Vitamin D-dependent rickets type II: report of three cases

In this study the dental findings of three patients with vitamin D-dependent rickets (DDR) type II with alopecia, who were treated with large doses of vitamin D3 derivatives, are described. Dental development that is at or near a normal level can be achieved in controlled patients, permitting routine treatment of carious teeth.

Disappearance of inhibitor to factor IX in a patient with severe haemophilia B and immunological characterization of the inhibitor

Disappearance of an inhibitor to factor IX in an 11-year-old boy with haemophilia B is described. He had been given a total of 14,200 units of a prothrombin complex concentrate (PCC) before an inhibitor to factor IX developed. He subsequently received four separate infusions of PCC and his inhibitor titre rose in response to the treatment for the following 4 years. No inhibitor is presently detected despite repeated administration of PCC. Immunological characterization of the inhibitor by inhibitor neutralization assays, modified crossed-immunoelectrophoresis and enzyme-linked immunosorbent assay demonstrated that it contained IgG2 and IgG4 heavy chains and kappa and lambda light chains. No large deletion of the factor IX gene in the patient was observed using cDNA (cVII).

Hemostatic effect of a heat-treated factor VIII concentrate (Haemate P) in von Willebrand's disease

A heat-treated factor VIII (F VIII) concentrate (Haemate P) has been administered to patients with various types of von Willebrand's disease (vWD). The 4 activities of F VIII/vWF as well as change in the multimeric structure of vWF were then studied. In 4 patients with type I vWF who were given a Ristocetin cofactor (Rcof) dose of 42-78 U/kg, there was a clear reduction of the bleeding time and an increase of F VIII: C, F VIII: Ag, Rcof and vWF: Ag for several hours. The recovery of Rcof. after 1 h was 50-75%. Although the multimeric composition of vWF in these patients was similar to that of normal plasma, the density of each multimer band was very low. After infusion, however, the density of all multimer bands increased for several hours, to decrease again after 24 h. In 4 patients with type II A vWD who received a dose of Rcof of 55-76 U/kg, the 4 activities of F VIII/vWF increased similarly as was the case in type I. All patients had only 3-4 smaller multimer bands. New larger and intermediate multimers appeared for several hours after infusion of the preparation. Two patients with type III vWD who received doses of Rcof of 52 and 65 U/kg showed also a similar increase in the 4 activities of F VIII/vWF after infusion. All the multimers lacking in these patients appeared for several hours after infusion.

In vitro characterization of various factor VIII concentrates

The in vitro properties of 5 heat-treated Factor VIII (F VIII) concentrates were studied and compared with those of conventional non heat-treated concentrates with special reference to F VIII/von Willebrand Factor (vWF) activities. The heat-treated F VIII concentrates were found to contain about 25 U/ml of F VIII: C as indicated on the label, 59.5-103.3 U/ml of F VIII: Ag, 20.0-74.0 U/ml of ristocetin cofactor activity (RCof), and 67.3-96.0 U/ml of vWF: Ag. The F VIII/vWF activities in the heat-treated concentrates were almost the same as those in the 6 non heat-treated concentrates. The antihemophilic factor (AHF)-cryoprecipitate contained 2.3 U/ml of F VIII: C which was roughly equivalent to the amount of F VIII: Ag. In addition, it contained 7.3 U/ml of RCof which was equivalent to the amount of vWF: Ag. The ratio of F VIII: Ag to F VIII: C in the F VIII concentrates ranged from 2.5 to 4.4. The ratio of vWF: Ag to RCof in the concentrates ranged from 1.1 to 4.8. There were, however, no significant differences in F VIII/vWF activities between the heat-treated and the non heat-treated F VIII concentrates with two exceptions. These findings suggest that the inactivation of the biological activities of F VIII and RCof, and/or the denaturation of both the F VIII: C protein and the vWF protein antigen occurred during the production procedure, while the heat-treatment did not lead to further changes of F VIII/vWF.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of sialagogues on the syntheses of polyamines and DNA in murine parotid gland

