Composite tissue (limb) allografts in rats. III. Development of donor-host lymphoid chimeras in long-term survivors

Eight LEW rat recipients possessing long-term-surviving (206-701 days) LBN vascularized hind limb allografts (CTAs) were tested for donor-host lymphoid chimerism. The recipients received various cyclosporine (CsA) treatment protocols in order to induce indefinite CTA acceptance. Histological examination of long-term-surviving CTAs demonstrated normal-appearing bone marrow in the donor limb. Lymphocytes isolated from host hemopoietic tissues (peripheral blood and/or spleen) by ficoll-hypaque density gradient centrifugation were tested against LEW-anti-BN antisera. Comparisons were made to standard curves employing various known concentrations of LBN and LEW cell combinations. The level of lymphocyte agglutination (dependent variable) showed a significant (P less than 0.025-0.005) linear relationship to the concentration of LBN donor cells (independent variable) present. Lymphocyte suspensions isolated from long-term CTA host peripheral blood and/or spleen showed a mean of 19.7% (+/- 9.7-95% confidence interval) donor LBN mononuclear cells present. Thus, it appeared that lymphoid cells originated from, and/or were released from LBN donor bone marrow into the circulation, resulting in chimeric repopulation of hemopoietic tissues. The presence of donor immunocytes in these limb allograft recipients may have been beneficial, and thus could have helped contribute to the long-term CTA survival observed.     

Prevalence of benign, atypical, and malignant breast lesions in populations at different risk for breast cancer. A forensic autopsy study

A forensic autopsy series of 519 women more than 14 years old was studied for prevalence of benign, atypical, and occult malignant breast lesions. The women included Anglos (non-Hispanic whites), Hispanics, and American Indians from New Mexico and Eastern Arizona. These three ethnic/racial groups are at markedly different risk for the development of breast cancer (Anglo 89 of 100,000 women per year, Hispanic 45.5, and American Indian 24.9. There were striking ethnic/racial and age-related differences in both the prevalence and magnitude of all forms of nonproliferative and proliferative fibrocystic disease. The various subsets of fibrocystic disease were highly associated with each other. Such lesions as apocrine metaplasia, sclerosing adenosis, and lobular microcalcification showed as much difference according to ethnic/racial background and age as the more common cystic change and duct epithelial hyperplasia. Atypical lobular and ductal hyperplasia, carcinoma in situ, and occult invasive carcinoma were uncommon and also occurred in ethnic/racial groups in a pattern that parallels the cancer risk in those groups.     

Inhibition of the Fc receptor-mediated oxidative burst in macrophages by the Yersinia pseudotuberculosis tyrosine phosphatase.

Suppression of host-cell-mediated immunity is a hallmark feature of Yersinia pseudotuberculosis infection. To better understand this process, the interaction of Y. pseudotuberculosis with macrophages and the effect of the virulence plasmid-encoded Yersinia tyrosine phosphatase (YopH) on the oxidative burst was analyzed in a chemiluminescence assay. An oxidative burst was generated upon infection of macrophages with a plasmid-cured strain of Y. pseudotuberculosis opsonized with immunoglobulin G antibody. Infection with plasmid-containing Y. pseudotuberculosis inhibited the oxidative burst triggered by secondary infection with opsonized bacteria. The tyrosine phosphatase activity of YopH was necessary for this inhibition. These results indicate that YopH inhibits Fc receptor-mediated signal transduction in macrophages in a global fashion. In addition, bacterial protein synthesis was not required for macrophage inhibition, suggesting that YopH export and translocation are controlled at the posttranslational level.     

