The moderating impact of social support following childhood sexual abuse. The role of social support in moderating the impact of childhood sexual abuse on adult psychological adjustment was examined. Subjects included 475 women, age 18-45, some of whom were currently receiving treatment, others who were not. Women in the treatment group were receiving therapy for either alcoholism, for being battered, or for mental health problems. The comparison group was drawn from two sources: a random household sample and a sample of women attending drinking driver classes. Among both groups, women who had been sexually abused exhibited more psychological symptoms and lower self-esteem compared to those who were not abused. Latency of disclosure of childhood sexual abuse had no impact on long-term consequences of the abuse for either the treatment or the comparison group. However, among women in the comparison group, those who experienced supportive reactions following disclosure of sexual abuse had fewer psychological symptoms and somewhat higher self-esteem relative to those who did not receive support. Social support had no apparent effect on the long-term adjustment of women in the treatment group. Possible explanations for this pattern and directions for future research are discussed.


Conventional and delinquent activities: implications for the prevention of violent victimization among adolescents. While age is one of the most important correlates of an individual's risk of violent victimization, research regarding the victimization of adolescents is relatively meager. Using two well-known national data sources and an analytical framework guided by lifestyle/routine activities theories, we describe the relationships between activity involvement and the risk of assault and robbery victimization among adolescents in the United States. Several findings relevant to victimization prevention emerge. First, we find that certain adolescent activities are related to risk of violence. Youth who engage in delinquent activities experience the highest risk of assault and robbery victimization. Second, we find very few conventional activities which protect adolescents from victimization net of background factors (e.g., gender, race, family structure) or offending levels. We discuss the implications of these findings for programs directed at reducing violent victimization among adolescents and for lifestyle/routine activities theories of victimization.


Brightness versus apparent contrast. 1: Incremental and decremental disks with varying diameter. This study describes the matching of the brightness and of the apparent contrast of foveal disks, presented as an increment or decrement with varying diameter against a 300 cd.m-2 background. If the brightness in the centre of the disks is matched with a constant reference brightness, the well-known spatial Broca-Sulzer phenomenon is obtained. This effect is not found if the apparent contrast of the disks is matched instead. All matching results and detection thresholds indicate that luminance increments and decrements are processed asymmetrically by the visual system: for decrements the threshold curve and curves of isobrightness as well as apparent iso-contrast are all shifted towards larger disk radii relative to those for increments. Two nonlinear single-channel models are tested against the data.


Measurement of the 2D affine Lie group parameters for visual motion analysis. A class of linear operators is presented for estimating the local components of 2D translation, dilatation, rotation, and the shear/deformations which span the six degrees of freedom of motion of arbitrarily textured surfaces. This results in a model of visual motion analysis which proposes that the local transformations in the image are analysed by decomposing them into the six one-parameter subgroups of the 2D affine group. Each of the required invariant integral operators are easily specified by the characters of these six subgroups. The 2D affine group, however, does not have a simple structure. It is a Lie group which possesses a semi-direct product manifold, and classical harmonic analysis cannot proceed unless some mechanism is prescribed to isolate the 2D 'general linear' transformations from the 2D translations. It must also do so using measures which receive only local support from the image, since the global affine group model is only valid tangentially. A form of 'active perception' is thereby implicated; it is proposed that spatial indexing and 2D tracking is needed in order to form reliable estimates of 3D motion parameters using local operators in a data-driven fashion.


Visual search for oriented lines: the role of angular relations between targets and distractors. Subjects can perform parallel visual search for an item of unique orientation when it is presented on a background texture composed of lines of two other orientations. A number of cues can be used to speed this search. It helps if the target has a unique categorical status (e.g., it is the only 'steep' item) (Wolfe et al., J. Exp. Psychol. Hum. Percept. Perf. 18, 34-49 1992). It helps if the two background orientations are symmetrical about a vertical axis (Wolfe and Friedman-Hill, Psychol. Sci. 3, 194-198, 1992). The experiments presented here show that it helps if the angles formed by the target with one of the distractor types are smaller than the angles formed by the two distractor orientations. These results illustrate that stimulus similarity is a complex concept even for a simple feature like orientation.


Phase shifts and the square-wave illusion. When observers view a vertical triangle-wave luminance profile, they often report a square-wave illusion with a depth component, resembling a corrugated surface. Alternate bars seem to be in front of or behind adjacent bars and the surface appears to be illuminated from the right or left. These perspectives alternate with continuous viewing. One explanation for this illusion stems from the notion of instability among phase-selective mechanisms. Two experiments (1 and 3) were designed to determine whether systematic phase shifts introduced between the fundamental and the odd harmonics of the waveform would lead to a systematic bias of the illusion. The results indicated that a significant bias occurred when a phase shift as small as 9 deg was introduced, and that the bias from the phase shifts was more powerful than previous reports of drift-induced bias. There was a highly significant effect of direction of phase shift and the corresponding perceived direction of illumination. Another experiment (2) was designed to determine if illusional cues within the phase-shifted profiles aided phase discrimination. The results indicated that experienced subjects, presumably using cues within the profiles, discriminated between the stimuli significantly better than did naive subjects. These data support the role of phase in the square-wave illusion, but they also raise questions about the role of contrast changes in local regions of the stimulus.


Abstract processes in texture discrimination. In this study some experiments on texture segmentation are reported using the local Gabor power spectrum. The techniques applied are: (1) supervised pixel classification; (2) boundary detection by spectral dissimilarity estimation; (3) region-based segmentation based on Gaussian spectral estimation; and (4) the same as (3) but based on central moments of the local spectrum. It is shown that very-acceptable-to-excellent results can be obtained. It is argued, however, that the shortcomings of region-based and boundary-based approaches require that both processes should act in parallel, not only in digital image processing but also in the modelling of visual perception.


Normal eye tracking is associated with abnormal morphology of medial temporal lobe structures in schizophrenia. Eye tracking and brain morphology assessed by magnetic resonance imaging were examined in 48 patients in their first episode of schizophrenia and in 15 normal controls. Schizophrenic patients showed higher rates of eye tracking dysfunction and more abnormal brain morphology involving the lateral ventricles, medial temporal lobe (MTL) structures and the frontal-parietal cortex than controls. Enlargement of the lateral ventricles and global rating of abnormal brain morphology were significantly more prevalent in male schizophrenics than female schizophrenics. These findings indicate that abnormalities in a variety of brain regions are present in some schizophrenics during the period shortly after the first hospitalization and could not be a function of treatment or chronic illness. We found no relation between abnormal eye tracking and any single feature of abnormal brain morphology. However, normal eye tracking was significantly associated with MTL abnormalities in schizophrenics, reflecting an inverse association between quality of eye tracking and degree of abnormality in MTL structures. These results suggest that abnormal eye tracking is not mediated by the same processes that lead to structural brain anomalies in schizophrenia.


Symptomatology and the prediction of social skills acquisition in schizophrenia. The relationship between patient symptomatology and the acquisition of social skills during an inpatient social skills training program, and the maintenance of skills at a one-month followup, were examined in a sample of recently hospitalized schizophrenic and schizoaffective disorder patients. Subtypes of patients with enduring Thought Disorder (vs. no enduring Thought Disorder) or enduring Anergia (vs. no enduring Anergia) on the BPRS during the treatment period were compared in their response to the social skills training intervention. Patients with enduring Thought Disorder acquired skills at the same rate as patients without Thought Disorder, but were unable to retain their skills at followup, in contrast to their counterparts. Enduring Anergia was not related to either the acquisition or maintenance of social skills. The results were unaffected when memory was statistically controlled. The findings suggest that patient symptomatology may be an important factor mediating the efficacy of social skills training interventions.


Left-handed first-episode, neuroleptic-naive schizophrenic patients have a higher prevalence of autoantibodies. Using standard immunological techniques, sera from first-episode, neuroleptic-naive schizophrenic patients (n = 51) and age, race and sex matched healthy controls (n = 51) were screened for seven common autoantibodies. Significantly more left-handed (67%) than right-handed (23%) schizophrenic patients had autoantibodies (p = 0.011). Left-handed schizophrenic patients were six times more likely than right-handed patients or controls and four times more likely than left-handed controls to test positive for autoantibodies (p = 0.012). These data suggest that disease and sinistrality contribute to the excess of autoantibodies in schizophrenia.


The Patient Rejection Scale in an Israeli sample: correlations with relapse and physician's assessment. The Patient Rejection Scale (PRS), which was developed to assess the feelings of rejection that relatives experience toward mental patients, was administered to a sample of 50 family members living with schizophrenic outpatients in Jerusalem, Israel. PRS response distribution was similar to that reported for a New York City sample. Total rejection scores were significantly correlated with a number of demographic variables and with the treating physician's assessment of the degree of rejection, hostility and criticism of the respective family members. Physician's rating of emotional over-involvement did not correlate with PRS scores. Both PRS and treating physician's ratings correlated significantly with course of illness parameters. The findings and their implications are discussed in the context of expressed emotion (EE) research.


Perioperative analgesia with subarachnoid sufentanil administration. Thirty-seven ASA Physical Status I parturients undergoing elective cesarean delivery were evaluated to determine the effects of subarachnoid sufentanil administration. This study was carried out in a randomized, double-blind fashion. All patients received 1.4 ml 0.75% bupivacaine with 8.25% dextrose following 10 micrograms, 15 micrograms, or 20 micrograms sufentanil, or 1 ml of normal saline containing no sufentanil. Onset and duration of sensory and motor anesthesia, duration of complete analgesia, duration of effective analgesia, and intraoperative parenteral opioid requirements were evaluated. Incidence of side effects such as respiratory depression, pruritus, nausea, and vomiting were evaluated. Duration of complete analgesia and duration of effective analgesia were prolonged significantly in all patient groups receiving sufentanil as compared to control groups receiving no narcotic. Pruritus was significantly increased in patient groups receiving subarachnoid sufentanil. Respiratory depression was not observed in any patient studied. One- and five-minute Apgar scores; umbilical, venous, and arterial blood gas results; and Early Neonatal Neurobehavioral Scale results were all within normal limits and were not significantly different among the groups.