When rat parotid explants were cultured on siliconized lens paper floating on chemically defined 199 medium, all of sialagogues tested increased ornithine decarboxylase activity, which was roughly proportional to the amylase released into the culture medium. S-Adenosylmethionine decarboxylase and DNA synthesis were also induced by isoproterenol, methoxamine, carbachol and pilocarpine, but not by serotonin or substance P. The increases of the two decarboxylase activities and DNA synthesis were observed in vivo in mouse parotid gland after repeated injections of carbachol or pilocarpine. These results indicate that both adrenergic and cholinergic sialagogues stimulate the syntheses of polyamines and DNA in murine parotid gland.

Clinical experience with a new rate-responsive TX pacemaker

In this report, we describe our initial experience with a new rate-responsive TX pacemaker in 10 patients. This pacemaker system uses a conventional transvenous ventricular electrode, which senses the evoked QT interval after a ventricular paced beat, as an indicator of physiological metabolic demand. Implantation of the TX pacemaker does not differ from that of conventional VVI units, and two special modes are available after implantation: TX and VVI mode. Bicycle ergometer tests showed that significantly higher rate response and exercise ability were achieved during the TX mode compared with the VVI mode (mean maximal heart rate: 115 +/- 13 bpm vs 96 +/- 21 bpm, p less than 0.01, and mean maximal exercise time; 10.7 +/- 3.9 min vs 8.0 +/- 3.8 min, p less than 0.01, respectively). In one patient, cardiac index was measured by a thermodilution method during the bicycle ergometer test, which confirmed that an adequate increase in cardiac index (rest: 3.38 liters/min/m2, vs exercise; 7.34 liters/min/m2) was obtained by an increase of the pacing rate (rest: 72 bpm vs exercise: 128 bpm). Our results show that physiological rate-responsive pacing using the QT interval provides a simple means of increasing the heart rate and cardiac index.

Effects of epidermal growth factor on the syntheses of DNA and polyamine in isoproterenol-stimulated murine parotid gland

The effects of epidermal growth factor (EGF) on isoproterenol (IPR)-stimulated DNA synthesis and the activities of the rate limiting enzymes of polyamine synthesis (ornithine and S-adenosylmethionine decarboxylases) in parotid glands were investigated in vitro in cultured rat parotid explants and in vivo in submandibulectomized mice (mice after bilateral removal of the submandibular and sublingual glands). When the explants were cultured on siliconized lens paper floating on chemically defined synthetic medium, IPR caused the increases of both tissue cAMP level and the two decarboxylase activities in the prereplicative period and the stimulation of DNA synthesis with similar time courses to those observed in vivo. Dibutyryl cyclic AMP (DBcAMP) also increased the enzyme activities, but not DNA synthesis. EGF (1-2 ng/ml) had little effect on the IPR- and DBcAMP-dependent increases of amylase secretion and the enzyme activities, but it markedly enhanced IPR-stimulated DNA synthesis. Moreover, increase in DNA synthesis by DBcAMP was clearly observed in the presence of EGF when the explants were treated with this nucleotide analogue only during the early prereplicative period. In in vivo experiments, IPR-dependent increase in DNA synthesis was less in submandibulectomized mice than in intact animals. This decreased response to IPR of DNA synthesis was completely reversed by administration of EGF, though EGF alone did not induce either the enzymes or DNA synthesis. In submandibulectomized mice, although increases in the enzyme activities 8 h after injection of IPR were lower and they were significantly reversed by EGF, the activities at 12 h and the changes in polyamine levels at 8 and 12 h were almost the same as those in intact mice and were not affected by EGF treatment. These results obtained in vitro and in vivo suggest that EGF participates in the maximal response of IPR-dependent DNA synthesis but is not involved in the change of polyamine synthesis induced by IPR in murine parotid glands.

