Intestinal perforation 14 years after abdominal irradiation and chemotherapy for Wilms tumor

A 3-year-old girl underwent left nephrectomy and removal of a tumor thrombus from the inferior vena cava and right atrium in 1978 because of Wilms tumor. Her treatment consisted of tumor bed irradiation (4,000 cGy) and chemotherapy with actinomycin D, vincristine, and doxorubicin. The patient underwent laparotomy 2 months after completion of abdominal irradiation to relieve intestinal obstruction. Fourteen years later, she underwent another laparotomy because of an "acute abdomen" and was found to have perforation of the jejunum in the radiation field. Histopathological examination of resected intestine revealed evidence of severe chronic radiation enteritis, A diagnosis of chronic radiation enteritis should be considered in patients who had received abdominal irradiation and who manifest abdominal pain/vomiting even several years after irradiation.

Immunoglobulin heavy chain variable region gene usage in bone marrow transplant recipients: lack of somatic mutation indicates a maturational arrest

Many recipients of bone marrow transplant (BMT) make normal amounts of serum immunoglobulin but are deficient in generating specific antibody responses to exogenous stimuli. To determine if abnormal usage of VH genes contributes to this immunodeficiency, the usage of VH genes was determined in peripheral blood B cells of four BMT recipients, two of whom had developed chronic graft versus host disease. The pattern of usage of VH3 or VH4 genes assessed at either 90 days or approximately 1 year after transplant was similar to that observed in healthy subjects and was marked by the over utilization of two elements, one VH3 and one VH4. However, the repertoires of each of the four BMT recipients appeared to be less complex than the repertoires of healthy subjects. The differences were a consequence of the accumulation of somatic mutations among rearrangements in the controls but not in the BMT recipients. The failure to accumulate somatic mutations in rearranged VH genes is consistent with a defect in antigen driven B-cell responses. These results indicate the although the VH gene content of the repertoire has normalized by 90 days posttransplant, a maturational arrest in B-cell differentiation associated with antigen activation persists for at least 1 year after BMT.

Analysis of the VH3 repertoire among genetically disparate individuals

It has been shown that a conserved but highly biased subset of the germline VH complement is utilized in the peripheral VH repertoire of Caucasians. To distinguish between VH-autonomous effects and background genetic effects, we have now assessed the incidence of rearrangement of eight VH3 gene segments in preimmune CD19+IgD+B cells from genetically disparate subjects of diverse ethnic backgrounds. Results indicate that the set of gene segments utilized for rearrangements by these subjects is similar, and predominantly reflects the bias previously observed in Caucasians. The preimmune repertoire of each subject is dominated by two or three gene segments, with a predominant expression of V3-23 in all the subjects. Variation in the use of individual gene segments, including V3-23, was observed among the subjects. These results indicate that the processes that favor the preferential use of particular genes is largely independent of genes outside the VH locus. The minor variation in utilization of VH segments, however, is probably influenced by the genetic background of the individual.

Effect of transfusion in acute chest syndrome of sickle cell disease

OBJECTIVE

To study the effects of transfusion on the clinical course and oxygenation indexes of children with sickle cell disease and acute chest syndrome.

METHODS

During a 2-year period, 36 children with sickle cell disease admitted with a total of 40 episodes of acute chest syndrome were examined. Patients were given a clinical severity score indicative of the degree of respiratory distress. Arterial blood gas values were determined 4 to 24 hours before and 12 to 24 hours after transfusion, and indexes of oxygenation were calculated; six patients who were not given transfusions also had blood gases measured on admission and approximately 24 hours later for comparison.

RESULTS

Blood transfusion was administered during 27 episodes (67.5%); 20 children received a simple packed cell transfusion, four had a partial packed cell exchange transfusion, and three had a simple transfusion followed by whole blood exchange transfusion because of worsening clinical symptoms. Although there was no significant change in oxygenation indexes for the six patients not treated with transfusion, there was significant improvement in all indexes after transfusion. The transfused group had more severe disease on admission, but there was no significant difference in duration of fever, tachypnea, retractions, or hospital stay between the transfusion and the nontransfusion groups.

