Report of a rare testicular teratoid Wilms Tumor in an adult patient.

Although primarily a pediatric disease, nephroblastomas (also known as Wilms tumor) occur in adults at a rate of less than 0.2 cases per million per year. Rarer still are teratoid Wilms tumors, which arise from teratomas and therefore can be extrarenal. We describe the sixth recorded case of a testicular teratoid Wilms tumor in an adult patient with accompanying histological images of the specimen. Following the case, there is a brief discussion of the current literature.

Scaling law for the partitioning of energy in fragmenting multicharged carbon clusters.

The complete fragmentation of highly excited and multicharged C(n)(q+) clusters (n=5-10; q=2-4), produced in high velocity collisions of C(n)(+) with atoms, has been measured. Multiplicity distributions are presented and used to deduce, within a statistical framework, the partitioning of energy between the fragments' production and fragments' kinetic energy. This partitioning is found to scale as the charge over mass ratio of the cluster.

IGLIAS: A new experimental set-up for low temperature irradiation studies at large irradiation facilities.

We designed and built a mobile experimental set-up for studying the interaction of ion beams with solid samples in a wide temperature range from 9 to 300 K. It is either possible to mount up to three samples prepared ex situ or to prepare samples by condensation of molecules from gases or vapours onto IR or Visible-ultraviolet (Vis-UV) transparent windows. The physico-chemical evolution during irradiation can be followed in situ with different analysis techniques including Fourier transform infrared spectroscopy, Vis-UV, and quadrupole mass spectrometry.

Correlation of ether lipid content of human leukemia cell lines and their susceptibility to 1-O-octadecyl-2-O-methyl-rac-glycero-3-phosphocholine.

A number of synthetic ether-linked phospholipids are selectively cytotoxic to neoplastic cells. However, the mechanisms underlying this selective cytotoxicity are not known. We have investigated the ether-lipid content of HL-60 and K562 human leukemia cells in relation to their sensitivity to 1-O-alkyl-2-O-methyl-rac-glycero-3-phosphocholine (ET-18-OCH3). HL-60 cells are much more sensitive than K562 cells to the cytotoxic effects of ET-18-OCH3 and, at the same time, they contain nearly twice as much ether lipid as the more resistant K562 cells. These observations suggested a relation between the cellular ether-lipid content and sensitivity to ET-18-OCH3. Further evidence linking these properties was obtained when the ether-lipid content of K562 cells was increased by incubating them in medium containing 1-O-hexadecyl-sn-glycerol. This supplementation not only increased the ether-lipid content of the cells but also increased their sensitivity to ET-18-OCH3. The 50% inhibitory concentration for ET-18-OCH3 decreased from 18.4 microM in the control cells to 9.83 microM in the supplemented cells.

Ether-linked phosphoglyceride content of human leukemia cells.

The glycerolipids of most cells are characterized by a specific proportion of ether linkages at the sn-1 position of the glycerol backbone. A number of tumors are known to have altered concentrations of ether-linked lipids compared to normal tissues. However, no through examination of the ether-lipid content of human leukemia cells has been reported despite the importance of these lipids in normal leukocyte function. In the present study samples were obtained from adults with acute myelogenous leukemia (AML), chronic granulocytic leukemia in blast crisis, and acute lymphocytic leukemia and from healthy human donors. The cellular lipids were extracted, the individual phospholipid classes were isolated, lipid phosphorus content was determined, and the lipids were converted to diglyceride benzoate derivatives for separation and quantitation of the subclasses by high performance liquid chromatography. The data indicate that all the leukemic cells analyzed have an altered phospholipid composition compared to their respective normal leukocytes. Furthermore, among the AML patients both the percentage of the choline-containing phosphoglyceride fraction (PC) which is alkyl linked and the nmoles alkyl-PC/10(6) cells differ significantly by FAB subtype. A positive correlation between the levels of alkyl-PC and the degree of cellular differentiation is observed. Although no differences are observed between chronic granulocytic leukemia in blast crisis and AML lipids, the leukemic cells contain dramatically lower levels of alkyl-linked PC than do normal polymorphonuclear leukocytes. In contrast, no differences are observed between the alkyl-PC content of normal and leukemic lymphocytes. In light of the relations among ether-lipids, protein kinase C, and cell differentiation, these data suggest the ether-linked lipids are important in myeloid cell function and differentiation.

