Elevated serum interleukin-2 receptor; increased in vitro immunoglobulin synthesis and lack of response to testosterone-enhanced in vitro interleukin-2 production in ankylosing spondylitis

The pathogenesis of ankylosing spondylitis (AS) remains unknown, although previous studies have strongly suggested that it may result from immunological aberration. To further explore the pathogenetic mechanisms, in vitro syntheses of immunoglobulins and interleukin-2 (IL-2) by peripheral blood mononuclear cells (MNC), and the serum level of the interleukin-2 receptor (IL-2R) were studied in 35 patients with definite AS and in 28 healthy controls. MNC were cultivated in the presence of pokeweed mitogen (PWM) for seven days. Immunoglobulins in the supernatants were measured by rate nephelometer (Immunochemistry System Analyser II, Beckman.) In vitro synthesis of IL-2 was carried out by cultivating MNC in medium only; in medium containing physiological concentration of the male sex hormone i.e., testosterone 500 ng/dl and estradiol 2 ng/dl; and in medium containing physiological concentration of female sex hormone, i.e., testosterone 50 ng/dl and estradiol 20 ng/dl. IL-2 was quantitated using an IL-2-dependent cytotoxic T lymphoid cell line (CTLL). Serum IL-2R was measured using an IL-2R test kit (CELLFREE, T Cell Sciences, Cambridge, MA). The results showed: In vitro synthesis of IgG, IgA and IgM was significantly higher in AS than in controls; In vitro synthesis of IL-2 was significantly enhanced by testosterone in normal control, but not in AS; and Serum IL-2R was significantly elevated in patients with AS. These findings, viewed in conjunction with previous results here, lead to postulation that an inflammatory process, elicited in HLA-B27-positive males and caused by an infectious agent invading via the mucosa may both cause immunological abnormalities and provoke various symptoms and signs of AS.

Establishment and characterization of five cell lines derived from human malignant gliomas

We established and characterized five cell lines derived from human malignant gliomas (four glioblastomas multiforme and one highly anaplastic astrocytoma). All cell lines exhibited tumor cell morphology and growth kinetics, and anchorage-independent growth in soft agar. Cytogenetic analysis revealed significant aneuploidy in all five cases as well as clonal chromosomal alterations unique to each cell line. No cell line was tumorigenic in athymic mice. Two of the cell lines were sensitive to carmustine (BCNU) in monolayer and soft-agar cultures. Electron microscopy showed marked variability between cell lines in the number and structure of intracytoplasmic organelles; SF-126 formed collagen fibers in vitro. Immunohistochemical analysis of the surgical specimens showed variable expression of glial fibrillary acidic protein (GFAP) in malignant astrocytes; positive immunostaining for glycoproteins of the extracellular matrix was found predominantly in perivascular regions. In early-passage cultures, only cell line SF-295 expressed GFAP; at establishment, none of the cell lines expressed GFAF or glutamine synthetase. Fibronectin and laminin were expressed by all cell lines in early-passage culture, but expression of these glycoproteins at establishment was variable. Only SF-126 was positively identified by immunostains for procollagen III; this was also the only cell line in which DEAE-cellulose chromatography and SDS-PAGE demonstrated interstitial collagen synthesis. These well-characterized glioma-derived cell lines may now serve as useful tools with which to study the cell biology of gliomas. The synthesis of interstitial collagen by a glioma-derived cell line may suggest a derivation from vascular mesenchymal elements, either reactive or transformed, in the original heterogeneous malignant glioma, rather than from a glial precursor cell.

Clinical aspects with regard to the occurrence of an endogenous luteinizing hormone surge in gonadotropin-induced normal menstrual cycles

A decline in serum E2 the day before laparoscopy indicated that ovulation had occurred in 16 cycles stimulated with exogenous gonadotropins for the purpose of in vitro fertilization (IVF). In contrast to 18 control cycles with rising E2 values after human chorionic gonadotropin (hCG) administration and without evidence of ovulation, the onset of the endogenous luteinizing hormone (LH) surge had been initiated. From this study, it is believed that the onset of an endogenous LH surge can be identified by the terminal preovulatory E2 pattern. Further, the incidence of an endogenous LH surge in gonadotropin-induced menstrual cycles and the present clinical approach of the Norfolk IVF program to this phenomenon are discussed.

