Antigenic study of the protein from a defective strain of tobacco mosaic virus.

Soluble protein from the defective strain PM2 of tobacco mosaic virus can be recognized as antigenically distinct from the protein of the wild-type tobacco mosaic virus by Ouchterlony and immunoelectrophoretic analyses at temperatures below 37 degrees C. At these temperatures a polymerized state of protein with a characteristic antigenic structure is present in the wild-type virus; this structure is absent from the PM2 preparations. Above 37 degrees C the precipitin patterns for tobacco mosaic virus and PM2 appear identical.

Syngeneic monoclonal antibodies to B16 melanoma viral antigens.

Four stable IgM monoclonal antibody-producing hybridomas were generated by fusing mouse myeloma cells with spleen lymphocytes from C57BL/6 mice hyperimmunized against the syngeneic B16 melanoma. All four monoclonal antibodies (R31/15, R37/4, R37/6, and R37/7), in common with polyclonal antiserum from immunized mice, recognized antigens on the same complex of related cell surface molecules specified by endogenous AKR-type murine leukemia virus, designated the B16-gp/70/80/85 antigen complex. Reactivity with this antigen complex was demonstrated by radioimmunoprecipitation. Specificity for viral Mr 70,000 glycoprotein-related antigens was indicated by absorption of antibody activity by endogenous AKR virus and by inhibition of antibody binding to B16 melanoma cells by monospecific antiserum to murine leukemia virus Mr 70,000 glycoprotein. Neither polyclonal nor monoclonal antibodies recognized antigens on fish, guinea pig, swine, or human melanoma cell lines. Polyclonal antiserum reacted with several other mouse melanomas and with certain mouse lymphoma lines induced by, or harboring, endogenous murine leukemia viruses, but the monoclonal antibodies were unreactive except for recognition of antigens on Harding-Passey mouse melanoma cells by antibody R37/4 and on RL male 1 mouse lymphoma cells by antibody R37/7. Only monoclonal R37/7 was cytotoxic for cultured B16 melanoma cells in an antibody- and complement-dependent assay with guinea pig complement, although all antibodies were cytotoxic with rabbit complement. In reflecting the predominant humoral immune response to the B16 melanoma detected in syngeneic mice during tumor growth, these monoclonal antibodies will permit experimental amplification of that response to help determine how that immunity influences tumor growth and metastatic dissemination.

Early fluctuations of BFU-E pool size after transfusion or erythropoietin treatment.

The kinetics of erythroid burst-(BFU-E) and colony-forming units (CFU-E) have been evaluated in marrow and spleen of normal or polycythemic mice, respectively, after transfusion or administration or purified erythropoietin (Ep). Ep injection induces an early but temporary rise of BFU-E number, versus a later but more prolonged expansion of the CFU-E pool. Symmetric patterns are observed after transfusion, i.e., an early but transient depletion of the BFU-E population, versus a later but more persistent decrease of the CFU-E number. It is suggested that the size of the BFU-E compartment is Ep-dependent in the "early" phase after erythroid perturbation. Later on, however, compensatory mechanisms allow the BFU-E pool to "escape" from the early Ep influence, thus allowing its size to return to and stabilize in the near normal range. It is further suggested that the BFU-E may represent an early target cell of Ep stimulus.

Correlation between maternal and fetal immunoglobulin E levels.

Immunoglobulin E (IgE) concentrations were measured in 157 paired samples of maternal-fetal sera. A correlation was found between maternal and fetal IgE levels, in contrast to earlier reports dealing with smaller series. The correlation is probably not due to placental transfer of maternal IgE but rather to genetic factors. The possible role of IgE in the fetal immune response is discussed.

A monoclonal antibody specific for the visual system of the goldfish.

Although several monoclonal antibodies (MAbs) have been reported that recognize antigens present in ganglion cells of the mammalian retina, these MAbs do not cross-react in the goldfish. In the current study we have identified a MAb that recognized a 14.4 kDa antigen that is present on the ganglion cells in the retinae of goldfish but is absent from the retinae of all other species that were tested. No other cell type in the goldfish retina or optic nerve was labeled with this MAb. Furthermore, the axons in the optic nerve, optic tract and the terminal layers in the optic tectum were labeled.

