Is the acetylcholine receptor a rabies virus receptor?

Rabies virus was found on mouse diaphragms and on cultured chick myotubes in a distribution coinciding with that of the acetylcholine receptor. Treatment of the myotubes with alpha-bungarotoxin and d-tubocurarine before the addition of the virus reduced the number of myotubes that became infected with rabies virus. These findings together suggest that acetylcholine receptors may serve as receptors for rabies virus. The binding of virus to acetylcholine receptors, which are present in high density at the neuromuscular junction, would provide a mechanism whereby the virus could be locally concentrated at sites in proximity to peripheral nerves facilitating subsequent uptake and transfer to the central nervous system.

Anisoylated plasminogen streptokinase activator complex in acute myocardial infarction: a placebo-controlled arteriographic coronary recanalization study.

Anisoylated plasminogen streptokinase activator complex (APSAC) is a new thrombolytic agent that is of interest because of its ease of administration as an intravenous bolus injection. This report describes the first double-blind, placebo-controlled evaluation of intravenous APSAC for coronary recanalization in acute myocardial infarction. Unequivocal documentation of recanalization was provided by coronary arteriography before and after the drug intervention. Forty patients with acute myocardial infarction underwent coronary arteriography 3.1 +/- 1.2 hours after the onset of symptoms. This demonstrated occlusion of the infarct-related coronary artery in 29 patients who were then randomized to treatment with intravenous APSAC, 30 mg (n = 16), and placebo (n = 13) 3.3 +/- 1.3 hours after the onset of symptoms. Repeat arteriography 90 minutes later demonstrated recanalization of the infarct-related coronary artery in nine patients who had received APSAC compared with only one patient who had received placebo (56 versus 8%, p less than 0.05). The 95% confidence limits for this 48% difference between the groups are 20 to 76%. Arteriography at 3 days showed persistent patency of all recanalized coronary arteries except one (APSAC group) and also showed late recanalization in another four patients, three of whom had received APSAC. In the patients who had a patent infarct-related coronary artery at the initial arteriographic study, patency was maintained throughout the study period regardless of whether the patient was randomized to APSAC (n = 4) or placebo (n = 7). Complications related to APSAC therapy were excessive bruising at the catheterization site in seven patients and minor sensitivity reactions in three.(ABSTRACT TRUNCATED AT 250 WORDS)

Genotypic analysis of cutaneous T-cell lymphomas.

The gene encoding the beta-chain of the T-cell antigen receptor (TCR) has been analyzed for evidence of rearrangement in skin, blood, and lymph node specimens from 23 cases of known or suspected cutaneous T-cell lymphoma (CTCL). Two cutaneous large cell lymphomas, 4 cases of Sézary syndrome, and 5 cases of advanced (tumor) stages of mycosis fungoides showed clonal rearrangement of the TCR beta-chain gene in all samples, including lymph nodes in which histologic examination revealed only dermatopathic lymphadenitis. These results indicate that DNA analysis provides a valuable means for improving the diagnosis of extracutaneous disease in advanced stages of CTCL. In contrast, the gene was in a germline configuration in all samples from 12 patients with plaque stages of mycosis fungoides or suspected early CTCL, suggesting that in these 2 conditions the T-cell proliferation is either polyclonal or contains very few monoclonal (i.e., neoplastic) cells.

An interim report of a double-blind placebo-controlled recanalisation study of anisoylated plasminogen streptokinase activator complex in acute myocardial infarction.

This is an interim report of the initial 36 patients entered into the first double-blind, placebo-controlled invasive arteriographic study of intravenous anisoylated plasminogen streptokinase activator complex (APSAC) for coronary recanalisation in acute myocardial infarction. Coronary arteriography was performed before and 90 minutes after a single intravenous bolus injection of APSAC or placebo given over 2 to 5 minutes. Pretreatment coronary arteriography was performed in 36 patients at a mean time of 189 +/- 75 minutes after the onset of symptoms. 28 patients had occluded infarct-related coronary arteries and were randomised to receive APSAC 30U (n = 15) or placebo (n = 13) by intravenous injection 195 +/- 72 minutes after the onset of symptoms. Coronary arteriography 90 minutes after treatment demonstrated recanalisation of the infarct-related coronary artery in 8 APSAC-treated patients compared with only 1 placebo-treated patient (p less than 0.02). Repeat coronary arteriography 3 days after treatment showed reocclusion in 1 of the 8 APSAC-treated patients and persistent perfusion in the single patient who reperfused on placebo. All patients with patent vessels at pretreatment coronary arteriography (3 APSAC, 5 placebo) remained patent throughout the study period. There were no haemorrhagic complications related to APSAC therapy. These data confirm that APSAC is a safe, effective thrombolytic agent which, when administered by the intravenous route, resulted in a 53% recanalisation rate.

MORPHOLOGICAL PLASTICITY AND MINERAL NUTRIENT CAPTURE IN TWO HERBACEOUS SPECIES OF CONTRASTED ECOLOGY.