Reacylation of platelet activating factor with eicosapentaenoic acid in fish-oil-enriched monkey neutrophils.

Platelet activating factor (PAF) is rapidly metabolized via a deacetylation: reacylation pathway which shows striking specificity for arachidonate at the sn-2 position of the 1-O-alkyl-2-acyl-GPC thus formed. We have now examined the effects of a diet enriched in fish oils on the metabolism of PAF and specificity for arachidonate in the reacylation reaction. [3H]PAF was incubated for various lengths of time with neutrophils from monkeys fed a control diet or one enriched in fish oils. The [3H]PAF added to the cell suspension was rapidly converted to 1-O-alkyl-2-acyl-GPC. Reverse-phase HPLC analysis of the acyl chains added at the sn-2 position revealed that arachidonate was the major fatty acid incorporated into the 1-O-alkyl-2-acyl-GPC formed by neutrophils from monkeys on the control diet. In contrast, both 1-O-alkyl-2-arachidonoyl-GPC and 1-O-alkyl-2-eicosapentaenoyl-GPC were formed by the fish-oil-enriched neutrophils. We also report on the fatty acid composition of neutrophil phospholipids during such a diet.

Metabolic clearance rate (MCR) of dehydroepiandrosterone sulfate (DS), its metabolism to dehydroepiandrosterone, androstenedione, testosterone, and dihydrotestosterone, and the effect of increased plasma DS concentration on DS MCR in normal women.

The combined infusion of [3H]dehydroepiandrosterone sulfate [( 3H]DS) and [14C]estrone (E1) for 6 h in four normal women in the follicular phase of the cycle demonstrated values of 13.77 +/- 0.27 L/day (mean +/- SE) for the DS MCR (MCRDS) and 1343 +/- 206 L/day for MCRE1. The fraction of DS metabolized to dehydroepiandrosterone (D), [rho]DS-D, was 0.285 +/- 0.044, and the fraction of D arising from DS (delta D) was 0.318 +/- 0.096, determined using isotopic techniques. Raising the plasma DS concentration by 8.6 micrograms/mL (23 mumol/L) by infusing DS iv increased the MCRDS to 24.49 L/day in the first subject, and raising the plasma DS by 11.40 +/- 0.33 micrograms/mL (30.94 +/- 0.90 mumol/L) in the next three subjects raised the MCRDS to 35.7 +/- 1.3 L/day (P less than 0.01) without changing the MCRE1. The increase in MCRDS produced by increasing plasma DS makes it difficult to accurately measure the MCRDS in effect at the subject's endogenous plasma DS concentration by infusion of nonisotopic DS. Determination of the fractions of D, androstenedione (delta delta 4A), and testosterone (T) arising from DS using the increase in the plasma concentrations of these steroids produced by infusion of nonisotopic DS gave the following estimates: delta D = 0.262 +/- 0.042, delta delta 4A = 0.089 +/- 0.046, and delta T = 0.273 +/- 0.14.

Receptor-independent metabolism of platelet-activating factor by myelogenous cells.

Human neutrophils incorporate and metabolize platelet-activating factor (PAF). We dissociated these events from PAF binding to its receptors. Cells were pretreated with either pronase, a PAF antagonist (L652731), or excess PAF. This reduced PAF receptor numbers by 70 to almost 100% but had no comparable effect upon the neutrophil's ability to metabolize PAF. Furthermore, HL-60 cells efficiently metabolized, but did not specifically bind, PAF. Thus, PAF receptor availability did not correlate with PAF metabolic capacity and we conclude that myelogenous tissues can process this bioactive ligand by a receptor-independent pathway.

Urbanization and differentials in white and nonwhite infant mortality.

This study analyzes infant deaths in the United States, 1962 to 1967, by place of residence, to determine to what degree variations in age at death are related to degree of urbanization and race. Results of the study indicate that: (1) after one day of life infant mortality increases progressively as degree of urbanization decreases; (2) the differences between urban and rural death rates are greatest in the posthebdomadal (1 week or older) period; (3) in all age groups at all levels of urbanization, the nonwhite infant is at a marked disadvantage relative to the white infant; (4) the older the infant, the greater the disadvantage for nonwhite infants in rural areas; (5) had the white infant mortality rate prevailed among the nonwhite population over the six-year period from 1962 to 1967 an estimated annual total of 11,597 nonwhite infants would have survived their first year of life; (6) 40% of the excess deaths are in infants under 7 days and 60% in the posthebdomadal period; (7) fetal death rates increase progressively as degree of urbanization decreases, complementing a direct relationship between under 1 day mortality and urbanization resulting in a level trend for perinatal mortality.

