Biochemical diagnosis of liver disease

It is important that clinicians and laboratorians, including clinical chemists and pathologists, recognize and understand the clinical significance of abnormal liver function tests. The liver regulates many important metabolic functions. Hepatic injury is associated with distortion of these metabolic functions. Hepatic disease can be evaluated and diagnosed by determining serum concentrations of a number of serum analytes. Many serum analytes exist to assist in the biochemical diagnosis of liver disease. The focus of this paper is on the analytes which are associated with hepatic necrosis, cholestasis, defects in excretion and end stage hepatic disease which results in decreased synthetic function. The abnormalities of these serum analytes will be correlated with the important types of liver disease.

Human angiopoietin gene expression is a marker for severity of pulmonary hypertension in patients undergoing pulmonary thromboendarterectomy

OBJECTIVE

A consistent pathologic feature seen in lungs of patients with pulmonary hypertension from thromboembolic disease is hyperplasia of the media of pulmonary arterioles. The molecular factors responsible for these vessel wall changes are unknown. Angiopoietin-1 is a gene responsible for the formation of the media of blood vessels in utero. We hypothesized that aberrant expression of the angiopoietin-1 gene in the adult lung would be a major contributing factor in the development of pulmonary hypertension.

METHODS

From April 1999 to March 2000, a total of 35 patients (18 men, 17 women, mean age 52 years) with pulmonary hypertension and pulmonary vascular resistance ranging from 407 to 2006 dynes x sec x cm(-5) underwent pulmonary endarterectomy at our institution. Before cardiopulmonary bypass, lung biopsy specimens were taken from each patient. Biopsy specimens were also obtained from 10 patients (5 women, 5 men, mean age 55 years) undergoing lung resection for causes other than pulmonary hypertension. All specimens were blindly scored by a pathologist for degree of medial hyperplasia. Quantitative reverse transcriptase-polymerase chain reaction, Western blot, and immunohistochemistry were used to quantitate angiopoietin-1 messenger RNA and protein in each sample.

RESULTS

Lung specimens from all patients with pulmonary hypertension demonstrated up-regulation of angiopoietin-1 at the messenger RNA level. The degree of angiopoietin-1 transcription was directly proportional to the preoperative pulmonary vascular resistance and medial wall hyperplasia/hypertrophy in each patient. By immunohistochemistry, angiopoietin-1 protein was confined to the media of pulmonary arterioles. Lung biopsy specimens from patients without pulmonary hypertension had no detectable expression of angiopoietin-1 at the messenger RNA or protein level.

CONCLUSION

Angiopoietin-1, a gene responsible for vessel development in the embryonic lung, is up-regulated in the lung parenchyma of patients with pulmonary hypertension. The level of expression of angiopoietin-1 at messenger RNA and protein levels correlates to the severity of pulmonary hypertension in patients with thromboembolic disease and serves as a target for strategies to treat this disease.

Assessment of myocardial postreperfusion viability by intravenous myocardial contrast echocardiography: analysis of the intensity and texture of opacification

BACKGROUND

Although defects on intracoronary myocardial contrast echocardiography (MCE) indicate loss of viability after reperfusion, opacified segments may also exhibit persistent dyssynergy. Therefore, we related the intensity and texture of opacification produced by an intravenous contrast agent to histological findings to determine the characteristics of necrotic tissue by postreperfusion MCE.

METHODS AND RESULTS

MCE was performed by intravenous injection of 0.15 mL/kg QW7437 in 14 dogs who underwent 3-hour coronary occlusion followed by 3-hour reperfusion. At baseline and 3 hours after reperfusion, midventricular short-axis images were digitized and segmented. Infarction fraction (IF) for each segment was determined by triphenyltetrazolium chloride stain. Of 224 segments, 140 showed no or small infarction and served as a control group. Of 84 segments with significant infarction (IF>30%), 52 exhibited a defect on MCE, and 32 exhibited no defect. Echo texture was quantified by computing entropy based on the co-occurrence matrix analysis of gray-level pairs within each segment. Three hours after reperfusion, average and maximal entropies in the infarct segments without opacification defects were significantly higher than control levels. Histologically, the degree of intracapillary erythrocyte stasis was less in this group than in the infarcted segments with MCE defects with similar magnitude of tissue injuries.

