Discoid lupus erythematosus-like skin lesions in a patient with autosomal recessive chronic granulomatous disease

A case of chronic granulomatous disease (CGD) in a 32-year-old female with two episodes of opportunistic infections is described. At the age of 29 the patient was suspected to be a carrier of X-linked CGD on the basis of discoid lupus erythematosus-like skin lesions. No respiratory burst activity, as measured by phorbol myristate acetate stimulated superoxide production, was observed in isolated neutrophils of the patient. Membrane-rich fractions elicited no superoxide production in the presence of NADPH. The neutrophil content of cytochrome b-245 was within normal range. Family investigations revealed neither cellular abnormalities nor any history of skin diseases or opportunistic infections in first degree relatives. The parents of the patient were first cousins. On the basis of family history and the in-vitro assessment of neutrophil function, the patient is believed to have autosomal recessive CGD. The presented case illustrates that lupus erythematosus-like skin lesions are not restricted to female carriers of X-linked CGD, but may also be found in the autosomal recessive type of the disease.

Effect of refeeding on polyamine biosynthesis in isolated enterocytes

Ornithine decarboxylase (ODC) activity has been found to be preferentially associated with small intestinal villus cells rather than crypt cells in the rat. In the present study, ODC, S-adenosylmethionine decarboxylase (SAMDC), and polyamines were measured in isolated enterocytes to determine which cell populations increased polyamine biosynthetic activity after refeeding. Two hours following refeeding, significant increases in ODC were observed in villus tip (10 times) and midvillus (20 times) enterocytes. No increase in ODC activity was found in isolated crypt cells. A similar pattern was observed for SAMDC. Enzyme activity increased in villus tip (2 times) and midvillus (27 times) cells but not in crypt enterocytes. Putrescine contents were increased following refeeding in midvillus enterocytes (P less than 0.05) and in crypt cells (P less than 0.05). The accumulation of putrescine in midvillus cells occurs via ODC-induced biosynthesis, whereas in crypt enterocytes it may be due to putrescine uptake. The lack of induction of ODC and SAMDC in crypt enterocytes following acute refeeding suggests these enzymes are apparently not involved in the initiation of cell proliferation known to occur under this condition.

Practical value of a new serum digitoxin assay

The purpose of this study was to evaluate a new fluorescence polarization immunoassay, TDx, for digitoxin by comparing the results of this assay with those of a radioimmunoassay (RIA). Thirty-three serum samples were obtained from 15 patients during, and for 4 weeks after, a 4-week course of digitoxin therapy. Each sample was separated by centrifugation, coded, and frozen until analysis. At the time of analysis, each sample was divided and analyzed simultaneously by TDx and RIA. Nine samples yielded results less than 2 ng/ml (limit of assay sensitivity) by one or both methods and were excluded from further data analysis. Linear regression analysis of the results of the remaining 24 paired samples (x = TDx, y = RIA) revealed a strong correlation coefficient of r2 = 0.95, slope = 0.95, and a y intercept of -0.99 (y = -0.99 + 0.95x). Additionally, the TDx results were lower than the RIA values in only five of 33 paired samples; and these occurred in four patients who had a significantly lower mean estimated creatinine clearance than that of the other 11 patients (39.0 +/- 9.1 ml/min/1.73 m2 vs. 63.3 +/- 11.8 ml/min/1.73 m2, p less than 0.01). The TDx system is a comparable alternative to the RIA method, but differences in specificity and sensitivity may exist and should be evaluated more thoroughly.

Electrophysiologic testing in patients with recurrent syncope: are results predicted by prior ambulatory monitoring?

Syncope is a common medical problem which can result from many etiologies, including cardiac dysrhythmias. Because ambulatory monitoring usually fails to capture a syncopal episode, electrophysiologic testing has been used to elucidate dysrhythmic mechanisms in patients with recurrent syncope. To assess whether findings on ambulatory monitoring not obtained during syncope can be used to indicate the results which are found on electrophysiologic testing in patients with recurrent syncope, we reviewed the ambulatory monitoring records of 59 such patients referred for electrophysiologic testing. Although 29 patients had abnormalities on electrophysiologic testing, 13 of which were severe, in only six were the findings suggested by the abnormalities recorded during ambulatory monitoring. Twenty-one patients actually had concordance between electrophysiologic testing and ambulatory monitoring results, but in 15 of the 21 results of both tests were normal. Severe abnormalities were more frequently detected in our patient population by electrophysiologic testing than by ambulatory monitoring, especially if patients had organic heart disease.

