Showing papers by "Baylor College of Medicine published in 1971"

Methods of scoring the progression of radiologic changes in rheumatoid arthritis. Correlation of radiologic, clinical and laboratory abnormalities

Abstract: Methods of scoring osseous defects and joint space narrowing in the hands and wrists of patients with definite or classical rheumatoid arthritis were devised. The usefulness of the scores was tested in a group of 90 patients who had one or more sets of X-ray films of the hands and wrists 36 months or more after onset of illness. Correlations were found between the extent of radiographic abnormalities or the rate of progression of radiographic changes and the age at onset, hand and wrist deformities, preceding physical signs of inflammation in the joints of the hands and wrists, hand function as measured by fist formation, the early appearance of subcutaneous nodules, and the titer of anti-IgG. Among black patients the extent of elevation of γ-globulins was associated with roentgenographic changes. The correlations between the scores of radiologic abnormalities and the clinical and laboratory manifestations of rheumatoid arthritis establish the value of the described methods of assessing the roentgenographic changes and indicate the usefulness of these methods in evaluating the effect of therapy in this disease.

Left ventricular bypass pump for cardiac assistance. Clinical experience.

Abstract: A gas-energized, synchronized, hemispherical pump, of Dacron®-reinforced Silastic®, has been used effectively to relieve the strain on the failing left ventricle during the early recuperative period after open heart surgery. Since 1963, when an early version was implanted in a patient, numerous improvements have been made, among the most important of which has been use of Dacron velour lining to minimize trauma to the blood. Two illustrative cases demonstrate the effectiveness of the pump during relatively sustained use: until the fourth postoperative day in a young girl with long-standing rheumatic heart disease, severe mitral insufficiency and cardiac failure; and until the tenth postoperative day in a woman with severe aortic insufficiency and mitral stenosis who required replacement of both valves. Both patients, critically ill before operation, recovered completely. Experimental and clinical experience indicates that the pump, by immediately reducing left atrial pressure and therefore left ventricular end-diastolic pressure, interrupts the vicious cycle of complex metabolic changes consequent to the hemodynamic disturbances associated with cardiac failure. The need for thoracotomy and the prohibitive cost, however, obviate broad clinical application of the pump. Development of a mechanical device for long-term support or for total cardiac replacement awaits the resolution of several critical problems, including a non-traumatic blood interface, improved control mechanism and portable power source.

Metabolic Profiles: Gas-Phase Methods for Analysis of Metabolites

Abstract: Multicomponent analyses were carried out for three types of urinary constituents: steroids, acids, and drugs and drug metabolites. The methods were based on gas-phase analytical techniques, which include the use of instruments and instrumental systems for gas chromatography, gas chromatography—mass spectrometry, and mass spectrometry—computerization. After isolating an analytical sample, we prepared derivatives in each instance. Gas chromatography was used for separations, mass spectrometry for identification. These procedures for obtaining metabolic profiles may be used in various ways, including studies of abnormal conditions, drug metabolism, and the effects of drugs on metabolic pathways, as well as for human developmental studies.

The impedance of stainless-steel electrodes.

Abstract: The resistive and capacitive properties of stainless-steel electrodes in contact with saline solutions of various concentrations were investigated over a frequency range extending from 20 to 10 kHz by using a variable-length conductivity cell. With a low current density, the series-equivalent resistance and capacitance of a single electrode-electrolyte interface were found to vary almost inversely as the square root of frequency. In the frequency range studied, it was found that the reactance was very nearly equal to the resistance and both varied almost inversely as the square root of the frequency, verifying Warburg's postulate. When current density was increased, resistance decreased and capacitance increased at all frequencies studied; the change in each was most apparent in the low frequency region. As a consequence, it can be stated that the impedance of an electrode-electrolyte interface decreases with increasing current density.

