Intraoperative QRS-interval changes caused by hyperkalaemia in an infant with Arima syndrome

A one-year-and-ten-months-old male infant with Arima syndrome, a very rare genetic disorder, underwent urgent insertion of a catheter for continuous ambulatory peritoneal dialysis (CAPD) under general anaesthesia. During the procedure he showed QRS-interval changes caused by hyperkalaemia which was successfully treated with calcium gluconate. The management and intraoperative complications of this syndrome are reported and available literature reviewed.     

Autolymphocytotoxins Following Immunization by Pregnancy, Transplantation, and Disease

Antibodies which were cytotoxic to lymphocytes were found in patients with kidney transplants, Graves' disease, Hashimoto's disease, rheumatic heart disease, and in multiparous women. These cytotoxins were 19S, optimally reactive at 15° C, were autocytotoxic to lymphocytes, and were inactive against granulocytes. The specificity of their reactivity to allogeneic lymphocytes was unrelated to HL-A specificities. In fact, though the sera varied from 1% to 99% in reactivity against a panel of random donors, much of the variation seems to be of a quantitative nature with relatively little specificity. Out of 6,105 x² comparisons between 110 sera of the diseases mentioned above, 83% were positive and none of the negative x² values were statistically significant. It is concluded that diverse stimuli elicit the formation of these low avidity 198 antibodies which are directed against a non-HL-A antigen richly represented on lymphocytes. Although their biologic significance may be difficult to show, as with cold hemagglutinins, they could possibly act as a "natural" antilymphocytic serum.     

A Case of Cytomegalovirus-Induced Gastric Lesions

Abstract: A 26-year-old woman was admitted to our hospital with epigastric pain, a husky voice, high-grade fever, hepatosplenomegaly and enlargement of the kidneys. An upper gastrointestinal endoscopy revealed scattered non-circular erythematous erosions, up to 5mm in diameter, in the gastric body and fornix. A histological examination of the biopsied specimens stained with hematoxylin and eosin showed the presence of intranuclear inclusion bodies in the glandular epithelial cells. Cytomegalovirus (CMV) antigen was found in the inclusion bodies using the enzyme-labeled antibody method. Subsequently, a needle biopsy taken from the kidney revealed a non-Hodgkin's lymphoma. Our review of the literature indicates that CMV-induced gastric lesions are endoscopically characteristic and can be diagnosed from their multiple, erythematous, non-circular depressed lesions.     

Cross-Reactivity in the HL-A System

A comprehensive study to elucidate the cross-reactivity between 25 specificities of the HL-A system was carried out systematically with 65 monospecific anti-HL-A antisera and nearly 150 cell donors. Antisera were absorbed by platelets in microvolumes and the degree of absorption was measured by the inhibition of lymphocytotoxicity. The following conclusions were drawn: (1). Cross-reactivity occurred only between allelic gene products of a single HL-A segregant series and not between those of the two different series. (2). Cross-reactive groups did not form isolated clusters but were interconnected. (3). Cross-reactivity was found to be one-way (unidirectional) or two-way (bidirectional). One-way cross-reactivity was observed between 24 pairs of antigen groups and two-way cross-reactivity was observed between 8 pairs of antigen groups. (4). Cross-reactivity is exhibited by certain antisera of a given specificity and not by others of the same specificity. (5). Some cells possessing a cross-reacting antigen cross-absorbed a certain anti-HL-A antiserum, whereas other cells with the same antigen did not. These results suggest the possibility that cross-reactivity depends also upon other antigens present on the cells.     

Six Cases of Carcinosarcoma of the Esophagus

Clinical aspects of six cases of esophageal carcinosarcoma werereported. They were all male in their sixties. Although almostall cases of carcinosarcoma of the esophagus reported in theliteratures had polypoid lesions, two of our cases showed ulcerativeappearance and were not considered to be carcinosarcoma by macroscopicobservations. Recently, preoperative irradiation has been adoptedfor the treatment of esophageal carcinoma in many hospitalsand it may be possible that some of sarcomatous component hasdisappeared at the time of operation. Therefore, more casesof esophageal carcinosarcoma could be present among those whohad been diagnosed as esophageal carcinoma.     