Technical and light microscopic comparison of four different small-diameter catheters used for continuous spinal anesthesia. Recently several manufacturers developed ultra-thin catheters for continuous spinal anesthesia. Their use may be associated with technical problems. Four spinal catheters [Preferred Medical 28-gauge and 32-gauge (polyurethane), Kendall CoSpan 28-gauge (nylon), and Microspinal 32-gauge (polyimide)] were compared in 41 patients who underwent knee or hip operations. Difficulties in using the catheters were recorded, and after their removal, the catheters were examined by light microscopy. The insertion of the 28-gauge catheters was always successful. However, five of 11 of the 32-gauge polyurethane and one of ten of the 32-gauge polyimide catheters could not be inserted. Plain 0.5% bupivacaine (2-6.5 ml) was administered, and the median pinprick analgesia level varied between T4 (28-gauge nylon) and T7 (other groups). During removal, one of ten of the 28-gauge nylon, four of ten of the 28-gauge polyurethane, and all six 32-gauge polyurethane catheters stretched. Two of six of the 32-gauge polyurethane catheters broke, but no fragment remained in any patient. Microscopic examination revealed deposits of fibrinous material on the tips of all polyurethane and polyimide catheters and on one nylon catheter. One polyimide catheter ruptured 15 cm from the tip. No signs of tearing or lost pieces of catheter material were observed by light microscopy. The use of the 32-gauge polyurethane catheter was associated with problems that limit its clinical usefulness. Nylon and polyimide catheters with stainless steel stylets were more resistant to stretching. The nylon catheter was most resistant to adhesion of fibrinous material.


Brachial plexus block with the nerve stimulator: motor response characteristics at three sites. Differences in motor response patterns, minimum electrical currents, and success rates using a nerve stimulator for brachial plexus block were determined for the interscalene, supraclavicular, and axillary approaches. Supervised, resident physicians performed 106 brachial plexus blocks. For each block, the minimum stimulating current, the strongest joint motion at the minimum current immediately before local anesthetic injection, presence or absence of other joint motion, and anesthetic success or failure were recorded. In the interscalene group (n = 43), strongest joint motions clustered at the shoulder (40%) and elbow (54%). In the supraclavicular group (n = 29), strongest joint motions distributed bimodally at the elbow (62%) and fingers (31%). In the axillary group (n = 34), strongest joint motions clustered at the wrist (35%) and fingers (61%). Overall, concurrent, weaker joint motion was observed in 26% (p not significant). Overall, the minimum current producing visually observable or palpable upper extremity motor responses was 0.69 +/- 0.02 mA (mean +/- SEM, range 0.2-1.5). No significant differences were found for minimum currents by site of approach, presence or absence of weaker joint motion, or success or failure of anesthesia. The overall success rate was 89%, with the rate being 91% for interscalene, 97% for supraclavicular, and 79% for axillary approaches (p not significant). Within the axillary group, elbow flexion as the strongest joint motion was a significant predictors of failure compared with other responses (p < 0.05). Localization of the brachial plexus with the nerve stimulator is equally effective at the interscalene, supraclavicular, and axillary sites. Current values in the range reported have no predictive value for success. Advantages of the nerve stimulator for brachial plexus block include an objective endpoint and continuous feedback.


Efficacy of subarachnoid morphine in a community hospital. Two hundred seventy-five patients who underwent major surgery and received subarachnoid morphine for postoperative pain relief were prospectively studied to establish the benefits of its routine use in a community hospital. Seventy-nine percent of all patients had a satisfactory analgesic-free interval of 18 hours, and postoperative analgesics were unnecessary for the first 24 hours in 56% of all patients. Pruritus developed in 26% of all patients, 16% experienced nausea, vomiting, or both, and 4% experienced urinary retention. There were no cases of respiratory depression. Ninety-two percent of all patients were managed on the medical/surgical floors without incident, and 90% of the patients were satisfied with their results. It was shown that, when there are properly trained floor nurses, subarachnoid morphine (0.1-0.4 mg) can be an effective, safe, and simple method for postoperative pain control in a community hospital.


Continuous pump pressures cannot be used to identify catheter tip migration into the subarachnoid space. Migration of an epidural catheter into the subarachnoid space is a potentially lethal complication of continuous epidural anesthesia. We evaluated the use of pump pressure measurement during infusion in detecting such an occurrence. Pump pressures at two flow rates (P1 and P10) and epidural space pressure (P0) were measured hourly in eight consecutive ASA Physical Status I parturients receiving continuous epidural anesthesia and compared to those of a patient whose catheter migrated into the subarachnoid space. In addition, total resistance to infusion (Rtot) was calculated as the slope of the least squares regression line linking pressure and flow. Epidural resistance (Repi) was computed as the difference between total resistance and catheter resistance; Repi = Rtot - Rcath. In epidural catheters, average P0 and P10 were 13 +/- 4 mmHg and 23 +/- 4 mm Hg, respectively, and did not change over time. Rtot and Repi averaged 960 +/- 180 RU and 980 +/- 120 RU, respectively. Pump pressures in the subarachnoid catheter were 10 mmHg for P0 and 20 mmHg for P10, while Rtot was 1000 RU. We conclude that epidural and subarachnoid space resistance is essentially zero and the pump pressure in the system is used to overcome the catheter resistance. Both spaces offer the same total resistance to infusion and, therefore, pump pressure will not change when a catheter migrates into the subarachnoid space.


Quaternary structure and assembly process of the T cell receptor. The human immune system contains T and B lymphocytes which respond in an antigen-specific manner to foreign antigens. These foreign antigens are recognized by multimeric receptors expressed on the cell surface of T and B lymphocytes. The subunits that make up the T and B cell receptor complexes have been identified, but their stoichiometries and positions in the complex remain to be resolved. Elucidation of the quaternary structures is necessary to understand the molecular basis of signal transduction events which follow antigen recognition and will contribute to the design of drugs that can modulate T and B cell responses. Here, I will discuss recent insights into the quaternary structures of the TCR and BCR and the striking similarities between the two, both in the structures of the subunits and in the overall quaternary structures. In addition, the intracellular assembly processes of these receptor complexes will be discussed, as well as the recent realization that these processes appear to be mediated by house-keeping proteins that transiently bind to partial TCR and BCR complexes. Similar to the role of BiP which mediates assembly processes of B cell immunoglobulins, a recently identified intracellular protein of 90 kD, called IP90, appears to play a role in TCR and BCR assembly processes. Analyses of the IP90 protein might contribute not only insight into the folding and assembly processes in lymphocytes, but also into those of newly synthesized proteins in many different cell types.


Selective block of nerves in the axillary approach to the brachial plexus. Optimal surgical conditions for flexor tendon tenolysis in the hand were achieved by ulnar, radial, and musculocutaneous nerve block at the axilla combined with median nerve block at the wrist. Because the median nerve function proximal to the wrist was preserved, the patient was able to flex the finger intraoperatively. Palpation of nerves together with a nerve stimulator were used to localize the nerves accurately.


Hodgkin's disease derived cell lines: a review. A number of so-called "HD cell lines" have been established over the last 10-15 years (Table 1). Or those 15 cell lines we studied, only the cell lines CO, DEV, HD-70, HDLM, KM-H2, L-428, L-540 and SUP-HD1 can be regarded to represent true HD cell lines. According to the immunostaining results and molecular genetic data, these 8 cell lines can be assigned either to the T-cell lineage (CO, HDLM, L-540) or B-cell lineage (DEV, HD-70, KM-H2, SUP-HD1). With the data currently available, the cell lineage origin of L-428 cannot be unequivocally determined, but appears to be lymphoid. All but one of these eight HD cell lines have been established from patients with the nodular sclerosis subtype. Therefore, the conclusions drawn from the in vitro studies are limited to this histological subtype of HD. It is conceivable that culture conditions select for a particular type of cell that will survive. The state of differentiation of these HD cell lines remains unclear due to the incomplete expression of T- or B-cell antigens. The in vitro cells and the in vivo H-RS cells share, however, the expression of the unique activation markers CD15, CD25, CD30, CD71 and HLA-DR. Recently published data indicate that the HD cell lines express and produce a large number of cytokines. Multiple non-random chromosomal abnormalities and the expression of various proto-oncogenes are also new and exciting findings and certainly deserve further study. In summary, although the cultured cells are not unequivocally proven to be the direct progeny of in vivo H-RS cells, several continuous HD cell lines have been established that display a variety of phenotypical features identical or similar to those of their presumed in vivo counterparts. Surface marker, molecular genetic and other features suggest a T- or B-cell derivation. An extrapolation of these conclusions would point to a lymphoid origin of H-RS cells. Whether H-RS cells can originate from other cell types such as monocytes/macrophages or reticulum cells, cannot be answered with the currently available HD cell lines.


Comparison of Sprotte and Quincke needles with respect to post dural puncture headache and backache. The objective of this study was to compare 24-gauge Sprotte and 25-gauge Quincke needles with respect to post dural puncture headache and backache. Three hundred ASA Physical Status I or II patients scheduled for minor orthopedic or urologic operations under spinal anesthesia were chosen for this randomized, prospective study at a university hospital and a city hospital. Anesthetic technique, intravenous fluids, and postoperative pain therapy were standardized. Patients were randomly divided into three equal groups. Spinal anesthesia was performed with either a 24-gauge Sprotte needle or a 25-gauge Quincke needle with the cutting bevel parallel or perpendicular to the dural fibers. Anesthesia could not be performed in three cases with the Sprotte needle and in one case with the Quincke needle. The most common complications were post dural puncture backache (18.0%), post dural puncture headache (8.2%), and non-postural headache (6.7%). No major complications occurred. The Quincke needle with bevel perpendicular to the dural fibers caused a 17.9% incidence of post dural puncture headache. The Quincke with bevel parallel to the dural fibers and the Sprotte needles caused similar post dural puncture headache rates (4.5% and 2.4%, respectively). Other factors associated with post dural puncture headache were young age, early ambulation, and sedation during spinal anesthesia. There were no significant differences between needles in the incidence of post dural puncture backache. Our data indicate that Quincke needles should not be used with the needle bevel inserted perpendicular to the dural fibers. The Sprotte needle does not solve the problem of post dural puncture headache and backache.


Headache from intracranial air after a lumbar epidural injection: subarachnoid or subdural? There is a growing awareness of the possibility of headache resulting from intracranial air secondary to identification of the epidural space by loss of resistance using air (LOR-A). Most reported cases have been attributed to subarachnoid air passage. A case is described of sudden headache following LOR-A. Various features of the case suggest that the passage of air to the head was subdural rather than subarachnoid. Recovery was uneventful.


