Johanson-Blizzard syndrome: clinical spectrum and further delineation of the syndrome

We report on 2 patients with Johanson Blizzard syndrome and review the literature, in an attempt to further characterize the clinical spectrum of this disorder.

Foraging mode in lacertid lizards: variation and correlates

Abstract

Foraging strategy was observed in five species of Israeli lacertid lizards in the field. Acanthodactylus scutellatus is a sit-and-wait strategist, whereas A. boskianus, A. schreiberi, Lacerta laevis and Mesalina guttulata forage widely. However, the actual values differed from those reported by Huey and Pianka (1981) for Kalahari lacertids, possibly indicating the existence of a continuum of foraging modes. Foraging intensity (proportion of time spent moving or frequency of moves) is positively correlated to relative tail length, and negatively correlated to relative clutch mass. Additional possible correlates are discussed, and some cautionary remarks added.

Transient inhibitory seizures mimicking crescendo TIAs

Somatic inhibitory seizures are thought to occur rarely. We describe a patient with somatic inhibitory seizures who initially presented with a clinical picture of crescendo transient ischemic attacks. He did not improve with anticoagulation, but the episodes ceased promptly after the administration of an anticonvulsant.

Immunology of celiac disease: tissue and species specificity of endomysial and reticulin antibodies

Patients with celiac disease and dermatitis herpetiformis have circulating antibodies to reticulin and endomysium, the 'extracellular matrix' components as defined by their detection on rodent and primate tissues, respectively. Because both types of antibodies occur in both forms of gluten-sensitive enteropathy, studies were conducted to determine if the two types of antibodies can be distinguished by species and organ specificity. The results of these studies indicate that distinct endomysium-specific and reticulin-specific antibodies can be found and that these differ in their species specificity; i.e., endomysium antigen occurs in primate and not in rodent tissues while the reticulin antigen occurs in rodent and not in primate tissues. However, the activity of both endomysium and reticulin antibodies demonstrates similar tissue distribution, in that both react to antigens associated with gastrointestinal smooth muscles, peritubular and periglomerular areas of the kidney, and sinusoidal and periportal areas of the liver. Also, both antigens seem to be present in sheep and goat tissue. These studies indicate that the antigens reactive with endomysial antibodies are distinct from those reactive with reticulin antibodies.

Effects of parenteral nutrition on whole body and extremity composition in children and adolescents with active inflammatory bowel disease

The effect of parenteral nutrition (PN), combined with corticosteroid therapy, on body composition was evaluated in 22 pediatric patients with active and complicated inflammatory bowel disease (IBD). The patients were divided into two groups according to the duration of PN. Group A consisted of 14 patients who received PN for an average of 43 days (short term) whereas eight patients received PN for an average of 104 days (long term); group B. Nutritional assessments were performed before and following the PN periods. In addition, a follow-up assessment was performed 50 days after the cessation of PN for group A. Serial evaluations included; weight, height, disease activity score, arm anthropometry, subscapular skinfold (SSSF) thickness, 24-hr urinary creatinine, and computed tomography (CT) scan of the thigh. Following PN with a glucose-fat mixture used as a nonprotein energy source, there were significant (p less than 0.05) increases in weight, SSSF, and muscle mass (MM) in both groups. Disease activity declined in both groups and height increased in group B and at the follow-up assessment for group A. Considering extremity composition, both groups exhibited increases in midarm muscle area, midarm fat area, thigh muscle area, and thigh fat area. However, a differential distribution of incremental change was observed depending on the duration of PN. Fat deposition predominated in both the upper and lower extremities for group A. Group B patients, however, although showing a predominance of fat accumulation in the upper extremities, gained muscle and fat components equally in the lower extremities.(ABSTRACT TRUNCATED AT 250 WORDS)

Pgp-1hi T lymphocytes accumulate with age in mice and respond poorly to concanavalin A