CONCLUSIONS

Opacification defects by MCE may be present or absent in myocardium with histologically confirmed infarction. The texture of MCE from opacified but infarcted myocardium differed significantly from control segments and may assist in determination of segmental viability after reperfusion.

Ischemia-reperfusion injury at the microvascular level: treatment by endothelin A-selective antagonist and evaluation by myocardial contrast echocardiography

BACKGROUND

The purpose of this study was to verify whether endothelin A-antagonist administration at the time of coronary reperfusion preserves postischemic microvasculature and whether myocardial contrast echo (MCE) is able to detect pharmacologically induced changes in microvascular reflow.

METHODS AND RESULTS

Twenty dogs underwent 90 minutes of LAD occlusion (OCC) followed by 180 minutes of reperfusion (RP). Five minutes before LAD reopening, an intravenous bolus (5 mg/kg) of LU 135252 was given in 10 dogs and vehicle in the remaining 10. At baseline (BSL), OCC, and 90 and 180 minutes of RP, microvascular flow (BF) was assessed by microspheres, and MCE was performed with intravenous echo contrast. MCE videointensity and BF were expressed as risk area/control ratio. Myocardial thickness of the risk area was calculated by 2D echo. No differences in BF between the 2 groups were observed at BSL, OCC, and 90 minutes of RP. At 180 minutes of RP, BF was decreased in controls (70+/-7.4% of BSL; P:<0.005 versus BSL) and preserved in LU 135252-treated animals (89+/-4% of BSL; P=NS versus BSL; P<0.05 versus controls). Videointensity at MCE closely followed the changes in BF observed in both groups throughout the protocol. Myocardial thickness at 180 minutes of RP increased to 138.6+/-9.9% of BSL in controls and remained at 108.9+/-7.4% of BSL in treated dogs (P<0.05).

CONCLUSIONS

Endothelin A-antagonist treatment at the time of reperfusion significantly limited the progressive decrease in postischemic microvascular reflow and the increase in myocardial thickness. MCE allowed a reliable evaluation of pharmacologically induced changes in microvascular flow.

Relationship between regional cardiac hyperinnervation and ventricular arrhythmia

BACKGROUND

Sympathetic nerve activity is known to be important in ventricular arrhythmogenesis, but there is little information on the relation between the distribution of cardiac sympathetic nerves and the occurrence of spontaneous ventricular arrhythmias in humans.

METHODS AND RESULTS

We studied 53 native hearts of transplant recipients, 5 hearts obtained at autopsy of patients who died of noncardiac causes, and 7 ventricular tissues that had been surgically resected from the origin of ventricular tachycardia. The history was reviewed to determine the presence (group 1A) or absence (group 1B) of spontaneous ventricular arrhythmias. Immunocytochemical staining for S100 protein, neurofilament protein, tyrosine hydroxylase, and protein gene product 9.5 was performed to study the distribution and the density of sympathetic nerves. The average left ventricular ejection fraction was 0.22+/-0.07. A total of 30 patients had documented ventricular arrhythmias, including ventricular tachycardia and sudden cardiac death. A regional increase in sympathetic nerves was observed around the diseased myocardium and blood vessels in all 30 hearts. The density of nerve fibers as determined morphometrically was significantly higher in group 1A patients (total nerve number 19.6+/-11.2/mm(2), total nerve length 3.3+/-3.0 mm/mm(2)) than in group 1B patients (total nerve number 13.5+/-6.1/mm(2), total nerve length 2.0+/-1.1 mm/mm(2), P<0. 05 and P<0.01, respectively).

CONCLUSIONS

There is an association between a history of spontaneous ventricular arrhythmia and an increased density of sympathetic nerves in patients with severe heart failure. These findings suggest that abnormally increased postinjury sympathetic nerve density may be in part responsible for the occurrence of ventricular arrhythmia and sudden cardiac death in these patients.