Recent trends in research on differentiation of hematopoietic cells and lymphokines (hemopoietins). A recent trend in hematological research fields has been to isolate and characterize hematopoietic stem cells/progenitors and their growth factors (hemopoietins) to gain a much better understanding of the nature of the stem cell and the mechanisms regulating its development. It is generally accepted that all the various types of blood cells develop from a single progenitor called a hematopoietic stem cell. Quantitative studies of the function of hemopoietic stem cells began two decades ago with the development of a spleen colony assay, and then, clonal cell culture techniques for committed progenitors were developed with several models for hematopoietic differentiation being proposed. Within the last few years, some hormones have been discovered that are known as hematopoietic growth hormones or hemopoietins, each of which is of protein nature and causes specific classes of blood cells to be made and primed. These hormones also enhance the function of the mature cells, the genes of which have recently been cloned. On the other hand, long-term bone marrow culture has recently permitted detailed investigations of the relationship between hematopoietic cells and the microenvironment in which they are found, e.g. stromal cells, in vitro, relating to the regulation of cell proliferation and differentiation. Further, in hematological fields, other bioactive factors including differentiation-inducing compounds, e. g. bioactive glycosphingolipids, and leukocyte-endothelial cell recognition molecules (adhesion receptors) have been discovered, the molecular mechanism(s) of which have yet to be elucidated. This communication focuses on recent advances in research on soluble hemopoietins and other bioactive factors relating to differentiation-induction and to cell-to-cell recognition.


Human T lymphotropic virus type-I (HTLV-I) immortalizes human T cells in vitro--its implication in the pathogenesis of adult T cell leukemia (ATL). HTLV-I is the first human retrovirus that was isolated from a patient with T-cell malignancy in 1980 in the United States. HTLV-I is detected in most patients with adult T cell leukemia (ATL) and healthy carriers, who are frequently found in the southwestern parts of Kyushu and Shikoku Districts. HTLV-I-infected cells express IL-2 receptors, and HTLV-I-infected T cell lines can be established from most of ATL patients in culture in the presence of IL-2. Furthermore, these IL-2 dependent T cell lines often begin to proliferate in the absence of IL-2 and to not respond to IL-2, despite IL-2 receptors on their cell surface, thus mimicking ATL cells in vivo. These findings suggest that HTLV-I is an etiological agent of ATL. In this mini-review, the T cell immortalizing activity of HTLV-I in vitro, with special reference to the evolution of ATL cells based on our results, is described.


[Key points and problems concerning chemosensitivity tests, with special reference to MTT assay]. Recently, the semiautomated tetrazolium-based MTT colorimetric assay have been used to measure chemosensitivity. We also have been used this assay for 4 ovarian clear cell carcinoma cell lines to investigate the chemosensitivity of this tumor. In this study, several problems have been faced to be solved. In this paper, we pointed out these problems and indicated solutions.


The expression of the mouse VpreB/lambda 5 locus in transformed cell lines and tumors of the B lineage differentiation pathway. The expression of RNA transcripts from two pre B lymphocyte related genes, VpreB and lambda 5, has been studied in a series of transformed cell lines which appear frozen at different states of B lineage differentiation, from early progenitors to surface Ig positive B cells. In the HAFTL-1 cell line, which arose from fetal liver by transformation with a retrovirus containing the Hras oncogene, Northern analysis of poly A+ mRNA as well as in situ hybridization of RNA in single cells revealed that lambda 5 and VpreB are already expressed at the progenitor stage and increase in expression as the progenitors differentiate to precursor (preB) cells, or are turned off as the progenitors differentiate to myeloid cells. Continued rearrangements of Ig genes in pre B cell lines leading to Ig expression on the surface of NFS-5 pre B cells do not influence the continued expression of VpreB and lambda 5. Surface Ig-positive B lineage cell lines also express the pre B-related genes. Both Ly1+ as well as Ly1- pre B cells are VpreB- and lambda 5-positive. Lipopolysaccharide (LPS) stimulation of 70Z/3 pre B cells does not turn off lambda 5 expression. It therefore appears that, at least in transformed cell lines, the expression of VpreB and lambda 5 is not directly regulated by the expression of microH, kappa L, or lambda L chains, LPS reactivity, or the Ly1 surface antigen. Fusion of plasmacytoma cells with normal pre B cells to generate pre B hybridomas leads to down-regulation of VpreB/lambda 5 expression.(ABSTRACT TRUNCATED AT 250 WORDS)


T cell receptor alpha-chain pairing determines the specificity of residue 262 within the Kb-restricted, ovalbumin257-264 determinant. Ovalbumin-specific, Kb-restricted T cells recognize the minimal fully active synthetic peptide ovalbumin (OVA)257-264. This sequence coincides with the eight residue, allele-specific peptide binding motif previously predicted from direct sequencing of naturally occurring Kb-associated peptides (Falk, K., Rotzscke, O., Stevanovic, S., Jung, G., and Rammensee, H.-G., Nature 351:290, 1990). T cell recognition of a panel of analogs with single residue substitutions between the two putative Kb anchor residues at OVA261 and OVA264 suggested that at least one residue, Glu at position 262, is involved in TCR interaction. OVA-specific cytotoxic T lymphocytes (CTL) derived from TCR beta-chain transgenic mice, where the beta-chain originates from an OVA-specific, Kb-restricted CTL B3, showed that differences in TCR alpha-chain pairing determined the specificity for OVA residue 262. These data support the notion that residue 262 of the OVA T cell determinant, corresponding to position 6 within the Kb-binding motif, represents a contact site for TCR. This residue interacts directly with the TCR alpha-chain or with a site on the TCR beta-chain whose conformation is affected by TCR alpha-chain pairing.


Properties of B cell stage specific and ubiquitous nuclear factors binding to immunoglobulin heavy chain gene switch regions. The Ig heavy chain (IgH) constant region (CH) class switch is manifested by DNA deletions which exchange the C mu gene of a functional VDJ-CH rearrangement for a C gamma, C epsilon or C alpha gene. Repetitive sequences (S regions) 5' of each CH gene mediate CH gene switch recombination by an illegitimate mechanism. S mu can be subdivided into S mu 5' (non-repetitive) and S mu 3' (repetitive) components with recombination occurring in either part. Here, we describe the properties of ubiquitous and B cell stage specific S mu binding factors NFS mu-U1 and NFS mu-B1 respectively. U1 only bound to S mu 5' sequences, and B1 to S mu 5', S mu 3' sequences and to other S regions with varying affinities. DMS and OP-Cu footprinting revealed the sequence AAAAAGCATGGCTGA in the U1 site while the B1 S mu 5' site overlapped the 3' end of the U1 binding site and also contained additional 3' flanking S mu repeat motifs (GAGCTGAGATGGGTGGGCT). Binding site competition assays reveal that NFS mu-B1 is either very related or identical to S alpha BP (described by Waters et al., Mol. Cell Biol. 9:5594, 1989) and BSAP (identified by Barberis et al., Genes Devl. 4:849, 1990) which were shown to bind to two sequences upstream of the S alpha repeats and within the promoters of sea urchin histone genes respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


Conformational changes in mouse MHC class II proteins at acidic pH. MHC class II molecules bind peptide antigens and present them to T cells. Recent evidence suggests that peptide--MHC class II interaction is regulated by pH. Both peptide binding to and dissociation from MHC class II molecules is enhanced at acidic pH. In this report we use circular dichroism to investigate the possibility that the modulation of peptide association with MHC class II molecules at acidic pH is associated with changes in MHC class II structure. Our results show that a change in the structure of the MHC class II protein A(d) occurs between pH 4 and 5, close to the pH optimum for peptide binding. More drastic changes in A(d) structure occur at lower pH levels, where peptide dissociation is enhanced. The structural changes at pH 4-5 are fully reversible upon neutralization, while changes at pH 3 are not. The pH stability of purified E(d) molecules is somewhat different, with changes observed only at pH less than 4. This may reflect a differential occupancy of the purified molecules with endogenous peptides.


T cell receptor usage by HLA-DQw8-specific T cell clones. To investigate whether T cells recognizing the same HLA molecule may demonstrate homology in parts of their TCR, five different HLA-DQw8-specific T lymphocyte clones (TLC) were studied. The TCR alpha and -beta genes of four alloreactive, HLA-DQw8-specific and one antigen-specific TLC were sequenced. All TLC used different V alpha and V beta genes. However, four of the TLC shared a certain CDR1 beta motif and all five used either J beta 2.3 or -2.5. In addition, two used the same J alpha. The results indicate a possible preferential usage of certain TCR structures by T cells specific for DQw8.


Characterization of Fc epsilon RI gamma in human natural killer cells. We report the characterization of the Fc epsilon RI gamma chain which associates with the transmembrane form of CD16 to form the low affinity receptor for IgG (Fc gamma RIII) expressed on human natural killer (NK) cells. cDNA cloning and sequence analysis of Fc epsilon RI gamma from a polyclonal CD3-CD16+ NK line established that this molecule is identical to Fc epsilon RI gamma previously identified in human basophils as part of a high affinity receptor for IgE. Polymerase chain reaction analysis of Fc epsilon RI gamma gene expression in a series of CD3+CD16- and CD3-CD16+ NK clones reveals that Fc epsilon RI gamma is not directly linked to NK activity since clones of the CD3+CD16- phenotype lack Fc epsilon RI gamma RNA but nevertheless mediate cytotoxicity. Taken together, these results demonstrate that the Fc epsilon RI gamma molecule is expressed in various types within the hematopoietic system as part of multimeric surface receptors involved in different biological functions.


N.m.r. study of interaction between sugar and peptide moieties in mucin-type model glycopeptides. In order to investigate the structural properties of the sugar and peptide linkage region in glycoprotein, some glycopeptides were synthesized as a model for AFGP (antifreeze glycoprotein), which is one of the mucin-type glycoproteins. The results from n.m.r. measurements in DMSO and aqueous conditions revealed that the glycopeptides form an intramolecular hydrogen bond between the amide proton of N-acetylgalactosamine (GalNAc) and the carbonyl oxygen of threonine (Thr) to which the GalNAc is covalently linked. This intramolecular hydrogen bond may play an important role in determining the orientation of the sugar moiety relative to the protein backbone. The roles for the activity of the proline (Pro) residue in AFGP were also discussed.


Construction of nucleosome cores from defined DNA sequences of prokaryotic origin. A procedure for the de novo construction of nucleosome core particles from defined DNA sequences of prokaryotic origin is described. Efficient de novo reconstitution without added carrier DNA is demonstrated. DNase I and exonuclease III analysis of a nucleosome core prepared from a 154 base pair fragment extending from base 853 to base 1006 of pBR322 indicates a non-random positioning of the histone core along the DNA. As bacteria have no histones, their DNA cannot be expected to have a histone core positioning signal encoded in it, the efficient formation of a uniquely positioned core particle is not self evident. The possibility that a phosphate end group positions DNA fragments on the histone is considered. The de novo reconstitution of carrier-less defined nucleosome core particles should facilitate the physicochemical study of nucleosomes on the fine structural level.


