Fatty acyl coupled catalase

Bovine liver catalase (hydrogen-peroxide:hydrogen peroxide oxidoreductase, EC 1.11.1.6) was derivatized by 9"(10")-[4'-(2-(4,6-dichloro-1,3,5-triazinyl) oxy)butoxy] stearic acid and the fatty acyl-coated enzyme was separated from native catalase and excess reagent by hydroxyapatite chromatography. The derivatization of catalase resulted in coupling the long-chain fatty acyl residues to lysine, histidine and arginine, while other amino acids remained essentially unaffected. The fatty acyl-coated enzyme was water soluble at pH greater than 7.0 but became octanol and ether soluble at pH less than 6.5. The derivatized enzyme retained 50-80% of the catalatic- and peroxidative-specific activities. The free carboxyl function of the coupled long-chain fattyl acyl residues could serve as substrate for ATP-dependent CoA-thioesterification catalyzed by the rat liver microsomal long-chain fatty acyl-CoA synthase.

Combined treatment of osteosarcoma of the spine

We reviewed the clinical features and results of treatment in 24 patients with osteogenic sarcoma of the spine treated over a 35-year period. There were 14 male and 10 female patients 13 to 71 years old. The tumor arose de novo in 13 patients and was secondary to other conditions in 11. All patients presented with pain, and 16 (67%) had neurological deficits. Patients were divided into two treatment groups. Thirteen patients treated from 1949 to 1977 usually underwent limited tumor resection and external radiation therapy. The second group, 11 patients treated from 1978 to 1984, underwent more aggressive surgical resection and received combination chemotherapy as well as local radiation to the tumor bed. In the second group, there were 5 long term survivors, and only 1 patient developed metastatic disease while on therapy. Failure to obtain local control was the major cause of treatment failure. Complete surgical resection of the tumor by spondylectomy and combination chemotherapy offer the best prospect for cure of osteogenic sarcoma of the spine.

Persistence of human leishmanial antibodies in an endemic area of visceral leishmaniasis in El Agamy, Egypt

In an endemic area of visceral leishmaniasis (VL), individuals with leishmanial antibodies that reacted in the radioimmunoassay (RIA) were retested to determine duration of leishmanial antibody retention. One fourth of adults retained antibodies for at least 10 months. At least 2/3 of asymptomatic children retained leishmanial antibodies for 5 to 7 months after detection. 2/3 of children treated for VL retained leishmanial antibodies for 5 to 7 months after treatment, while 1/3 retained antibodies for over a year. These data modify conclusions that can be drawn from a single serosurvey. Since leishmanial RIA antibodies can persist in humans for at least two transmission seasons, incidence estimates require serial serosurveys.

Immunosuppressive medication associated with leishmanial antibodies in adults residing in an endemic focus of infantile visceral leishmaniasis--a case/control study

In a focus of infantile visceral leishmaniasis in Al Agamy (Alexandria), Egypt, adults were found by radioimmune assay to have leishmanial antibodies. This finding was unexpected, and an explanation was sought. Seropositive adults and age- and sex-matched seronegative controls were interviewed to ascertain possible predisposing risk factors. Ten of 16 seropositive individuals were taking corticosteroids compared to one of 22 seronegative individuals (P = 0.0002). Two seropositive individuals (one woman and one man) were taking phenylbutazone, and two women were taking female sex hormones. The association between immunosuppressive medication and leishmanial seropositivity suggests that acquired changes in host population immunocompetence may significantly alter age-specific seroprevalence of leishmanial antibodies.

