Synthesis of factor II antigen by isolated perfused rat liver.

Rat Factor II (prothrombin), isolated and purified by chromatography on Blue Dextran-agarose, was used to raise an antiserum in rabbits. On the basis of single radial immunodiffusion measurements. Factor II synthesis by isolated perfused rat liver amounted to 0.54 mg/300 cm2 body surface area of the liver donor in 10 h. Corresponding measurements of Factor II coagulant activity revealed cumulative synthesis of 802 Iowa units. Coumadin added to the liver perfusate blocked production of Factor II coagulant activity, but did not change synthesis of the immunologically measured protein. In perfusions in which either heparin or citrate was used as anticoagulant, synthesis of albumin was not affected by the choice of anticoagulant but bile production and synthesis of Factor II were significantly less in citrate perfusions.

The evaluation of patients with human immunodeficiency virus-related disorders and brain mass lesions.

In patients at risk for acquired immunodeficiency syndrome who present with a mass lesion, a dilemma arises as to whether to treat empirically for toxoplasmosis or perform a brain biopsy. We present data that further define the indications for performing brain biopsy vs empiric treatment. We reviewed charts on 59 patients with acquired immunodeficiency syndrome--related disorders and cerebral mass lesions. Thirty-two patients met diagnostic criteria for toxoplasmosis. Bayesian analysis demonstrated that the prior probability of toxoplasmosis was increased by the presence of contrast enhancement on computed tomographic scans (0.68) and toxoplasmosis titers greater than 1:64 (0.81). Features associated with decreasing probabilities of toxoplasmosis included the absence of contrast enhancement on computed tomographic scans (0.29) and toxoplasmosis titers less than or equal to 1:64 (0.14). Ten percent of patients had complications of brain biopsy. Treatment with pyrimethamine and sulfadiazine produced complications in 29% and serious complications in 8% of treated patients. These data favor empiric therapy for patients with typical features of toxoplasmosis and brain biopsy for defined subsets of patients with atypical features.

Diagnosis and management of fetal ductus arteriosus constriction-closure.

Pathognomonic features of in utero premature restriction/closure of the ductus arteriosus (DA) are increased right ventricular afterload, impaired right ventricular function, and consequently tricuspid regurgitation and right heart dilation. The most common reason for constriction-closure of DA is maternal administration of non-steroidal anti-inflammatory drugs (NSAIDs) during the 3rd trimester of gestation. The idiopathic form is a rare event and, maybe, an underestimated abnormality that, if it is not promptly recognized, may result in severe fetal-neonatal compromise. We describe a case of a 38-year-old woman presenting at 34+0 weeks of gestation with a normally grown male fetus whose fetal echocardiography had shown right ventricular hypertrophy, a tortuous S-shaped DA and a significant pulmonary hyperflow. All signs were consistent of an idiopathic severe constriction of DA with a significant fetal cardiac involvement. The patient was admitted to a tertiary care center equipped with Neonatal Intensive Care Unit (NICU), and delivered by cesarean section at 34+4 weeks with a good maternal and neonatal outcome. Based on our experience and a review of the Literature we propose a management algorithm to use when dealing with preterm or early term pregnancy complicated by this fetal hemodynamic malfunction.

Arterial supply of limbic structures in the guinea pig.