CONCLUSION

Blood transfusion, even simple transfusion of packed erythrocytes, significantly improves oxygenation in children with acute chest syndrome and is a valuable adjunct to therapy.

Anti-pneumococcal antibody levels three to seven years after first booster immunization in children with sickle cell disease, and after a second booster

We measured pneumococcal antibody levels in 55 patients (ages 7 to 20 years) with sickle cell disease 3 to 7 years after the first booster immunization. Only 6 of the children had protective levels of antibodies (> 300 ng/ml) against all 12 serotypes tested. Thirty-two children (58%) had suboptimal levels against 1 to 3 serotypes; 17 had suboptimal levels against 4 to 10 serotypes. Ten patients from the latter group (ages 13 to 17 years) received a second booster 6 to 8 years after the first booster immunization, and had a marked increase in antibody levels against all serotypes with the exception of serotypes 3 and 4 in two patients and serotype 6A in one patient.

Naturally occurring rearranged taxoids

The rearranged taxoids have recently been reported from different Taxus species. The literature concerning the chemistry, biogenesis, and bioactivity of such compounds is reviewed.

Molecular and functional characterization of recombinant human metabotropic glutamate receptor subtype 5

We have isolated and characterized overlapping cDNAs that encode two isoforms of the human metabotropic glutamate receptor subtype 5 (hmGluR5). The deduced amino acid sequences of human and rat mGluR5a are 94.5% identical. However, a region in the putative cytoplasmic domain (SER926-ALA1121) displays significant sequence divergence. Genomic analysis of this region showed that the sequence divergence results from species-specific differences in the genomic sequences, not from alternative splicing. The distribution of mGluR5 mRNA in human brain was most strongly detected throughout the hippocampus, with moderate levels in the caudate-putamen, cerebral cortex, thalamus, and deep cerebellar nuclei, and at low levels in the cerebellar cortex. Activation of both hmGluR5a and hmGluR5b transiently expressed in Xenopus oocytes and HEK293 cells was coupled to inositol phosphate (InsP) formation and elevation of the intracellular free calcium ([Ca2+]i). The agonist rank order of potency for activating recombinant hmGluR5a receptors in either system was quisqualate > L-glutamate > 1S,3R-ACPD. Both the quisqualate stimulated InsP and [Ca2+]i were inhibited by (+)-MCPG. Recombinant human mGluR5a was also stably expressed in mouse fibroblast Ltk- cells, in which the efficacy and potency of quisqualate were unchanged for more than 30 cell passages.

Priapism in children with sickle cell disease

A review of hospital admissions during 80 months revealed only 8 patients with episodes of priapism of approximately 400 pediatric male patients with sickle cell disease. The patients, who ranged in age from 5 to 19 years, underwent a 99mtechnetium penile scan, and 4 had a low and 4 had a high flow scan. Three cases resolved with hydration alone. Five patients received exchange transfusion of whom 3 subsequently underwent shunt procedures. One patient with a 5-year history of recurrent stuttering episodes was placed on transfusion therapy for 6 months and stuttering episodes have not recurred. One patient had a cerebrovascular accident 1 day after hospital discharge and another had priapism while on chronic transfusion therapy for a cerebrovascular accident. Each postpubertal patient had a severe clinical course; 1 had temporary impotence for 3 months and another had impotence at 2 weeks but was lost to followup. While 99mtechnetium penile scans may help clarify the severity of vascular stagnation, in our small group they were not helpful in predicting clinical course.

Effect of angiotensin converting enzyme inhibitor (captopril) on gastric ulcer production in pylorus ligated rats

Intraperitoneal injection of Angiotensin Converting Enzyme inhibitor, captopril, reduced significantly (P < 0.001), the production of gastric ulcers in pylorus-ligated albino rats, compared to the control groups, irrespective of the dose schedule--single or quadruple. In the light of evidence available in the literature, it is reasonable to hypothesise that the anti-ulcer effect of captopril may be mediated through prostaglandins.