Nerve sprouting and sudden cardiac death

The factors that contribute to the occurrence of sudden cardiac death (SCD) in patients with chronic myocardial infarction (MI) are not entirely clear. The present study tests the hypothesis that augmented sympathetic nerve regeneration (nerve sprouting) increases the probability of ventricular tachycardia (VT), ventricular fibrillation (VF), and SCD in chronic MI. In dogs with MI and complete atrioventricular (AV) block, we induced cardiac sympathetic nerve sprouting by infusing nerve growth factor (NGF) to the left stellate ganglion (experimental group, n=9). Another 6 dogs with MI and complete AV block but without NGF infusion served as controls (n=6). Immunocytochemical staining revealed a greater magnitude of sympathetic nerve sprouting in the experimental group than in the control group. After MI, all dogs showed spontaneous VT that persisted for 5.8+/-2.0 days (phase 1 VT). Spontaneous VT reappeared 13.1+/-6.0 days after surgery (phase 2 VT). The frequency of phase 2 VT was 10-fold higher in the experimental group (2.0+/-2.0/d) than in the control group (0.2+/-0.2/d, P<0.05). Four dogs in the experimental group but none in the control group died suddenly of spontaneous VF. We conclude that MI results in sympathetic nerve sprouting. NGF infusion to the left stellate ganglion in dogs with chronic MI and AV block augments sympathetic nerve sprouting and creates a high-yield model of spontaneous VT, VF, and SCD. The magnitude of sympathetic nerve sprouting may be an important determinant of SCD in chronic MI.

Early expression of angiogenesis factors in acute myocardial ischemia and infarction

BACKGROUND

When the myocardium is deprived of blood, a process of ischemia, infarction, and myocardial remodeling is initiated. Hypoxia-inducible factor 1 (HIF-1) is a transcriptional activator of vascular endothelial growth factor (VEGF) and is critical for initiating early cellular responses to hypoxia. We investigated the temporal and spatial patterns of expression of the alpha subunit of HIF-1 (HIF-1alpha) and VEGF in specimens of human heart tissue to elucidate the early molecular responses to myocardial hypoxia.

METHODS

Ventricular-biopsy specimens from 37 patients undergoing coronary bypass surgery were collected. The specimens were examined by microscopy for evidence of ischemia, evolving infarction, or a normal histologic appearance. The specimens were also analyzed with the reverse-transcriptase polymerase chain reaction for HIF-1alpha and VEGF messenger RNA (mRNA) expression and by immunohistochemical analysis for the location of the HIF-1alpha and VEGF proteins.

RESULTS

HIF-1alpha mRNA was detected in myocardial specimens with pathological evidence of acute ischemia (onset, <48 hours before surgery) or early infarction (onset, <24 hours before surgery). In contrast, VEGF transcripts were seen in specimens with evidence of acute ischemia or evolving infarction (onset, 24 to 120 hours before surgery). Patients with normal ventricles or evidence of infarction in the distant past had no detectable levels of either VEGF mRNA or HIF-1alpha mRNA. HIF-1alpha immunoreactivity was detected in the nuclei of myocytes and endothelial cells, whereas VEGF immunoreactivity was found in the cytoplasm of endothelial cells lining capillaries and arterioles.

CONCLUSIONS

An increase in the level of HIF-1alpha is an early response to myocardial ischemia or infarction. This response defines, at a molecular level, one of the first adaptations of human myocardium to a deprivation of blood. HIF-1alpha is a useful temporal marker of acutely jeopardized myocardium.

Tropical sprue and subclinical enteropathy: a vision for the nineties

Aside from infectious intestinal diseases with known etiology, there is a group of gastrointestinal disorders mainly affecting the small intestine of individuals predominantly living in and less often visiting or returning from the Third World, usually the tropics, and ranging from asymptomatic structural and/or functional abnormalities of the gastrointestinal mucosa (subclinical enteropathy, SE) to a fully symptomatic condition highlighted by malabsorption of nutrients with associated nutritional deficiencies responsive to folate and broad spectrum antibiotic treatment (tropical sprue, TS). Mounting evidence supports an infectious cause in many instances. The exact nature of the infection, whether initiated and/or perpetuated by enterotoxigenic coliform bacteria, virus(es) or a combination of these, is not clear. Further studies, including those using molecular techniques, are needed in order to clarify various aspects of these widely prevalent disorders.