The perimenopausal patient in in vitro fertilization: the use of gonadotropin-releasing hormone

The perimenopause, incipient ovarian failure, is a major problem in stimulation failures during an in vitro fertilization program. This must be recognized as not necessarily related to age but also associated with adnexal inflammatory and operative processes. Although ovulation occurs uninterruptedly, the follicle-stimulating hormone in the early follicular phase is elevated and the luteinizing hormone is normal. Characteristically, there is no estradiol response to human menopausal gonadotropin therapy or a rapid response with a premature luteinizing hormone surge. These problems sometimes may be overcome with pulsatile intravenous gonadotropin-releasing hormone therapy, 5 or 10 micrograms/90 or 120 minutes. The major therapeutic problem is in the identification of a luteinizing hormone surge in these patients. Of eight women who were treated, two failed to respond with follicular maturation, three either had no oocytes aspirated from apparently postmature follicles or had postmature oocytes; and one had treatment cancelled due to ovulation. The four latter patients may have failed because of unrecognized ovulation. In the remaining two patients, one oocyte was fertilized and transferred, and one pregnancy occurred.

Retreatment of pediatric brain tumors with radiation and misonidazole. Results of a CCSG/RTOG phase I/II study

Twenty-nine patients with recurrent pediatric brain tumors after full-dose treatment with radiation were retreated with misonidazole (9 gm/m2) and whole-brain irradiation (300 rad X 10). Seventeen of 29 patients (59%) experienced nausea and vomiting with misonidazole administration and 6 patients (21%) developed peripheral neuropathy. Serum levels of misonidazole were similar to those reported for adults. One patient died of trauma shortly after retreatment. For the remaining 28 patients, the median time-to-progression was 5.5 months. Median survival was 13 months. Six patients (21%) developed radiation toxicity, two of whom died from the toxicity. Whereas the results on this study are similar to reported series of patients receiving salvage chemotherapy for recurrent pediatric brain tumors, more effective treatment clearly is needed.

Transplantation of anastomosed vascular allomentum and split thickness autogenous skin grafting for repair of deep electrical burns of the wrist

The use of allomentum to replace automentum or skin flaps in treating 3 patients with severe electrical burns of the wrist is discussed, as are the specific advantages and disadvantages, and the prospects for clinical use of the technique.

Abnormal in vitro immunoglobulin synthesis of lymphocytes and increased circulating immune complex in patients with ankylosing spondylitis

To explore the immunopathogenetic mechanisms of hypergammaglobulinemia in ankylosing spondylitis (AS), the functions of B cell, helper T (OKT4) cell and suppressor T (OKT8) cell were examined, by using the co-cultivation technique for in vitro immunoglobulin biosynthesis, in 7 patients with active AS, 7 with inactive AS and 14 normal controls. Circulating immune complexes (CIC) in those subjects were also measured by a solid phase C1q binding assay. After B, OKT4 and OKT8 cells were separated from the heparinized peripheral blood, coculture of these cells which were either from the same patient, the same normal control, or their combination was carried out. The in vitro synthesized immunoglobulins were measured by a rate nephelometer (Immuno-chemistry system, analyzer II). The results were: In patients with active AS, the amounts of IgG and IgA synthesized by co-cultured B and T4 cells from patients (p) and T8 from the normal (n) were significantly higher than those of the normal controls; In patients with inactive AS, the amounts of IgG and IgA produced by co-cultured Bp + T4p + T8n, Bp + T4n + T8n, Bn + T4n + T8p, and Bn + T4p + T8p were significantly higher than those for the respective normal controls; The CIC in active AS was elevated significantly over that in the normal controls. These results suggest that in patients of AS, B cells and helper T cells are hyperactive, while suppressor T cells are depressed. The abnormal function of lymphocytes may cause elevated concentrations of immunoglobulins and CIC in the serum.