Developmental plasticity and nitrogen capture were compared in Agrostis stolonifera and Scirpus sylvaticus grown in compartmentalized root growth arenas which allowed simulation of the spatial and temporal patchiness distinguishing the conditions of mineral nutrient supply associated with fertile and infertile soils. Despite the small root system, higher rates of nitrogen capture and dry matter production were achieved by A. stolonifera at both high and low external concentrations of mineral nutrients. This species also showed a marked ability rapidly to adjust partitioning of growth between parts of the root system, thus allowing local proliferations of fine roots into sectors of high mineral nutrient concentration. Under the conditions of the experiment, this form of plasticity was only weakly developed in S. sylvaticus, which instead maintained a large but relatively unresponsive root mass under each experimental treatment. It is concluded that the high plasticity observed in A. stolonifera allows the dynamic exploitation of fertile soil by competing roots. It is predicted that the more stable pattern of root development in S. sylvaticus will confer a selective advantage in environments where mineral nutrients are strongly limiting upon productivity and become available in temporally unpredictable pulses.

Evidence for monoclonal T lymphocyte proliferation in angioimmunoblastic lymphadenopathy.

The arrangement of the T cell receptor and immunoglobulin genes was analysed in lymphoid tissue biopsy specimens from 25 cases of angioimmunoblastic lymphadenopathy. Nineteen cases showed a rearrangement of the gene coding for the beta chain of the T cell receptor, and in one case a clonal rearrangement of immunoglobulin genes was shown (in which the T cell receptor gene was in a germline configuration). These findings indicate that a monoclonal T cell proliferation is present in most cases of angioimmunoblastic lymphadenopathy, and they also correlate with the fact that some patients who present with this disorder subsequently develop a T cell lymphoma.

Use of monoclonal antibody against human neutrophil elastase in normal and leukaemic myeloid cells.

A monoclonal antibody, NP57, was produced and used against the neutrophil granule protein elastase, which selectively stain neutrophils in cryostat and paraffin wax sections. The antibody stains neutrophils and a subpopulation of monocytes in blood smears and neutrophil precursors in bone marrow smears, and gives positive reactions with the cell lines HL60 and U-937. It labelled the blast cells in 68% of cases of acute myeloid leukaemia (M1-M5) but was unreactive with all cases of lymphoid leukaemias. Most of the elastase negative myeloid leukaemias were labelled by monoclonal anti-myeloperoxidase (antibody MPO-7) as were cells from the promyelocytic line HL60. No cases of myeloid leukaemia showed the opposite pattern--that is elastase positive, myeloperoxidase negative, suggesting that the production of myeloperoxidase precedes the onset of elastase synthesis during myeloid maturation. The anti-elastase antibody NP57 is a useful addition to the range of monoclonal antibodies available for the differential diagnosis of acute leukaemia by alkaline phosphatase-antialkaline phosphatase (APAAP) labelling of cell smears; it may also be of value for the histopathological diagnosis of tumour deposits in myeloid leukaemia and for the detection of neutrophils in paraffin sections.

Practical value of genotypic analysis for diagnosing lymphoproliferative disorders.

The value of DNA hybridisation (using immunoglobulin and T cell receptor gene probes) was assessed during the diagnosis of problematical lymphoid tissue biopsy specimens. In 14 of 18 specimens (78%), which contained a malignant lymphoproliferation of uncertain aetiology, this technique permitted the demonstration of a monoclonal proliferation of B cells (nine cases) or T cells (five cases). In five further lymph node biopsy specimens, in which the differential diagnosis lay between a reactive or malignant process, a clonal proliferation was shown in three cases. DNA analysis is, therefore, of practical value in resolving many of the diagnostic problems that arise in the assessment of lymphoid tissue biopsy specimens.

Rabies virus and the problems of rabies vaccination in man.

The structure of rabies virus and the importance of its glycoprotein in immunization are discussed. The improvement in vaccines for use in man, culminating in the production of the human diploid vaccine is described. Nevertheless problems remain, particularly with regard to post-exposure therapy. Possible disadvantages in the use of subunit vaccines are mentioned and attention is drawn to the discovery of the rabies-related viruses.

Early percutaneous transluminal coronary angioplasty in the management of unstable angina.

This report describes the results of percutaneous transluminal coronary angioplasty in 56 patients with unstable angina. In each case diagnostic coronary angiography had demonstrated a critical proximal stenosis in a major vessel. The stenosis was successfully dilated without complication in 70% of cases. Angiographic success was reflected by the abolition of symptoms and a nonischaemic predischarge stress test in 82 and 72% of cases, respectively. Importantly, at six months follow-up 69% of these patients remained symptom free though repeat angioplasty had been necessary in 21% of cases. The in-hospital incidence of myocardial infarction and death was 7.1 and 5.4%, respectively, but during the six month follow-up period only one additional complicating event occurred. Results were particularly favourable in patients with single vessel disease, 83% of whom had successful procedures. There was one uncomplicated myocardial infarct in this subgroup but no deaths. These data indicate that percutaneous transluminal coronary angioplasty may be undertaken with relative safety in patients with unstable angina and leads to a substantial improvement in symptoms that is sustained during early follow up. The benefits of this therapeutic approach may be particularly marked in patients with single vessel disease.