Effects of chemical subendocardial ablation on activation rate gradient during ventricular fibrillation

The mechanism by which an endocardial-epicardial activation rate gradient develops after 1 or 2 min of sustained ventricular fibrillation is unknown. We recorded from electrodes on the epicardium and from hook electrodes in the endocardium in three open-chest control dogs during prolonged ventricular fibrillation. The same recordings were also made in seven dogs after right ventricular subendocardial ablation with Lugol solution and in three dogs after substitution of air for the cavitary blood. The effects of these interventions, i.e., Lugol ablation (n = 2) and the exposure to air (n = 2), on the subendocardial Purkinje fiber transmembrane action potential properties were also evaluated in vitro using microelectrode recording techniques. The in vivo studies showed a significant endocardial-epicardial rate gradient in the control dogs and in dogs that had air substituted for the cavitary blood. In comparison, in dogs that underwent chemical subendocardial ablation, the activation cycle lengths for the endocardium and epicardium were not significantly different. The in vitro studies showed that subendocardial Purkinje fiber action potentials could still be recorded for up to 10 min of exposure to air. In comparison, in the tissues subjected to chemical ablation, no transmembrane action potentials could be recorded from either the Purkinje fibers or superficial ventricular muscle cells. We conclude that the development of an endocardial-epicardial activation rate gradient during prolonged ventricular fibrillation depends on the presence of intact subendocardial Purkinje fibers and ventricular myocytes. The retained cavitary blood is not responsible for the development of the rate gradient.

The mechanism of termination of reentrant activity in ventricular fibrillation

The reentrant wave fronts in ventricular fibrillation (VF) have only a limited life span. The mechanisms by which these reentrant wave fronts terminate are unknown. We performed computerized mapping studies in six open-chest dogs before and after right ventricular subendocardial ablation with Lugol's solution. Recordings were made with 56 bipolar electrodes separated by 3 mm. Baseline pacing was performed on the right side of the tissue to create parallel activation wave fronts. A premature 50-V shock of either anodal or cathodal polarity was given to a bar electrode on the upper edge of the tissue. Counterclockwise reentrant wave fronts and VF were induced both before (60 episodes) and after (57 episodes) subendocardial ablation with either anodal or cathodal shocks. Among these reentrant wave fronts, 8 episodes before and 10 episodes after ablation had over 10 rotations (P = NS). The reentrant wave fronts in other episodes terminated with an average of 3.2 +/- 1.9 rotations before and 3.1 +/- 1.8 rotations after the ablation (P = NS). The reentrant wave-front cycle length was 118 +/- 19 milliseconds before and 124 +/- 20 milliseconds after ablation (P = .001). Conduction block occurred when the wave front was traveling across the myocardial fibers. When conduction was blocked in these episodes, the leading edge of the reentrant wave front encountered tissue that had been excited within the past 58 +/- 12 milliseconds (range, 28 to 77 milliseconds), which corresponded to 47 +/- 12% of the preceding VF cycle length. This period was significantly shorter than the recovery period in the same region that had allowed conduction (91 +/- 19 milliseconds; range, 48 to 137 milliseconds), which corresponded to 72 +/- 18% of the preceding VF cycle length (P < .001). In nine episodes, reentrant wave-front activity terminated when wave fronts that had originated from outside the mapped tissue interfered with the reentrant pathways. Conclusions are as follows: (1) The refractory period of fibrillating ventricular muscle ranges from 48 to 77 milliseconds. Because the refractory period is much shorter than the VF cycle length, a large excitable gap is present in the reentrant circuit. The presence of a large excitable gap contributes to reentrant wave-front termination. (2) Myocardial fiber orientation is an important determinant of the site of conduction block. (3) Although subendocardial ablation slowed the wave-front propagation, it did not prevent the generation and the maintenance of reentry and VF.

Clinical significance of serum high-molecular-mass alkaline phosphatase, alkaline phosphatase-lipoprotein-X complex, and intestinal variant alkaline phosphatase