An unusual spinal meningioma in a child: case report

Meningiomas seldom occur in children, and spinal meningioma in a child is rare. We report the case of a boy, 3 years and 5 months of age, who had an unusual atypical meningioma involving the subarachnoid space from T-2 to the cauda equina. To our knowledge, no similar case has been reported previously.

The significance of the ratio in follicle-stimulating hormone and luteinizing hormone in induction of multiple follicular growth

Among the patients enrolled in the Norfolk In Vitro Fertilization Program there were 32 who had been stimulated according to the basic stimulation protocol using two ampules of human menopausal gonadotropin (hMG) daily. Because of their inadequate response, 23 of these 32 patients were stimulated subsequently with a combination of two ampules of "pure" follicle-stimulating hormone (FSH) and two ampules of hMG on cycle days 3 and 4. The remaining nine patients received four ampules of "pure" FSH only on cycle days 3 and 4. Stimulation was continued with hMG in both FSH regimens. Ten thousand units of human chorionic gonadotropin was used for final maturation. Parallel with the increase in the ratio of exogenous FSH to luteinizing hormone, an increase in oocyte recovery was observed, as well as an improvement in transfer and pregnancy rates. It was concluded that FSH enrichment had a beneficial effect in these patients.

Lymphocyte aberrations in ankylosing spondylitis

Because the etiology of IgA and IgG hyperimmunoglobulinemia in ankylosing spondylitis (AS) remains unknown, the cellular immune system has been further studied by measuring the lymphocyte and its subpopulations in peripheral bloods of 50 definite AS patients and 40 normal controls. The system's functions have also been assessed in terms of proliferative responses to phytomitogens (Con A, PHA and PWM) and autologous mixed lymphocyte reaction (AMLR). The following results were obtained: The number of lymphocytes, total T, active T, OKIa1, OKT3, OKT4 and OKT8 cells in peripheral bloods of AS patients decreased more significantly when compared to the normal controls. The ratio of OKT4/OKT8 also decreased. However, the number of OKT8 cells was normal in inactive stage. While the lymphocytes of AS responded hyperreactively to PWM (B-cell mitogen), the response to Con A (T-cell mitogen) was depressed significantly. AMLR was impaired in AS patients no matter whether monocytes or B cells were used as stimulators. The aforementioned changes were especially evident in the active stage and most of them returned to normal after the disease became quiescent. It is therefore concluded that the etiology of hyperreactivity of B-cells in AS may be caused by T-cell immune aberration as evidenced by depressed lymphoproliferative response to T-cell mitogen (Con A) and impaired AMLR and/or the hyperfunction of B-cells themselves.

Anti-Müllerian hormone is not cytotoxic to human endometrial cancer in tissue culture

To determine whether anti-Müllerian hormone (AMH) is the factor responsible for the cytotoxic effect of testicular preparations towards endometrial cancer, homogenates and incubation media of bovine fetal testes were fractionated by lectin affinity chromatography on wheat germ agglutinin and their cytotoxic effect tested on an endometrial cancer cell line, HEC-1, and on a control cell line of renal origin. Homogenate-derived testicular proteins proved more cytotoxic than incubation medium-derived ones, and the cytotoxic factor did not bind to the lectin of wheat germ, in contrast to AMH which did. Bioactive AMH purified by monoclonal antibody chromatography, at a concentration, determined by RIA, more than 20 times that present in the cytotoxic testicular preparations, had no effect upon the growth of the malignant endometrial cells. These results indicate that the testicular agent cytotoxic to malignant endometrial cells is a substance other than AMH.

Painful lumbosacral plexopathy with elevated erythrocyte sedimentation rate: a treatable inflammatory syndrome

Six patients had a syndrome of painful lumbosacral plexopathy and elevated erythrocyte sedimentation rate. Sural nerve biopsy in each case showed axonal degeneration and epineurial arterioles surrounded by mononuclear inflammatory cells. Differential fascicular involvement suggested an ischemic cause in three nerves, but no patient had a necrotizing vasculitis. None of the six patients had vasculitis or cancer. Three of the six were diabetic and were initially thought to have diabetic plexopathy, but deterioration continued despite control of the diabetes. These six patients appeared to have an ischemic neuropathy with an immunological basis. Five were treated with immunosuppressant drugs, and in four the plexopathy improved or was arrested. The pathogenesis is unclear, but postmortem findings in one case suggest that the syndrome does not stem from an underlying vasculitis.