Innervation of the late distal nephron: an autoradiographic and ultrastructural study

A study of the monoaminergic innervation of the cortical distal nephron beyond the thick ascending limb of Henle (TALH) was carried out by surveying nine autoradiograms, from three rats injected with exogenous tritiated norepinephrine, for overlapping of the tubule by accumulations of autoradiographic grains (AAGs). The largest number of the AAGs appeared on the late distal convoluted tubule-connecting tubule (LDCT-CNT) portion and the vast majority of the AAGs were related to the afferent arteriole. The distal convoluted tubule (DCT) and cortical collecting duct (CCD) showed half of their AAGs related to the efferent arterioles and capillary-interstitium although a substantial amount was associated with the afferent arterioles or arteries. Electron microscopy of reembedded autoradiograms demonstrated the presence of neuroeffector junctions with the CNT and CCD at sites of AAG overlap. The presence of adrenoceptors in the late distal nephron suggests the possibility of a local response of the nephron to the action of the adrenergic nerves shown in this study.

Sinus node echoes and concealed concealed conduction: additional sinus node phenomena confirmed in man by direct sinus node electrography

Direct sinus node electrography has been previously used to assess several aspects of sinus node physiology: sinus node pauses, overdrive suppression, sinoatrial entrance block. This report presents data in which sinus node electrograms confirm two additional physiologic phenomena in man: concealed conduction in the sinoatrial junction and sinus node reentry. These findings verify the presence of previously suspected phenomena by careful deductive analysis of electrocardiographic and electrographic tracings.

A radiometric whole blood test for chronic granulomatous disease

Chronic granulomatous disease (CGD), caused by an inherited deficiency in the oxygen metabolism of granulocytes and monocytes, is often a diagnostic problem in patients with severe infections. CGD can be diagnosed by several methods, all requiring some knowledge of cell handling and specialized equipment. We describe a simple screening test for CGD, based on the production of 14CO2 from glucose-1-14C following stimulation of the granulocytes in whole blood with zymosan, CV: 14.8%, intraassay. The test can be carried out with equipment available in most routine laboratories and without expertise in granulocyte function tests.

Innervation of the renal cortical tubules: a quantitative study

A quantitative assessment of the innervation of the different portions of the cortical tubular nephron in the rat was made using tritiated norepinephrine uptake to label monoaminergic nerves, followed by autoradiography. The proximal tubules (PT) showed the greatest number of innervated profiles (IPs) [i.e., tubular profiles overlapped by accumulations of autoradiographic grains (AAG)] followed by the thick ascending limb of Henle (TALH), the distal convoluted tubule (DCT), and the collecting duct (CD). However, the highest relative frequency of innervation (RFI), i.e., the ratio of the number of IPs to the total number of profiles surveyed, occurred in the TALH followed by the DCT and PT. The number of IPs of the CDs was too low to permit adequate statistical evaluation. The PT showed the largest number of AAGs facing the interstitium or in contact with capillaries, while the TALH had the highest number in contact with the efferent arteriole. The DCT showed a disproportionately high number of AAGs in contact with the afferent arteriole. Our results suggest that all portions of the cortical tubular nephron are under some degree of neural influence.