This study outlines the vascular territories of the cerebral arteries that originate from the Willis circle to supply limbic structures in the guinea pig brain. The entire cerebral vascular system was visualized in four preliminary experiments by performing superselective microangiographic studies with iodine contrast medium perfusion of the whole brain after in vitro isolation according to a technique described previously (de Curtis et al. [1991] Hippocampus 1:341-354). Subsequently, the perfusion territory of the different arteries that originate from the Willis circle was characterized after cannulation and perfusion of individual arteries with a gelatin solution that contained waterproof black ink. The analysis was performed by identifying the brain regions that contained the black stain on 150-microm-thick coronal sections that were cut after brain fixation with paraformaldehyde for at least 1 week. The middle cerebral artery and the rostral and caudal posterior cerebral arteries supply the limbic cortices and some related subcortical regions. In particular, large portions of the hippocampal formation are supplied by both the rostral posterior cerebral artery and the rostral branch of the caudal posterior cerebral artery, whereas the ventral temporal part of the hippocampus is served exclusively by the rostral posterior cerebral artery. The amygdala, the periamygdaloid cortex, and the piriform cortex are served by the middle cerebral artery and in part by the perforating arteries. The entorhinal, perirhinal, and postrhinal cortices are vascularized by the posterior and middle cerebral arteries, with a very broad overlap between the distal territories of these vessels. The demonstration of an extensive superimposition between the arterial supply of the entorhinal and the perirhinal regions suggests the presence of anastomotic connections that potentially are protective against ischemic events. Such an arrangement was not observed for the arteries that supply the ventral portion of the hippocampal formation and the basolateral amygdala, which showed nonoverlapping boundaries. The pathophysiological consequences of a similar vascular organization are discussed.

Urinary pharmacokinetics of the glucuronide and sulfate conjugates of genistein and daidzein.

Consumption of soybean-rich diets is thought to provide significant health benefits such as prevention of cancer, primarily because of the high contents of factors such as the isoflavones genistein and daidzein. Isoflavones circulate and are excreted into the urine mainly as glucuronide and sulfate conjugates. This study was conducted to determine the urinary pharmacokinetics of sulfate and glucuronide conjugates of genistein and daidzein. Twelve volunteers consumed a soy beverage providing 1 and 0.6 mg/kg body weight of genistein and daidzein equivalents, respectively. Urine was collected at various times during the 48 h after soy consumption and was digested with either glucuronidase or sulfatase, and the liberated aglycones were extracted and analyzed by liquid chromatography-mass spectrometry. Urinary isoflavone sulfate levels were determined by two methods: (a) assessment of aglycone after sulfatase hydrolysis (measured); or (b) calculated by subtracting the aglycone + glucuronide levels from the total urinary isoflavone levels. The apparent terminal half-life for daidzein sulfate (3.9+/-0.5 h) that was determined from sulfatase-treated urine was 32% shorter (P < or = 0.02) than that of the calculated daidzein sulfate (5.7+/-0.08 h). A similar trend was obtained for genistein sulfate (4.5+/-0.7 versus 6.8+/-0.1 h). The apparent terminal half-lives for genistein and daidzein glucuronides were 6.0+/-0.4 and 3.8+/-0.4 h, respectively. These data suggest that the measured urinary isoflavone sulfate values provide a better understanding of the pharmacokinetics than the calculated values. Additional studies are needed to determine whether the apparent terminal half-lives can be attributed to elimination or absorption processes.

Altitudinal neglect.

Previous clinical observations on patients with hemispatial neglect from unilateral hemispheric lesions suggest the brain's attentional mechanisms are organized along the horizontal dimensions of extrapersonal space. We now report a patient with Balint's syndrome caused by bilateral parieto-occipital infarctions, who demonstrated altitudinal neglect. On visual and tactile bisection of vertical rods, the patient consistently placed her mark well above the true midpoint, and this performance remained unchanged when the stimuli were simultaneously explored visually and tactually. She also showed altitudinal inattention in the visual modality by extinguishing the stimulus presented in the lower quadrants during double simultaneous stimulation across the horizontal meridian. These findings suggest that bilateral damage to the parietal lobes can lead to multimodal attentional and exploratory deficits along the vertical dimensions of extrapersonal space.

Driving safety in Parkinson's disease.

In this study, 39 patients with PD and 25 control subjects without neurologic disease completed testing in a driving simulator. PD patients had more total collisions on the driving simulator than control subjects (t = -3.7, p < 0.01). In PD patients, collisions were associated with Hoehn and Yahr stage (chi(2) = 12.4, p = 0.006) and correlated with Unified Parkinson's Disease Rating Scale score (r = 0.5, p < 0.01).

