol; the latter is transitorily occupied by ADP arising from ATP hydrolysis. Indeed, experiments on the effect of ADP in ITP hydrolysis by submitochondrial particles show the existence of two ADP inhibitory sites.

The association of semen factors with the recovery of Ureaplasma urealyticum

Ninety-six semen samples from males under examination for suspected subfertility were examined to determine if alterations in specific semen parameters could be associated with the presence or absence of Ureaplasma urealyticum. Forty-three (44.8%) of the specimens cultured positive for U. urealyticum. Both positive and negative specimens have a normal average motility rating. Sperm counts (millions per milliliter) were slightly higher in U. urealyticum positive samples. Average ejaculate volumes were identical between the two groups. Morphologic abnormalities were not found more frequently in U. urealyticum-positive samples. No statistically significant difference between seminal parameters of positive and negative samples were noted with the one-way analysis of variance test. Nonparametric analysis produced similar nonsignificant results.

[A study of the urinary acidifying capacity of patients chronically treated with anticonvulsants (author's transl)]

The subjects of this study were 18 patients with essential or secondary epilepsy under treatment with anticonvulsant drugs (hydantoins and phenobarbital) for periods of time varying between 8 months and 22 years. In all of them the serum levels of calcium, phosphorus, alkaline phosphatase, and the renal tubular capacity to acidify the urine were measured. Mean serum calcium and phosphorus levels were normal, while alkaline phosphatase was significantly elevated (p less than 0.0005). The renal threshold for bicarbonate was lowered to a mean of 23.01 +/- 2.86 (p less than 0.01). Distal tubular function was normal in all cases. When the patients are divided into two groups according to the duration of treatment (more or less than 100 months), the group with longest therapy shows an elevation of alkaline phosphatase (p less than 0.0005), a lowering of serum calcium (p less than 0.025) and a reduction of the renal threshold for bicarbonate (p less than 0.005) when compared to the group with shortest therapy.

Hernia of Morgagni

París, F., Tarazona, V., Casillas, M., Blasco, E., Cantó, A., Pastor, J., and Acosta, A. (1973).Thorax, 28, 631-636. Hernia of Morgagni. Nine patients with Margagni's hernia of the diaphragm are reported, seven of whom have been operated on. Four patients had gastrointestinal symptoms, two respiratory symptoms, and one retrosternal pain; the other two were asymptomatic. In the first case the diagnosis was made at the time of thoracotomy, in the other eight it was suggested by radiological studies. The standard midline epigastric incision was used for repair in four cases and thoracotomy in two; the last patient was operated on through a preperitoneal subxiphoid route. This route has the advantage of not requiring a wide incision of peritoneum.