The normal occurrence of two molecular forms of the eight complement component (C8) and their concentrations in a family with C8 deficiency

A haemolytically inactive alpha-mobile complement C8 component was identified by crossed immunoelectrophoresis in a 27-year-old male with recurrent meningococcal infections and absence of complement mediated serum haemolytic activity. The patient's serum/plasma contained no demonstrable normal C8. C8 inhibitor activity was not demonstrable in his serum and the alternative activation pathway appeared to be intact. Serum from the proband's parents and both siblings had normal total haemolytic complement activity and they were without symptoms. However, both the normal and the haemolytically inactive C8 protein were demonstrable in their sera. Their normal C8 concentrations were less than one-half of the normal C8 mean value and distinctly below the lowest value found in ten healthy persons. The concentration of the inactive C8 component in the proband's serum was roughly 1 . 5 times higher than that of the other family members, whereas its concentration in sera of the family members was between 1 . 8 and 2 . 5 times the highest concentration found in ten healthy donors, all of whom also had an alpha-mobile C8 in measurable quantities.

Surgical treatment of carcinoma of the esophagus and cardia among the Chinese

Clinical data on 1,450 patients with epidermoid carcinoma of the esophagus and 727 with adenocarcinoma of the cardia (seen from 1952 to 1980) are presented, with the results of surgical treatment in 387 epidermoid carcinomas and 164 adenocarcinomas. The rates of resectability, postoperative complications, and surgical mortality were 44.3%, 28.5%, and 5.1% in epidermoid carcinoma and 39.6%, 17.4%, and 5.9% in adenocarcinoma, respectively. Five-year survival after resection was 11.9% in epidermoid carcinoma and 6.7% in adenocarcinoma. The operative procedure is described. According to our experience, extensive resection of the esophagus followed by reconstruction of the alimentary tract with esophagoileocoloplasty or esophagogastrostomy retrosternally for the epidermoid carcinoma appears to be the treatment of choice. For adenocarcinoma of the cardia, resection of the tumor and esophagogastrostomy or esophagojejunostomy, can be done transthoracically if the esophageal involvement is not high. In any case, early diagnosis and early treatment are the only ways to improve the present results.

Simultaneous ultrastructural visualization of acetylcholinesterase activity and tritiated norepinephrine uptake in renal nerves

In this investigation we have combined the methods of ultrastructural demonstration of acetylcholinesterase activity with electron microscopic autoradiography for the demonstration of norepinephrine uptake. The results show electron-dense deposits indicative of acetylcholinesterase activity associated with perivascular axons overlaid by concentrations of silver grains representing exogenous tritiated norepinephrine. Forty-five percent of the intervaricose regions and 19% of the varicosities overlaid by autoradiographic grains showed "moderate" amounts of cholinesterase staining. A greater proportion of autoradiographic grains was observed on the varicosities than in the intervaricose regions; however, the amount of acetylcholinesterase activity was greater in the intervaricose regions than in the varicosities. This investigation provides evidence for the presence of periaxonal acetylcholinesterase staining in adrenergic axons in the rat kidney.

Experimental maternal phenylketonuria: an examination of two animal models

Two satisfactory rat models of maternal phenylketonuria (PKU) have been developed. Continuous subcutaneous infusion into pregnant rats from the 9th-20th day of gestation of either (1) phenylacetate (PA), to elevate plasma levels of unconjugated PA to 0.25-0.60 mumol/ml, or (2) a nontoxic dose (0.2 mumol/g/day) of p-chlorophenylalanine (pClPhe) with L-phenylalanine (Phe), to elevate plasma Phe levels at least 10-fold (1.7-2.3 mumol/ml) and unconjugated PA to at least 0.2 mumol/ml, produced the syndrome of untreated maternal PKU: spontaneous abortion, mortality rate greater than normal among the newborn, retarded growth of fetal body and brain, and a learning deficit among the progeny. From the plasma of rats infused with only pClPhe, a metabolite was isolated and identified as p-chlorophenylacetic acid. This compound, at a concentration greater than 0.15 mumol/ml plasma was found to retard fetal body and brain growth. In the pregnant rat, plasma levels of unconjugated PA, in the range observed in some PKU individuals on a normal diet, effectively induced a simulation of maternal PKU. The results of this investigation support our contention that PA, which is produced in excessive amounts in clinical PKU, is the primary cause of the brain dysfunction.