The epidemiology of human visceral leishmaniasis in El Agamy (Alexandria Governorate), Egypt: serosurvey and case/control study

In Alexandria Governorate, Egypt, 27 cases of visceral leishmaniasis (VL) were detected from 1982-1985 through active and passive case detection. Twenty-two were located in El Agamy, a resort town of 50,000 residents located 15 km west of the City of Alexandria. To describe the disease focus, eight areas of 100-200 households in El Agamy were mapped and censused. All individuals were examined clinically, and blood was obtained by finger stick to measure leishmanial antibodies by radioimmune assay. Two case/control studies were carried out in the mapped areas. In one study, case households were more often found near open garbage containers than were control households. In a second case/control study, houses with cases of VL or seropositive individuals were found more likely to face open areas. These results demonstrate that characteristics of houses which could increase exposure to reservoir hosts can be associated with VL or leishmanial seropositivity. This suggests that control programmes should improve garbage disposal and should focus on houses located in peripheral areas of the community.

Dot-ELISA, a potential immunoassay for the detection of Plasmodium falciparum antibodies

The dot enzyme-linked immunosorbent assay (dot-ELISA) was compared to the indirect immunofluorescent assay (IIFA) and radioimmunoassay (RIA) for the detection of malaria antibodies. Of 281 sera tested by dot-ELISA, 220 were from Ethiopia, 11 from the Sudan, and 50 from Egypt. A close correlation between the dot-ELISA and RIA results was observed in 92% of the 220 Ethiopian cases. Of the remainder, 6% gave positive RIA and negative dot-ELISA results, and 2% gave positive dot-ELISA and negative RIA results. Antibody titres determined by dot-ELISA and RIA were positively correlated in 10 of the 11 Sudanese cases tested by direct microscopical examination. The eleventh case was positive by dot-ELISA at 1:1000 dilution, but negative by RIA and direct examination. With the 50 Egyptian sera, the dot-ELISA results showed close correspondence to the IIFA results, but the dot-ELISA was 20-40 fold more sensitive than the IIFA. To test specificity, 62 samples from patients with 11 different diseases and conditions were examined by dot-ELISA. No malaria antibodies were detected in any of these or in sera from healthy controls. Dot-ELISA is a potentially useful method for sero-epidemiological studies of malaria.

Rhabdomyosarcoma of the trachea

A 12-year-old girl was admitted on two occasions to our department because of severe dyspnoea, necessitating emergency tracheostomy. On the second admission, a lateral neck X-ray demonstrated a globular tumour which was found to be an embryonal rhabdomyosarcoma. The patient received post-operative radiation therapy followed by two years of continued chemotherapy. She is now five years post diagnosis and requiring no further therapy for about three years and her condition remains in remission.

Primary osteosarcoma of toe phalanx: first documented case. Review of osteosarcoma of short tubular bones

A case of a sclerosing variant of osteosarcoma of a toe phalanx is reported in a 28-year-old man. This represents the first reported case of osteosarcoma of any kind at this site. This is based on a review of 4,214 cases of conventional osteosarcoma. The reason for the extraordinary rarity in toe or hand phalanges is unknown although osteosarcoma is the second most common primary tumor of bone. Since the neoplasm had minimal signs of cytologic anaplasia, it was originally mistaken for and treated as an osteoid osteoma. The lesion recurred and extended into soft tissues. Reevaluation revealed the tumor to be an osteosarcoma, sclerosing variant with "normalization" of nuclei. The lesions that this tumor should be distinguished from are osteoid osteoma and osteoblastoma.

Preradiation high-dose intravenous methotrexate with leucovorin rescue for untreated primary childhood brain tumors

Although high-dose intravenous (IV) methotrexate (MTX) with leucovorin rescue (HDMTX) is effective for certain recurrent primary brain tumors, concern for inducing leukoencephalopathy has restrained its use as adjuvant therapy following therapeutic brain irradiation (RT). We have conducted a phase I to II clinical trial using four biweekly courses of HDMTX (8 g/m2) in a neoadjuvant setting in ten patients with newly diagnosed high-risk pediatric primary brain tumors. Four patients experienced an objective response after two to four courses of HDMTX alone (medulloblastoma, one; pineoblastoma, one; malignant cerebral astrocytoma, two). All ten patients subsequently received a course of therapeutic RT, and in seven cases, adjuvant chemotherapy with other agents. One patient acquired an acute transient encephalopathy before RT that completely resolved, and another developed a seizure disorder following RT associated with white matter abnormalities on a magnetic resonance imaging (MRI) scan. Five patients have survived a minimum of 33+ months, and four remain in continuous remission. The acute and delayed neurotoxicity of neoadjuvant HDMTX is acceptable, and we favor further use of this neoadjuvant approach in the context of a phase III trial.