Clinical and electroneurophysiological assessment of leprosy patients on dapsone monotherapy--a two year follow-up study

Fifty-three persons with tuberculoid type of leprosy having a thickened nerve on one side and a clinically normal nerve on the contralateral side were studied before, during and after two years of therapy for electrophysiological abnormalities in apparently normal and in obviously thickened nerves. Twenty-seven patients had received treatment with dapsone 100 mg orally and 26 cases had received rifampicin therapy. It was found that there was no extension of anesthesia or diminution of motor power over a period of two years. There was no significant difference between the initial and final recordings of motor and sensory nerve conductions if aggregate figures were taken. However, taking individual cases, deterioration in nerve conduction (increased latency and decreased velocity) was found in two patients, of whom one had received dapsone and the other had received rifampicin.

Structure-antitubercular activity relationship of phenothiazine-type calmodulin antagonists

Six neuroleptic (antipsychotic) phenothiazine derivatives which are calmodulin antagonists were tested for their activity against Mycobacterium tuberculosis H37Rv in order to understand their structure-antitubercular activity relationship. Out of the six derivatives tested (trifluoperazine, chlorpromazine, triflupromazine, thioridazine, acetopromazine and fluphenazine), trifluoperazine appears to be a more potent antitubercular drug than others with a minimum inhibitory concentration (MIC) of 5 micrograms/ml. Chlorpromazine, triflupromazine and thioridazine are also active but less potent and have a higher MIC of 20 micrograms/ml. Acetopromazine and fluphenazine could not completely inhibit the growth even at a high concentration of 20 micrograms/ml. These results indicate that a methylpiperazinylpropyl group attached to the nitrogen (position 10) atom and trifluoromethyl group at the second carbon confer antitubercular activity to the phenothiazine molecule. It is suggested that trifluoperazine or one of its derivatives could be useful as one of the drugs in the multi-drug regimen for the treatment of tuberculosis with psychotic problems or vice versa.

Antibodies to 68, 52, and 48 kd proteins of Mycobacterium avium in serum samples from patients with Mycobacterium avium infection

Mycobacterium avium complex (MAC) is responsible for the highest incidence of disseminated bacterial infection in patients with AIDS. Disease caused by this organism was originally thought to be rare in nonimmunocompromised individuals, but it is now being encountered more frequently. Relatively little is known about the components that play a role in the immunopathology of infection caused by MAC. To identify the immunoreactive antigens of this organism that are important targets of the humoral immune response in MAC infection, serum samples from MAC-infected and non-MAC-infected patients were analyzed by Western Blot analysis with sonic extracts of M. avium (MA) as the antigen. The MAC-infected population included patients who were HIV-negative as well as patients with AIDS, and the non-MAC-infected population included non-AIDS, HIV-positive patients and normal, purified protein derivative-negative individuals. The immunodominant antigens recognized by the MAC-infected patients were the 68, 52, and 48 kd proteins of MA. These antigens were also recognized by a few of the non-MAC-infected patients. However, significant differences were observed between the number of MAC-infected and non-MAC-infected patients reacting with these antigens. Sixty-nine percent of the MAC-infected patient serum samples were found to react with the 68 kd antigen, whereas only 24% of the serum samples from patients without MAC infection recognized this antigen (p < 0.001). Of the MAC-infected serum samples, 53.1% were found to react with the 52 kd antigen, whereas only 22% of the non-MAC-infected patient serum samples reacted with this antigen (p = 0.008).(ABSTRACT TRUNCATED AT 250 WORDS)

Identification of a 68 kd surface antigen of Mycobacterium avium that binds to human macrophages