Glass transition of gluten. 1: Gluten and gluten-sugar mixtures. The glass transition in hydrated wheat gluten has been studied using dynamic mechanical thermal analysis, differential scanning calorimetry, pulsed nuclear magnetic resonance and a three point bend test. The results for gluten alone are in good agreement with results obtained by other workers for gluten and glutenin. In contrast to their effect on the Tg of amylopectin, a gluten:sugar ratio of 10:1 (where the sugar is amorphous fructose, sucrose or glucose) has little effect on the glass transition temperature, as a function of water content. A sample containing gluten and fructose in the ratio 2:1 showed plasticization due to the sugar.


Glass transition of gluten. 2: The effect of lipids and emulsifiers. The effects of lipids and emulsifiers on the glass transition temperature (Tg) of gluten have been studied as a function of water content, using differential scanning calorimetry, dynamic mechanical thermal analysis, a three point bend test and pulsed nuclear magnetic resonance. Lipids and emulsifiers were found to have little or no effect on Tg, with the exception of the lower molecular weight caproic and hydroxycaproic acids, which had a plasticizing effect. In the case of hydroxycaproic acid this was found to be in accordance with the Couchman-Karasz equation. The magnitude of the drop in modulus at Tg was increased in the presence of these additives at low water contents. The effect of lipids and emulsifiers on the Tg of gluten and their compatibility with gluten appears to depend both on their hydrophobicity and on their molecular weight.


Behaviour of mouse macrophage cell line and mouse fibroblast on copolymers containing cellulose triacetate. Copolymers containing cellulose triacetate were prepared under various conditions. A bacteriological plastic dish was coated with the copolymer (HCTA-MDI copolymer) composed of hydrolysed cellulose triacetate (HCTA) and diphenylmethane diisocyanate (MDI). The deacetylated copolymer (DA-copolymer) was prepared by the deacetylation of HCTA-MDI copolymer. The behaviour of animal cells such as a mouse macrophage cell line (A640-BB-2 cells) and a mouse fibroblast (3T6 cells) on prepared dishes was investigated morphologically. A640-BB-2 cells showed good adhesion and smooth spreading, and 3T6 cells also showed good adhesion and sufficient cell growth on the dish coated with HCTA-MDI copolymer. These results suggest that these copolymers are useful for biomedical materials.


Binding study of metal ions to S100 protein: 43Ca, 25Mg, 67Zn and 39K n.m.r. The interactions of the S100 protein (S100) with metal cations such as Ca2+, Mg2+, Zn2+ and K+ were studied by the metal n.m.r. spectroscopy. The line widths of 43Ca, 25Mg, 67Zn and 39K n.m.r. markedly increased by adding all S100s. A broad 43Ca n.m.r. band of Ca(2+)-S100a solution was not affected by Zn2+ and K+, while it was greatly decreased by adding Mg2+. The 43Ca n.m.r. spectra of Ca(2+)-S100a0 and -S100b solutions consisted of two slow-exchangeable signals which corresponded to Ca2+ bound to two environmentally different sites of the S100a0. These two 43Ca n.m.r. signals were not affected by Zn2+ and K+. The line width of broad 25Mg n.m.r. band of the Mg(2+)-S100 solution greatly decreased by adding Ca2+, while it did not change by adding Zn2+ and K+. Further, the addition of Ca2+, Mg2+ and K+ did not affect the line width of the 67Zn n.m.r. of the Zn(2+)-S100 solutions. These findings suggest that: (1) Mg2+ binds to all S100s, and at least one of the Mg2+ binding sites of S100 molecule is the same as the Ca2+ binding site; (2) Zn2+ binds to S100s, although the binding site(s) is/are different from Ca(2+)- or Mg(2+)-binding site(s), and the environment of Zn2+ nuclei will not change even though Ca2+ binds to S100s.


Gelation of globular proteins: effect of pH and ionic strength on the critical concentration for gel formation. A simple model and its application to beta-lactoglobulin heat-induced gelation. The influence of pH (2-9) and ionic strength (0-0.14 M NaCl) on the sol-gel transition of beta-lactoglobulin was investigated in order to determine the critical gel concentration (C0). The concentration necessary to form a gel near the isoelectric pH remains approximately constant (approximately 1% w/v) independently of the ionic strength. At other pH values, the higher the ionic strength is, the lower the protein concentration must be to form a gel. A theoretical model to relate the effect of the intensity and the range of electrostatic interactions on the critical concentration (C0) is proposed and fits reasonably with the experimental results.


Control of collagen fibril diameters in tissues. It is proposed that radial growth of collagen fibrils, which takes place in all connective tissues to varying extents, according to the tensile stresses exerted on them, proceeds mainly by aggregation of protofibrils (approximately 10 nm) and existing fibrils. In young tissues, fibrils are prevented from making frequent intimate contacts which would lead to aggregation by abundant interfibrillar proteoglycan, that keeps the fibrils apart. Collagen fibrils are probably unable to fuse except when the molecules within them are packed in the same sense, i.e. fusing fibrils are parallel. The roughly equal numbers of parallel and antiparallel fibrils seen in several tissues must limit radial fibril growth in older tissues, where proteoglycan is usually less abundant. Possible origins of the balance of fibril polarities, which must be conserved after fibril nucleation on cell or non-cell templates, are analysed. The two controlling factors, ambient proteoglycan and fibril polarity, working against the tendency of fibrils to fuse, account for many features of the observed distributions of collagen fibril diameters in diverse tissues and at different ages.


Study on the prevention of surface-induced platelet activation by albumin coating. To understand how albumin on the surface inhibits surface-induced platelet activation, we adsorbed albumin on dimethyldichlorosilane-coated glass (DDS-glass) and modified the adsorbed albumin by three different methods. The adsorbed albumin was crosslinked with glutaraldehyde, dried and rehydrated, or digested with trypsin. Surface albumin concentration did not change by crosslinking; however, it decreased by about 15% by a simple dry-and-rehydration process. Trypsin digestion reduced the surface albumin concentration by 50%. Platelets were found to adhere and activate on albumin coated DDS-glass, if the adsorbed albumin was modified. The extent of platelet activation was quantified with two numeric parameters, the spread area and circularity. Fibrinogen adsorption to the dried or digested albumin layer resulted in enhancement of platelet activation, while adsorption of more albumin inhibited platelet activation. The results suggest that albumin can inhibit platelet activation as long as it covers the surface completely and remains flexible on the surface. This study indicates that steric repulsion is one of the mechanisms of surface passivation by albumin.


Influence of a preadsorbed terpolymer on human platelet accumulation, fibrinogen adsorption, and ex vivo blood activation in hemodialysis hollow fibers. Results are presented on kinetics of platelet accumulation in charged polyacrylonitrile (AN69) hollow fibers by continuous data recording under flow conditions (wall shear rate 108-1050 s-1), using suspensions of washed 111In-labeled human platelets in Tyrode's-albumin buffer, containing washed red blood cells (0-40%). Preadsorption of a terpolymer of acrylonitrile, poly(ethyleneoxide) methacrylate and trimethylaminoethyl chloride methacrylate leads to very efficient passivation with respect to platelet accumulation and fibrinogen adsorption. In human ex vivo tests, evaluation of complement peptide C3a, platelet beta-thromboglobulin, leucocyte-polymorphonuclear neutrophile elastase and fibrinopeptide A shows no detectable activation. Furthermore, preadsorption appears to result in simultaneous improvement in hemocompatibility of the blood lines leading to and from the dialysis module. This single pretreatment of dialysis membranes should allow injection of lower doses of anticoagulant to patients submitted to hemodialysis.


Growth of uropathogenic Escherichia coli strains at solid surfaces. The adhesion and growth of two catheter-associated (O2K2 and O83K?) and two non catheter-associated (O111K58 and O157K-) uropathogenic Escherichia coli strains on glass, poly(methyl methacrylate) (PMMA), a negatively charged copolymer of MMA and methacrylic acid (MAA) and a positively charged copolymer of MMA and trimethylaminoethyl methacrylate chloride (TMAEMA-Cl) were studied. The solid surfaces were placed in a parallel plate perfusion system. After preadhesion of the bacteria onto the surfaces, growth was initiated by perfusing the system with MacConkey broth. Growth was measured by counting adherent bacteria as a function of time. Bacterial strains were characterized by means of water contact angle, microbial adhesion to hydrocarbon (MATH), anion exchange resin retention (ARR) and zeta potential measurements. Solid surfaces were characterized by means of water contact angle and zeta potential measurements. The catheter-associated strains had significantly higher water contact angles, zeta potentials and ARR values than the non catheter-associated strains. Non catheter-associated strains did not grow at the surfaces used. Catheter-associated strains did not grow at the positively charged surface but exhibited growth at the other surfaces. Strains grew more rapidly at surfaces with a relatively high negative zeta potential and a low water contact angle than at surfaces with a relatively low negative zeta potential and a high water contact angle. The growth of strain O2K2 on glass was significantly reduced when urine instead of MacConkey broth was used as perfusion medium.


A new apheresis system using a copolymer (polyvinyl alcohol triethylene glycol diacrylate) for removal of LDL from dog whole blood. Studies were undertaken to determine the effectiveness of a copolymer composed of PVA-TEGDA (Poly Vinyl Alcohol TriEthylene Glycol) as a plasma-cholesterol lowering procedure. For a comparative study, five dogs underwent plasmapheresis including the transfusion bag containing gel in the plasma line, while three control dogs underwent the same plasmapheresis without gel. Numerous biological determinations were performed firstly in whole blood circulation before and after treatment over 10 days, and secondly in plasma before and after LDL binding on the gel. In the whole blood circulation, the average significant depletion of cholesterol levels was 31-51% for treated, 0-16% for control dogs and the average significant depletion of LDL cholesterol was 26-75% for treated and 0-3% for control dogs. Gel was therefore able to bind 121-217 mg of total cholesterol and 34-70 mg of LDL cholesterol per gram of gel. Lipid and lipoprotein levels rebounded 3-4 days after treatment. Adverse effects were not observed during all plasmapheresis. No significant differences between control plasmapheresis and gel-plasmapheresis were obtained for blood cell counts while lengthened coagulation times were observed during 24 h. Complement was not significantly activated by the copolymer as shown by a same decreased activity in the blood stream of all dogs: in fact, CH 50 depletion in the gel incubated plasma was due to a protein adsorption on the hydrogel. This new approach for LDL apheresis appears to be a promising new technique.