Outcome of infants and children with dilated cardiomyopathy.

A review of 81 infants and children with dilated, poorly contracting left ventricles without associated structural abnormalities was undertaken to identify risk factors for poor outcome, which could be used in selecting candidates for cardiac transplantation. Significant atrial or ventricular dysrhythmias, or both, were detected on presentation or during follow-up in 24 patients. Arrhythmias were present in only 8 of 51 survivors (16%) but were detected in 16 of 30 patients (53%) who died (p less than 0.05). Patients dying suddenly were even more likely to have had documented dysrhythmias (8 of 11, p less than 0.05). Left ventricular shortening fraction was similar in survivors and nonsurvivors (14.9 +/- 1.0% vs 15.3 +/- 1.7%). Left ventricular end-diastolic pressure in 44 patients who had cardiac catheterization averaged 20.8 +/- 1.6 mm Hg. Left ventricular end-diastolic pressure was significantly higher in patients who died than in those who survived (29.5 +/- 2.2 vs 15.0 +/- 1.6 mm Hg, p less than 0.001). Analysis of actuarial survival revealed that mortality was highest during the first 6 months after presentation (19% mortality). Survival declined more gradually thereafter and was 70% at 2 years, 64% at 5 years and 52% after 11.5 years. Age at initial presentation did not have any significant impact on survival. However, left ventricular end-diastolic pressure greater than 25 torr was associated with a significantly increased mortality rate (p less than 0.05). Early cardiac transplantation should be considered in patients with markedly elevated left ventricular end-diastolic pressure or complex atrial or ventricular arrhythmias.

Evaluation of myocardial damage during coronary artery grafting with serial determinations of serum CPK MB isoenzyme.

Serial determinations of creatine phosphokinase isoenzymes (CPK) were made during the operative period and the first postoperative week in 60 patients undergoing coronary artery bypass surgery. Electrocardiograms (ECG) and serum levels of glutamic oxaloacetic transaminase (SGOT) and lactic dehydrogenase (LDH) were also evaluated. All patients had increased CPK MB activity which first became detectable during the operative period. The CPK MB curves usually showed a peak during the first postoperative hours and then a rapid decay. Some curves, however, showed a different profile with a prolonged liberation of CPK MB. This type of curve was more frequent in patients with electrical signs of necrosis or ischemic injury. In this group, the total amount of CPK MB released was greater than that in patients with unchanged ECG tracings (p less than 0.05). A mean curve of CPK MB activity was calculated for the patients without electric and/or enzymatic signs of myocardial injury. Serum CPK MB determination is a useful technique for identifying perioperative myocardial infarction (MI) and the time sequence of its occurrence. The appearance of this isoenzyme in every patient undergoing coronary surgery is an interesting finding, and it significance needs to be clarified.

MB creatine kinase and the evaluation of myocardial injury following aortocoronary bypass operation.

Myocardial injury was studied in 104 patients undergoing coronary artery grafting without cold chemical cardioplegia using the quantity of the isoenzyme MB of the creatine kinase liberated as an indicator. This method of evaluation, which is said to permit comparison of different techniques of myocardial protection, allowed us to consider the relative importance of several factors believed to have an influence on intraoperative myocardial injury. Indices of significance were duration of symptoms before operation, presence of chronic arterial hypertension, and the type of antiangina treatment employed. Other operative factors included severity of the arterial lesions, number of anastomoses performed, and duration of extracorporeal circulation and of aortic cross-clamping.

Bioavailability of three commercial sustained-release tablets of quinidine in maintenance therapy.