Erythrokeratodermia variabilis treated with isotretinoin. A clinical, histologic, and ultrastructural study.

A 30-year-old woman with erythrokeratodermia variabilis was treated with oral isotretinoin for four months. Clinical and light and electron microscopic observations were made before and after treatment. A characteristic electron microscopic feature was subnormal numbers of keratinosomes within the stratum granulosum of hyperkeratotic plaques. Isotretinoin therapy resulted in almost complete clinical clearing of these plaques and restoration of normal numbers of epidermal keratinosomes. In addition, distinctive dyskeratotic cells containing clumped tonofilaments were observed within the stratum granulosum by electron microscopy. These cells persisted after retinoid treatment.

Congenital arteriovenous fistula of the maxillofacial region.

Long-term follow-up is essential to evaluate our present modalities of treatment of arteriovenous malformations of the maxillae. Embolization followed by surgical resection has produced long-term survival in our patient population.

Prevention of Frey's syndrome with superficial musculoaponeurotic system interposition.

Frey's syndrome after parotidectomy has an incidence generally reported to be 50% to 60% and is thought to be due to aberrant reinnervation of sweat glands by postganglionic parasympathetic fibers normally supplying the parotid gland. One hundred twelve patients had interposition of a flap of the superficial musculoaponeurotic system between the parotid bed and the overlying skin. Only one patient developed symptomatic Frey's syndrome, and one other patient had positive results on starch iodine testing. In patients not having the interposition, the incidence of symptomatic Frey's syndrome and positive starch iodine testing was 83% and 87%, respectively.

Tumors of the facial skeleton in children. Growth patterns after maxillectomy and mandibulectomy.

Thirteen children who had major extirpative surgery of the maxilla or the mandible were followed up an average of five years postoperatively. They ranged in age from three months to eleven years. Facial and oral photographs, cephalograms and cephalometric analysis, and plaster dental models were used to document longitudinal and cross-sectional growth patterns; Our experiences in this limited number of cases has indicated the following: (1) Extensive extirpation of facial bones may be performed in children without significantly jeopardizing function or growth. (2) The roots of healthy teeth may be resected without fear of their noneruption or early loss; loss of sensation with continued viability is the rule. (3) The use of an iliac bone crib with particulate grafts has proved a highly successful means of reconstruction of the mandible in children. (4) Particulate bone has proved to be an effective means of reconstructing large contour defects of the mandible caused by enucleating large tumors in children.

Microvascular reconstruction of the mandible.

Five microvascular reconstructions of the mandible were performed in the past 2 years. One dorsalis pedis osteocutaneous flap was used to reconstruct the alveolar ridge and four groin osteocutaneous flaps were used for various defects of the mandible. Free microvascular bone grafts were found useful in previously irradiated fields, in anterior arch reconstruction, and in patients with massive soft tissue and bone loss.

Adaptive mechanisms of speech and swallowing after combined jaw and tongue reconstruction in long-term survivors.

Twelve patients have been studied for speech and swallowing function after major combined jaw and tongue reconstruction with the microvascular iliac bone and groin skin composite flap. Cinegraphic barium swallows demonstrated that for bolus propulsion, it is important to be able to occlude the palate with the flap. Glottic competence prevents aspiration. Speech studies show that although there is loss of certain speech sounds, approximate sounds are substituted. Speech is intelligible when soft-tissue contact to the palate can be accomplished. The adaptive mechanisms in these patients have been compared with the mechanisms used by a patient with uncorrected congenital aglossia and hypomandibulosis who developed excellent speech and swallowing. The mobility of this patient's mouth and pharynx was similar to that in the reconstructed cancer patients who were able to swallow and speak. This procedure has become our reconstruction method of choice for these major defects.

Persistent oral antral fistulas.