The effect of an intramedullary self-reinforced poly-L-lactide (SR-PLLA) implant on growing bone with special reference to fixation properties. An experimental study on growing rabbits. Polylactic acid (PLA) is a synthetic biodegradable material. The self-reinforced implants made of poly-L-lactic acid (SR-PLLA) were manufactured of biodegradable polymeric matrix reinforced with fibres of the same material. The purpose of this study was to find out the effect of an intramedullary SR-PLLA implant on growing bone and its applicability to the fixation of a femoral shaft osteotomy in a growing rabbit. In seven rabbits 6 weeks of age a SR-PLLA implant 2.0 mm in diameter and 50 mm in length was introduced into the intramedullary cavity of the right femur. A proximal femoral shaft osteotomy of the right femur was made in another ten 6-weeks-old rabbits. After accurate reduction, fixation of the osteotomy was achieved with an intramedullary 2.0 mm by 50 mm SR-PLLA-rod. The follow-up times were 6 and 28 weeks. An intramedullary SR-PLLA-rod neither caused any disturbance of the bone growth nor abnormalities of the peripheral blood cell counts. Solid union of the osteotomy was seen in six weeks after fixation with SR-PLLA implant.


A new hydrophilic polymer for biomaterial coatings with low protein adsorption. BIOPOL polyurethane polymers, an extension of the HYPOL Polymer series of foamable hydrophilic polymers, have been developed which exhibit improved performance for selected biomedical applications. Members of the BIOPOL polyurethane polymer series, with molecular weights in the range of 7000 to 30,000, are larger molecules than HYPOL polymers (MW less than 3000) and produce hydrogels, rather than foams, when mixed with water. The prototype material in this series, BIOPOL XP-5, is a liquid prepolymer which chain extends in water and forms a hydrogel which can contain greater than 85% water. The time required for polymerization with water was dependent on the prepolymer: water ratio. This prepolymer was coated onto silica and medical grade tubing and then cured in place with water to form a stable coating which was resistant to non-specific protein binding. In addition, soluble, isocyanate-free forms of the prepolymer were tested for toxicity and shown to produce no adverse effects when injected intravenously into mice or when applied to a chicken chorioallantoic membrane. BIOPOL polymers can be useful in applications where protein adsorption is an undesirable event.


In vitro cytotoxicity of melanized poly(2-hydroxyethyl methacrylate) hydrogels, a novel class of ocular biomaterials. Due to their ability to absorb ultraviolet and visible radiation, we have proposed the melanized poly(2-hydroxyethyl methacrylate) hydrogels as biomaterials suitable for the manufacture of soft artificial intraocular lenses. Their biocompatibility has not been evaluated so far. In this study, poly(2-hydroxyethyl methacrylate) containing various amounts of adrenochrome-melanin were synthesized and the cytotoxicity of their aqueous extracts was assessed by using four in vitro testing techniques (trypan blue dye exclusion, inhibition of DNA synthesis, lactate dehydrogenase release, and inhibition of cell growth). Assays were based on incubation with human choroidal fibroblasts. By the first three techniques, no cytotoxicity was found in the extracts. The inhibition of cell growth test showed a slight cellular protein loss, however only in the extracts of polymers with high melanin content. The results suggest that the release of potentially toxic agents from melanized hydrogels into an aqueous medium is not significant. However, when an assay in collagen gel was carried out in the presence of specimens of melanized hydrogels, a toxic reaction was clearly revealed. This can be caused by a delayed release of toxic molecules from melanin, or by some other mechanism. The use of melanin-containing polymers as implant materials becomes questionable and further research is necessary.


Surface characterization of 2-hydroxyethyl methacrylate/styrene copolymers by angle-dependent X-ray photoelectron spectroscopy and static secondary ion mass spectrometry. The surface composition and structure of three structurally distinct amphiphilic copolymers of 2-hydroxyethyl methacrylate (HEMA) and styrene have been examined with angle-dependent X-ray photoelectron spectroscopy (XPS) and static secondary ion mass spectrometry (SIMS). The phase-separated block copolymer made by anionic living polymerization, HSH-A50, showed significant surface enrichment of styrene. The outermost 2-3 A appeared to be approximately 100% styrene, with the styrene concentration decreasing to its bulk value at a depth of approximately 50 A from the surface. However, HEMA was detected in the outer 20 A of this copolymer. The presence of HEMA in the surface region implies this copolymer may undergo significant restructuring when hydrated in a hydrophilic environment (as opposed to the hydrophobic environment in which the sample was prepared and analyzed). The phase-separated block copolymer made by telechelic coupling of free radical polymerized functionalized oligomers, HSH-B60, showed only slight styrene enrichment at the surface. Both HEMA and styrene were detected at all sampling depths, including the outermost surface layer, consistent with the presence of discrete HEMA and styrene domains at the copolymer surface. Since both components are already present at the surface under hydrophobic conditions, the degree of restructuring this copolymer may undergo upon hydration should be minor. The random HEMA--styrene copolymer made by conventional free radical initiation techniques, HS-RAN50, had a surface composition that was similar to the bulk composition and independent of depth, as expected for a homogeneously mixed copolymer film.


Control of adhesion and detachment of parenchymal liver cells using lactose-carrying polystyrene as substratum. Adhesion of hepatocytes on culture dishes whose surface was coated with a lactose-carrying styrene homopolymer (PVLA) was investigated. Hepatocytes maintained their round shape on PVLA substratum, which is in contrast to the usual spread shape characteristic of those cultured on collagen and fibronectin substrata. Calcium ion was indispensable for hepatocyte adhesion in PVLA substratum, and hence the hepatocytes on PVLA were easily detached when the culture was treated with ethylenediamine tetraacetic acid (EDTA). The recovered hepatocytes readheres to PVLA. The adhesion of hepatocytes to PVLA was not inhibited by cytochalasin B but by colchicine. Hepatocytes recognize the galactose moieties on the surface of asialoglycoproteins and removes these proteins from the blood stream by receptor mediated endocytosis. The mechanism of adhesion of hepatocytes on PVLA substratum which contains a high density of galactose residues was distinct from the attachment on collagen and fibronectin substrata, and showed great similarity to the receptor and ligand interactions which occurs in the clearance of asialoglycoproteins by hepatocytes.


Cytocompatibility study of NHLBI primary reference materials using human endothelial cells. Four different materials, low density polyethylene (LDPE), polydimethylsiloxane (PDMS), polyvinylcholoride (PVC) and cellulose, were selected by the Devices and Technology Branch of the National Heart Lung and Blood Institute (NHLBI) as primary reference materials for blood contacting. Among the wide variety of tests proposed to assess hemocompatibility of short-term blood contacting catheters, it was desirable to rule out whether these materials could release toxics for vascular cells of the physiological environment. Thus, the cytocompatibility of these materials have been checked towards human umbilical vein endothelial cells: the method used avoids direct contact between cells and materials but evaluates the effect of possible toxic substances leached from materials. These substances were obtained under defined conditions according to a standard. The results show that the extracts of cellulose and LDPE provoke an important cytotoxic effect on the endothelial cell cultures, while the extracts of PDMS and PVC allow the obtention of endothelial cell lining of the reference surface, with a correct global metabolic activity and the intracellular presence of von Willebrand factor.


Some methods for evaluating clinical itch and their application for studying pathophysiological mechanisms. Research on itch has been hampered by difficulties in measuring the itch sensation. A microcomputer-based system, where the patients themselves record their symptoms on portable data loggers can be used for quantitative measurements of clinical itch and for the detection of antipruritic effects of drugs. By using this system we have found that itch in atopic dermatitis is not inhibited by antihistamines but by cyclosporin A, a drug inhibiting cytokine production. Thus histamine is not a major pruritogen in atopic dermatitis. A hypothesis is proposed that cytokines are involved in itch in atopic dermatitis.


Localization of fibronectin in the initial lymphatics and blood vessels of normal human skin: an immunoelectron microscopic investigation. The initial lymphatics of the human skin do not possess a basal lamina, but a subendothelial fibrous network, of which we do not know the biochemical and immunohistological composition. We investigated the wall of blood vessels and initial lymphatics in normal human skin for the presence of fibronectin by immunoelectron microscopy. We found discontinuous linear subendothelial diaminobenzidine (DAB) reaction products in both blood vessels and lymphatics. In addition fibronectin could be found at the anchoring fibrils of the initial lymphatics.


Immunohistological analysis of P53 expression in human skin tumors. The p53 expression in various skin tumors was immunohistologically evaluated using two mouse monoclonal anti-p53 antibodies, PAb421 and PAb1801. The p53 expression was not detected in the normal epidermal cells. Nuclear staining suggested that the p53 expression was observed in 10 of 26 squamous cell carcinomas (SCCs) from 24 patients, in one undifferentiated carcinoma, one proliferating trichilemmal cyst, one malignant proliferating trichilemmal tumor and in one metastatic carcinoma of breast cancer. None off four cases of Bowen's disease (SCC in situ) showed nuclear staining. In the SCCs, five of 20 primary lesions, three of four recurrent lesions and both of two metastatic lesions had positive nuclei. There was one case of SCC in which a primary lesion was negative but a recurrent lesion was positive. Thus, p53 expression was more frequently observed in SCCs at more clinically advanced stages. This may suggest that p53 has some relevance to progression of SCC. Nuclear staining was not detected in any of the following cases: two cases of seborrheic keratosis, one eccrine poroma, one keratoacanthoma, 11 basal cell epitheliomas, two mammary Paget's disease, three genital Paget's disease, one sebaceous carcinoma, four malignant melanomas, six lymphomas, two leukemia cutis and two angiosarcomas.


Differences in HTLV-I integration patterns between skin lesions and peripheral blood lymphocytes of HTLV-I seropositive patients with cutaneous lymphoproliferative disorders. We examined HTLV-I integration patterns in nine cases of HTLV-I-seropositive patients with cutaneous lymphoproliferative disorders. The Southern blot on EcoRI digests of DNA revealed a discrete band of HTLV-I provirus (monoclonal integration) in either skin lesions or peripheral blood lymphocytes (PBL). Four cases showed the monoclonal integration of HTLV-I provirus only in skin lesions: one case showed only in PBL and two cases showed in both skin and PBL. The Southern blot on PstI digests of DNA revealed a 2.4 Kb band of the internal construct of HTLV-I provirus (polyclonal integration) in the PBL of EcoRI-negative samples. The difference in HTLV-I integration patterns between skin lesions and PBL in these cases suggests that the monoclonal outgrowth of HTLV-I-infected cells in the skin is causatively associated with the pathogenesis of cutaneous ATL.