Bilateral human fetal striatal transplantation in Huntington's disease.

BACKGROUND: Transplanted striatal cells have been demonstrated to survive, grow, establish afferent and efferent connections, and improve behavioral signs in animal models of Huntington's disease (HD). OBJECTIVE: To evaluate feasibility and safety and to provide preliminary information regarding the efficacy of bilateral human fetal striatal transplantation in HD. METHODS: Seven symptomatic patients with genetically confirmed HD underwent bilateral stereotactic transplantation of two to eight fetal striata per side in two staged procedures. Tissue was dissected from the lateral half of the lateral ventricular eminence of donors 8 to 9 weeks postconception. Subjects received cyclosporine for 6 months. RESULTS: Three subjects developed subdural hemorrhages (SDHs) and two required surgical drainage. One subject died 18 months after surgery from probable cardiac arrhythmia secondary to severe atherosclerotic cardiac disease. Autopsy demonstrated clearly demarcated grafts of typical developing striatal morphology, with host-derived dopaminergic fibers extending into the grafts and no evidence of immune rejection. Other adverse events were generally mild and transient. Mean Unified HD Rating Scale (UHDRS) motor scores were 32.9 plus minus 6.2 at baseline and 29.7 plus minus 7.5 12 months after surgery (p = 0.24). Post-hoc analysis, excluding one subject who experienced cognitive and motor deterioration after the development of symptomatic bilateral SDHs, found that UHDRS motor scores were 33.8 plus minus 6.2 at baseline and 27.5 plus minus 5.2 at 12 months (p = 0.03). CONCLUSIONS: Transplantation of human fetal striatal cells is feasible and survival of transplanted cells was demonstrated. Patients with moderately advanced HD are at risk for SDH after transplantation surgery.

Neuromuscular involvement in mild, asymptomatic primary hyperparathyroidism.

PURPOSE: The classic neuromuscular abnormalities of primary hyperparathyroidism are based on observations from an earlier time when the disease presented commonly with signs and symptoms. The purpose of the present study was to test for neuromuscular abnormalities among patients currently seen with primary hyperparathyroidism, in whom the vast majority are asymptomatic. PATIENTS, METHODS, AND RESULTS: Forty-two patients (30 women, 12 men) were studied. Serum calcium level was 11.1 +/- 0.1 mg/dL (normal, 8.7 to 10.7 mg/dL); phosphorus level was 2.8 +/- 0.1 mg/dL (normal, 2.5 to 4.5 mg/dL). Parathyroid hormone levels by radioimmunoassay for N-terminal and for mid-molecule regions were 32.6 +/- 2.4 pg/mL (normal, 8 to 24 pg/mL) and 831 +/- 127 pg/mL (normal, 50 to 330 pg/mL), respectively. Although generalized weakness and easy fatigability were common complaints, they were not seen on neurologic examination. No patient showed typical neuromuscular findings such as muscle weakness or atrophy, hyperreflexia, abnormal gait, tongue fasciculations, or objective changes in mental status. On the other hand, paresthesias and muscle cramps were reported by 22 patients (52%). Neurologic examination in 12 patients (29%) demonstrated findings consisting of either stocking-glove loss of pain sensation or loss of vibratory sensation with diminished reflexes. Creatine phosphokinase levels were normal in all patients. Electromyography and nerve conduction studies were performed in nine patients. None showed myopathy or signs of motor unit denervation. Isolated nerve abnormalities (n = 6) and nonspecific sensory neuropathy (n = 2) were observed. CONCLUSION: We conclude that the classic neuromuscular syndrome of primary hyperparathyroidism is rarely seen among a typical modern-day group of patients with primary hyperparathyroidism. The results suggest that the neurologic component of primary hyperparathyroidism should be included among those features of the disease that have changed along with other aspects of the clinical profile of primary hyperparathyroidism.