Aging is associated with an accumulation of T cells functionally hyporesponsive to the effects of mitogens such as concanavalin A. Recent studies in mice and human have identified surface markers useful for distinguishing antigen-stimulated memory T cells from virgin T cells. In mice, memory T cells within the CD8+ cell population have been shown to express relatively high levels of the cell surface glycoprotein Pgp-1. On the theory that aging might diminish the supply of virgin thymic emigrants without compromising the production of memory T cells, we examined the proportion of Pgp-1hiCD4+ and CD8+ cells in the spleen, blood and lymph nodes of mice of varying age. We found a dramatic (2.5-fold) age-associated increase in the percentage of cells with the Pgp-1hi phenotype. By limiting dilution methods, the frequency of concanavalin A-responsive T cells was found to be significantly reduced in the Pgp-1hi cell pool, whether measured by interleukin 2-dependent proliferation, interleukin 2 production or generation of cytotoxic effectors. Pgp-1hi and Pgp-1lo T cells from young mice proliferate equally well when stimulated by optimal doses of phorbol myristate acetate and ionomycin suggesting that the poor responses to concanavalin A do not simply reflect low viability. Aging leads both to an increase in mitogen-hyporesponsive Pgp-1hi T cells, and also to lower responsiveness of cells in the Pgp-1hi subset.

Serum antibodies to cow's milk proteins in pediatric inflammatory bowel disease. Crohn's disease versus ulcerative colitis

Serum antibodies to five cow's milk proteins (alpha-casein, bovine serum albumin, beta-lactoglobulin A and B, and alpha-lactalbumin) were investigated in young patients with inflammatory bowel disease (56 Crohn's disease, 24 ulcerative colitis). IgG antibodies against bovine serum albumin, beta-lactoglobulin A and beta-lactoglobulin B were higher in Crohn's disease patients than in those with ulcerative colitis or the controls. IgG anti-bovine serum albumin antibodies were higher in those Crohn's disease patients who had higher scores of disease activity. Finally, IgA antibodies to alpha-casein were higher in patients with Crohn's disease and ulcerative colitis when compared to controls. These findings may be due to increased uptake of dietary antigens or enhanced immunological response occurring in Crohn's disease patients.

Endomysial antibodies in the diagnosis of celiac disease and the effect of gluten on antibody titers

Celiac disease, a common chronic gastrointestinal disorder, is gluten induced and is controlled with a gluten-free diet. While the management of CD with a gluten-free diet is quite effective, the diagnosis is rather difficult. The ESPGAN criteria for the diagnosis of CD seems to be tedious and time-consuming. Serological tests for IgA class endomysial antibodies, as detected by indirect immunofluorescence, on human and primate smooth muscles are specific and sensitive markers of celiac disease. Of all the specimens examined, endomysial antibodies were present in patients with gluten-sensitive enteropathy. These antibodies occurred in all active cases of celiac disease, in 90 percent suspected celiac patients where all the ESPGAN criteria has not been fulfilled. This contrasts to the presence of endomysial antibodies in 46 percent of confirmed and 17 percent of suspected celiac patients maintained on a gluten-free diet for various time intervals. Endomysial antibodies also occurred in all cases with chronic diarrhea and gut histology consistent with CD and 8% of asymptomatic family members of CD patients. None of the patients with other gastrointestinal and liver diseases had endomysial antibodies. These studies thus emphasize the specificity and sensitivity of endomysial antibodies for celiac disease.

Serum antibodies to cow's milk proteins in pediatric inflammatory bowel disease: Crohn's disease vs. ulcerative colitis

Serum antibodies to five cow's milk proteins, alpha-casein, bovine serum albumin (BSA), beta-lactoglobulin A and B (BLG-a, BLG-b) and alpha-lactalbumin (ALA) were investigated in young patients with inflammatory bowel disease, 56 with Crohn's disease (CD), 24 with ulcerative colitis (UC). IgG antibodies against BSA and BLG-a and -b were higher in Crohn's disease patients as compared to those with ulcerative colitis and controls. The IgG anti-BSA were higher in the group of CD patients with higher score of disease activity. Additionally, IgA antibodies to alpha-casein were higher in CD and UC compared to control. These findings may be due to increased uptake of dietary antigens or enhanced immunological response occurring in CD patients.

