Cationic neutrophil proteins increase transendothelial albumin movement

Neutrophils play a role in the development of pulmonary edema in many models of the adult respiratory distress syndrome, but the mechanism of their action is not completely understood. We asked whether two neutrophil secretory products, human neutrophil cationic protein (NCP) and human neutrophil elastase (HNE), would nonenzymatically alter the movement of albumin across a cultured endothelial monolayer. Both enzymes were inactivated by heating before use. HNE was additionally enzymatically inactivated with a chloromethylketone oligopeptide (CMK) inhibitor and with alpha 1-proteinase inhibitor (alpha 1-PI). Heated NCP, heated HNE, and CMK-complexed HNE all increased transendothelial albumin transfer. The cation protamine also increased albumin transfer across the endothelium and this increase was blocked by heparin. Alpha 1-PI and fetal bovine serum also prevented the cationic proteins from increasing albumin transfer. Using the release of lactate dehydrogenase as a marker of cytotoxicity, heated HNE was toxic to endothelial cells, heated NCP had only minimal toxicity, and protamine had no toxicity. Changes in endothelial cell shape with gap formation was seen after exposure to both heated HNE and heated NCP. Both the cytotoxicity associated with heated HNE and the cell shape changes associated with heated NCP and heated HNE could be blocked by heparin. These results suggest that in addition to neutrophil proteases and reactive O2 molecules, neutrophil-derived cationic proteins can directly and nonenzymatically contribute to edema formation during acute inflammation.

The association of an elastase with amyloid fibrils

The fibrils of all systemic forms of amyloid (primary, AL; secondary, AA; and hereditary, AF) that had been isolated by the water extraction procedure demonstrated elastolytic enzyme activity when examined in a specific assay using tritiated elastin. The source of this fibril-bound enzyme activity was consistent with human neutrophil elastase (HNE), since it was readily extracted by high salt solutions and inhibited by an elastase-specific chloromethyl ketone inhibitor, human alpha-1-protease inhibitor or by an antibody specific for HNE. The presence of an elastase on the amyloid fibril may suggest physiologic mechanisms of amyloid precursor protein degradation.

Relaxation techniques in general practice

Many common disorders which present in general practice may be treated successfully when patients learn techniques of relaxation. Tension headache, migraine, chronic nervous diarrhoea, pre examination tension and some phobias have a high success rate. The technique is a lifelong asset for both patient and doctor.

Evidence that hospital care for acute myocardial infarction has not contributed to the decline in coronary mortality between 1973-1974 and 1978-1979

To investigate whether the reported 17% decline in the national rates of acute ischemic heart disease mortality between 1973 and 1978 was attributable to decreased in-hospital mortality for patients with acute myocardial infarction (MI), we surveyed all 63 acute care hospitals in the Boston, Massachusetts, area. Compared with 1973-1974, more 1978-1979 MI patients were admitted to hospitals in metropolitan Boston, and especially to the five university teaching hospitals. Between 1973-1974 and 1978-1979, hospital admission rates decreased for younger patients and increased for older patients, but overall admission rates were almost identical. In-hospital mortality rates from acute MI did not change significantly in any age group. Because overall MI mortality was declining while in-hospital MI mortality was unchanged, the proportion of acute MI deaths that occurred inside the hospital increased from about 30% to about 40%. Although current hospital care undoubtedly benefits many individual patients, this study suggests that improvements in the in-hospital care of acute MI patients are a major explanation for nationwide mortality trends between 1973 and 1978.

Cholesterol determination in high-density lipoproteins separated by three different methods

We describe a simplified method for measuring high-density lipoprotein cholesterol in serum after very-low- and low-density lipoproteins have been precipitated from the specimen with sodium phosphotungstate and Mg2+. Values so obtained correlate well with values obtained with the heparin-Mn2+ precipitation technique (r = 0.95, CV less than 5% in 66% of the subjects studied and between 5 and 10% in the remaining ones) or by ultracentrifugal separation (r = 0.82, CV less than 5% in 80% of the subjects studied and between 5 and 10% in the remaining ones). Our precipitation technique is more appropriate for routine clinical laboratory use.

Cholesterol determination in high-density lipoproteins separated by three different methods

We describe a simplified method for measuring high-density lipoprotein cholesterol in serum after very-low- and low-density lipoproteins have been precipitated from the specimen with sodium phosphotungstate and Mg2+. Values so obtained correlate well with values obtained with the heparin-Mn2+ precipitation technique (r = 0.95, CV less than 5% in 66% of the subjects studied and between 5 and 10% in the remaining ones) or by ultracentrifugal separation (r = 0.82, CV less than 5% in 80% of the subjects studied and between 5 and 10% in the remaining ones). Our precipitation technique is more appropriate for routine clinical laboratory use.

The comparative value of amantadine and levodopa

Sixty-nine patients with Parkinson's disease were randomly allocated in a trial to compare the therapeutic effects of levodopa and amantadine. The patients were assessed clinically and scored by occupational therapy tasks and degrees of disability. Both drugs were used for 2 months; in the first 4 weeks the doses were gradually increased to 400 mg of amantadine or 4 g of levodopa respectively, and in the second 4 weeks' period the maximum tolerated dose was maintained throughout. Fourteen patients withdrew and these were excluded from the series. Of the fifty-five patients who completed the trial, thirty-four were taking levodopa and twenty-one amantadine.

The results showed an average 33% improvement on levodopa and 23% on amantadine as regards tremor, rigidity and akinesia and their total scores improved 26% and 18% respectively. More cases showed substantial improvement on levodopa.

There was little difference in response between 200 and 400 mg amantadine daily, but side-effects with 400 mg amantadine daily were more frequent and severe. Side-effects with levodopa were similar to those reported in previous trials but we also noted brown body fluids in three patients. The average effective dose of levodopa was lower than in previous reports, and the largest number of patients received benefit from 1·5 g daily. The superior effect of levodopa was shown.

Use of amantadine in Parkinson's disease. Results of a double-blind trial

In a four-week double-blind trial of 62 patients with Parkinsonism 29 were treated withamantadine and 33 with a placebo. Modest but statistically significant improvement was observed in the first group, optimum benefit occurring after the first two weeks. Patients' reactions to the drug were favourable in 79%, and side effects were insignificant. Though amantadine appears to be a useful additive drug in the treatment of Parkinsonism, its value as a single treatment is as yet undetermined.