Oral antral fistulas that have been already subjected to previous attempts at closure have been difficult to treat. Gold foil, bony plugs, and other materials have been used for many years to close these fistulas. Because of all of the various techniques and materials used in this procedure, it has been vexing to evaluate their efficacy. Although the persistent fistula is a rare entity, the surgeons faced with treating this condition must understand the principles of flap closure. In six cases in which multiple attempts at oral antral fistula closure had failed, we used either bilateral or unilateral palatal flaps based on the posterior palatine artery. The patients have been followed up for ten years after surgery and can wear dentures if indicated. There has not been any recurrent fistulization in any of these cases.

"Lethal midline granuloma".

We have recently had two cases of midfacial granulomas in which laboratory examinations and multiple biopsies did not reveal a more specific diagnosis. Both responded to treatment. We feel that in such cases therapy should be given and based on the extent of local destruction and the history of the disease in the patient.

Functional oromandibular reconstruction with the microvascular composite groin flap.

Ten patients were reconstructed with the microvascular osteocutaneous groin flap for oromandibular defects with the objective of improving function. The flap was based on the superficial and deep circumflex iliac vessels for optimal positioning of the bone and contouring of the skin. Patients with major glossectomies and arch resections had intelligible speech and were able to eat a soft diet without aspirating. Cineradiographic studies to evaluate swallowing in selected patients showed that the shape of the intraoral flap and the location of the bone graft played an important role in swallowing and prevention of aspiration.

Reconstruction of the base of the tongue with the microvascular ulnar forearm flap: a functional assessment.

Ten patients with infiltrating carcinomas of the base of the tongue/tonsillar region underwent 30 to 100 percent resection of the base of the tongue and lateral pharyngeal wall. The surgical defect was reconstructed (9 primary, 1 secondary) with a large microvascular ulnar forearm flap that was selectively contoured to provide bulk for the base of the tongue and a thin lining for the pharyngeal wall. Seven patients were evaluated for swallowing and speech 6 weeks to 2 years following the reconstruction. Cineradiographic studies showed excellent base of the tongue and flap mobility allowing glossopharyngeal closure in all patients and complete pharyngeal evacuation in four patients. Four patients who were in good health preoperatively were able to eat a regular diet postoperatively, and the remaining three patients were able to handle soft food. Functional recovery after major tongue base surgery is contingent upon a three-dimensional microvascular reconstruction using a thin forearm flap.

Total and subtotal glossectomy: function after microvascular reconstruction.

Twelve patients with advanced carcinoma of the floor of the mouth and tongue were treated with total (five patients) or subtotal (seven patients) glossectomy, partial mandibulectomy, and immediate reconstruction with the microvascular composite groin flap. The osteomusculocutaneous groin flap was used in eleven patients, and the osteomuscular flap was used in one patient. The groin musculocutaneous or muscle flap was designed to resemble the shape of the tongue for dynamic food transport, improved swallowing, and acceptable speech. Eight of the 12 patients who survived more than 1 year were evaluated for speech and swallowing. Eight patients were able to speak intelligibly, six patients could tolerate a soft/pureed diet, and two patients were limited to fluids. Cinefluorographic swallow studies using semisolid contrast material showed voluntary active intraoral transport and propulsive pharyngeal emptying without aspiration in six patients with complete flap to palate contact; the remaining two patients were unable to move the intraoral contrast material effectively for swallowing because of poor palatal contact.

Principles and concepts of brain death and organ donation: the Jewish perspective.

The harvesting of organs for transplantation is dependent on a stringent definition of brain death. Different societies have had to struggle with their cultural heritage, adapting it to conform to the advances in medical science and the need of the sick. In this article, the development of the concept of brain death as it applies to organ transplantation in Judaism is outlined. The ability of traditional Jewish values to address themselves to the challenges of modern medicine can serve as a basis for cultural cross-fertilization and comparison in modern societies.

Variation's in the use of SMAS (superficial musculoaponeurotic system) to prevent Frey's syndrome after parotidectomy.

Since 1979, the SMAS (Superficial Muscular Aponeurotic System) has been used in over 100 parotidectomies to ameliorate the sunken facial appearance, and to prevent Frey's Syndrome. The procedure involves a rhytidectomy incision followed by variations including superior rotation, posterior advancement and plication of the SMAS. Appropriateness of such variations considers the defect from the surgery, and the histology of the tumor.