Relationship of endomysial antibodies to jejunal mucosal pathology: specificity towards both symptomatic and asymptomatic celiacs

Serum immunoglobulin A class antibodies reactive to the endomysial lining of the smooth muscle bundles of the gastrointestinal tract have recently been reported to be specific and sensitive indicators of celiac disease (CD). A total of 203 subjects were examined for serum endomysial antibodies (EmA) and in 103 small bowel biopsies were obtained. EmA were detected in 43 cases including 26 CD patients evaluated during the gluten challenge phase of diagnosis by European Society for Pediatric Gastroenterology and Nutrition criteria, 11 of 53 symptomatic patients, and 6 asymptomatic family members. All patients with detectable antibody at the time of biopsy exhibited grade III-IV villous atrophy. Disaccharidase activities performed in 19 cases revealed severe deficiencies. EmA were not detected in 160 subjects including 42 infants and children with chronic nonspecific diarrhea. Eighteen of these possessed grade II-III villous atrophy with moderate disaccharidase deficiency and 24 were found to have normal histology and enzymes. The EmA were also not detected in 3 CD patients who were well maintained on a gluten-free diet for greater than 1 year and 25 asymptomatic family members exhibiting normal histology and enzymes. An additional 90 infants and children with other gastrointestinal and liver diseases were also negative for the serum EmA. Fourteen of these patients underwent biopsies and were demonstrated to have normal histology.

Antigliadin antibodies detected by enzyme-linked immunosorbent assay as a marker of childhood celiac disease

Using an enzyme-linked immunosorbent assay (ELISA) assay, we studied the sera of 17 patients with celiac disease and 114 control subjects for the levels of IgG and IgA antigliadin antibodies. As a group, the patients with celiac disease had significantly higher levels of antigliadin antibodies of both IgG and IgA classes (p less than or equal to 0.001). However, there was a significant overlap of values, resulting in respective sensitivities and specificities of 88% and 90% for IgG antigliadin antibodies, and 73% and 65% for IgA antigliadin antibodies. The combined use of both IgG and IgA antigliadin antibody levels produced a sensitivity of 86% and a specificity of 90%. A gluten-free diet in celiac patients did not seem to affect these results. We conclude that the antigliadin antibody ELISA assay cannot be used as a definitive diagnostic test for celiac disease. The small-bowel biopsy remains the principal diagnostic method; the ELISA assay should, at best, be considered a screening test for this disease.

Juvenile acid maltase deficiency presenting as paravertebral pseudotumour

In addition to the infantile lethal form of glycogen storage disease with cardiomyopathy (GSD Type IIa, Pompe disease) 1,4 glucosidase or acid maltase deficiency has been reported in a few children and adults (GSD Type IIb or IIc) erroneously thought to have muscular dystrophies. The clinical heterogeneity of the muscle involvement in these latter cases is illustrated in a 12-year-old boy presenting with a right lumbar mass, growth retardation, muscular weakness including difficulty in walking, and marked elevations of muscle and liver enzymes. Light- and electron-microscopic examination of specimens from the lumbar mass, apparently normal skeletal muscle and liver, showed typical changes consistent with the biochemical and enzymatic features of acid maltase deficiency. GSD Type IIb and IIc are more frequent than suspected, may present as local pseudohypertrophy and should be considered in patients with progressive muscle disease and abnormal serum enzymes.

Cyclic AMP concentrations modulate both calcium flux and hydrolysis of phosphatidylinositol phosphates in mouse T lymphocytes

Activation of T cells by lectins or mAb directed at components of the Ag-specific TCR results in hydrolysis of phosphorylated derivatives of phosphatidylinositol and an increase in intracellular free calcium concentration (Cai). We report that cholera toxin, which activates adenylate cyclase by ADP ribosylation of a G protein, also reduces both inositol phosphate (IP) production and the rise in Cai in Con A-stimulated murine T cells. We find that similar dose-dependent inhibitory effects can be induced by each of four other agents that raise cAMP levels in such cells: forskolin, PGE2, 2-chloroadenosine, and isoproterenol. The effects of these agents on IP production are reversible and therefore do not simply reflect cytotoxicity. Activation by PHA and by antibody to the T3-epsilon-chain of the TCR complex are also inhibited by agents that increase intracellular cAMP. Thus, changes in cAMP concentration seem to regulate both IP production and the Ca2+ response, two early components of the mitogen-induced activation process.