A plasma factor enhances activity of vitamin K-dependent coagulation proteins.

A plasma factor, "coagulopoietin", present in animals with depleted vitamin K-dependent coagulation factors, appears to enhance activity of these factors in normal animals. We have investigated the effects of "coagulopoietin" on synthesis of certain coagulation proteins by the isolated rat liver perfused for eight hours. Liver donor rats received plasma injections from vitamin K-deficient rats or from normal rats 24 hr before sacrifice. Coagulation activity of Factor VII and Factor II in liver perfusate samples was measured with a coagulation assay; Factor II synthesis was also measured by rocket immunoelectrophoresis and by activation with E. carinatus venom. Cumulative hepatic synthesis of Factor VII coagulation activity was increased by 43% when rat liver donors received vitamin K-deficient rat plasma compared to normal rat plasma. Cumulative synthesis of Factor II coagulation activity was increased by 51%, but synthesis of the protein measured immunologically or by activation with venom was not affected. The "coagulopoietin" factor in these studies appears to increase measurable coagulation factor activity without increasing total protein synthesis.

Testosterone effects on biosynthesis of coagulation proteins.

Studies were performed to assess the effects of testosterone on synthesis of selected coagulation proteins using the isolated rat liver perfused in vitro for 10 hours, as well as effects of testosterone on plasma levels of these same proteins. Pretreatment of castrated male rat liver donors for 14 days with pellets containing placebo or testosterone, 0.5 mg, 5.0 mg or 15.0 mg had no significant effects on cumulative biosynthesis of Factor II, Factor VII, antithrombin III, plasminogen or fibrinogen. Plasma concentrations of these proteins in liver donor animals were also unchanged by such hormonal manipulations. In contrast, biosynthesis of fibronectin was increased significantly by increasing doses of testosterone, and plasma concentrations of fibronectin in liver donor rats showed a similar effect.

Prospective comparison of the immune response of infants to three Haemophilus influenzae type b vaccines.

The antibody response to three Haemophilus influenzae type b vaccines was examined in 134 infants 17 to 22 months of age. Sera were collected from each subject before and 1 month after vaccination with either purified H. influenzae type b capsular polysaccharide (polyribosyl-ribitol phosphate (PRP] or one of two protein-conjugated vaccines (PRP-D or HbOC). Comparison of the two conjugate vaccines revealed that HbOC produced an antibody response greater than or equal to 1.0 micrograms/ml in 96% compared with 72% who were vaccinated with PRP-D (P less than 0.05). The isotype distribution of the antibodies produced by the two vaccines was similar. While all of the vaccines resulted in higher concentrations of anticapsular IgG1 than IgG2, the IgG1:IgG2 ratio was significantly higher in subjects immunized with HbOC. The IgG1:IgG2 ratio was similar in subjects immunized with PRP or PRP-D. The clinical significance of these observations remains to be determined.

The immunogenicity of Haemophilus influenzae type b conjugate (HbOC) vaccine in human immunodeficiency virus-infected and uninfected infants.