Heterogeneity of sugar composition of factor VIII/von Willebrand factor in von Willebrand's disease: analysis by crossed affinoimmunoelectrophoresis using lectin (ricinus communis agglutinin-120)

The nature of sugar chain of factor VIII/von Willebrand factor in plasma of normal subjects and patients with von Willebrand's disease (vWd) was examined by crossed affinoimmunoelectrophoresis using anti-human factor VIII rabbit serum, with inserted Ricinus communis agglutinin-120 (RCA-120) agarose layer (RCA - CIE). Molecular weights of factor VIII-related antigen (VIIIR:Ag) were estimated by SDS polyacrylamide gel electrophoresis - crossed affinoimmunoelectrophoresis (SDS PAGE - RCA - CIE). VIIIR:Ag, in normal plasma and in classical form of vWd, showed two precipitin peaks on RCA - CIE. The slower moving component of VIIIR:Ag with molecular weights over 3 x 10(6) daltons from normal subjects and patients with classical form of vWd showed a high affinity for RCA-120. The faster moving component of VIIIR:Ag below 3 x 10(6) daltons from the above-mentioned subjects and patients with a variant form (Type IIA) showed a very weak affinity for RCA-120. These results suggested that all of VIIIR:Ag in these variant cases may have a deficiency of galactose residues reactive with RCA, in addition to an incomplete polymerization of VIIIR:Ag, similar to that of the faster moving component of normal subjects.

Heterogeneity of molecular size of factor VIII/von Willebrand factor in von Willbrand's disease

Patterns of VIIIR:AG in the plasma and its fractions, cryoprecipitate and cryosupernatant, from various types of von Willebrand's disease (vWd) were observed by SDS 1.5% polyacrylamide gel electrophoresis - cross immunoelectrophoresis (SDS PAGE - CIE). VIIIR:AG in normal cryoprecipitate showed several precipitin peaks which correspond to molecular weights ranging from 8 X 10(5) to 1 X 10(7) daltons and are similar to those in normal plasma. Normal cryosupernatant VIIIR:AG gave smaller molecular weights from 8 X 10(5) to 2 X 10(6) daltons. VIIIR:AG in the plasma and cryoprecipitate from 2 patients with classical vWd gave low precipitin peaks with molecular weights in normal range. VIIIR:AG from 2 patients with subgroup A variant which showed fast anodal migration on the conventional CIE, presented 3 peaks with molecular weight of 8 X 10(5) to 3 X 10(6) which are similar to those in normal cryosupernatant. VIIIR:AG from 2 patients with subgroup B variant which showed normal migration on the CIE, gave normal patterns through all fractions.

The laser-Raman spectroscopic studies on human enamel and precipitated carbonate-containing apatites

Laser-Raman spectra of synthetic apatites containing from zero to 12.4 wt% carbonate ions and enamel apatite are reported. Special attention is paid to the correlation between the intensities of the carbonate, phosphate, and hydroxyl modes and the carbonate content in the apatites. The data presented here indicate that most of the CO2-3 incorporated in the apatite lattice substitutes for PO3-4 and suggest that a small amount of CO2-3 might be located in the OH- position.

Intestinal involvement in Behçet's disease: review of 136 surgical cases in the Japanese literature

A survey was prepared of 136 cases of laparotomy in patients with Behçet's disease and intestinal ulcers in Japan. The incidence of the disease is highest in males in the fourth and fifth decades. The ulcers are frequently found in the terminal ileum and the cecum. The ulcers are liable to perforate into the abdominal cavity, so that many patients require emergency operation. Resection of the ileocecal region or right half of the colon is the usual operation in the treatment of this disease. However, it is necessary to search for skip lesions, because multiple ulcers may be present. The incidence of postoperative complications and postoperative recurrence of ulcers is so high that supplementary management is often required.