Cyclic AMP concentrations modulate both calcium flux and hydrolysis of phosphatidylinositol phosphates in mouse T lymphocytes

Activation of T cells by lectins or mAb directed at components of the Ag-specific TCR results in hydrolysis of phosphorylated derivatives of phosphatidylinositol and an increase in intracellular free calcium concentration (Cai). We report that cholera toxin, which activates adenylate cyclase by ADP ribosylation of a G protein, also reduces both inositol phosphate (IP) production and the rise in Cai in Con A-stimulated murine T cells. We find that similar dose-dependent inhibitory effects can be induced by each of four other agents that raise cAMP levels in such cells: forskolin, PGE2, 2-chloroadenosine, and isoproterenol. The effects of these agents on IP production are reversible and therefore do not simply reflect cytotoxicity. Activation by PHA and by antibody to the T3-epsilon-chain of the TCR complex are also inhibited by agents that increase intracellular cAMP. Thus, changes in cAMP concentration seem to regulate both IP production and the Ca2+ response, two early components of the mitogen-induced activation process.

Nutritional assessment of children with short-bowel syndrome receiving home parenteral nutrition

Serial nutritional assessments using arm anthropometry, computed tomography of the thigh, and serum biochemical indexes during an eight-month period were performed on nine children with short-bowel syndrome receiving home parenteral nutrition. The mean patient age at the beginning of the study was 3.0 years. In anthropometric measurements, the mean body weight of our test population did not deviate from that of the normal population. Most patients were below the normal median for height. The mean midarm muscle area was 114% of the normal median, and the mean midarm fat area was 98% of the normal median. The mean weight and height velocities were 148% and 122% of the standard, respectively. Retinol-binding protein values, albumin levels, and total lymphocyte counts of the patients were low, while levels of aspartate aminotransferase and alanine aminotransferase were slightly elevated. Midarm muscle and fat compartment sizes were highly correlated with thigh muscle and fat compartment sizes, as demonstrated by computed tomography. Our results demonstrate that children with short-bowel syndrome receiving home parenteral nutrition can maintain normal growth characteristics and extremity compartment sizes.

Response to cosmetic disfigurement: patients with vitiligo

Vitiligo presents an excellent opportunity to focus on the effect of impaired appearance on the lives of persons with this disease. We questioned 326 patients with vitiligo and obtained an overview of how they perceived others' reactions to them, their own reactions to the disease, and their experiences with physicians. Many patients are frightened and embarrassed by vitiligo, experience discrimination from others, and believe that they do not receive adequate support from their doctors. Implications of these findings for patient care are presented.

Intestinal mucosa in nephropathic cystinosis

The major manifestations of nephropathic cystinosis are renal tubular acidosis, vitamin D-resistant rickets, and dwarfism. Cystine crystals are deposited in a variety of cells, mainly phagocytic, including macrophages of the intestinal lamina propria. Previously, ultrastructural changes were suggested to occur in the absorptive epithelium as well, possibly as a result of local cystine toxicity. We report here on the light- and electron-microscopic findings in the jejunal mucosa of two patients, aged 4 and 9 years with nephropathic cystinosis. Cystine crystals were easily identified in semithin sections of plastic-embedded specimens as brick- and hexagon-shaped spaces in macrophages. Electron microscopy showed that all crystals were in single-membrane-limited bodies (lysosomes), within phagocytic cells, and exclusively located in the lamina propria. In contrast to previous findings, the absorptive epithelium showed no abnormalities. We conclude that the growth failure in cystinosis is not a consequence of morphological toxic alterations in the intestinal epithelium, but is related to the known metabolic abnormalities of this condition. The use of rectal suction biopsy as a means of diagnosing cystinosis is also suggested as an alternative to other diagnostic methods.