Association of ras p21 with differentiation of epidermal keratinocytes in proliferating skin diseases. We examined the localization of DNA replicating cells and ras oncogene product p21 positive cells in proliferating skin diseases, such as psoriasis vulgaris, lichen planus, verruca vulgaris, verruca plana juvenilis and seborrheic keratosis. ras p21-positive cells were found rather in the differentiated layers than in the proliferating layers of the epidermis. We indicate that the expression of ras p21 can be associated with the differentiation of epidermal keratinocytes not only in tumor tissues but also in inflammatory skin disease.


Role of fibronectin in the adherence of Staphylococcus aureus to dermal tissues. Staphylococcus aureus has a fibronectin receptor on its surface. Fibronectin seems to play a role in the initiation and modification of infection with S. aureus. We studied the role of fibronectin in the binding of S. aureus (clinical isolates) to dermal tissues in mice, and the relationship between the fibronectin binding ability of S. aureus and clinical features of S. aureus skin infections. Mice were inoculated with S. aureus incubated with gold-particles bound fibronectin and skin specimens were taken for electron microscopic examination. The number of gold particles surrounding the S. aureus cells decreased with time, with none detected 4 h after inoculation. At both 5 min and 1 h after inoculation, gold particles were only found on the free surface of S. aureus cells and not in the interface between S. aureus cells and fibroblasts. Fibronectin-bound gold particles were bound more extensively to S. aureus strains isolated from furunculosis or furuncle than to those from bullous impetigo. These results suggest that the matrix fibronectin on the surface of the fibroblasts of mice contributes to the adherence of S. aureus to the fibroblasts, and that the number of fibronectin binding sites on S. aureus cells is related to the degree of local invasiveness.


Decompensation in proteinase-inhibitor system and application of proteinase inhibitors in pemphigus and pemphigoid. The goal of this study was to determine levels of serine proteinases and their inhibitors in serum and blister fluid of patients with pemphigus vulgaris (PV) and bullous pemphigoid (BP) in the course of treatment with prednisolone and proteinase inhibitors such as Contrycal and epsilon-aminocaproic acid. Assessment of the total proteolytic activity of serine proteinases (TPASP) and total antitryptic activity (TATA) is sera and blister fluids from 53 PV and 38 BP patients showed abnormalities in the proteinase and proteinase inhibitor levels in the acute stage of these bullous dermatoses. In PV, the level of TRASP was raised to 495 +/- 73 mU/ml (control 246 +/- 48 mU/ml; P < 0.001) in serum and to 849 +/- 96 mU/ml (control 189 +/- 34 mU/ml; P < 0.001) in blister fluid. In BP, the level of TRASP was raised to 472 +/- 101 mU/ml (P < 0.001) and 796 +/- 103 mU/ml (P < 0.001) in serum and blister fluid, respectively. In both dermatoses, the increase in serine proteinase activity developed against the background of decreased or unchanged antiproteolytic activity. TATA levels dropped to 16 +/- 5 inhibitory units (iU)/ml (control 26 +/- 5 iU/ml; P < 0.001) in PV serum and to 6 +/- 1 iU/ml (control 20 +/- 2 iU/ml: P < 0.001) in PV blister fluid. In BP, serum TATA levels were within normal values, whereas blister fluid TATA levels were significantly decreased (14 +/- 3 iU/ml; P < 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)


Sebaceous gland activity and urinary androgen levels in children. Sebum and 24-h urine samples were collected from 17 children, aged 10-17 years. Wax ester (WE) secretion rates were measured as the index for sebaceous gland activity. The fatty acid methyl esters were analyzed by capillary gas chromatography. Urinary testosterone as well as 17-ketosteroids (androsterone, dehydroepiandrosterone (DHEA), and etiocholanolone) were separated from the urine samples and analyzed by gas chromatography. WE secretion rates increased with age and there were correlated changes in the monounsaturated fatty acids of WEs. Straight chain types such as 14:1 and 16:1 tended to increase, while 18:1 tended to decrease. There was a negative correlation between iso even fatty acids and WE secretion rates. However the other chain types such as straight odd, iso odd and anteiso odd showed no statistically significant change in relation to WE secretion rates. WE secretion rates were correlated positively with testosterone levels in both sexes, with DHEA in males, and with etiocholanolone in females. The results suggest that sebaceous gland activity is stimulated by adrenocortical androgens in prepuberty, in addition to the strong effect of testosterone during puberty.


Antenatal cardiotocogram quality and interpretation using computers. To test the application in practice of computerized fetal heart rate (FHR) analysis in pregnancy. Randomized distribution of subjects with computerized analysis automatically revealed or concealed. A district general hospital and a teaching hospital outside London. 2869 pregnant women studied within a year. Quality and duration of the cardiotocogram; quantitative measurement of FHR variation; number of stillbirths. With interactive advice to the operator, records were of improved quality (up to 28% without signal loss) with potentially much reduced recording time. The short-term FHR variation measured in the last records before intervention is reported for the first time. The benefits of using the computers include improvement in record quality and saving of time. In addition, where interpretation depended on estimation of FHR variation there was prima facie evidence of observer misinterpretation; visual analysis was unreliable. A larger trial is now required with more rigorous constraints on intervention.


Previous miscarriage and stillbirth as risk factors for other unfavourable outcomes in the next pregnancy. To look for associations between previous fetal loss and fetal malformation or low birthweight in a subsequent pregnancy. A case-control study with place of birth, time and sex matched controls. 72 South American maternity hospitals. 18,534 malformed, 1150 non-malformed babies of low birthweight and 16,394 controls. All babies were from mothers with at least one previous pregnancy. Frequency of stillbirths and miscarriages in the previous pregnancy and outcome of the index pregnancy. Multiple malformation, Down's syndrome, anencephaly, spina bifida, pes equinovarus, congenital dislocation of the hip and low birthweight are associated with previous fetal loss. A miscarriage or a stillbirth in a previous pregnancy should be taken into account when the risk of malformations or low birthweight in a subsequent pregnancy is assessed.


Lack of relation between fetal blood gases and fetal blood flow velocity waveform indices found in rhesus isoimmunised pregnancies. To investigate the relation between umbilical vein blood gas components and the vascular resistance in four fetal arteries in Rh-immunised pregnancies. A prospective observational study over a 4-month period. King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. Fifteen Rh-isoimmunised pregnant women. Pulsed Doppler examinations of the umbilical artery, fetal internal carotid artery, thoracic aorta and abdominal aorta before transabdominal fetal blood sampling from the umbilical vein on 38 occasions. Doppler flow velocity pulsatility index (PI), systolic/diastolic ratio (A/B) and resistance index (RI) in the four fetal arteries investigated were related to the umbilical vein blood gases and acid-base status (PO2, PCO2, O2-content, CO2-content, HCO3, base excess and lactate concentration). There were no correlations between the Doppler indices in any of the vessels studied and the blood gases components in the umbilical vein. The ratios between the corresponding Doppler indices in the different vessels were also independent of the blood gases and acid-base status and there were no significant differences in the Doppler indices in the same vessel between fetuses with blood gas values over the 75th centile and those with values below the 25th centile. This study does not support a reduction in peripheral vascular resistance in the fetal cerebrum in relation to fetal hypoxia in Rh-immunized pregnancies.


A comparison between computerised (mean range) and clinical visual cardiotocographic assessment. To compare computer cardiotocographic (CTG) analysis with clinical visual analysis. A retrospective blind comparison of the two techniques of CTG assessment. Fetal Assessment Unit, King's College Hospital, London. One hundred CTG traces of women referred to the unit were studied; the traces were taken after 32 weeks' gestation, within 10 days of delivery and where outcome was known. The CTG traces were assessed both by the computer (System 8000 computerised CTG analyser, Oxford Sonicaid Ltd) and visually, by one of us. Computer mean range from 0 to 80 in ms clinical visual CTG score from 0 to 80 (arbitrary units). A score < 20 is ominous; suspicious when between 20 and 30; and normal when > 30. There was close correlation between the computer mean range and clinical visual assessment (r = 0.78, n = 100, P = 0.001). However, there were 13 occasions where the computer classified the trace as abnormal when clinical visual assessment was normal, indicating computer false positives. All these pregnancies had normal outcomes. There were no traces where computer analysis was normal and clinical visual assessment abnormal. Computerised CTG analysis gives an objective assessment which agrees closely with experienced visual assessment. It also provides a number which can be used to assess the value of fetal heart rate analysis.


The risk of acute myocardial infarction after oestrogen and oestrogen-progestogen replacement. To determine the relative risk of developing a first acute myocardial infarction after treatment with oestrogens alone or oestrogen-progestogen combinations. Prospective cohort study utilizing a prescription-based and record linkage system for a follow-up period from 1977 to 1983. Average individual observation time was 5.8 years. The entire female population of the Uppsala Health Care Region (1.4 million inhabitants), one-sixth of the total Swedish population. 23,174 women aged 35 years and older, identified from pharmacy records as having been prescribed non-contraceptive oestrogens during 1977-1980. Admissions to hospitals for first acute myocardial infarctions. Overall, 227 cases of a first acute myocardial infarction were observed as against 281:1 expected, RR = 0.81 (95% confidence limits 0.71 to 0.92). Women who were younger than 60 years at entry into the study and prescribed oestradiol compounds (1-2 mg) or conjugated oestrogens (0.625-1.25 mg) showed a significant 30% reduction of the relative risk (RR = 0.69, 0.54 to 0.86). Those prescribed a combined oestradiol-levonorgestrel brand also demonstrated a significantly lowered relative risk (RR = 0.53, 0.30 to 0.87). The risk estimates were near unity during the first year of follow-up but decreased during subsequent years. Exposure to the weak oestrogen oestriol did not alter the risk. Hormonal replacement therapy with oestrogens alone, and maybe also when cyclically combined with progestogens, can reduce the risk of acute myocardial infarction.