PS-6 and PS-7, new beta-lactam antibiotics. Isolation, physicochemical properties and structures

Antibiotics PS-6 and PS-7 which are shown to be 5R,6R-3-(2-acetamido)ethylthio-6-isopropyl-7-oxo-1-azabicyclo[3.2.0]hept-2-ene- 2-carboxylic acid and 5R,6R-3-(E)-(2-acetamido) vinylthio-6-ethyl-7-oxo-1-azabicyclo[3.2.0]hept-2-ene-2-carboxylic acid respectively, are new beta-lactam compounds isolated from fermentation broths of Streptomyces cremeus subsp. auratilis A271, S. fulvoviridis A933, S. olivaceus ATCC 31126 and S. flavogriseus NRRL 8139. Fermentation, isolation, physicochemical properties and structures of antibiotics PS-6 and PS-7 are described.

Patterns of factor-VIII related antigen on crossed immunoelectrophoresis and large pore polyacrylamide gel-crossed immunoelectrophoresis in von Willebrand's disease

Plasma samples from patients with various types of von Willebrand's disease were subdivided into six patterns according to the electrophoretic mobility and shape of VIIIR: Ag on crossed immunoelectrophoresis (CIE): pattern 1 no precipitation are, pattern 2 normal mobility with low arc, arc, pattern 3 intermediate mobility with low arc, pattern 4 faster anodal mobility with low arc, pattern 5 normal mobility with normal are height, pattern 6 faster anodal mobility with normal are height. Of 62 patients, 14 had pattern 1, 6 pattern 2, 16 pattern 3, 12 pattern 4, 9 pattern 5, and 5 pattern 6. Large pore polyacrylamide-agarose gel-crossed immunoelectrophoresis (PAAG-CIE) of crude factor VIII fraction from cryoprecipitate revealed no arcs in patients with pattern 1, three arcs of reduced height in the patients with patterns 2 and 3, four arcs very similar to normal control in patients with pattern 5, and two arcs with fast anodal migration in the patients with patterns 4 and 6. Crude factor VIII fractions from normal cryosupernatant showed one low fast anodally migrating arc corresponding to the fourth arc of normal cryoprecipitate. No peak was seen in patients with pattern 1, and one low fast anodal arc similar to normal control was present in the patients with patterns 2, 3, 4, 5 and 6.

Superiority of hemofiltration to hemodialysis for treatment of chronic renal failure: comparative studies between hemofiltration and hemodialysis on dialysis disequilibrium syndrome

A significantly lower incidence of DDS, hypotension, and impending shock was found during and after hemofiltration as compared with conventional hemodialysis. Hemofiltration, in contrast to hemodialysis, showed less decrease of circulating plasma volume, mild change in plasma osmolality without red cell swelling, better compensation of acidosis despite less uptake of acetate, more stable PCO2 during the procedure, less paradoxical acidosis in cerebrospinal fluid, and a lower urea concentration gradient between cerebrospinal fluid and plasma. These phenomena might be explained by better mass transfer between compartments bithin the body during hemofiltration. Mass transfer from the intracellular as well as the extracellular space to circulating plasma occurred more rapidly and smoothly during HF than during HD. HF is preferable to HD in patients with severe cardiovascular complications such as hypertension, as well as hypotension and cardiac failure, and in those subject to DDS during HD. Accordingly, hemofiltration therapy promises patients more comfortable and more stable treatment of chronic uremia.

Malignant hyperthermia and althesin

General anaesthesia with Althesin was administered on two occasions to a patient who was identified as susceptible to malignant hyperthermia, in whom there was identified familial subclinical myopathy and once in another patient suffering from arthrogryposis multiplex congenita with a history of fever associated with two previous anaesthetics. In the first patient halothane was administered by accident in association with the Althesin, but no hyperpyrexia occurred. In the second instance nitrous oxide-oxygen and halothane were associated purposely with Althesin. In none of these cases was there any rise in temperature, muscle rigor or elevation of the serum CPK level. This experience corroborates the experimental evidence of Hall, et al.10 and Harrison, who reported that Althesin prevented the onset of hyperthermia, and the clinical reports of Page and Judelman. Althesin can be assumed to be an effective anaesthetic for malignant hyperthermia susceptible patients.