Quantitative characterization of dense body, autophagic vacuole, and acid phosphatase-bearing particle populations during the early phases of glucagon-induced autophagy in rat liver

Abstract: Quantitative characterization of dense body, autophagic vacuole and acid phosphatase-bearing particle populations of rat liver have been made at 10 min intervals during the first 50 min following the intraperitoneal administration of glucagon. Beginning 10 to 20 min postinjection, increases in the number of autophagic vacuoles and in the osmotic sensitivity of acid phosphatase-bearing particles were observed, associated with a progressive disappearance of dense bodies. These changes appeared to reach a maximum 50 min after treatment. The average volume of autophagic vacuoles was found to be 440–870% greater than that of normal dense bodies during this time period. No consistent change in total acid phosphatase activity was noted. A detailed study of autophagic vacuole profile populations revealed the presence of five different types of profiles, two of which, types I and II, accounted for 76.3–94.4% of the profiles examined. Type I profiles primarily contained elements of the endoplasmic reticulum, free ribosomes, and ground cytoplasm. Type II profiles had mitochondrial profiles as their principal constituent, but endoplasmic reticulum and free ribosomes were also seen. At all time points type I profiles predominated, comprising 55–69% of the profiles found. Both profile types were bounded by single and double limiting membranes, the former being predominate. A time-dependent change in the ratio of single to double membrane-limited profiles could not be demonstrated. Morphometric parameters derived from profile size distributions indicated that the number of types I and II autophagic vacuoles increased with time, the rate being greater for the type II particle, except between 40 and 50 min. The average volume of the type II autophagic vacuole was consistently greater than that of the type I.

Cerebral Embolization: Prospective Clinical Analysis of 42 Cases

Abstract: The sites, sources, and incidence of cerebral embolization were established in an unselected series of hospitalized patients using recommended epidemiological criteria. Criteria for diagnosis of cerebral embolization as a cause of stroke are defined. Forty-two (15%) from a total of 280 patients with various forms of cerebrovascular disease were diagnosed as having cerebral embolization. The epidemiology has been altered by antibiotics and cardiac surgery, particularly the use of prosthetic heart valves. In this series, the mortality rate was 9.5%, which is lower than in previously reported series probably due to emergency medical treatment. The heart was the most common source. Prosthetic heart valves emerged as the most common source of emboli in this series. Ulcerated plaques of the carotid arteries in the neck ranked second. Seizures occurred in 42.8% of cases. The left cerebral hemisphere was involved approximately twice as frequently as the right one. Possible explanations based on the anatomy of the...

Influence of Temperature of Incubation and Type of Growth Medium on Pigmentation in Serratia marcescens

Abstract: Maximal amounts of prodigiosin were synthesized in either minimal or complete medium after incubation of cultures at 27 C for 7 days. Biosynthesis of prodigiosin began earlier and the range of temperature for formation was greater in complete medium. No prodigiosin was formed in either medium when cultures were incubated at 38 C; however, after a shift to 27 C, pigmentation ensued, provided the period of incubation at 38 C was not longer than 36 hr for minimal medium or 48 hr for complete medium. Washed, nonpigmented cells grown in either medium at 38 C for 72 hr could synthesize prodigiosin when suspended in saline at 27 C when casein hydrolysate was added. These suspensions produced less prodigiosin at a slower rate than did cultures growing in casein hydrolysate at 27 C without prior incubation at 38 C. Optimal concentration of casein hydrolysate for pigment formation by suspensions was 0.4%; optimal temperature was 27 C. Anaerobic incubation, shift back to 38 C, killing cells by heating, or chloramphenicol (25 mug/ml) inhibited pigmentation. Suspensions of washed cells forming pigment reached pH 8.0 to 8.3 rapidly and maintained this pH throughout incubation for 7 days. Measurements of viable count and of protein, plus other data, indicated that cellular multiplication did not occur in suspensions of washed cells during pigment formation. By this procedure utilizing a shift down in temperature, biosynthesis of prodigiosin by washed cells could be separated from multiplication of bacteria.

Antibodies to viral antigens in systemic lupus erythematosus.