Outpatient falloposcopy: intra-luminal imaging of the fallopian tube by trans-uterine fibre-optic endoscopy as an outpatient procedure. To develop trans-uterine falloposcopy using the linear eversion technique in outpatients. A prospective, descriptive study of the introduction and application of this new technique. A tertiary referral University Research Clinic independent of operating theatres and inpatient admission. Twenty-one infertile women with previous evidence of fallopian tube disease. Rate of successful tubal cannulation and procedure completion, tubal section visualized, condition of the tubal epithelium, subsequent treatment plan. A bilateral examination was attempted in 19/21 patients and completed in 18. Two early falloposcopies with inadequate analgesia were aborted due to pain after only one tube had been examined without an attempt to identify or cannulate the contralateral tubal ostium. In one patient, neither ostium was identified or cannulated. After ostial localization, 37/37 tubes were cannulated. If the ostium was not localized but 'blind' cannulation attempted, 1/3 were cannulated successfully. Epithelium characteristic of the ampulla was seen in 31/38 (82%) tubes, and of the proximal tube only in 3/38 (8%). Successful bilateral assessment noted complete bilateral proximal obstruction in 2/18 patients, non-obstructive bilateral endotubal damage in 7/18, unilateral damage in 3/18 and bilateral healthy tubes in 6/18. Unilateral examination in two patients found minimal evidence of damage in one and severe intra-tubal adhesions in the other. After falloposcopy, 11/21 patients elected for IVF, 9/21 tubal surgery and 1/21 for IVF whilst awaiting surgery. Falloposcopy is a technique which can be performed in an outpatient clinic. It is well tolerated, and high rates of luminal cannulation and visualization are possible. Atraumatic access to the tube and visualization of its lumen offer exciting opportunities for diagnosis and treatment of tubal conditions.


Intergenerational studies of human birthweight from the 1958 birth cohort. II. Do parents who were twins have babies as heavy as those born to singletons? To ascertain whether maternal twinning influences the previously described association between the birthweight of singleton mothers and their infants. The association between the birthweight of singleton parents and their offspring and that between twin parents and their offspring was compared using data from the 23-year-old sample of the 1958 British national birth cohort. The numbers available for full comparison were 1027 female and 611 male singleton cohort members, and 26 female and 17 male twin cohort members and their first singleton livebirths. Of the mothers who had been twins, half had been of low birthweight, and overall their mean weight was 700 g less than that of their singleton counterparts. Nevertheless, the mean birthweight of babies of twin mothers was 133 g, and of twin fathers 94 g, greater than of babies of corresponding singletons. For female, but not male, parents this difference persisted after adjustment for confounding variables. We suggest two possible reasons for the difference between the weight of babies of twin and singleton mothers. Firstly, the growth of twins becomes retarded late in pregnancy, possibly after a period critical in determining long-term reproductive effects. Secondly, the twin survivors were of higher birthweight than the original twin cohort, whilst the singleton survivors were more representative of all singleton births, thus introducing a possible bias.


A prospective study comparing the outcome of oocytes retrieved in the aspirate with those retrieved in the flush during transvaginal ultrasound directed oocyte recovery for in-vitro fertilization. To study prospectively the fate of oocytes collected from the follicular aspirate and subsequent flushes during transvaginal ultrasound directed oocyte recovery for in-vitro fertilization (IVF). A tertiary referral assisted conception centre. 100 consecutive patients undergoing 100 cycles of IVF. Four patients were withdrawn because their embryos were electively cryopreserved. Therefore 96 cycles were studied. The oocyte recovery rate, viability, fertilization and cleavage rates and outcome of embryos generated from oocytes that were obtained from either the initial aspirate (A1), dead space in the collecting system (A2) or the first two 2 ml flushes (F1 and F2) were compared. The overall oocyte recovery rate was 87.8%. Of the 1046 oocytes collected, 40.3% were from A1, 41.3% from A2, 13.7% from F1 and 4.7% from F2. There were comparable numbers of viable and fertilized oocytes and cleaved, transferred and frozen embryos in tubes A1 and A2 but all these parameters were significantly lower in tubes F1 and F2 (P < 0.0001). All these parameters were also significantly higher in F1 compared with F2 (P < 0.001), except for the number of embryos frozen, in which there was no difference. The overall pregnancy rate per cycle was 28.1% and the pregnancy rate per embryo transfer was 31.0%. There were no pregnancies in any of the cycles in which embryos originating from F2 were transferred, nor were there pregnancies in cycles in which only embryos from F1 were transferred. Follicular aspiration together with one 2 ml flush maximises the recovery of oocytes that will result in pregnancies.


Maternal and fetal atrial natriuretic peptide levels at delivery from normal and growth retarded pregnancies. To determine whether circulating fetal levels of the vasodilator atrial natriuretic peptide (ANP) are reduced in pregnancies complicated by intrauterine growth retardation (IUGR). Prospective observational study. University teaching hospital and research laboratory. 25 normal singleton pregnancies delivered at term by spontaneous vertex delivery (n = 16) or by elective caesarean section (n = 9), and a series of 14 singleton pregnancies complicated by IUGR. Measurement of ANP by radio-immunoassay in maternal venous, umbilical artery, and umbilical vein plasma from a series of normal, and IUGR pregnancies. Comparison of plasma ANP levels between the three groups; relation between fetal ANP, PO2 and pH. Mode of delivery did not influence either maternal, umbilical artery or umbilical vein plasma ANP levels in normal term singleton pregnancies. Umbilical vein ANP levels were significantly higher in the IUGR group when compared with normal pregnancies at term (mean 66 95%, CI 36-122 vs mean 37, 95% CI 29-47 pg/ml, P = 0.03) and were inversely related to umbilical artery pH (R2 = 65%; P = 0.003). These data suggest that umbilical vein ANP levels are elevated in pregnancies complicated by IUGR, and rise appropriately in response to the stress of acidosis. In the absence of any receptor or second messenger defect within feto-placental vascular smooth muscle, these data suggest that ANP is not directly implicated in the vascular pathophysiology of IUGR.


A case-control study of unexplained antepartum stillbirths. To ascertain factors that will identify women who are at increased risk of unexplained antepartum stillbirth. Matched case-control study. The cases and controls were initially analysed as a whole group and again after dichotomizing into those of low birthweight (< 2500 g) and those of normal birthweight (> or = 2500 g). Western Australia 1980-1983. Unexplained antepartum stillbirths of > or = 1000 g birthweight (cases) and liveborn infants individually matched for year of birth, plurality, sex and birthweight of infant and race of mother (controls). The case pregnancies had more polyhydramnios (OR 10.83, 95% CI 2.41-48.69) and cord problems (OR 6.57 95% CI 1.36-31.75) than the controls but, paradoxically, other obstetric and medical complications were less common in the cases. The association with polyhydramnios persisted when the analysis was confined to those with low birthweight. With normal birthweight fetal distress was more frequent in the cases (OR 3.65 95% CI 1.36-9.80) but there were few other differences. The clinical and diagnostic systems currently in use are unable to identify many fetuses at risk of death. Decreases in the rate of unexplained antepartum stillbirths await the discovery of new preventable causes, or of innovations in clinical or laboratory aspects of obstetric care.


A case-control study of intrapartum stillbirths. To determine antenatal and intrapartum risk factors for intrapartum stillbirths in a total population. Matched case-control study. Western Australia 1980-1983. Intrapartum stillbirths of > or = 1000 g birthweight (cases) and liveborn infants (controls) individually matched for year of birth, plurality, sex and birthweight of infant and race of mother. Intrapartum stillbirths were more likely than controls to have had placental abruption (OR = 9.55, CI = 2.09-43.69), fetal distress (OR = 4.64, CI = 1.92-11.19), cord prolapse (OR = 10.00, CI = 1.17-85.60) and unhealthy placentas (OR = 2.26, CI = 1.13-4.52), and more likely to have been born by vaginal breech manoeuvre (OR = 3.51, CI = 1.40-8.80) and emergency caesarean section (OR = 2.15, CI = 1.13-4.10); mothers of intrapartum stillbirths were less likely to have had no labour (OR = 0.14, CI = 0.04-0.55) and to have been delivered normally (OR = 0.20, CI = 0.10-0.40). Mothers of cases born by emergency caesarean section had longer labours than mothers of controls born by this method. All intrapartum stillbirths with breech presentation were born by vaginal breech manoeuvre compared with only 53% of the controls; the remainder of the controls were born by caesarean section. Results indicate that little could have been done early in pregnancy to prevent the intrapartum stillbirths as no antenatal risk factors predicted these deaths. Most of the risk factors identified related to labour and delivery problems. Considering cases born by emergency caesarean section, delivery of the mother earlier in labour may have prevented some of the deaths.


Risks of anal incontinence from subsequent vaginal delivery after a complete obstetric anal sphincter tear. To assess the influence of various risk factors on long term anal incontinence in women with a complete obstetric tear of the anal sphincter. Postal questionnaire. Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark. 152 women with complete obstetric tear of the anal sphincter. Occurrence and duration of anal incontinence in relation to any delivery. 56 of 121 respondents had experienced a subsequent vaginal delivery; 23 (41%) of these had had transient anorectal incontinence directly after the complete tear and four (7%) had permanent anorectal incontinence. In the 23 women with transient anorectal incontinence directly after the complete tear, 9 (39%; 95% CI 19%-59%) developed anorectal incontinence after the next delivery, and this was permanent in four (17.4%; 95% CI 2%-33%). In the 29 women without anorectal incontinence after complete tear, two had transient incontinence of flatus but for less than 14 days after the next delivery. Transient anal incontinence after a complete tear is a predictor of anal incontinence after subsequent vaginal delivery. The major long term problem in our study of premenopausal women was incontinence of flatus. This possibility should be discussed with the women when a further pregnancy is planned.


A comparative study of the use of epoprostenol and dihydralazine in severe hypertension in pregnancy. To compare the antihypertensive effects of epoprostenol sodium (prostacyclin) with that of dihydralazine in acute hypertensive crises of pregnancy. A prospective randomized study. A minimum of 20 patients per group was considered statistically acceptable (alpha = 0.05, power = 0.9). A large urban tertiary hospital. Forty-seven pregnant patients with diastolic blood pressures of > 100 mmHg were studied. Lowering of high blood pressure with either dihydralazine (n = 25), the standard drug for this purpose, or epoprostenol (n = 22). A significant drop in high blood pressure was regarded as a fall of 15 mmHg diastolic and 30 mmHg systolic blood pressure. There were no statistically significant differences in the antihypertensive effects between the two treatment groups. Epoprostenol infusion caused less tachycardia; the mean pulse rate changed from 81.77 beats/min, before treatment to 88.36 at stabilization, compared with a change from 80.96 beats/min to 102.68 in the group treated with dihydralazine (P = 0.0024). The place of epoprostenol in pregnancy might be in patients with severe hypertension and tachycardia and in those requiring acute control of severe hypertension on the operating table before general anaesthesia.


Determinants of pregnancy heartburn.