Enzyme-linked immunosorbent assay polyribosyl ribitol phosphate (PRP) antibody responses to Haemophilus influenzae type b conjugate vaccine (HbOC) given at 2, 4 and 6 months of age were retrospectively compared in 23 human immunodeficiency virus (HIV) and 24 non-HIV-infected infants. HIV-infected infants were divided into those who were P1 (asymptomatic) or P2 (symptomatic) by 1 year of age. The P2 group was further divided into P2A (mildly symptomatic) and > P2A (rapidly symptomatic) by 1 year of age. The post-third HbOC dose geometric mean antibody titer to PRP was significantly lower in 12 P2 infants (0.43 microgram/ml) than either the 11 P1 infants (5.03 micrograms/ml, P < 0.05) or the 24 non-HIV infected infants (3.43 micrograms/ml, P < 0.05). Within the P2 group, the geometric mean antibody titer to PRP was significantly higher in 5 P2A infants (1.63 micrograms/ml) compared with 7 infants who were > P2A (0.17 microgram/ml, P < 0.05). After the third HbOC dose, PRP antibody titers were > or = 1.0 micrograms/ml for 4 of 12 P2 compared with 9 of 11 P1 infants (P < 0.05). Within the P2 group, PRP antibody titers were > 1.0 micrograms/ml for 4 of 5 P2A compared to 0 of 7 infants who were > P2A (P < 0.05). HIV-infected infants with PRP antibody titers > or = 1.0 micrograms/ml after the third HbOC dose had significantly higher mean CD4 counts (2842 cells/mm3) at the time of the third HbOC dose than those with lower PRP titers (1655 cells/mm3) (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Building national electronic medical record systems via the World Wide Web.

Electronic medical record systems (EMRSs) currently do not lend themselves easily to cross-institutional clinical care and research. Unique system designs coupled with a lack of standards have led to this difficulty. The authors have designed a preliminary EMRS architecture (W3-EMRS) that exploits the multiplatform, multiprotocol, client-server technology of the World Wide Web. The architecture abstracts the clinical information model and the visual presentation away from the underlying EMRS. As a result, computation upon data elements of the EMRS and their presentation are no longer tied to the underlying EMRS structures. The architecture is intended to enable implementation of programs that provide uniform access to multiple, heterogeneous legacy EMRSs. The authors have implemented an initial prototype of W3-EMRS that accesses the database of the Boston Children's Hospital Clinician's Workstation.

Estimating software development costs for a patient multimedia education project.

The authors compare alternative methods of cost estimation for a patient multimedia education (PME) program, using a computerized weight-reduction PME project as an example. Data from the project planning and budgeting process and actual costs of the completed project are analyzed retrospectively to calculate three different estimates-pre-work, post-work, and actual work. Three traditional methods of estimating the cost of computer programs (the lines-of-code, function point, and task ratio analyses) underestimate costs in this example. A commercial program (Cost Xpert) that calculates the cost of developing a graphical user interface provided a better estimate, as did a tally reflecting the complexity and quality of media material in the project.

The interaction of salicylate and vitamin K in synthesis of Factor II (prothrombin).

The effects of sodium salicylate on synthesis of a vitamin K-dependent plasma coagulation protein, Factor II (prothrombin) was studied using the isolated rat liver perfused for 10 hours in vitro. Cumulative synthesis of Factor II was measured by a standard coagulation assay, by activation with E. carinatus venom, and by rocket immunoelectrophoresis. When sodium salicylate 5 mg or 25 mg was added to the liver perfusate (volume 100 ml) at the outset of the perfusion, cumulative synthesis of both coagulation activity and immunoreactive protein was significantly less than that seen in control perfusions containing no salicylate. The inhibitory effect of salicylate was prevented by pretreatment of rat liver donors with supplemental vitamin K injected 24 hours before sacrifice. Although some interaction between salicylate and vitamin K was apparent from these experiments, the results from vitamin K-deficient rat liver donors were quite different from those containing salicylate. There was no assayable Factor II coagulation activity produced in 10 hours of perfusion of vitamin K-deficient rat livers, but cumulative synthesis of immunoreactive Factor II was quite comparable to that seen in control perfusions.

Measurements of rat plasma coagulation proteins during prolonged exposure to diethylstilbesterol.