Immunological aberrations in ankylosing spondylitis patients

In order to explore the alteration in immunological function in patients with ankylosing spondylitis (AS), serum concentrations of IgG, IgA, IgM, C3 and C4, and lymphocyte subpopulations defined by monoclonal antibodies (OKT series) were studied in 40 AS and 20 age-matched normals. The results showed that i) The IgG and IgA in AS patients were much higher than those in normals (p less than 0.001) and C3, C4 and IgM were also increased (p less than 0.01, less than 0.05, less than 0.05, respectively), ii) The percentage of B cells and OKT3 cells of AS patients were lower, but OKT8 and OKIa1 were higher than that of normals (p less than 0.05). When the AS patients were further divided into active group (22 cases) with c-reaction protein (CRP) higher than, or equal to 15 mg/l and inactive group (18 cases) with CRP less than 15 mg/l, it was found that the inactive group had decreased B cells (p less than 0.01) and OKT3 (p less than 0.05) as compared with normals. On the other hand, the active group had increased percentage of OKT8 than normal controls (p less than 0.05), and increased OKIa1 than both inactive group and normal controls (p less than 0.01), but OKT3 decreased than the normal (p less than 0.05). It is therefore concluded that the immunological aberration plays a role in the pathogenesis of AS.

Early vascular grafting to prevent upper extremity necrosis after electrical burns: II. Experience with wound infection management

Since May 1972, vein grafts have been used to restore circulation in electrical injuries of the upper extremity when the wrist has been the centre of electrical injury associated with obstructed blood supply. Saphenous vein grafts were used in fifteen limbs in fourteen patients where electrical injuries at the wrist threatened complete loss of the hand. Ten of the hands were free of necrosis with motion basically recovered. The other four cases (five limbs) failed in operation for various reasons, resulting in forearm amputations. Clinical practice showed that successful operations depend upon whether secondary infection is effectively controlled, particularly in those who were brought to the hospital late with wound infection and gangrene of the fingers. This paper reviews the measures for controlling postoperative infections in vascular grafting to restore blood flow at the wrist, and the clinical experience gained in treating these patients (six injured limbs of six cases), and preventing amputation. We hope the method could be improved and its use broadened.

Microscopic evaluation of the sequential degeneration and repair of the retinae of albino mice after high-dose laser irradiation

After irradiation of the retinae of albino mice with a dose of 13 J, using a ruby pulse laser, the lesions were followed for a period of 60 days. Severe degenerations were observed in the outer layer 2-9 days after irradiation. By the 21st day after irradiation, the pigment epithelium started to regenerate and outer segments began to reform. Progressive recovery and repair were by and large completed by the 60th day after irradiation.

The morphology and maturation of the optic tectum of the small shark (Hemiscyllium plagiosum): a morphometrical, ultrastructural and histochemical study

The morphometrical, ultrastructural and histochemical aspects of the optic tectums of the sharks (Hemiscyllium plagiosum) of different sizes were studied. The 1,000 g animals revealed 2 areas of heavy neuronal concentration. Ultrastructural studies showed an increase in the sizes of tectal neurons and in the sizes of myelinated fibers as well as an increase in the branching system of neurons as the animal matured. A change in the ratio of the types of synaptic contacts was evident in the larger animals. 3 types of glia cells were also observed in these animals. Histochemical studies indicated very little difference between the animals of different sizes except a possible increase of cytochrome oxidase activity.

Histochemical studies of fibroblasts from patients with Menkes kinky hair disease and Wilson's disease

Cultured fibroblasts from Menkes kinky hair disease patients showed markedly reduced succinate dehydrogenase and amine oxidase activities. Cytochrome oxidase activity, however, was greatly reduced in some cells and almost normal in others. Cultured fibroblasts from patients with Wilson's disease showed moderately reduced succinate dehydrogenase and cytochrome oxidase activities. Amine oxidase activity was only slightly reduced when compared to that of normal. These results indicated that the histochemical phenotype observed in fibroblasts from patients with Menkes kinky hair disease and Wilson's disease were distinctly different from each other and from normal fibroblasts.