Comparative studies of different gliadin preparations in detecting antigliadin antibodies

Antigliadin antibodies (AGA) have been used as indicators of celiac disease. The presence of these antibodies in other gastrointestinal and liver disorders and even in normal healthy controls casts a shadow on the diagnostic significance of AGA. We examined 91 normal controls of varying ages and 97 patients with various gastrointestinal and liver disorders. Forty-eight of 97 nonceliac patients were positive for AGA, and diagnosis-specific incidences ranged as high as 75% in patients with small bowel disease. In addition, the levels of AGA were dependent upon age as their presence increased from 12% in children with a mean age of 10, to 35-40% in normals within the 60-70 age group. The lack of celiac disease specificity of AGA was not due to either the source of gliadin nor to the sensitivities of the test methods. Both the enzyme-linked immunosorbent assay (ELISA) and the immunofluorescence methods gave comparable results. ELISA was more sensitive than immunofluorescence. These results thus strongly suggest that AGA are not markers of celiac disease and increase with age in normals.

Effect of nutritional rehabilitation on the development of intestinal brush border disaccharidases of postnatally malnourished weanling rats

The reversibility of the effects of postnatal malnutrition on the intestinal brush border enzymes and somatic and intestinal weights were examined using either ad libitum or restricted feedings. Malnutrition was induced in the immediate postnatal period by expanding newborn rat litters to 20 pups/dam. At 21 days of age, malnourished pups exhibited significantly decreased body and intestinal weights as compared to those from control litters. Malnourished pups also had significantly elevated lactase specific activities whereas sucrase and maltase activities were not affected in the proximal small intestine. With subsequent nutritional rehabilitation by an ad libitum (food available 24 h/day) or restricted feeding regimen (food available 2 h/day), body and intestinal weights remained significantly depressed by 56 days in malnourished as compared to control animals. Rats on 2-h feedings consumed approximately 35% of the food consumed by their ad libitum-fed counterparts. Comparison of the ratio of weight gained to the amount of food consumed did not demonstrate a greater food efficiency with any particular feeding pattern. With ad libitum or restricted feedings, lactase specific activity in the proximal segment attained control values by 14 days. Restricted feedings resulted in an apparent elevation of specific activity of sucrase and of maltase, when rats were sacrificed at one chosen time point. Multiple time studies in a 24-h cycle showed that maximal elevations in enzyme activities were associated with feeding time. There were no significant differences in mean specific daily enzyme activities between the two feeding regimens. Restricted feedings show no advantage in enzyme efficiency or in promoting the rate of recovery of the intestine after postnatal malnutrition.

Psychosocial effect of vitiligo: a comparison of vitiligo patients with "normal" control subjects, with psoriasis patients, and with patients with other pigmentary disorders

To ascertain the psychosocial effects of vitiligo, patients with vitiligo were compared with control subjects without skin diseases who were matched for age, sex, race, educational level, and marital status. Vitiligo patients were also compared with a matched sample of psoriasis patients and a matched sample of patients with other pigmentary disorders involving discoloration. The vitiligo patients scored lower on the Coopersmith Self-Esteem Inventory than did the "normal" control subjects. Vitiligo patients exhibited better adjustment to their disorder and experienced less social discrimination than did psoriasis patients, although the two groups did not differ on overall self-esteem. Patients with vitiligo did not differ significantly from those with other pigmentary disorders on any measure.

Computed axial tomographic scanning of the thigh: an alternative method of nutritional assessment in pediatrics

In this study we compared the findings of computed axial tomographic (CT) scanning of the thigh with the findings of arm anthropometry and urinary creatinine determinations to assess nutrition in children with inflammatory bowel disease receiving total parenteral nutrition. All 14 children received our standard solution for total parenteral nutrition as well as prednisone and sulfasalazine (Azulfidine) therapy. All patients were assessed by arm anthropometry, 24-hour urine collections for creatinine clearance, and CT scanning of the thigh during total parenteral nutrition. Arm muscle and fat area were estimated by anthropometry, and those in the thigh were estimated by CT scanning. Our results show the total muscle area from the CT scan can predict muscle mass calculated from the urinary creatinine excretion rates. In addition, there is a close correlation between the thigh muscle area as measured by CT scanning and the muscle area calculated from urinary creatinine excretion rates. In addition, the comparison of thigh muscle area and thigh fat area to the midarm muscle area and midarm fat area, respectively, showed that the thigh is a better predictor of muscle than fat in the midarm. We conclude that the total thigh muscle area is a better predictor of muscle mass as compared to the midarm muscle area. In addition, the CT scan cut at the level of the thigh in children and adolescents with inflammatory bowel disease can provide valuable information about the thigh compartment and analyses of different cross-sectional areas of the thigh.