Infection caused by Mycobacterium avium is the major cause of bacteremia in patients with AIDS. A critical event in the initiation of a variety of bacterial infections is the adherence of bacteria to host cell surfaces, which is often brought about by the interaction of specific molecules on the bacterial surface with host cell surface receptors. In the present study, a sonicate of M. avium was used to isolate monocyte-binding proteins by affinity chromatography with CNBr-Sepharose-4B coupled to extracts of monocytes. A 68 kd protein present on the surface of M. avium was identified as one of nine monocyte-binding proteins. This protein was isolated and further characterized. The N-terminal amino acid sequence (22 residues) of the protein was determined and was found to exhibit strong homology with the 65 kd heat shock proteins of M. tuberculosis, M. leprae, and M. bovis. However, a previously characterized monoclonal antibody directed against a 66 kd antigen of M. avium was found to cross-react with the 68 kd protein from M. avium but not with the 65 kd proteins from M. leprae and M. bovis, suggesting that the 68 kd antigen may differ from the 65 kd proteins of M. leprae and M. bovis with respect to certain epitopes. In an in vitro inhibition assay, the 68 kd protein was found to compete with the attachment of intact fluorescein isothiocyanate-labeled M. avium to monocyte-derived macrophages, inhibiting this attachment in a dose-dependent manner up to 42%. The 65 kd proteins of M. leprae and M. bovis, on the other hand, did not appear to inhibit this attachment substantially (13.9% and 14.6%, respectively). These results suggest that the 68 kd protein of M. avium may be involved in binding to receptors on macrophages and help in the attachment of the organism to its host cell.

Prevalence of lymphopenia in children with AIDS

Hematologic abnormalities, such as anemia, neutropenia, lymphopenia, and thrombocytopenia, are frequently observed in patients with acquired immunodeficiency syndrome (AIDS). While lymphopenia has been noted in up to 80% of adults, only 50% of children with AIDS are reported to be lymphopenic. We reviewed the blood counts of hospitalized children with AIDS to determine the frequency of lymphopenia and other hematologic abnormalities. Seventy-four children with AIDS (ages 4 months to 9.5 years) were admitted to Kings County Hospital Center (Brooklyn, New York) from January 1990 to March 1991; data consisted of 709 CBCs (range one to 39, median 11) from 176 admissions (range one to 15). In some patients admitted during the study period, charts from previous admissions were reviewed. Anemia (Hb less than than third percentile for age) was noted in 68 of 74 (92%) patients. Leukopenia (WBC less than 4000/mm3) was noted in 32 of 74 (43%) patients. Lymphopenia (lymphocyte counts below normal for age) was seen in 59 of 74 (78%) patients; of these, more than half (31 of 59) had persistently low absolute lymphocyte counts. Thrombocytopenia (platelet count less than 150,000/mm3) was seen in 20 of 74 (27%) and was found in four of eight patients who expired. Pancytopenia was seen in nine of 74 (12%) patients. Progression of hematologic abnormalities with anemia followed by lymphopenia, thrombocytopenia, and finally leukopenia was demonstrated in 22 patients. This review shows a prevalence of hematologic abnormalities that is similar to those of previous reports in children except for a considerably higher prevalence of lymphopenia. As expected, lymphopenia was a marker for disease progression.

B19 parvovirus infection in children with malignant solid tumors receiving chemotherapy

Two children with rhabdomyosarcoma developed severe anemia following chemotherapy; anemia was more severe compared to that observed following earlier chemotherapy cycles. While one patient had a brisk reticulocytosis, the other had no demonstrable reticulocytes. Both patients had evidence of acute B19 parovirus infection and subsequently developed appropriate antibody response. A diagnosis of B19 parvovirus infection should be considered in any patient who develops persistent or severe anemia while on chemotherapy.