The natural course of hepatitis B surface antigen-positive chronic active hepatitis in Taiwan

A prospective study on the natural course of hepatitis B surface antigen (HBsAg)-positive chronic active hepatitis (CAH) in 84 patients was conducted at the Taiwan Veterans General Hospital in Taipei. On presentation, 36% of the patients had jaundice and 94% had elevated serum transaminase activity in addition to clinical symptoms. Of the 84 patients with HBsAg-positive CAH, 76 were followed for an average of 46 months, and at the time of the last visit 46% either had evidence of progressive liver disease or had died. Of the 15 deaths, nine were due to complications of liver disease and six were due to primary hepatocellular carcinoma (PHC), alpha-Fetoprotein levels of greater than 400 ng/ml were found only in patients in whom PHC was detected. The course of HBsAg-positive CAH in this predominantly male Asian population was progressive, and deaths occurred either by liver failure, by bleeding esophageal varices, or by progression to PHC.

Rupture of a previously unruptured giant middle cerebral artery aneurysm after extracranial-intracranial bypass surgery

The fatal rupture of a previously unruptured giant middle cerebral artery aneurysm occurred 13 days after an extracranial-intracranial bypass had been carried out, before definitive aneurysm surgery. Alterations in blood flow adjacent to the aneurysm after the bypass may have led to the fatal hemorrhage. After a preliminary extracranial-intracranial bypass procedure, there should be no undue delay in the direct attack on a giant aneurysm, regardless of its mode of presentation.

Scanning electron microscopic and histochemical studies of foliate papillae in the rabbit, rat and mouse

The foliate papillae of the rabbit, rat and mouse were studied by scanning electron microscopy and histochemistry. The papillae consisted of folds and grooves located on the posterolateral margin of the tongue in front of the circumvallate papillae. The numbers of folds and taste buds varied among the three animals species. Scanning electron microscopy showed that in longitudinal sections the taste buds were oval in shape and their pores were surrounded by microvilli. The reaction product of alkaline phosphatase could only be demonstrated in the superficial epithelium of the rabbit as well as in the mouse foliate papillae, but it also diffused into the taste buds in the rat. The intensity and distribution of the reactions of adenosine triphosphatase, acetylcholinesterase and butyrylcholinesterase were identical to those reported by other investigators in spite of differences in animal species and histochemical techniques employed.

Stimulation of arylsulfotransferase activity by progestins in human endometrium in vitro

The effect of progestin on the rate of estradiol (E2) sulfurylation in human endometrium was studied in two culture systems: 1) in intact endometrial tissue fragments and 2) in isolated endometrial epithelial glands and stromal cells. Human endometrial tissue fragments were cultured in medium in the presence and absence of progesterone (P) for 24-48 h. The arylsulfotransferase activity was determined in the cytosol of the tissue homogenate by measuring the rate of conversion of E2 to E2-3 sulfate (E2S) in the presence of an excess amount of substrate and cofactor (adenosine-3'-phosphate-5'-phosphosulfate). The enzyme activity was found to be stimulated in the sample cultured with P. The increase in activity correlated with the dose of P and period of culture. Stimulation of endometrial estradiol dehydrogenase activity by P, which has been reported in a series of previous publications, was also evident in the current study. Human endometrial glandular epithelial and stromal cells were cultured separately in medium in the presence and absence of medroxyprogesterone acetate (MPA). The cultured cells were incubated with E2 (0.4-0.6 nM) for 2 h. The formation of estrogen sulfates, [estrone sulfate (E1S) and E2S] was greatly increased in all the proliferative glandular epithelial cells cultured with MPA. However, the rate of sulfurylation was not appreciably affected by MPA in stromal cells and in glandular epithelial cells from secretory endometrium. The oxidation of E2 in these cultured cells was also influenced by P but not to the extent of sulfurylation. These results indicate that arylsulfotransferase in endometrium originates from glandular epithelial cells and can be stimulated by progestin.