Intravenous amiodarone in the acute termination of supraventricular arrhythmias.

This study was performed to ascertain whether intravenous amiodarone would revert supraventricular tachycardias to sinus rhythm, and if so, whether this effect depended upon the underlying mechanism of the arrhythmia. Fourteen patients were studied. Seven had Wolff-Parkinson-White (WPW) syndrome, 1 had dual atrioventricular nodal pathways and 1 an ectopic atrial tachycardia. Five patients had atrial fibrillation without accessory pathways. An atrial electrode was inserted to initiate tachycardias and record the electrogram. If tachycardias were stable for more than 5 min, amiodarone (5 mg/kg) diluted with dextrose saline was infused intravenously over 5 min. Two electrocardiographic leads and the right atrial electrogram were monitored. In 7 patients with atrial fibrillation (2 with accessory pathways), 6 did not revert to sinus rhythm, 1 reverted only after 1 hr. In 5 cases without accessory pathways the ventricular rate fell 5-10 min after commencing amiodarone. Four of the 5 patients with WPW syndrome and re-entrant tachycardias returned to sinus rhythm within 6 min of commencing the infusion (atrioventricular and ventriculoatrial times increased by 0-38% and 0-14% respectively). (Tachycardias terminated in the anterograde limb.) Three patients underwent intermittent right atrial stimulation for 1 hr. No tachycardias could be initiated for 30 min post amiodarone. The ectopic atrial tachycardia and that due to dual atrioventricular nodal pathways terminated within 7 and 2 min, respectively, of commencing intravenous amiodarone. Thus the use of intravenous amiodarone would be appropriate in the acute management of sustained supraventricular tachycardias.

Fascicular nerve repairs. A comparative study of epineurial and fascicular (perineurial) techniques.

At present, fascicular nerve repairs produce almost identical results to epineurial repairs. There are still theoretical advantages to the improved alignment potentially offered by fascicular nerve repair, and fascicular technique already offers an advantage in partial nerve injuries. As fascicular capabilities improve, fascicular nerve repair may still offer the best solution for nerve recovery.

Fractures about the interphalangeal joints in children.

Fracture patterns in 87 interphalangeal joint fractures in children's hands were studied and correlated with unique anatomic features of these joints. The collateral ligaments, which extend beyond the physis into the metaphysis, were found to protect the growth plate in the frontal plane. With laterally directed forces, fractures on the proximal side of the joint occurred, rather than epiphyseal fractures. There was good remodeling of angular deformities in the sagittal plane, but minimal correction in the frontal plane. In those patients treated surgically, angular deformities did not result. Of 24 condylar fractures followed for an average of 55 months, 11 (46%) demonstrated some restriction of joint motion.

Open reduction and internal fixation of volar lip fractures of the distal radius.

Fractures of the volar lip of the distal radius are relatively uncommon injuries. However, controversy exists concerning the treatment of these fractures. We reviewed our experience with open reduction and internal fixation through a volar approach using buttress plates. Sixteen patients with 17 fractures were treated by this method. Their ages ranged from 16 to 65 years (average 38 years). Eight fractures occurred secondary to motor vehicle accidents, while the remaining patients sustained falls. Mean follow-up time was 19.5 months. All fractures healed with no infections. Sixteen of the fractures were treated primarily with open reduction and internal fixation, while one patient was treated 6 weeks after injury for a malunion. Ranges of motion averaged 71 degrees dorsiflexion, 60 degrees palmar flexion, 79 degrees pronation, 78 degrees supination, 22 degrees radial deviation, and 32 degrees ulnar deviation. Analysis of results demonstrated 12 excellent, 2 good, and 3 fair results. Two patients with fair results had nonanatomic restoration of the joint surface at surgery, while the other patient with a fair result was treated late. We recommend early open reduction and internal fixation of displaced or unstable volar lip fractures of the distal radius. Accurate anatomic alignment and stable fixation are achieved with the volar buttress plate. Motion can begin 2-3 days after surgery to aid in obtaining excellent functional results.

Pediatric hand injuries. Types and general treatment considerations.

Growth arrests may occur after fractures, burns, and frostbite injuries, but children generally have a better prognosis from most hand and forearm injuries than adults. Stiffness is less frequent, open wounds heal faster, remodeling of angular deformities may occur, and nerve recovery following repair is significantly better than adults. Parents should be aware of potential problems and the need for follow-up care for evaluating growth and scar development. Perhaps the greatest challenge for nurses as both parents and as members of society is the prevention of traumatic hand injuries. Children should be placed in seat belts when riding in motor vehicles, and toys and play areas should be geared toward the child's developmental age and abilities. Despite careful attention to a child's surroundings, some children will require emergency care for traumatic hand injuries. Health care workers must provide emotional support for parents who may feel guilty about their child's injury. They also must be prepared to give skilled clinical care guided by the child's development and the needs of the family members.