Abstract: Sera from 31 patients with lupus erythematosus, 31 controls matched by age and sex and 33 patients with connective tissue disorders other than SLE were examined for specific antibodies to 15 viral antigens by hemagglutination-inhibition tests. Complement-fixation tests were also employed to measure antibodies to measles virus and rubella virus. Sera from patients with LE had significantly higher geometric mean antibody titers than matched controls to measles, rubella, parainfluenza types 2 and 3 and reovirus type 2 antigens. When antibody levels from patients with LE were compared with those from patients with other connective tissue disorders, significant differences were noted for measles, rubella, parainfluenza types 1 and 2 and mumps antigens. Removal of nonspecific antinuclear antibodies from selected SLE sera by adsorption with mouse liver nuclear antigens failed to appreciably alter specific viral antibody. The elevated antibody levels in sera from patients with SLE are consistent with the existence of a hyperreactive immunologic state in this disorder and do not necessarily carry etiologic implications.

Formation of a Carcinogen in Human Skin irradiated with Ultraviolet Light

Abstract: THE role of ultraviolet light and sunlight in the aetiology of certain types of human skin cancer is now well established1. The mechanism(s) by which light induces such changes, however, are not understood. One explanation2,3 of the induction of skin cancers by ultraviolet light and sunlight is that steroids in the skin are converted photochemically to carcinogenic materials, but failure to obtain such compounds by irradiation of naturally occurring sterols in biological systems has cast doubt upon the validity of such a hypothesis. Although Blum has argued against this hypothesis4, he has recently described the induction by ultraviolet radiation of a diffusible substance that mediates hyperplasia5. Here we provide evidence for the formation of a cholesterol-derived carcinogenic photoproduct in human skin.

Ultrastructure of granular cell ameloblastoma.

Abstract: To our knowledge, this is the first description of the ultrastructure of the granular cell ameloblastoma, an odontogenic tumor. The granular cells of this tumor are shown to be epithelial in origin. The organelles resulting in their cytoplasmic eosinophilia, as seen in the light microscope, are mainly pleomorphic, osmiophilic lysosome-like granules. A comparison with granular cell myoblastoma shows a striking morphological similarity between the cytoplasmic granules of these two lesions. We conclude that the granular cell ameloblastoma and the granular cell myoblastoma, probably along with the granular cell ameloblastic fibroma and the congenital epulis, constitute a group of lesions in which the lysosomes are the common denominator as the expression of their cytoplasmic eosinophilia.

Choriocarcinoma and adenocarcinoma of the esophagus with gonadotropin secretion

Abstract: A 44‐year‐old man died of disseminated choriocarcinoma. The esophagus was verified as the apparent primary source at postmortem examination. The esophageal tumor, but not the metastases, also contained well‐differentiated adenocarcinoma. Similar cases of mixed adenocarcinoma and choriocarcinoma have been reported to occur in the stomach. We believe that the basic lesion was an adenocarcinoma which underwent metaplasia to form cells morphologically and functionally indistinguishable from trophoblasts. This explanation would supplant the traditional idea of “embryonic rests” as the source of extragenital choriocarcinomas of the viscera. The literature is reviewed on the uncommon involvement of the gastrointestinal tract by choriocarcinoma.

Some biochemical studies on subcellular systems isolated from fresh recipient human cardiac tissue obtained during transplantation.

Abstract: Three subcellular membrane systems were isolated from recipient human cardiac tissue obtained during transplantation. (1) Respiratory control and rates of oxygen consumption were higher in mitochondria isolated from nonfailing, hypertrophied human cardiac tissue than in mitochondria from failing, recipient hearts. Calcium accumulation by human mitochondria was lower than in mitochondria from various animal hearts. (2) Na+,K+-adenosine triphosphatase activities were low compared to those in a variety of animal heart preparations. The recipient human preparations were also less sensitive to inhibition by ouabain. (3) The cardiac “relaxing system” accumulated less calcium and bound and released calcium at slower rates compared to similar systems isolated from animals. This system has been shown to be insensitive to cardiac glycosides, in vivo and in vitro.