Comparison of coaxial and side-by-side double lumen subclavian catheters with the single lumen catheter

Subclavian catheters are increasingly being used for vascular access. Many double lumen catheters (DLCs) have been designed to alleviate the need for a single-needle machine. Clinical studies comparing the safety of various DLCs with single lumen catheters (SLCs) are scarce. This study compares our experience with Sh-SLCs (Single-Shiley), Vas-DLCs (Coaxial-Vascath), and Qu-DLCs (Side-by-Side, Quinton). Similar aseptic insertion and handling techniques were used. The catheters were filled with heparin at the end of dialysis (HD) and no interdialytic infusions were given. Fifty-two Sh-SLCs were inserted in 46 patients for 253 HDs, 71 Vas-DLCs in 47 patients for 185 HDs, and 51 Qu-DLCs in 38 patients for 215 HDs. HDs/catheter were 4.9, 2.6, and 4.2, the percent incidence of septicemia was 2%, 7%, and 0%, and the catheter failure was 11%, 48%, and 16% for Sh-SLCs, Vas-DLCs, and Qu-DLCs, respectively (P less than 0.05 Vas-DLC v Sh-SLC and Qu-DLC). The poor flow problems were more frequent on the left side with Vas-DLCs (16/31) and Qu-DLCs (7/17), but not with Sh-SLCs (2/25). Other major complications were not noted. These results suggest that infections and mechanical problems may be more frequent with Vas-DLCs than Sh-SLCs and Qu-DLCs. Use of Qu-DLCs is a safe and may be preferred since a single-needle machine is not required. Insertion of a DLC on the right side may be preferred due to higher mechanical problems on the left side.

Acute starvation and suckling rat pancreas. Effect on exocrine pancreas and role of corticosteroids

Starving of rat pups at the 5th or 10th day of life for three days led to lower body and pancreatic weights compared to age-matched controls. When compared to the weights before fasting, only the 5-day-old pups showed increases in pancreatic protein and DNA contents despite food deprivation. Pancreatic acinar responsiveness to carbachol stimulation was not affected. Accumulations of amylase and lipase in the pancreas of the rat pups were increased by fasting, with an accompanied surge in the level of serum corticosterone. In 10-day-old rat pups, injection with aminoglutethimide (AG), a drug which suppresses steroidogenesis, prevented the enzymatic increases and concomitantly suppressed the serum total corticosterone levels at 12 and 24 hr after the onset of fasting. These results strongly support the role of corticosterone in the modulation of the pancreatic adaptation to food deprivation in the suckling rat.

Characterization of a novel Burkitt's lymphoma-associated antigen: GP70. Reactivity of anti-GP70 antibodies with various malignant and non-malignant cell lines

A glycoprotein of 70 kDa (GP70) was isolated from sera of Burkitt's lymphoma (BL) patients and used to immunize rabbits. Anti-GP70 antibodies at a high titer were obtained and used for screening of cancer cells of various origin by the indirect immunofluorescence test. Thus, 66% of BL-cell lines tested were positive to GP70. On the other hand, all lymphoblastoid cell lines tested were negative. Moreover, all peripheral blood cells and mononuclear cells from tonsils were negative, indicating specificity of antibodies to malignant transformation. Comparison between positively stained BL-cell lines indicated no correlation between the presence of GP70 and EBNA. Positive stain (1-5%) obtained with bone marrow cells might indicate that anti-GP70 antibodies are directed against a surface membrane differentiation glycoprotein.

Increased serum antibody levels against cow's milk proteins in children with chronic liver disease

We measured IgG, IgM and IgA antibodies to cow's milk proteins: alpha-casein, alpha-lactalbumin, bovine serum albumin, beta-lactoglobulin-a and beta-lactoglobulin-b in the sera of 29 pediatric patients with liver disease. IgG antibodies to bovine serum albumin, beta-lactoglobulin-a and beta-lactoglobulin-b and IgA antibodies to alpha-casein were elevated in most of the patients compared to age-matched controls. We postulate that, in patients with liver disease either increased intestinal uptake resulting in increased humoral response, or decreased hepatic clearance of food antigens intensifying a humoral response to these foreign antigens, may occur.