Cell-mediated responses and protection elicited by a carbohydrate-lipid-containing fraction extracted from Leishmania major promastigotes

Carbohydrate-lipid-containing fractions (CLF) extracted from Leishmania major promastigotes and recognized by sera from immune but not from normal human donors were evaluated for their capacity to elicit cell-mediated responses. It was found that one of these fractions, CLF-1, stimulated the in vitro response of lymphocytes from immune but not from normal human donors. A similarly extracted fraction from L. donovani parasites also elicited an in vitro response by cells from donors immune to L. major. The response was mediated by antigen-presenting cells, and specific Leu 3+ Leu 2- T cells from a human T-cell line responded to the antigen. In vivo, the CLF-1 elicited delayed-type hypersensitivity (DTH) response in L. major-immunized C3H mice, which was comparable to the DTH response elicited by freeze-thawed and sonicated L. major promastigotes. C3H mice were vaccinated with CLF-1 prior to challenge with live L. major promastigotes. Mice vaccinated with CLF-1-containing liposomes showed a significant degree of protection to challenge. These results suggest that the carbohydrate-lipid-containing fraction described here may represent a functional antigenic entity from Leishmania parasites.

Leishmania major: glycolipid antigens recognized by immune human sera

Extraction of whole promastigotes with a mixture of hexane-isopropanol yielded two carbohydrate-lipid fractions immunologically active against immune sera from patients with cutaneous leishmaniasis (CL): CLF-1 and CLF-2. Thin layer chromatography (TLC) separated both fractions into eight bands labeled A-H. Four of these bands, Rf 0.19, 0.25, 0.39 and 0.48 (A, B, C and E, respectively) were recognized by antibody from patients with CL in a solid phase radioimmunoassay. Antigens were also detected by autoradiography after immunoblotting of TLC. Compound A could be labeled biosynthetically with [3H]oleic acid, [14C]galactose, [14C]mannose, [14C]glucose and [32P]phosphate. B incorporated [14C]galactose, [14C]mannose, [14C]glucose and [14C]myo-inositol. C was labeled with [14C]galactose and [14C]mannose, while E incorporated [14C]glucose, [14C]mannose, [3H]oleic acid and [14C]myoinositol. Two antigens (A and B) could be also labeled on the surface of living promastigotes using galactose oxidase and [3H]sodium borohydride. Experimental data showed that CLF-1 and CLF-2, both carbohydrate-containing fractions, had different chromatographic patterns from excreted factor (EF), a polysaccharide antigen from Leishmania. The present study characterizes glycolipid molecules from L. major promastigotes, able to stimulate the immune system from patients with CL.

Correlation between chlamydia infection and clinical evaluation, vaginal wet smear, and cervical swab test in female adolescents

Vaginal wet smear, endocervical swab test, gynecologic examination, and history were investigated in 148 healthy female adolescents. Cultures for Chlamydia trachomatis were obtained from all patients. The overall prevalence was 19/148 (13%). No significant correlation was found between chlamydia infection and any of the parameters investigated in the wet smear. Results of swab test or history showed no discrimination between young women with cultures positive for C. trachomatis and those with cultures negative for C. trachomatis. Chlamydia was found in 32% of patients when the gynecologic examination showed signs of infection and in 10% when no signs of infection were seen (p less than 0.025). Thirteen of the 19 (70%) adolescents with chlamydia infections had no signs of infection. We conclude that neither swab test, vaginal wet smear, nor the history of the patient can give conclusive evidence of a chlamydial infection. Detection of C. trachomatis in this population can be done only by culture or other specific methods.