This paper is a study to identify the clinical significance of high-molecular-mass alkaline phosphatase (ALP:E:C..3.1.3.1.), ALP-lipoprotein-X complex (LP-X) and intestinal variant ALP. We used cellulose acetate and agarose gels and techniques including wheat germ lectin, cetavlon-diethyl ether, thermostatability, neuraminidase and L-phenylalanine to improve the electrophoretic separation of the alkaline phosphatase isoenzymes. Patients' serum samples were electrophoresed from a diverse group of individuals ill with cholestasis, neoplastic disease metastatic to the liver, hepatocellular carcinoma, cirrhosis, diabetes mellitus, and chronic renal disease. Agarose gels provided better separation of ALP isoenzymes than cellulose acetate gels. The results also indicated that high-molecular mass ALP is present in patient's serum in conditions associated with cholestasis especially caused by hepatic malignancy. High-molecular mass ALP was frequently found to co-exist with the liver isoenzyme and LP-XALP complex. The intestinal variant was identified in patients with malignancy, cirrhosis, chronic renal disease and diabetes mellitus. Intestinal ALP coexisted concomitantly with a variant intestinal ALP. Intestinal variant ALP is most likely composed of intestinal ALP attached to a cellular membrane-binding domain, or may be an artifact produced by neuraminidase incubation.

The epidemiology of traumatic death. A population-based analysis

Despite the proliferation of trauma systems, there are no population-based data describing the epidemiology of traumatic death. To provide these data, we reviewed all trauma deaths occurring in San Diego (California) County during 1 year. There were 625 traumatic deaths during the study (27.3 deaths per 100,000 population per year). Motor vehicle trauma was the most common cause of injury leading to death (N = 344 [55.2%]; 15.0 annual deaths per 100,000 population). Central nervous system injuries were the most common cause of death (48.5%, or 13.2 deaths per 100,000 population per year). Sepsis was responsible for only 2.5% of the overall mortality. Based on life-table data, traumatic death resulted in an annual loss of 1091 years of life per 100,000 and an annual loss of 492 years of productivity per 100,000. Injury continues to account for an enormous loss of life despite improvements in survival wrought by trauma systems.

AIDS and malignant mesothelioma--is there a connection?

A 35-year-old male homosexual, a former intravenous drug abuser, was found to be human immunodeficiency virus (HIV) positive in 1984. He developed AIDS in 1987 and began treatment with zidovudine in 1989. One year later he developed left apical pleural blebs, a pneumothorax and an exudative pleural effusion. A malignant mesothelioma developed at the pleural blebs in the left apex. He was treated with adriamycin but rapid progression of the malignancy occurred and he died three months later. At autopsy, a malignant mesothelioma, causing respiratory failure and death, was found. The patient had no exposure to asbestos and asbestosis was not present at autopsy. We postulate that the development of malignant mesothelioma was probably related to HIV immune suppression or HIV and/or cytomegalovirus or zidovudine and is a complication of AIDS similar to the development of other malignant neoplasms in patients with AIDS.

Effects of subendocardial ablation on anodal supernormal excitation and ventricular vulnerability in open-chest dogs

BACKGROUND

In Langendorff-perfused hearts and in hearts on cardiopulmonary bypass, chemical ablation of the subendocardium of both ventricles decreases ventricular vulnerability to fibrillation. It was hypothesized that the effects of ablation are a result of the elimination of the subendocardial Purkinje fiber network. This hypothesis has been supported by recent observations that the supernormal excitability that is demonstrable in the Purkinje fibers is associated with arrhythmogenesis.

METHODS AND RESULTS

We tested this hypothesis on 10 open-chest dogs by evaluating the strength-interval curves of anodal and cathodal stimulation with the assistance of computerized mapping techniques. The ventricular fibrillation threshold was also determined. The same test was then performed after chemical ablation of the subendocardium of either the right ventricle (six dogs) or both ventricles (four dogs). Anodal supernormality was consistently demonstrated in all the dogs studied both before and after subendocardial ablation. The ventricular fibrillation thresholds were 23 +/- 5 mA both before and after right ventricular subendocardial ablation (p = NS). The ventricular fibrillation thresholds before and after biventricular subendocardial ablation were 25 +/- 3 and 22 +/- 10 mA, respectively (p = NS).

CONCLUSIONS

We conclude that 1) subendocardial ablation does not decrease ventricular vulnerability when the heart is in situ and is not on cardiopulmonary bypass and 2) anodal supernormal excitability can be demonstrated in ventricles without a subendocardial Purkinje fiber network.

Lactate dehydrogenase isoenzymes in myocardial disease

Serum lactate dehydrogenase (LD) is elevated in various myocardial diseases. A certain pattern of LD isoenzyme elevation occurs in myocardial disease. Since LD is an ubiquitous enzyme, it is not surprising that serum LD is increased in a wide variety of other diseases, which are analyzed in this article.