Determinants of pregnancy heartburn. To study the prevalence and severity of reflux symptoms in pregnancy. Self-administered questionnaire detailing age, race, gestational age, parity, weight, height, symptoms and severity of gastro-oesophageal reflux. An antenatal clinic in a teaching hospital. 607 consecutive women at various stages of pregnancy were recruited during attendance at antenatal clinic. The prevalence of heartburn increased with gestational age (22% in the first, 39% in the second, and 72% in the third trimester; P < 0.0001), as did severity of heartburn (P < 0.0001). Pharyngeal regurgitation as a symptom showed little increase during advancing pregnancy. Symptoms of heartburn rapidly increased towards the end of the second trimester. The decrease in heartburn traditionally expected during the last three weeks of pregnancy (fetal head descent) was not observed. Logistic regression analysis showed increased risk of suffering heartburn with increasing gestational age (P < 0.0001), pre-pregnancy heartburn (P < 0.0001), parity (P < 0.0001) and inversely with maternal age (P < 0.05) but not with body mass index before pregnancy, race, or weight gain in pregnancy. Heartburn, but less so pharyngeal regurgitation, increases in prevalence and severity with gestational age and parity. We speculate that hormone-related impairment of distal oesophageal clearance mechanisms may have a crucial bearing on whether heartburn develops in those individuals at greatest risk.


Do fetal pulse oximetry readings at delivery correlate with cord blood oxygenation and acidaemia? To assess the accuracy of a pulse oximeter in the fetus. A prospective descriptive study, comparing oxygenation and acidaemia of cord blood with oxygen saturation in the arteries of the fetal scalp measured by a pulse oximeter just before delivery. The data were collected using an experimental pulse oximeter and a sensor specifically adapted to cope with the problems of fetal pulse oximetry. The labour ward in a teaching hospital. Thirty seven Caucasian fetuses presenting by the vertex in normal uncomplicated labour. Fetal pulse oximetry reading shortly before birth, umbilical cord oxygenation and pH, and Apgar scores. Data of sufficient quality were obtained from 28 fetuses. There was a highly significant correlation between pulse oximetry reading and umbilical vein oxygen saturation r = 0.59, P = < 0.001). There was also a significant correlation between the pulse oximeter reading and cord blood pH (vein: r = 0.57, P = 0.002, artery: r = 0.63, P = 0.001). Apgar scores were not related to the oximetry results. Pulse oximetry readings reflect fetal oxygenation at birth.


The role of abnormal fetal heart rate in scheduling chorionic villus sampling. To assess the value of fetal heart rate (FHR) measurements in predicting spontaneous fetal loss in pregnancies scheduled for chorionic villus sampling (CVS). A prospective descriptive study. Two hospital departments of obstetrics and gynaecology in Israel. 114 women between 9 and 11 weeks gestation scheduled for chorionic villus sampling (CVS). Fetal heart rate was measured by transvaginal Doppler ultrasound and compared with a monogram established from 75 fetuses. Whenever a normal FHR was recorded, CVS was performed immediately. 106 women had a normal FHR and underwent CVS; two of these pregnancies ended in miscarriage. In five pregnancies no fetal heart beats could be identified and fetal death was diagnosed. In three pregnancies an abnormal FHR was recorded and CVS was postponed; all three pregnancies ended in miscarriage within 2 weeks. Determination of FHR correlated with crown-rump length could be useful in predicting spontaneous miscarriage before performing any invasive procedure late in the first trimester.


Fetal heart rate in early pregnancy and chromosomal disorders. To investigate normal fetal heart rate in early pregnancy and assess the hypothesis that abnormal fetal heart rate is associated with fetal chromosomal abnormalities. Prospective descriptive cross-sectional study. Antenatal clinic associated to the University Clinic of Obstetrics, University Hospital Groningen, The Netherlands. 424 pregnant women who attended for prenatal counselling. Measurements of fetal heart rate from 6-16 weeks gestation, cross-sectional study. Fetal heart rate expressed as beats/min. Karyotyping showed a normal chromosomal pattern in 414 fetuses. The median fetal heart rate increased from 138 beats/min at 6 weeks to 177 beats/min at 9 weeks, thereafter, fetal heart rate gradually decreased to 150 beats/min at 16 weeks. Karyotyping showed 10 abnormalities: five trisomies 21, three trisomies 18, and two mosaic patterns in chorionic villi. Fetal heart rate of the trisomic fetuses was distributed around the median with that of all Down's syndrome fetuses within the normal range. In one fetus with trisomy 18, the heart rate exceeded the 90th centile, in another it fell under the 10th centile. The two fetuses with a mosaic pattern in chorionic villi had heart rates outside the normal range. Fetal heart rate in chromosomally abnormal fetuses in early pregnancy do not appear to be consistently different from that in normal fetuses. The use of a single measurement of fetal heart rate is not valuable for screening purposes. Chromosomal mosaicism in chorionic villi may be associated with abnormal fetal heart rate.


The prognosis of adenosquamous carcinomas of the uterine cervix. Firstly, to identify a cohort of women with invasive adenosquamous carcinomas of the uterine cervix, including mucin-producing squamous cell carcinomas. Secondly, to compare the biological characteristics and behaviour of a cohort of adenosquamous carcinomas with a cohort of non-mucin-producing squamous cell carcinomas. Histological review, retrospective survival analysis. Regional multidisciplinary gynaecological oncology service. 161 cases of stage 1B and above invasive cervical carcinoma presenting between 1 January 1980 and 31 July 1987. Thirty nine women with adenosquamous carcinomas were compared with 103 women with non-mucin-producing squamous cell tumours. Inclusion of routine stains for mucin in the assessment of histological material resulted in the reclassification of 38 (24%) of the cases, including the identification of 31 mucin-producing squamous cell carcinomas. The survival with adenosquamous tumours was significantly worse than with squamous cell cancers (P = 0.006), 5-year survival rates being 52% and 75% respectively. Multivariate analysis showed that this effect was explained by differences in clinical stage, pelvic lymph node metastasis and vascular invasion by tumour. The application of routine mucin stains to cervical tumours identifies a group of previously unrecognized adenosquamous cancers. Tumours so identified are likely to pursue a more aggressive clinical course associated with a poorer survival when compared to non-mucin-producing squamous carcinomas.


Increase in bone mass after one year of percutaneous oestradiol and testosterone implants in post-menopausal women who have previously received long-term oral oestrogens. To determine the effect on the bone density of the skeleton after changing from oral oestrogen to subcutaneous oestradiol and testosterone replacement. Prospective non-randomized single centre study. Twenty women who were receiving long-term oral oestrogen replacement. Ten changed to oestradiol and testosterone implants; the remaining ten continued with oral oestrogens. Bone density was measured using dual photon absorptiometry at the lumbar spine and neck of femur at the start of the study and after one year. The bone density increased significantly by 5.7% at the spine and by 5.2% at the neck of femur in those women who changed to implant therapy but remained unchanged in those women who continued with oral therapy. Subcutaneous oestradiol and testosterone implants will result in an increase in bone mass even after many years of oral oestrogen replacement therapy.


Plasma endothelin, atrial natriuretic peptide (ANP) and uterine and umbilical artery flow velocity waveforms in hypertensive pregnancies. To investigate the relation between concentrations of endothelin and atrial natriuretic peptide (ANP) in maternal plasma and vasospasm in the uterine and umbilical arteries as detected by duplex pulsed colour Doppler ultrasonography in hypertensive pregnancies. An observational study. 32 women admitted consecutively to hospital with pregnancy induced hypertension (seven without proteinuria and 25 with proteinuria) and 78 healthy pregnant women examined at 28-40 weeks gestation. Systolic/diastolic (S/D) ratio in flow velocity waveforms (FVWs) and plasma concentrations of endothelin and ANP in the 32 women with pregnancy induced hypertension; plasma concentrations of endothelin and ANP in 78 healthy pregnant women (controls). Pathological FVWs suggesting vasospasm in the uterine or umbilical artery, or both arteries, were found in 12 women with hypertension. Plasma ANP was significantly higher (P = 0.03) in the women with hypertension and pathological FVWs (median 23.0, range 10.1-52.8 pmol/l) than in those with hypertension and normal FVWs, (median 13.8, range 5.3-42.3 pmol/l) but corresponding plasma endothelin levels did not show any significant difference (median 1.63, range 0.51-3.33 pmol/l and median 1.38, range 0.51-3.51 pmol/l, respectively). Local release of endothelin from the vascular endothelium is thought to cause vasospasm in pregnancy induced hypertension but this does not seem to increase the concentration of endothelin in the maternal peripheral plasma, probably because of its rapid disappearance from the blood circulation. As ANP dilates the blood vessels, the increase of its release in hypertensive pregnancies may be a compensatory mechanism against vasospasm.


Distribution of renin-containing cells in the developing human kidney: an immunocytochemical study. To characterize the pattern of renin containing cells (RCC) within the human kidney between 20 weeks of gestation and 6 months of postnatal life. Descriptive study using paraffin-embedded blocks of kidney stored following postmortem examination. Sections of kidney were stained immunocytochemically using an antibody to human renin; the proportion of RCC within each of three zones (superficial, middle and deep) of the cortex, and their anatomical relation to individual glomeruli were determined. The cases were divided into five groups for analysis to gestational or postnatal age. Fetal RCC were usually at the vascular pole of the most mature glomeruli within the deeper areas of the cortex and were occasionally located within glomeruli. This distribution persisted until birth, even when the kidney was histologically mature. By contrast there were fewer RCC in neonatal and infant kidneys and, as in adult kidneys, these were located predominantly in the superficial cortex. The change in RCC distribution around the time of normal birth may relate to the transition to independent renal function. The location and density of RCC during fetal life may influence renal perfusion and amniotic fluid production.


[Infection status of the sea eel (Astroconger myriaster) purchased from the Noryangjin fish market with anisakid larvae]. Although the sea eel (Astroconger myriaster) is suspected as one of the most important fish host for human anisakiasis in Korea, no report has been made on the infection status of the sea eel with anisakid larvae. In the present study, 26 sea eels (Astroconger myriaster) were purchased from the Noryangjin fish market in Seoul, and anisakid larvae were collected from their viscera, muscle, head and skin. The collected larvae were classified by their morphological types. A total of 1,351 anisakid larvae were collected from 15 of 26 fish examined. Among them, 1,269 were recovered from the viscera, 66 from the muscle, and 16 from the head and skin. Morphologically, most of the anisakids were classified into 6 known larval types, Anisakis type I (564 larvae) of Berland (1961), Contracaecum type A (409) and type D (5) of Koyama et al. (1969), Contracaecum type C' (83) and type D' (117) of Chai et al. (1986), and Contracaecum type V (1) of Yamaguti (1935). Remaining 172 specimens were new in the available literature, hence, designated as Contracaecum type A' (new type). The present results revealed that the sea eels caught in the Korean waters are heavily infected with anisakid larvae, not only in their viscera but also in the muscle, and Anisakis type I was the most common among the 7 larval types.