Characterization of lipidous antigens derived from erythrocytes infected with Plasmodium berghei

A lipid extract obtained from reticulocyte membranes of Plasmodium berghei-infected rats showed antigenic activity against sera from convalescent or immune rats. Following chromatography on silicic acid column, 85% of the activity was recovered from the column with chloroform:methanol (1:3, vol/vol). The active fraction was further resolved by thin layer chromatography (TLC) into four lipid components, two sugar-containing components and two phosphorous-containing components, but neither the individual components nor various combinations of the components showed antigenic activity after elution from the TLC plate. The immunological activity was not affected by phospholipase A2 treatment.

Auditory brainstem evoked potentials in sudden deafness

Auditory Brainstem Evoked Potentials (ABEP) were recorded from 53 adult subjects suffering from sudden deafness at the time of examination. The onset of sudden deafness was up to three years prior to the study. ABEP were recorded in response to 75 dBHL clicks presented at rates of 10/sec and 40/sec. ABEP peak latencies as well as interpeak latency differences, and also the effect of increasing stimulus rate, were determined for each patient and compared with the clinical symptoms. The psychoacoustic and ABEP detection thresholds were also compared. A highly significant correlation was observed between ABEP detection threshold and the psychoacoustically determined hearing threshold, and the differences between them were found to be insignificant. The results of this study indicate a central component in sudden deafness. This impairment manifests itself in abnormal effects of increasing stimulus rate on ABEP, and may be related to reduced central synaptic efficacy.

The feasibility of a Dot enzyme-linked immunosorbent assay (Dot-ELISA) for the diagnosis of Plasmodium falciparum antigens and antibodies

An enzyme-linked immunosorbent assay for rapid detection of malarial antibodies and antigens was developed. Plasmodium falciparum antigen preparation, obtained from sonicated cultures of the parasite at a parasitemia of 10%-15%, was applied to cellulose filter discs in volumes of 0.1 microliter in 96-well microtiter plates. Antibodies were detected by successive incubations with: bovine serum albumin for blocking, tested serum at different dilutions, peroxidase-conjugated antihuman IgG, and the precipitable substrate 4-chloro-1-naphtol. Positive reactions appeared as blue dots on a white background which are easily read by eye. Pools of sera from patients with recent disease or from individuals with a history of malaria, contained antibodies detectable up to a dilution of 1:64,000. Negative results were obtained when normal RBC were used for dotting the filters. Normal sera showed no reaction at any antigen concentration. P. falciparum antigens were detected by their ability to inhibit the binding of antibody to the filters. RBC infected with P. falciparum in vitro can be detected at a level of 0.001% parasitemia. This report presents the feasibility of an assay for detecting malarial antibodies and antigens in blood samples which is easily applicable to field conditions.

Transient cerebral dysfunction secondary to high-dose methotrexate

A transient acute neurologic syndrome occurred in 22 patients receiving high-dose methotrexate (HDMTX) (8 to 9 g/m2) for a variety of malignancies. The neurologic signs were similar in all cases. The syndrome occurred an average of six days after the second or third weekly treatment. Common findings included behavioral abnormalities, focal sensorimotor signs, and abnormal reflexes. Signs often alternated from one side to the other. Evaluations including computed tomography (CT) scan, lumbar puncture, hemogram, and blood chemistry were normal. The EEG revealed some slowing in all cases. The cause of this syndrome is unknown. It is transient and usually does not recur. Its appearance does not preclude further treatment with HDMTX.

Auditory brainstem evoked potentials in asymptomatic lead-exposed subjects

Auditory Brainstem Evoked Potentials (ABEP) were recorded from 29 adults and children, accidentally exposed to lead through food until approximately a year prior to this study. ABEP were recorded in response to 75 dBHL clicks presented at rates of 10/sec. and 55/sec. Average values were calculated for peak latency and for interpeak latency differences. Average values of the effect of increasing stimulus rate were calculated as well. Similar values were calculated for normative child and adult control groups. IPLD(I-III) showed the most significant and recurring results, with longer intervals in lead-exposed children compared with their control group. Increasing stimulus rate, on the other hand, affected the adult lead-exposed subjects more than the children. These results may imply an impairment of the peripheral portion of the auditory system with axonal and myelin involvement. ABEP is suggested as a sensitive detector of subclinical lead exposure effects on the nervous system.