Interaction and rearrangement of trimethylsilyloxy functional groups. The structural significance of the m/e 147 ion in the mass spectra of trimethylsil steroidal ethers

Abstract: Requirements for trimethylsilyloxy group interaction and rearrangement are discussed. It is evident that formation of the m/e 147 ion is a function of the stereochemistry, steric hindrance and separation of the trimethylsilyloxy groups and reflects the stereochemistry of the steroid itself. It is postulated that ring cleavage is not necessarily a prerequisite for the formation of this ion. The occurrence of the m/e 147 ion can be structurally informative in trimethylsilyl derivatives of steroidal alcohols.

A Laboratory Procedure for the Acetylation and Permethylation of Oligopeptides on the Microgram Scale

Abstract: The amino acid sequence of oligopeptides can be determined from the mass spectra of their volatile derivatives. A general procedure for the N-acetylation and N,O,S-permethylation of unknown peptides that do not contain arginine is described. The procedure is illustrated by the derivatization of lysyl-tyrosyl-glutamic acid. The mass spectrum of the resulting N a, N' -diacetyl-N a, N'-dimethyllysyl-N a, O-dimethyltyrosyl-Na-methyl glutamic acid α, β dimethyl ester (I)1 is given.

Microagglutination Procedures for Febrile Agglutination Tests

Abstract: Febrile agglutination tests were done by using as antigens Brucella abortus, Salmonella group D, Proteus OX19, and Pasteurella tularensis. Comparison of results from 23 sera showed that the microtechnique, rapid slide, and test tube methods gave similar titers, although those from the microtechnique were generally higher. The sensitivity of the microtechnique depended upon the concentration of antigen, and, to obtain reproducible results, the optimal concentration of antigens had to be determined by preliminary titrations against specific, positive control antisera. Readability of reactions in the microtechnique was enhanced by adding the dye Safranin O to diluent for antigen and by use of V-type, rather than U-type, microtiter plates. Tests were also done to determine the effects of dye and salt concentrations, pH, and temperature of incubation upon the titer of agglutinations by the microtechnique. Our results indicated that the microtechnique could be used for agglutination tests involving febrile antigens. The procedure is less time-consuming than the tube method and requires less antigen and serum than the latter method or the rapid slide method.

Lymphoid cell dependence of eosinophil response to antigen.

Abstract: Quantitative determinations were made of the capacity of isogenic bone marrow, spleen, and thymic cells from primed and/or nonprimed mice to repopulate the hemopoietic tissues and to mount an inflammatory and antibody response to specific antigen (tetanus toxoid) in heavily irradiated and reconstituted recipients. Spleen cells from primed mice but not from normal mice had the capacity to adoptively transfer an anamnestic antitoxin titer in irradiated animals in the absence of transplanted bone marrow cells, and during retarded myeloid regeneration. Spleen cells alone or bone marrow cells alone produced an insignificant and a moderate peritoneal eosinophil response, respectively, to antigen. In the presence of bone marrow cells, normal spleen cells augment the capacity of recipient animals to mount an eosinophil response to antigen. A much greater augmentation occurs in animals reconstituted with splenic or thymic cells from primed animals. The increase in antitoxin titers appears to be independent of the response of eosinophils since: (a) marked accumulation of eosinophils can occur in animals with no measurable humoral antitoxin, and (b) high antitoxin titers can occur in animals which do not have marked eosinophil responses. It is suggested that a thymic-derived or thymic-dependent mononuclear cell population is necessary for optimal eosinophil response to antigen. The neutrophil and mononuclear cell responses to antigen are determined by different mechanisms from those which determine the eosinophil response. These studies together with earlier findings strongly indicate that the eosinophil granulocytes play a role in the immune response to antigen.