A case of dyshormonogenetic goiter complicated with growth hormone deficiency

A 17-year-old male patient with dyshormonogenetic goiter complicated with follicular adenoma and growth hormone deficiency is described. He had short stature (-2.3 SD), diffuse goiter and a particularly large nodule in the right lobe of the thyroid gland. The endocrinological studies revealed slight hypothyroidism. He underwent surgical removal of the tumor, diagnosed histopathologically as follicular adenoma, embryonal type; and the diffuse goiter was diagnosed as dyshormonogenetic goiter. It was speculated that long-term hypersecretion of thyroid stimulating hormone (TSH) caused adenoma in the thyroid gland. Although the goiter disappeared after oral thyroxine replacement therapy, his height gain remained poor. Then, he was diagnosed partial growth hormone deficiency, and growth hormone therapy improved his height gain. It has been reported that a high percentage of patients with congenital hypothyroidism have additional anomalies. This is, however, the first reported case of dyshormonogenetic goiter complicated with growth hormone deficiency.     

Escape from Sensitization to HL-A Antibodies

Human lymphocytes sensitized with HL-A antibodies could not be killed by the addition of complement if the lymphocytes were incubated for periods of 1 to 5 hours at 37° C. This phenomenon was not produced by simple dissociation of the antibodies or by loss of antigens (modulation), but rather is postulated to result from an active release or pinocytosis of HL-A antigens together with the attached antibody. "Escape from sensitization" is followed closely by reformation of antigens, for the cells can readily be resensitized and killed by addition of complement. Loss of sensitization is an active process, since one-day-aged lymphocytes or lymphocytes treated with actinomycin D or puromycin were unable to express this activity. A differential escape rate for different specificities was encountered indicating that HL-A9 was produced more rapidly than several other specificities present on the same lymphocytes. A correlation was noted between the rate of HL-A antigen synthesis by lymphocytes (indicated by escape rate) and the quantity of HL-A antigen in the serum.
Inhibition of lymphocyte cytotoxicity was used to detect the presence of HL-A antigens in serum. Certain specificities, such as HL-A9, were generally present in serum whereas others, such as HL-A8, could not be detected. Cross-inhibition tests with over 100 sera clearly showed an association of inhibition with specificity, although nonspecific inhibition was often observed. Sephadex fractions of sera tested at different concentrations revealed the greatest inhibitory activity in the 19S and 7S fractions.     

Reversibility of organic anion-induced cholestasis: Association with compensatory hypersecretion of biliary phospholipid and protein in the dog

Abstract The effect of a concomitant infusion of organic anions, structurally related phthaleins, on bile flow was studied in anaesthetized dogs. A combination of rose bengal and sulfobromophthalein was found to uniquely and synergistically produce an acute, reversible form of intrahepatic cholestasis (< 10% of control level). This phenomenon was not observed with the administration of those individual organic anions at concentrations previously associated with the induction of intrahepatic cholestasis. The infusion of either a micelle forming bile salt, sodium taurocholate, or a non-micelle forming bile salt, sodium dehydrocholate, rapidly reversed the intrahepatic cholestasis (within 20 min after bile salt infusion). During the choleretic phase immediately following the bile salt infusion, a transient but marked hypersecretion, a disproportionately increased output in relation to that of bile acids, of biliary phospholipid (176% of control level by taurocholate and 138% of control level by dehydrocholate), and an even more striking amount of biliary protein hypersecretion were observed (392% of control level by taurocholate and 357% of control leverl by dehydrocholate). Although the significance of these new post-cholestatic observations requires clarification, it is suggested that the intrahepatic cholestasis induced by organic anions reflects a reversible defect in the mechanism(s) involved in transcellular transport.