The bioavailability of three quinidine formulations was estimated during a dosing interval at steady state following their administration in 12 selected patients in accordance with a Latin-square 3 x 3. Each subject received the three dosage forms as two tablets every 12 hr for 6 days. Blood and urine samples were taken on the 7th day during the regular 12-hr dosing interval. Unchanged quinidine was determined by a reported spectrofluorometric procedure. The total fluorescence of plasma quinidine and metabolites also was monitored. The data obtained indicate that one dosage form gave a high peak level followed by a fall in the concentration. The two other forms presented a relatively lower peak followed by a plateau and then a decline. The differences between the dose-corrected values of Cp,max were statistically significant. Secondary effects were observed particularly with one dosage form and could be related to the high Cp,max value and/or the high percentage of quinidine liberated rapidly in the GI tract. Blood and urinary data indicated an equivalent degree of absorption. The dissolution behavior of the formulations and their absorption data suggest that there is a correlation between the quantity dissolved at 30 min and Cp,max.

Electrophysiologic effects of intravenous diltiazem in patients with recurrent supraventricular tachycardias.

The electrophysiologic effects of intravenous diltiazem were evaluated in 10 patients with recurrent supraventricular tachycardias. The tachycardia incorporated an accessory pathway in 7 patients and was due to AV nodal reentry in 3 patients. Diltiazem 0.25 mg/kg was administered intravenously over 5 minutes during sustained supraventricular tachycardia. Programmed electrical stimulation was used to restore sinus rhythm if diltiazem failed to terminate the arrhythmia within 10 minutes. Conduction intervals, refractory periods and tachycardia characteristics were evaluated before and immediately after drug administration. Diltiazem did not significantly modify sinus cycle length, AH and HV intervals. Atrial and ventricular effective refractory periods were similar before and after diltiazem. The effective refractory period of the AV node was prolonged by 42 msec after diltiazem (p less than 0.05). Diltiazem increased the tachycardia cycle length from 320 +/- 41 to 353 +/- 36 msec (p less than 0.01) but terminated the arrhythmia in only 2 patients. After diltiazem, supraventricular tachycardia could not be reinitiated in only 2 patients and the tachycardia initiating window was not significantly reduced (56 +/- 26 to 41 +/- 33 msec). The infusion of diltiazem was accomplished without side effects. Thus, 0.25 mg/kg of intravenous diltiazem produces a modest depression of AV nodal function and is not very effective in terminating supraventricular tachycardia or preventing its initiation in this study population. Further studies using higher doses of intravenous diltiazem would be useful to determine its maximal therapeutic benefit in patients with recurrent supraventricular tachycardias.

[Mitral prolapse syndrome. Simple diagnosis of forms with severe arrhythmia]. / Syndrome du prolapsus mitral. Détection simple des formes arythmiques sévères.

The mitral valve prolapse syndrome encompasses a wide clinical spectrum with a majority of patients presenting with a benign course while a few present with severe arrhythmias. Nineteen patients with a systolic click and angiographic mitral valve prolapse were studied to determine which of several simple tests identified the subgroup with severe ventricular arrhythmias. The incidence and type of ventricular arrhythmias, documented by a 24 hour recording (Holter), were correlated with: 1) cardiac size assessed by the cardiothoracic ratio; 2) echocardiographic indices: end-diastolic septal and posterior wall thickness and left ventricular end-diastolic dimension; 3) a ten minute rhythm strip (mini-Holter). Only patients with ventricular hypertrophy (5 patients) or dilatation (7 patients) had frequent and severe arrhythmias. In these two subgroups, the cardiothoracic ratio was larger than in patients with a normal echocardiogram (7 patients). The ten minute rhythm strip was abnormal in all those patients with severe ventricular arrhythmias (ventricular tachycardia). Thus, in patients with mitral valve prolapse, the presence of an abnormal cardiothoracic ratio, echocardiogram and ten minute rhythm strip identifies patients with potentially severe ventricular arrhythmias. The mechanism of these arrhythmias is still poorly understood; however, a certain number of them may be related to a dysfunction of the autonomic nervous system.

[Value of the automated analysis of the electrocardiogram by the Telemed program (V version)]. / Valeur de la lecture automatisée de l'électrocardiogramme par le programme Télémed (version V).