Epidemiology and pathology of traumatic deaths occurring at a Level I Trauma Center in a regionalized system: the importance of secondary brain injury

We reviewed the hospital records and autopsy data of all deaths occurring at a Level I Trauma Center during a 1-year interval to determine the epidemiology of traumatic death in a regionalized system of care: 1,581 patients were admitted and 106 died (6.6%). Nonsurvivors (NS) differed significantly from survivors (S) in age, Trauma Score, Injury Severity Score, and probability of survival, but there was no difference between NS and S in scene time or transport time. Of the NS 91.4% died within 7 days; only 8.6% died after 7 days. Central nervous system (CNS) injury was responsible for 48.1% of deaths, followed by hemorrhage (36.8%) and cardiovascular disease (5.7%). Sepsis was responsible for 5.5% of deaths. Secondary brain injury was found at autopsy in 66% of patients dying of CNS injury. The relatively small number of septic deaths may be due, in part, to improvements in treatment associated with regionalization of trauma care. The frequency of secondary brain injury, despite rapid transport and evacuation of mass lesions, suggests that it may play a major role in the pathophysiology of CNS death occurring in a trauma system.

Effects of cyclosporin A on the splenic tissue of rats: a histomorphometric analysis

Histological studies demonstrated that long-term cyclosporin A treatment of nonantigenically challenged (untransplanted and unimmunized) Lewis rats markedly reduces the total percentage of splenic white pulp when compared to untreated control spleens (mean = 24 vs 34%, P less than 0.001). Direct measurements of periarteriolar sheaths and marginal zones demonstrated a marked reduction in size of these compartments in cyclosporin A-treated rats compared to untreated controls (P less than 0.001). In addition, there was a striking reduction in cellular density of the periarteriolar sheaths (P less than 0.001) and a minimal reduction in cellular density of the marginal zones (P less than 0.1) in the cyclosporin A-treated group when compared to untreated controls. There was no significant difference in total splenic size between the cyclosporin A-treated and the control groups, as indicated by total cross section measurements (mean = 33.3 vs 35.0, P less than 0.4). Qualitative observations of methyl green-pyroninophilic cells within and surrounding the marginal zones of the cyclosporin A-treated spleens revealed a much greater proportion of large pyroninophilic lymphocytes, which suggests that they are B immunoblasts. We conclude that long-term cyclosporin A treatment depletes splenic periarteriolar sheaths and marginal zones, compartments known to contain primary T lymphocytes, and induces an immunoblastic cell proliferation within the marginal zones and red pulp as well.

Histometric investigations of the effect of cyclosporin A on the testicular tissue of rats

The effect of cyclosporin A (CsA) on rat testes was assessed in Lewis rats which were given 10 mg/kg of CsA im per day. The rats were divided into 13 subgroups, and 1 subgroup was sacrificed each month. The rat testes were measured and examined for histometrical and morphological changes in comparison to controls. Histometrical analysis included testicular cross-sectional surface area, tubular density, tubular diameter, and the amounts of testicular germinal epithelium, lumen, and interstitial tissue. In the parameters examined, there were no overall differences between CsA-treated animals and controls. CsA does not affect rat testicular tissue.

Changes in serum enzymes, lactate, and haptoglobin following acute physical stress in international-class athletes

Skeletal muscle is rich in creatine kinase (CK), lactate dehydrogenase (LD), and other enzymes. Many reports describe changes in serum CK and LD following exercise. In our study, 11 male international-class medium-distance runners were followed over a 10-month period prior to the 1984 US Olympic Trials. Cardiorespiratory fitness, evaluated through repetitive treadmill testing, was unchanged in our athletes. Total CK increased significantly during the course of training, and the CK-MB activity was higher than that of sedentary individuals; CK-MB never rose to more than 3% of the total CK. Total LD also rose following acute exercise; however, the proportions of the five isoenzymes were unaltered. There was no change in the LD-1/LD-2 ratio from normal. The origin of the increased serum enzymes was believed to be primarily skeletal muscle. A decrease of serum haptoglobin following acute stress was attributed to intravascular hemolysis and binding of hemoglobin. As expected, serum lactate was dramatically increased immediately postexercise.