Purification of human liver cytosolic epoxide hydrolase and comparison to the microsomal enzyme

Epoxide hydrolase (EC 3.3.2.3) was purified to electrophoretic homogeneity from human liver cytosol by using hydrolytic activity toward trans-8-ethylstyrene 7,8-oxide (TESO) as an assay. The overall purification was 400-fold. The purified enzyme has an apparent monomeric molecular weight of 58 000, significantly greater than the 50 000 found for human (or rat) liver microsomal epoxide hydrolase or for another TESO-hydrolyzing enzyme also isolated from human liver cytosol. Purified cytosolic TESO hydrolase catalyzes the hydrolysis of cis-8-ethylstyrene 7,8-oxide 10 times more rapidly than does the microsomal enzyme, catalyzes the hydrolysis of TESO and trans-stilbene oxide as rapidly as the microsomal enzyme, but catalyzes the hydrolysis of styrene 7,8-oxide, p-nitrostyrene 7,8-oxide, and naphthalene 1,2-oxide much less effectively than does the microsomal enzyme. Purified cytosolic TESO hydrolase does not hydrolyze benzo[a]pyrene 4,5-oxide, a substrate for the microsomal enzyme. The activities of the purified enzymes can explain the specific activities observed with subcellular fractions. Anti-human liver microsomal epoxide hydrolase did not recognize cytosolic TESO hydrolase in purified form or in cytosol, as judged by double-diffusion immunoprecipitin analysis, precipitation of enzymatic activity, and immunoelectrophoretic techniques. Cytosolic TESO hydrolase and microsomal epoxide hydrolase were also distinguished by peptide mapping. The results provide evidence that physically different forms of epoxide hydrolase exist in different subcellular fractions and can have markedly different substrate specificities.

The role of the human caudate nucleus in acupuncture analgesia

The role of the caudate nucleus in acupuncture analgesia was studied in 17 patients receiving caudate stimulation through chronic implanted electrodes to relieve intractable pain caused by late malignancy. Electrical stimulation of the head of the caudate nucleus provided relief from intractable pain in all 17 patients. The pain and pain tolerance threshold were elevated, the alteration in skin galvanic activity, respiratory movement and fingertip plethysmography elicited by a given painful stimulus were depressed. The analgesia required a period of induction and persisted for some time after cessation of stimulation; it showed no obvious segmental topography. These characteristics are similar to those observed in acupuncture analgesia. The effect of caudate stimulation was similar to that of electric needling in depressing the late component of the somatosensory evoked potentials (SEPs) recorded over the scalp and from the centrum medianum of the thalamus. Evoked potentials could be recorded from the caudate nucleus when an acupuncture point was electrically stimulated. The evoked potential record was a complex wave of positive and negative components, the peak latencies of main components being 100-180 msec for positive wave and 148-332 msec for negative wave components. The present study supports the supposition that the caudate nucleus may play a role in acupuncture analgesia. The possibility that the effect of caudate stimulation is brought on by inhibiting the activity of the medial thalamus is discussed.

Photoperiod induction of fertile oestrus and changes in LH and progesterone concentrations in yearling dairy goats (Capra hircus)

Oestrus and ovulation were induced in a group of 19 yearling dairy goats which had been maintained for 70 days on a 19 h/day photoperiod regimen. Six yearling females, raised under natural photoperiod, served as controls. An intact, light-treated male was introduced to each group 42 days after termination of the artificial lighting. Behavioural, endocrine and kidding observations indicated that 15 of the experimental females (79%) ovulated within 21-30 days after introduction of the male, that 12 (63%) conceived at the induced ovulation, and that 10 (53%) gave birth to live kids, while none of the controls ovulated during this time. The breeding season was advanced between 60 and 80 days. In experimental and control nannies there was a brief, small surge (320 +/- 42 pg/ml) of plasma progesterone which occurred 19.5 days after introduction of the male and which closely preceded oestrus in the nannies that ovulated and at 25 days in control females. Ovulatory surges of LH (to 70 ng/ml plasma) were closely associated with oestrus, and remained above basal levels for 9.0 +/- 0.75 h, in 7 experimental females. Two of 6 control nannies also showed LH surges but they did not ovulate.