The effects of diethylstilbesterol (DES) on concentration of selected plasma coagulation proteins in male rats was studied sequentially over a 28-day period. At the outset of the study, male rats underwent orchiectomy and implantation of a pellet containing DES 5.0 mg or a placebo pellet. At intervals of 7 days, 3 of the animals from each treatment group were sacrificed and blood samples were withdrawn for assay. Plasma concentrations of Factor II (prothrombin) and Factor VII, two vitamin K-dependent coagulation proteins, were significantly decreased in DES-treated animals (approximately 70% normal activity for both Factors) compared to placebo-treated animals. In contrast, Factor VIII activity was higher with DES treatment than with placebo. Plasma concentrations of both antithrombin III (AT III) and plasminogen were decreased in DES-treated animals compared to placebo by immunologic as well as activity assays. Albumin concentrations were not different between the two groups at any point of study, although both were increased at day 21 compared to beginning values. Fibronectin concentrations were slightly decreased in DES-treated animals compared to those which received placebo. The combination of orchiectomy and treatment with DES had profound metabolic effects on the animals; the DES treated animals had a mean body weight loss of 100 g after 28 days, while the placebo group gained an average of 78 g compared to a control group (no surgery) which had average weight gain of 85 g during the 28 day period of study.

Hemispheric lateralization of perception and memory for emotional verbal stimuli in normal individuals.

The purposes of this study were to extend the literature on lateralization of perception of emotional verbal stimuli in normal individuals, including a test of both the right hemisphere and valence models, and to investigate predictions from these models regarding lateralization of memory for emotional verbal stimuli in normal individuals, an area that, to our knowledge, has not been investigated. Seventy-nine undergraduates were presented lateralized positive, negative, and neutral English words and nonwords. Participants were then asked to freely recall the presented words and, after a 20-min delay, to recognize the words. Recognition memory data provided strong support for the valence model. In addition, free-recall and perception data provided partial support for this model. The literature on the lateralization of processing emotional verbal and nonverbal material is discussed.

An LC-MS method to determine concentrations of isoflavones and their sulfate and glucuronide conjugates in urine.

Most methods for detecting isoflavones in biological samples do not measure the concentration of sulfate conjugates. An LC-MS method is reported here to estimate urinary concentrations of genistein and daidzein, their sulfate and glucuronide conjugates and other major metabolites. Human and rat urine samples were extracted with diethyl ether, or pre-digested with sulfatase and/or beta-glucuronidase followed by extraction. The isoflavones were separated using gradient LC methods and detected by negative single ion monitoring on an MS system using a heated nebulizer atmospheric pressure chemical ionization interface. CVs for inter- and intra-assay variability were generally < 20 and 10%, respectively. Preliminary studies using these procedures demonstrate 52+/-4 and 26+/-4% of genistein in rat urine was found as the aglycone and sulfate conjugates, respectively, compared to 0.36 and 4%, respectively, in human urine. This method is suitable for the study of isoflavone sulfate conjugates in biological fluids.

Spinal meningiomas: review of 174 operated cases.

The long-term results obtained in a series of 174 patients operated on for spinal meningiomas are critically analyzed. This series was similar to those of other authors with regard to age, sex, location of the tumors, and clinical presentation. Before surgery, about 70% of the patients were included in Groups I and II (mild neurological impairment), and about 30% of the patients were classified in Groups III and IV (significant to severe neurological impairment, up to paraplegia). Complete tumor removal was achieved in 96.5% of the patients, and surgical mortality was about 1%. Microsurgical technique, which was adopted in the last 29 cases, proved to be very effective in reducing undue damage to the spinal cord and in minimizing the postoperative neurological deficits. Of the 174 patients who underwent surgery, 156 underwent late follow-up study for an average of 15 years (2 patients died in the immediate postoperative period, and 16 patients were lost to follow-up). Twenty-nine patients died of causes unrelated to the spinal meningioma; of the remaining 126 patients, 92% were categorized in Groups I and II, and only 8% in Groups III and IV. The rate of recurrence was 6% (9 patients) among the 150 patients who had complete tumor removal, and the rate of regrowth was 17% (1 patient with anaplastic meningioma) among the 6 patients treated by subtotal removal. The early diagnosis of the disease and the use of microsurgical technique appeared as the most relevant factors for further improvement of the surgical results.