Development of a novel C1q immunoadsorbent for removal of circulating immunecomplexes: quantitative isolation of hepatitis B virus surface antigen and immunecomplexes

A technique for large scale production of human C1q from plasma by affinity chromatography on an anti-C1q column is described. Affinity purified C1q was covalently coupled to a newly developed agarose polyacrolein microsphere beads immunoadsorbent. This immunoadsorbent was utilized for quantitative removal of artificially formed bovine serum albumin (BSA)-anti-BSA immune complexes (IC). The C1q affinity column was then used for the isolation of immunecomplexes containing hepatitis B virus (HBV) surface antigen (HBsAg) from serum of an HBsAg carrier. Identical columns may be utilized for quantitative removal of a variety of IC from blood of patients with infectious and autoimmune diseases, as well as neoplastic diseases. Furthermore, dissociated immunecomplexes will provide an additional source for purification of specific antigens.

Subgroup analysis of BL-cell lines with polyclonal BL-specific antibodies

A Burkitt's lymphoma (BL)-specific antibody (anti-GP70), previously described, was used to analyse 22 different BL-cell lines. The results indicated specificity of antibodies to lines that contain both surface membrane Ig (SmIg) and cytoplasmic Ig (CyIg). BL-cell lines derived from more immature B cells that do not have SmIg but rather have only CyIg were negative. A comparative study with antibody to common ALL antigen (CALLA) and to another BL-specific antigen (BLA) revealed coexpression of GP70 with those two antigens, but no identity between them.

A CT sign: the "disappearing mass" as a clue to the diagnosis of intermittent intestinal intussusception in children

During the course of evaluation of a child with recurrent abdominal pain, a mass lesion was noted on computed tomography of the abdomen. This mass lesion was not evident within 30 min of the finding. Child was subsequently diagnosed to have intussusception. A "disappearing mass" lesion may therefore be a manifestation of recurrent intussusception.

Chemical adrenalectomy by aminoglutethimide and the pancreas in suckling rats

The role of corticosterone in the development of pancreatic enzymes of suckling rats was studied through a partial and transient blockade of steroidogenesis by aminoglutethimide. Rats were injected with aminoglutethimide the night before their 14th day of age. Ten hours later they showed a transient decrease of serum total corticosterone level as compared with rats injected only with the vehicle. At 34 and 58 h after injection, their corticosterone levels returned to that of control rats. Pancreatic weight, protein, DNA contents, and total activities of amylase, lipase, and trypsinogen were depressed only in the aminoglutethimide-treated pups 34 h after injection. These pancreatic parameters returned to the control level 58 h after injection. Hydrocortisone given to another group of rats completely abolished the effect of aminoglutethimide on the pancreas. Thus, a transient suppression of serum corticosterone level caused a delay in the developmental accumulation of pancreatic exocrine enzymes that resumed only after the serum corticosterone returned to the control level. These results further confirm that corticosterone is an important modulator of pancreatic enzyme development in the rat.

Rhesus isoimmunization in twin gestation

The incidence of Rh isoimmunized twin gestation is extremely low. There are several perinatal risks inherent to twinning. Rhesus isoimmunization further increases hazards of such a compromised gestation. This paper reports three cases of rhesus isoimmunization in twin gestation, discusses the selective problems of such pregnancies, and reviews the pertinent literature.

A new variant of glycogen storage disease. Type IXc

Three siblings, a body and two girls, had clinical, laboratory, and morphologic findings that were suggestive of glycogen storage disease (GSD) type IXa. Patients of both sexes with phosphorylase kinase (PK) deficiency usually have an excessive glycogen content only in the liver and normal glycogen content and PK activity in muscle. The siblings in this study had an increased glycogen content in the liver but also in muscle and reduced PK activity in liver, muscle, erythrocytes, and leukocytes. This condition should be labeled as GSD type IXc.