Immunological comparison of rat, rabbit, and human liver NADPH-cytochrome P-450 reductases

NADPH-cytochrome P-450 reductase (EC 1.6.2.4) preparations were purified to electrophoretic homogeneity from rat, rabbit, and human liver microsomes. These preparations had apparent monomer molecular weights (Mr's) of 72 000-74 000 and were catalytically active in reducing rat and rabbit liver cytochromes P-450 as well as cytochrome c. A form of the human liver reductase devoid of a peptide of about Mr 6000 was isolated in the absence of protease inhibitors; this enzyme catalyzed the reduction of cytochrome c but not cytochromes P-450. Rabbits were immunized with purified rat liver NADPH-cytochrome P-450 reductase and the resulting antibody preparation was used to examine the species specificity of the enzyme. Immunological differences among the three species were detected by using double-diffusion analysis, quantitative microcomplement fixation, and inhibition of enzyme activity. Microcomplement fixation techniques indicated immunological differences in both rat and human reductase preparations due to removal of a peptide of Mr 6000-8000; these differences were not detected by using double-diffusion analysis. The antibody inhibited rat liver microsomal d-benzphetamine N-demethylase activity to the same extent as NADPh-cytochrome c reductase activity, suggesting that the level of reductase controls the rate of this cytochrome P-450-mediated activity. On the other hand, the antibody was much less effective in inhibiting rat liver benzo[a]pyrene hydroxylase activity. The antibody exerted different effects in inhibiting d-benzphetamine N-demethylase and benzo[a]pyrene hydroxylase activities as compared to NADPH-cytochrome c reductase activity in human liver microsomes.

Immunological comparison of rat, rabbit, and human microsomal cytochromes P-450

Antibodies were raised in rabbits to electrophoretically homogeneous cytochromes P-450 isolated from rat and human liver microsomes. These antibodies were used to compare various forms of rat, rabbit, and human cytochromes P-450 present in microsomes and in purified preparations by using double-diffusion analysis, immunoelectrophoresis, quantitative microcomplement fixation, competitive radioimmune assay and inhibition of enzyme activity toward d-benzphetamine and benzo[a]pyrene. The results indicate that (1) at least some forms of cytochrome P-450 from the three species share certain common immunological determinants, (2) there are immunological differences between cytochromes P-450 isolated from the three species, (3) some immunological differences exist between cytochromes P-450 isolated from rats of different strains, (4) immunologically distinguishable forms of cytochrome P-450 exist within individual human liver samples, and (5) human liver samples obtained from different individuals contain immunologically different forms of cytochrome P-450. Quantitative microcomplement fixation techniques were used to assign immunological distances to different form of rat, rabbit, and human liver microsomal cytochrome P-450. Cross-reactivity was observed in all systems tested, and the extent of immunological similarity was dependent upon the particular assay used.

The effect of ritodrine on carbohydrate and lipid metabolism in normal and diabetic pregnant women

The metabolic effects of a one hour intravenous infusion of the β-2-receptor stimulating drug ritodrine were studied in seven normal pregnant women, three White class A pregnant diabetics and eight White class B-D pregnant diabetics.

During ritodrine infusion all subjects in the three groups exhibited increases in plasma glucose (1.0, 1.6 and 2.1 mmol/l respectively), free fatty acids (360, 850 and 1150 μmol/l), lactate (0.43, 0.80 and 0.86 mmol/l) and β-hydroxybutyrate and decreases in standard bicarbonate. The rise in plasma glucose, free fatty acids and lactate was more pronounced in insulin treated diabetic. The rises in β-hydroxybutyrate and decreases in standard bicarbonate were of the same magnitude in all three groups. Plasma potassium fell in all subjects, whereas no detectable changes in plasma sodium were observed.

The endocrine pancreatic function was assessed by measuring plasma insulin (White class A and normals), C-peptide (White class B-D) and glucagon (all subjects). Plasma insulin increased in normals (22 μIU/ml) and White class A diabetics (33 μIU/ml), whereas plasma C-peptide of the insulin treated patients (White class B-D) were below measurable concentrations. Plasma glucagon and cortisol concentrations were not influenced by ritodrine.