Neurosecretion of human hypothalamic immunoreactive beta-endorphin: in vitro regulation by dopamine

An in vitro perifusion system was used to investigate immunoreactive beta-endorphin (beta-END-I) release from adult human hypothalami in response to dopamine (DA) and the DA receptor antagonist haloperidol (HAL). Administration of a 1 microM pulse of DA consistently elicited a mean (+/- SE) 88 +/- 9% increase (p less than 0.05, n = 5) in beta-END-I release, whereas 1 microM HAL had no effect. Administration of 1 microM DA during three perifusions in which 1 microM HAL was added to the medium failed to alter basal beta-END-I release. In contrast, DA did evoke an acute 230 +/- 31% increase (p less than 0.05) in beta-END-I release during three matching perifusions with medium containing the alpha-adrenergic antagonist phentolamine. These studies demonstrate that DA can stimulate in vitro release of beta-END-I from the adult human hypothalamus by a DA receptor mediated mechanism.

Alpha-heavy chain disease

A review of alpha-heavy chain disease (AHCD) emphasizing its histopathology and associated lesions is presented. Unusual clinicopathologic presentations and modern concepts regarding histogenesis of AHCD in the light of recent immunohistochemical findings are discussed. Increasingly reported cases of Burkitt's (or Burkitt-type) lymphoma involving distal small intestine or the ileocecal region in children are noted.

Interpretation of electrophoretic patterns of serum proteins

Serum protein electrophoresis enables the physician to correctly interpret abnormalities in the serum proteins. This article identifies these abnormalities.

Gonadotropin-releasing hormone neurosecretion in the human hypothalamus: in vitro regulation by dopamine

An in vitro perifusion system was used to investigate GnRH release from adult human hypothalami in response to dopamine (DA) and the DA receptor antagonist haloperidol (HAL). Administration of a 1-microM pulse of DA consistently elicited a mean +/- SE 218 +/- 59% increase (P less than 0.05; n = 5) in GnRH release, whereas 1 microM HAL had no effect. Administration of 1 microM DA during three perifusions in which 1 microM HAL was added to the medium failed to alter basal GnRH release. In contrast, DA did evoke an acute 98 +/- 39% increase (P less than 0.06) in GnRH release during three matching perifusions with medium containing the alpha-adrenergic antagonist phentolamine. These studies demonstrate that DA can stimulate in vitro release of GnRH from the adult human hypothalamus by a DA receptor-mediated mechanism.

Lactate dehydrogenase-6. A biochemical sign of serious hepatic circulatory disturbance

I confirmed the existence of an additional isozyme band of lactate dehydrogenase (LD) (EC 1.1.1.27) cathodic to LD-5 utilizing agarose gel isozyme electrophoresis in seven patients. Three of the patients died of circulatory failure within three weeks after the isozyme was identified. Four patients survived after successful therapy for heart failure. The under-lying clinical condition was arteriosclerotic cardiovascular disease causing congestive heart failure with passive congestion of the major viscera. I performed biochemical analysis on the isozyme and found that it was extremely heat stable, was not immunoglobulin bound, and contained only M, not H, subunits. It may represent a posttranslationally modified LD-5 or alcohol dehydrogenase.

Quantitative morphological studies of aging changes in the kidney of the Lewis rat

Spontaneous aging changes in the kidneys of the rat have been previously described. In the Lewis strain, we performed semiquantitative studies of kidney histology and quantitative studies of glomerular basement membrane thickness and mesangial area in animals aged 6-30 months. There is a progressive increase in glomerular basement membrane thickness and mesangial area throughout the life of the rat. Spontaneous glomerulosclerosis in the Lewis rat does not appear to be as extensive as in other strains. The importance of spontaneous glomerulosclerosis in studies of induced kidney disease is emphasized.

Endogenous opioid regulation of gonadotropin-releasing hormone release from the human fetal hypothalamus in vitro

Endogenous opioid regulation of GnRH release from the human fetal (21-23 weeks gestation) mediobasal hypothalamus was investigated in an in vitro perifusion system. Pulse injection of an opiate receptor antagonist, naloxone, reproducibly elicited an acute increase in GnRH release within 30 min. Constant infusion of naloxone (60 min) induced a sustained increase in GnRH release, which was promptly inhibited by a pulse of beta-endorphin administered halfway during the naloxone infusion. These studies unequivocally demonstrate that endogenous opiates exert an inhibitory effect on GnRH release from the human fetal mediobasal hypothalamus in vitro.