Leishmania major: solid phase radioimmunoassay for antibody detection in human cutaneous leishmaniasis

A radioimmunoassay for the quantitative determination of antileishmanial antibody in sera from patients suffering from cutaneous leishmaniasis was developed. The assay, using as antigen either the soluble fraction from freeze-thawed sonicated Leishmania major (LRC-L137) promastigotes or a carbohydrate-lipid containing fraction obtained by extraction with hexane-isopropanol, was shown to be sensitive and reproducible. The sera of 95 patients were examined. These were from patients with cutaneous leishmaniasis (26 from the Jordan Valley and 13 from Sinai), kala-azar (9), malaria (24), schistosomiasis (10), toxoplasmosis (5), and leprosy (8); controls were 37 normal human sera. No significant antigen dependent differences were observed using sera from cutaneous leishmaniasis patients, although differences in the immunological response were observed between the two populations of these patients. Antileishmanial activity was not detected in sera from patients with malaria, schistosomiasis, or toxoplasmosis. Although sera from leprosy patients crossreacted with the carbohydrate-lipid containing fraction, it was nevertheless more strain specific than freeze thawed sonicated L. major.

Acute bilateral total deafness complicating mumps

While it is well known that mumps is a potential cause of deafness, it is not generally appreciated that it can produce total deafness. The damage is usually unilateral but bilateral disease has been recorded. A case is presented of severe bilateral hearing loss during a mumps epidemic in which, in spite of intensive conventional as well as lesser known therapy, no improvement occurred. In the absence of a successful therapeutic regime it is clearly advisable to intensify immunization in non-developed countries.

Telangiectatic osteogenic sarcoma. Improved survival with combination chemotherapy

Since the inception of adjuvant chemotherapy for osteogenic sarcoma (OS), 25 patients were treated for telangiectatic osteogenic sarcoma (TOS) from 1973 through 1980. This represented 12% of all patients with primary OS of an extremity seen during this time period. Tumors that demonstrated only focal areas of TOS with areas of other subtypes were designated not as TOS but as "mixed" subtypes of OS. In the 25 patients with pure TOS, surgery included 18 amputations and seven resections for the primary tumor. Ten patients were treated on the first chemotherapy protocol (T-4) including high-dose methotrexate (HDMTX) with citrovorum factor rescue (CFR), Adriamycin (ADR), and cyclophosphamide (CYC). Of those 10 patients, five have been free of disease for seven to ten years from the time of diagnosis. Nine patients were treated on the second protocol (T-7) including HDMTX with CFR, ADR, and the combination bleomycin, cyclophosphamide, and dactinomycin (BCD). Six of those nine patients are disease-free survivors 63 to 88 months (median, 63 months) from diagnosis. Six were treated on the third chemotherapy protocol (T-10) including HDMTX with CFR, ADR, BCD, and the substitution of cisplatinum for those not having a complete response to preoperative chemotherapy with HDMTX. All six of the latter are disease-free survivors 42 to 56 months (median, 49 months) from the start of treatment. Toxicity included two HDMTX-related drug deaths in patients started on treatment prior to 1977. Of the entire group, 17/25 (68%) have remained free of disease at a mean follow-up time of over five and one-half years. This study demonstrates that TOS is responsive to chemotherapy and is potentially curable. Some prior reports of the uniformly poor prognosis of this variant of OS should not discourage attempts of curative therapy by chemotherapy and surgery.