The results suggest that the diabetogenic changes induced by ritodrine are augmented with the severity of diabetes but not ascribable to a diabetes-like change in the function of the endocrine pancreas.

Localization of tritiated norepinephrine in the renal arteriolar nerves

The innervation of the glomerular arterioles was investigated by light and electron microscopy autoradiography for localization of exogenous tritiated norepinephrine. By light microscopy accumulations of grains were seen associated with afferent arterioles and in lesser numbers with efferent arterioles and neighboring tubules. Accumulations of grains were noted to be in contact with juxtaglomerular granular cells. Electron microscopy autoradiography revealed that nearly two-thirds of the silver grains were on axons. Most of the label was on varicosities packed with small, clear and dense-cored, vesicles. Most varicosities, including those in contact with smooth muscle, juxtaglomerular granular or tubular cells, were labeled. Some varicosities which appeared unlabeled in a given section were labeled in subsequent sections. These findings are consistent with the notion that the glomerular arterioles are innervated mainly by adrenergic nerves. This view is supported by the previously reported observations of the concomitant virtual disappearance of fluorescent and acetylcholinesterase-positive nerves from the region of the glomerular arterioles after two injections of six-hydroxydoapmine (a drug which selectively destroys adrenergic nerves) and the presence of small dense-cored vesicles in all axons of the juxtaglomerular region when examined by serial section electron microscopy.

Induction and regulation of neuraminidase synthesis in Arthrobacter sialophilus

A variety of N-acetylneuraminic acid (AcNeu) derivatives and analogs were examined as inducers of the extracellular neuraminidase of Arthrobacter sialophilus. Neuraminidase inductions were primarily studied with tryptone-yeast extract-grown cells after washing and resuspension in a defined replacement medium. The addition of readily metabolizable carbon sources to the latter, such as 0.1% casein hydrolysate, glutamate, or glucose, enhanced enzyme synthesis. Enzyme appearance occurred after a lag in the uptake of inducers, suggesting the participation of a co-inducible transport system. Neuraminidase formation during exponential growth in the presence of AcNeu ceased after depletion of this end product from the medium. It was found, besides AcNeu, that its methyl ester, 2-deoxy-2,3-dehydro-N-acetylneuraminic acid and 2-deoxy-2,3-dehydro-N-acetyl-neuraminic acid methyl ester are each active inducers, whereas beta-anomers of AcNeu-ketosides are not. These results, in comparison to known enzyme specificity, have revealed significant differences and parallels between the inductive and catalytic processes for neuraminidase. In particular, it would appear that the free carboxylate and oxygenation at C-2 of AcNeu, essential for enzyme catalysis with traditional AcNeu substrates, are not necessary for induction and, furthermore, that transition state analogs can specifically induce this enzyme. The failure to observe catabolite repression in this system is discussed in relation to the intermediary metabolism of the genus Arthrobacter.

Purification and properties of Arthrobacter neuraminidase

Neuraminidase (EC 3.2.1.18) from an Arthrobacter species was purified homogeneity by conventional procedures (yield approx. 1 mg/1) and was judged to be homogeneous by sodium dodecyl sulfate gel electrophoresis. Gel electrofocusing of neuraminidase revealed 1 major band (85-90%), pI 5.35 +/- 0.05, and 6 minor bands, whose pI ranged from 5.25 to 5.70, and each of which had catalytic activity. Arthrobacter neuraminidase is a monomeric glycoprotein of molecular weight 88 000, has an apparent Km of 7.8-10(-4) M for N-acetylneuraminlactose, is insensitive to inhibition by N-acetylneuraminic acid, and is about 2% carbohydrate by weight. The amino acid composition as well as the galactosamine and glucosamine content was determined. The enzyme can hydrolyze (alpha, 2-3), (alpha, 2-6), (alpha, 2-8) linkages. The active size of the enzyme appears to be inaccessible since no inhibition was observed by reagents known to modify sulfhydryl, lysyl, carboxyl, histidinyl, and argininyl residues. In contrast, N-bromosuccinimide at a 60-fold molar ratio to enzyme, gave complete inhibition. These results suggest that a tryptophan residue is essential for catalysis.