A series of 1000 12 lead ECGs recorded in 1000 consecutive ambulatory patients were analysed by the Telemed (V Version) programme and its interpretation and the precision of the French translation were compared with the interpretation of two physicians using standard criteria. The computer identified 90% of the 285 ECGs coded as "normal" by the physicians, 69% of the 57 ECGs coded as "borderline" and 96% of the 658 ECGs coded as "abnormal". The computer interpretation was correct in 74% of cases and acceptable in 87,4% of cases. The computer classified 80% of the 240 arrhythmias correctly. Atrial fibrillation was detected in 91% of cases, and ventricular and supraventricular extrasystoles in 88% of cases. The recognition of other arrhythmias was not as good but the small number of cases did not allow statistical evaluation. The 148 cases of axis deviation and 98% of ventricular conduction defects were identified. The programme detected 84% of transmural infarcts, the sensitivity being greater for anterior or lateral than inferior infarctions. The majority of undiagnosed infarcts were "possibles" according to the criteria of the Minnesota Code. Of 536 ECGs with ST-T segment abnormalities, 81% were classified correctly; ST depression of less than 0.5 mm comprised the majority of false negatives. The sensitivity of the programme to left ventricular hypertrophy was excellent (95%) with a specificity of only 92,5% as the programme uses the Romhilt-Estes criteria which are more liberal than those of the Minnesota Code. The comparison of the sensitivity and specificity for the commonest ECG changes showed excellent all round diagnostic performance of the Telemed programme. In conclusion, despite the large number of abnormal ECGs, the level of computer-physician concordance was high. The French translation of the V Version of the Telemed programme is therefore suitable for clinical use Nevertheless, the computer interpretation should still be checked by a physician.

Detection of atomic and molecular mega-electron-volt projectiles using an x-ray charged coupled device camera.

We show that an x-ray charge coupled device (CCD) may be used as a particle detector for atomic and molecular mega-electron-volt (MeV) projectiles of around a few hundred keV per atomic mass unit. For atomic species, spectroscopic properties in kinetic energy measurements (i.e., linearity and energy resolution) are found to be close to those currently obtained with implanted or surface barrier silicon particle detectors. For molecular species, in order to increase the maximum kinetic energy detection limit, we propose to put a thin foil in front of the CCD. This foil breaks up the molecules into atoms and spreads the charges over many CCD pixels and therefore avoiding saturation effects. This opens new perspectives in high velocity molecular dissociation studies with accelerator facilities.

Fragmentation branching ratios of highly excited hydrocarbon molecules CnH and their cations CnH+ (n

We have measured fragmentation branching ratios of neutral C(n)H and C(n)H(+) cations produced in high velocity (4.5 a.u) collisions between incident C(n)H(+) cations and helium atoms. Electron capture gives rise to excited neutral species C(n)H and electronic excitation to excited cations C(n)H(+). Thanks to a dedicated setup, based on coincident detection of all fragments, the dissociations of the neutral and cationic parents were recorded separately and in a complete way. For the fragmentation of C(n)H, the H-loss channel is found to be dominant, as already observed by other authors. By contrast, the H-loss and C-loss channels equally dominate the two-fragment break up of C(n)H(+) species. For these cations, we provide the first fragmentation data (n>2). Results are also discussed in the context of astrochemistry.

The effect of treatment with angiotensin-converting enzyme inhibitors on survival of pediatric patients with dilated cardiomyopathy.

Outcome in 81 pediatric patients with dilated cardiomyopathy was reviewed to assess whether treatment with angiotensin-converting enzyme (ACE) inhibitors affected survival. Age at onset was 3.6 +/- 0.6 years. Twenty-seven children (group 1) were treated with ACE inhibitors. Conventional therapy was used in the remaining 54 patients (group 2). There were no significant differences between the two groups in age at onset, left ventricular shortening fraction, left ventricular end-diastolic pressure, or mean pulmonary artery pressure. Patients treated with ACE inhibitors had a significantly better survival during the first year (p < 0.05) with continuation of this trend throughout the second year (p = 0.06). Beyond 2 years there was a tendency toward better survival in ACE inhibitor-treated patients, but the differences were no longer significant (p = 0.14). These data, along with observations in adult patients with chronic cardiac failure, indicate that converting enzyme inhibitors have a beneficial effect on prolonging survival of infants and children with severe left ventricular dysfunction from dilated cardiomyopathy.

Metabolism of prostaglandin E2 by mouse embryo palate mesenchyme cells in vitro.

Mouse embryo palate mesenchyme cells synthesize a number of prostaglandins, particularly prostaglandin E2 (PGE2). However, the ability of such cells to metabolize prostaglandins was unknown. By use of radiolabeled PGE2 we determined that palate mesenchyme cells have little ability to degrade that prostaglandin in vitro but are able to metabolize products formed from its spontaneous degradation.