Exposure to naphthalene-diisocyanate in a rubber plant: symptoms and lung function

Twenty-three subjects exposed to naphthalene-diisocyanate (NDI, [mean air concentration 0.002-0.007 mg/m3]) were examined with regard to symptoms and pulmonary function. Irritation of the eyes, cough, and exertion dyspnea were more common in exposed subjects than in unexposed controls. Closing volume, as a percentage of vital capacity (CV%), was 6% higher than the reference value (P = .01) on Monday morning after 2 days with no exposure to NDI. The other lung function variables were normal. Two days of industrial exposure caused no further change in any lung function variable. The difference between measured and expected CV% increased with age in the exposed subjects. Five employees who had complained of severe symptoms during NDI exposure and who, therefore, had been transferred to other tasks with no exposure to NDI, displayed marked increases in CV% and a reduction in the forced vital capacity by an average of 0.6 L. Smokers and nonsmokers displayed similar lung function changes.

Combined-modality treatment of osteogenic sarcoma of the skull

The authors present the results of combined-modality treatment in eight patients with osteosarcoma of the skull. Six patients had de novo tumors, and two others had secondary sarcomas resulting from malignant transformation in Paget's disease. Wide surgical excision and combination chemotherapy were used in seven patients, and surgery and radiation therapy were employed in one case. Following chemotherapy, six patients underwent additional surgery. This aggressive approach resulted in four long-term survivors among the patients with de novo tumors. These data suggest that surgery in combination with chemotherapy provides the best potential for long-term disease control in patients with osteosarcoma of the skull.

Surgical management of osteogenic sarcoma of the lower limb

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Preoperative (neoadjuvant) chemotherapy for osteogenic sarcoma: a ten year experience

During the past ten years, (November 1973 through November 1983) 208 patients with fully malignant primary osteogenic sarcoma of an extremity were treated with preoperative chemotherapy on four successive treatment protocols. Continuous improvements in the disease-free survival of patients were attributed to refinements in the chemotherapy regimens. These refinements were made after direct observation of the response of the primary tumor to chemotherapy. At a minimum follow-up time of 36 months for 87 patients treated on the T-10 chemotherapy protocol, 67 (77%) have remained alive and continuously free of disease, and 71/87 (81.6%) are currently free of disease. Of the entire group of 208 patients receiving preoperative chemotherapy, 150 (72%) have remained continuously free of disease, and 158/208 (76%) are currently free of disease from three to 11 years (median five years). The overall complete response rate of the primary tumor to preoperative chemotherapy was 49%. Relapses in 19 patients with tumors about the knee were attributed to local recurrences following en bloc resection. Of the 58 patients undergoing amputation following preoperative chemotherapy, 46/58 (79.3%) have remained alive and continuously free of disease. 23/25 patients (92%) having undergone resection for proximal humerus lesions remain alive and free of disease at this time. There have been no local recurrences for patients having humeral resections. Preoperative chemotherapy has given rise to better chemotherapy regimens, higher cure rates, and the appropriate selection of the best postoperative therapy for patients with osteogenic sarcoma.

Unusual extraosseous tumoral accumulation of 99mTc-MDP

Three cases (rhabdomyosarcoma, lymphoma, and metastatic malignant melanoma) of unexpected increased uptake of methylenediphosphonate labelled by technetium 99m sodium pertechnetate (99mTc-MDP) are described. The possible mechanisms of the extraosseous tumoral accumulation of 99mTc-MDP in these malignancies are discussed. The usefulness of this method for the diagnosis, localization, and follow-up of some extraosseous tumors is evaluated.

The radionuclide diagnosis, evaluation and follow-up of malignant external otitis (MEO). The value of immediate blood pool scanning

A patient suffering from malignant external otitis (MEO) underwent early blood pool scanning followed after 2 hours by 99m Tc MDP bone scanning and serial Ga-67 citrate scintigraphies of the skull. The former two procedures served as a diagnostic tool to MEO. The latter was used for estimating the extent of the infective process and for following-up the efficacy of treatment. The complementary role of these three procedures in the diagnosis and follow-up of MEO, with special emphasis on immediate blood pool scanning as part of the diagnostic procedure, is illustrated.