Concurrent primary parathyroid hyperplasia and parathyroid carcinoma

We noted the association of parathyroid carcinoma and primary parathyroid hyperplasia in a 53-year-old woman who had a clinical and laboratory profile of primary hyperparathyroidism. At surgery, three hyperplastic parathyroid glands were excised, one of which also demonstrated parathyroid carcinoma. Postoperatively, she was treated for persistent hypercalcemia and died of congestive cardiac failure. At autopsy, there was evidence of metastatic parathyroid carcinoma, and a further hyperplastic parathyroid gland was identified. The association of parathyroid hyperplasia and carcinoma is rare.

Angiosarcoma of the lung with fatal pulmonary hemorrhage

A patient with fatal pulmonary hemorrhage was found to have angiosarcoma of the lung at postmortem examination. This case, occurring in a man with a prior history of industrial exposure in South African copper mines, is the third well-described primary occurrence of this tumor in the lung.

Elevated hemoglobin A1 in streptozotocin diabetic rats and in rats on sucrose and galactose-enriched diets

Increased hemoglobin A1 (HbA1) occurs in diabetes mellitus as a direct consequence of hyperglycemia, which causes postsynthetic modification of hemoglobin proportional to blood glucose concentration. Glycosylation of hemoglobin is demonstrable also in vitro, not only by glucose, but with other reducing sugars such as galactose. The purpose of this study was to show that increased HbA1 could be induced by feeding rats a diet enriched either by galactose or sucrose. A third experimental group consisted of rats made diabetic by injection of streptozotocin. Exposure to a diet of 40% galactose resulted in a diabetes-like state with polyuria, weight loss, muscle atrophy, fat depletion, bilateral cataracts, peripheral neuropathy and significantly elevated HbA1. Blood glucose levels were not elevated and after four months of galactose feeding there was hypoglycemia. Total HbA1 was determined by a microcolumn chromatographic procedure, recently made available for clinical use. Increased HbA1 was also found in rats which received a diet of 68% sucrose for several months. The highest values of HbA1 were determined in streptozotocin diabetic rats and there was significant correlation with plasma glucose concentration. Development of experimental models for increased HbA1 by dietary exposure makes it possible to relate increases in HbA1 to measured amounts of sugar included in the diet. Increased HbA1 in galactosemic and diabetic rats provides a biochemical marker which may be correlated with the evolving morphologic changes such as basement membrane thickening occurring in certain tissues in diabetes mellitus.

A radioimmunoassay and biological profile of Ia-like antigens on human melanoma cells

Human melanoma cells have unexpectedly been found to express Ia-like antigens, histocompatibility type antigens which are believed to be the gene products of the immune response region. Melanoma derived Ia-like antigens are immunologically functional. Monoclonal antibodies have been produced to these antigens. The level of Ia-like antigens on melanoma cells is significantly lower than on B lymphoid cells, and this is more likely to reflect a reduced synthesis than an increased shedding. We have employed radioimmunometric and immunofluorescent procedures in this investigation, Melanoma cell-derived Ia-like antigens have a structure similar to that of B lymphoid cell-derived Ia-like antigens. The antigens are composed of two non covalently associated glycoproteins. One chain, referred to as the alpha chain, has an approximate molecular weight of 34,000 and the other one, referred to as the beta chain, has an approximate molecular weight of 29,000. The expression of Ia-like antigens is restricted to malignant melanoma and not on benign nevi.

Clinical significance of an ultrafast alkaline phosphatase isoenzyme

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Hemolytic anemia in hepatic disease with decreased erythrocyte adenosine triphosphate

Erythrocyte adenosine triphosphate (ATP) was assessed in patients with hepatic disease who had developed hemolytic anemia. Erythrocyte ATP was decreased, and this finding documents another cause for hemolytic anemia in patients with hepatic disease. The decreased erythrocyte ATP is secondary to hypophosphatemia, which is a common biochemical abnormality associated with hepatic disease.