Alveolar-arterial oxygen gradient in acute chest syndrome of sickle cell disease

In 44 episodes of acute chest syndrome of sickle cell disease occurring in 37 children, simple clinical severity score, duration of hospital stay, transfusion data, and alveolar-arterial oxygen gradient were analyzed as indicators of severity of disease. The alveolar-arterial oxygen gradient, measured during breathing of room air, proved, on multivariate analysis, to be the strongest predictor of both clinical severity and the need for blood transfusion.

Dental caries and periodontal diseases among urban, rural and tribal school children

The oral health status in school children of Wardha was studied to find out the geographical differences in oral health status and to relate it with the teeth cleaning habit and nutritional status. A cluster sample of 778 children studying in 2 urban, 4 rural and 2 tribal primary schools was selected. Majority (60.8%) of children were habituated to clean their teeth with Manjan. The prevalence of periodontal diseases was significantly high in children habituated to ash, Manjan and coal. The tribal children showed a better oral health status than urban counterparts. Nutritional status has played no role in dental decay. The school oral health education campaigns should be addressed to dental caries, periodontal diseases and the harmful teeth cleaning materials.

Electro neuro physiological studies in early tuberculoid leprosy

Electro physiological studies were carried out in early tuberculoid type of leprosy in order to study their utility in detecting nerve damage before the onset of obvious functional deficit. Fifty-three cases showing one mixed nerve thickening in one limb were selected. Nerve conduction studies (both motor and sensory) were done using single blind technique. There was no statistically significant difference between the findings obtained from clinically thickened and non-thickened nerves. There was also no direct relationship between clinical sensory deficit and electro physiological abnormality. Clinical motor power loss was well correlated with electro physiological abnormalities.

Skeletal muscle metastasis in a patient with Wilms tumor and multiple late recurrences

Stage III Wilms tumor was diagnosed in a 9-year-old girl. Four and a half years after the treatment, which consisted of an operation, radiation therapy, and chemotherapy, the patient had a solitary metastasis in the liver, which was successfully treated with chemotherapy and surgical resection. Five years later, right lung metastases were eradicated by chemotherapy, radiation, and surgical resection. Three and a half years later, she had a metastasis in the left calf, for which she underwent surgical resection and received chemotherapy. This patient has several interesting features: (1) multiple recurrences, two in the usual sites of metastasis and one in an extremely rare site, i.e., skeletal muscle; (2) long intervals between recurrences; and (3) unusual histopathologic features, i.e., gradual evolution from a triphasic Wilms tumor at the primary site, to a predominance of differentiated mucinous epithelium in the skeletal muscle metastasis.

Mycobacterium avium-M. intracellulare binds to the integrin receptor alpha v beta 3 on human monocytes and monocyte-derived macrophages

Mycobacterium avium-M. intracellulare is an intracellular pathogen responsible for the highest incidence of disseminated bacterial infection in patients with AIDS. Treatment of the infection is difficult and has been of limited efficacy. Attachment of the organism to macrophages is a critical early step in the establishment of the disease. In the present study, we isolated and identified a receptor that mediates attachment of M. avium-M. intracellulare to human peripheral blood monocytes and monocyte-derived macrophages. On Western blotting, (immunoblotting), the receptor was found to cross-react with antibodies against a human vitronectin receptor (alpha v beta 3). The receptor could be purified from monocyte extracts by using monoclonal antibodies (MAbs) against the alpha v subunit of vitronectin receptor coupled to CNBr-Sepharose 4B, as well as with the adhesive tripeptide sequence arginine-glycine-aspartic acid (RGD) coupled to CNBr-Sepharose 4B. Surface-bound MAbs directed against alpha v beta 3 were found to inhibit the attachment of M. avium-M. intracellulare to monocyte-derived macrophages in an in vitro inhibition assay, while MAbs directed against CD14, CD18, alpha 2 beta 1 and platelet glycoprotein gpIIb/IIIa receptors did not inhibit this attachment. These observations suggest that alpha v beta 3 on the surface of human monocytes and monocyte-derived macrophages may function as a receptor for M. avium-M. intracellulare. Identification of a receptor for M. avium-M. intracellulare on macrophages may offer new approaches to the prevention and control of M. avium-M. intracellulare infection at the cellular level.