Genetic and hormonal characterization of cryptic 21-hydroxylase deficiency

Cryptic 21-hydroxylase deficiency has been previously described in asymptomatic family members of patients with classical congenital adrenal hyperplasia (CAH). These family members were detected by high baseline 17-hydroxyprogesterone levels found in the course of family studies. The hormonal responses to ACTH of the family members with cryptic 21-hydroxylase deficiency were determined and compared to the responses of patients with CAH, patients with acquired adrenal hyperplasia, family members predicted to be heterozygous for CAH, family members predicted to be unaffected, and the general population. The ACTH-stimulated levels of 17-hydroxyprogesterone and delta 4-androstenedione in the cryptic family members were elevated above the level of the general population or family members heterozygous for classical CAH, but below that of patients with CAH. The hormonal profile of patients with cryptic 21-hydroxylase deficiency is similar to that of patients with acquired adrenal hyperplasia. The response of family members heterozygous for the cryptic gene (21-OH CRYPTIC/21-OH NORMAL) was indistinguishable from that of family members heterozygous for the classical CAH gene (21-OH CAH/21-OH NORMAL). These studies support our previous proposal that patients with cryptic 21-hydroxylase deficiency are genetic compounds, having one gene for a severe enzyme deficiency and one gene for a mild 21-hydroxylase deficiency. Thus, the 21-hydroxylase genotype in cryptic 21-hydroxylase deficiency is 21-OH CAH/21-OH CRYPTIC.

Glycogenosis due to liver and muscle phosphorylase kinase deficiency

A four-year-old Israeli Arab boy was found to have glycogen accumulation in both liver and muscle without clinical symptoms. Liver phosphorylase kinase (PK) activity was 20% of normal, resulting in undetectable activity of phosphorylase a. Muscle PK activity was about 25% of normal, resulting in a marked decrease of phosphorylase a activity. Two sisters showed a similar pattern, whereas one brother had normal PK activity. The patient's liver protein kinase activity was normal Addition of exogenous protein kinase did not affect PK activity, whereas exogenous PK restored phosphorylase activity to normal. These findings indicate that these patients are affected by a rare variant of PK deficiency, which involves both muscle and liver and which apparently is not sex linked. It is possible that this defect represents an unusual mutation of a subunit of the phosphorylase kinase enzyme.

Cryptic 21-hydroxylase deficiency in families of patients with classical congenital adrenal hyperplasia

Serum androgens and 17-hydroxyprogesterone concentrations and HLA genotypes were determined in 124 families of patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH). In 8 pedigrees, we discovered 16 pubertal or postpubertal family members of either sex who had biochemical evidence of 21-hydroxylase deficiency but were without clinical symptoms of excess virilism, amenorrhea, or infertility. We designated these family members as individuals with cryptic 21-hydroxylase deficiency. Within each generation, the family members with cryptic 21-hydroxylase deficiency were HLA identical. It is proposed that these family members are genetic compounds, having 21-hydroxylase deficiency as a result of two recessive gene defects: 1) a severe 21-hydroxylase gene defect present in the index case with classical CAH (21-OHCAH) and 2) a mild 21-hydroxylase gene defect (21-OHCRYPTIC). Thus, the CAH genotype in the family members with cryptic 21-hydroxylase deficiency is 21-OHCAH/21-OHCRYPTIC. Lod score analysis for linkage between the cryptogenic 21-OH trait and HLA gave a combined Lod score for males and females of theta = 0.00 of 3.409. Close genetic linkage between HLA and 21-OHCRYPTIC was thus established. This study provides support for the previously reported heterogeneity of 21-hydroxylase deficiency which may result from allelic variability at the locus for steroid 21-hydroxylase.

Gastrointestinal bleeding: treatment with intra-arterial vasopressin

Seventeen patients with upper and lower gastrointestinal hemorrhage were treated with selective intra-arterial continuous vasopressin infusion. 62.5 per cent of variceal and 60 per cent of nonvariceal episodes of hemorrhages were permanently controlled by vasopressin. The initial total success rate was 76.5 per cent. No major complications occurred. Early success with this technique has encouraged its continued use under a controlled setting for indications for its use to be evaluated.