Ductal carcinoma involving the lobule of the breast: A source of confusion with lobular carcinoma in situ

Abstract: A review of 205 consecutive breast carcinomas of ductal type disclosed that 45 concomitantly involved the terminal ducts of the lobule. Carcinoma presumably invaded the lobule by intraluminal extension from lactiferous ducts. The presence of this type of lobular involvement may be mistaken for lobular carcinoma in situ and is especially confusing when found in the breast remote from the grossly detectable ductal neoplasm. The diagnosis of lobular carcinoma has important therapeutic implications for the second breast because of the high frequency of bilaterality in that disease compared with ductal carcinoma. In our group of ductal carcinomas with lobular invasion, short term follow-up and examination of tissue from the opposite breast in 10 patients indicates that the frequency of bilaterality for lobular carcinoma is not attained. Therefore, it is important to sharply separate lobular carcinoma in situ from lobular invasion by ductal carcinoma. Carcinoma in a lobule is not necessarily lobular carcinoma.

L-asparaginase therapy in children with advanced leukemia. The Southwest Cancer Chemotherapy Study Group.

Abstract: Each of 105 children with advanced acute leukemia in relapse was randomly assigned to one of three treatment schedules utilizing L‐asparaginase. L‐asparaginase used alone induced bone marrow remissions in 43% of all cases and 54% of evaluable cases. L‐asparaginase combined with vincristine and prednisone induced remissions in a significantly greater number of children—50% of all cases and 77% of evaluable cases: There was a suggestive advantage in survival experience for patients receiving the 3‐drug combination compared with L‐asparaginase alone. Survival in this study population was clearly related to the length of disease prior to start of therapy, the longer survivals occurring in those with longer prestudy duration of disease. Fourteen of 17 children who had relapsed following inductions of remissions with the first course of L‐asparaginase treatment had remissions again following retreatment with a second course. These results indicate that L‐asparaginase has considerable therapeutic activity in children with advanced leukemia.

Intracellular branched tubular structures in osteosarcoma. An ultrastructural and serological study

Abstract: Intracytoplasmic tubular structures, approximately 23 mμ, in diameter, were seen by electron microscopy within endothelial cells, malignant osteoblasts, and lymphocytes of an osteosarcoma. Although similar tubular structures have been seen in many different cells in vivo and in vitro, their presence within endothelial cells of glomeruli in patients with systemic lupus erythematosus prompted the suggestion that they represent measles virus nucleocapsids. Although the morphogenesis of these tubules remains obscure, we have presented evidence that these tubules may form by condensation of intracisternal granular material secreted by the endoplasmic reticulum and probably represent response of the cell to injury by providing it with more structural stability. Measles antibody titers were performed on the sera of the patient and his immediate family, because similar tubules had been equated with measles virus nucleocapsids. Because these antibody titers were all markedly elevated, a comparative ultrastructural study was undertaken between the tubules reported herein and measles virus nucleocapsids. Although the ultrastructural features were superficially similar, their morphology and morphogenesis were different. Thus, we concluded that such tubular structures could not be equated with measles virus nucleocapsids. Several possible reasons for the high measles antibody titer in the sera of the patient and his immediate family are discussed.

Incidence of cytomegaloviremia in blood-bank donors and in infants with congenital cytomegalic inclusion disease.

Abstract: During a 15-month period, cytomegalovirus (CMV) isolations were attempted from leukocytes derived from 290 healthy blood-bank donors The major proportion of the specimens were tested 2 to 5 hr after donation However, CMV was not recovered from any of the specimens examined At the time of donation, 75% of donors had CMV complement-fixing antibodies demonstrable in titers of 10 to >/=320 The age of the study group ranged from 17 to 57 years During the same time period and with the use of identical isolation techniques, postnatal cytomegaloviremia was demonstrated in four infants with cytomegalic inclusion disease Failure to detect cytomegaloviremia in 290 normal blood donors questions its occurrence outside pathological conditions These results do not support the concept that CMV infection, concurrent with post-transfusion mononucleosis syndrome, is transmitted through the blood donor's leukocytes