Transient aplastic crisis in patients with sickle cell disease. B19 parvovirus studies during a 7-year period

OBJECTIVE

To determine (1) the proportion of cases of transient aplastic crisis (TAC) in patients with sickle cell disease due to B19 parvovirus infection in several years, (2) longitudinally, the immune response to B19 parvovirus infection, and (3) whether patients with sickle cell disease experience recurrent or chronic B19 parvovirus infection.

DESIGN

Prospective evaluation of patients with sickle cell disease and TAC to find evidence of B19 parvovirus infection and, if present, to document the pattern of serologic response with time.

SETTING

Large urban teaching hospital.

PATIENTS

Patients younger than 18 years with sickle cell disease who were admitted to the hospital with a diagnosis of TAC or who developed TAC while in the hospital for other reasons. Follow-up serologic studies of B19 parvovirus infection were done in eight patients.

MEASUREMENTS/MAIN RESULTS

Serum was tested for B19 parvovirus DNA/viral particles and specific anti-B19 parvovirus IgM and IgG antibodies. B19 parvovirus DNA/viral particles were detected in 11 (21%) of 53 patients with TAC. Specific anti-B19 parvovirus IgM antibodies were detected in 34 (64%) of the 53 patients. Overall, 36 (68%) of 53 patients with TAC had evidence of acute B19 parvovirus infection as shown by the detection of B19 DNA parvovirus and/or specific anti-B19 parvovirus IgM antibodies in acute-phase serum. Follow-up serologic studies in eight patients with acute infection revealed disappearance of B19 parvovirus DNA/viral particles and anti-B19 parvovirus IgM antibodies and persistence of anti-B19 parvovirus IgG antibodies for up to 3 1/2 years after the diagnosis of acute B19 parvovirus infection. No patient had evidence of recurrent or chronic B19 parvovirus infection.

CONCLUSIONS

Approximately 70% of cases of TAC in patients with sickle cell disease identified in a 7-year period were caused by acute B19 parvovirus infection. Once detected, anti-B19 parvovirus IgG antibodies remain detectable for several years. There was no evidence of chronic or recurrent B19 parvovirus infection in patients with sickle cell disease.

Identification of a beta 1 integrin on Mycobacterium avium-Mycobacterium intracellulare

Mycobacterium avium-Mycobacterium intracellulare (MAI) is an opportunistic intracellular pathogen responsible for the highest incidence of disseminated bacterial infection in patients with AIDS. Treatment of the infection is extremely difficult and has shown limited efficacy. A critical event in the initiation of a variety of bacterial infections involves the adherence of bacteria to host cell surfaces. In the present study, we have shown that MAI organisms bind avidly to extracellular matrix proteins such as laminin, collagen I, and fibronectin in an in vitro attachment assay. Immunoblot analysis of a sonicate of MAI with polyclonal antibodies against different integrin receptors indicated that the sonicate cross-reacts with polyclonal antibodies against a human laminin-binding integrin, alpha 3 beta 1, and a human fibronectin-binding integrin, alpha 5 beta 1, although it is reactive with only the beta 1 subunit in the case of both antisera. Antibodies against the alpha 3 beta 1 and alpha 5 beta 1 integrins specifically inhibited the binding of MAI to laminin, collagen I, and fibronectin by 70 to 97%, depending on the ligand, suggesting that the attachment of MAI to these extracellular matrix proteins may be mediated by a beta 1 integrin. Furthermore, the attachment of MAI to laminin, collagen I, and fibronectin was found to be cation dependent. MAI may use this and other beta 1-containing integrins to adhere and penetrate through basement membrane structures that underlie host cell linings. An understanding of the mechanism of attachment and a definition of the adhesive molecules on the surface of MAI may open up new approaches to the prevention of serious infection caused by this organism.