Weight changes in a couples program: negative association of marital adjustment

This study investigated the difference in weight changes of subjects who rated their marriages as more adjusted vs subjects who rated their marriages as less adjusted. Twenty-six moderately obese subjects were assigned to one of two groups based on their initial scores on the Locke-Wallace Marital Adjustment Scale (MAS). The 10 subjects in the "moderately unhappy" group (MAS less than or equal to 99) lost significantly more weight than the 16 subjects in the "relatively happy" group (MAS greater than or equal to 100) at the end of the one-year treatment program (29.9 lb vs 20.4 lb) and at 3-month follow-up (27.7 lb vs 17.8 lb). Significantly more subjects in the unhappy group also reached ideal weight than subjects in the happy group (50% vs 7.7%). Subjects' initial MAS scores were significantly and negatively correlated with weight changes at post-treatment and follow-up; partners' MAS scores at the end of treatment were also significantly and negatively correlated to subjects' weight losses at post-treatment. None of the couples was initially maritally distressed but one couple met this criterion (MAS less than or equal to 85) by the end of treatment and follow-up. It was concluded that marital counseling is not a prerequisite for weight counseling, couples' marital adjustment does not improve as the subject loses weight and a moderate level of marital dissatisfaction does not seem to be an insurmountable barrier to successful weight loss and may be an advantage for some individuals.     

Complicated mania. Comorbidity and immediate outcome in the treatment of mania

In a case-control study, 57 manics with antecedent or coexisting nonaffective psychiatric disorders (n = 38) or serious medical illnesses (n = 19) ("complicated mania") were compared with 114 age-, sex-, and year-of-admission-matched controls with no other disorder ("uncomplicated mania"). Significant differences emerged between the three groups in age, marital status, age at onset, number of prior hospitalizations and prior suicide attempts, organic features, and outcome measures (recovery and death rates). Patients were divided into four treatment groups based on primary mode of therapy during index admission; the groups included electroconvulsive therapy, adequate lithium carbonate, inadequate lithium carbonate, and neither treatment. Uncomplicated manics were significantly more likely to receive adequate lithium carbonate and less likely to receive inadequate lithium carbonate than were complicated manics. The latter patients had a significantly poorer immediate response to treatment overall, and to adequate lithium carbonate specifically. Seventy-eight (68.4%) uncomplicated manics had recovered ad discharge, compared with 26 (45.6%) complicated manics. Logistic regression suggested that the influence of comorbidity on outcome was more important for women than men. We conclude that complicated mania is a useful clinical construct.     

Attention-deficit hyperactivity disorder in adults.

It has been estimated that 30% to 70% of children who are diagnosed as having attention-deficit hyperactivity disorder (ADHD) will continue to show symptoms of the condition as adults. Since the prevalence of ADHD among school children may be 3% or more, its prevalence among adults may be 1% or 2%. The third revised edition of the Diagnostic and Statistical Manual (1987) of the American Psychiatric Association lists three essential features for the diagnosis of ADHD: "developmentally inappropriate inattention, impulsiveness, and hyperactivity." Other conditions associated with ADHD in adults include learning disabilities (or their sequelae), general anxiety disorder, drug and alcohol abuse, and dysthymic and cyclothymic disorders. Strong correlations have been found between ADHD and oppositional defiant and conduct disorders in children and an increased risk for antisocial disorders in adults. A combination of genetic, biologic, and environmental factors appears to be implicated in the etiology of ADHD. The management of adult ADHD requires a multimodal approach. The patient needs to be informed of the cause of his or her impulsive and often self-destructive behavior. Many patients will have learning difficulties that require evaluation and remediation by specialists in learning disabilities. Psychotherapy can help the patients resolve disturbances in perceptions of self and others and family therapy can address difficulties in the adult's relationships with family members. Pharmacotherapy of adult ADHD includes the use of central nervous system stimulants, such as methylphenidate, dextroamphetamine, and pemoline, of the tricyclic antidepressants imipramine and desimipramine, and of other antihypertensive, analgesic, and antimanic drugs.     

Requirements for successful total knee replacement. Material considerations

Despite the overall clinical success of TKR arthroplasty, materials' limitations are becoming increasingly obvious as designs and surgical techniques improve. As in the case of THR components, the ultimate limiting factor now appears to be wear of the tibiofemoral articulation and its biologic consequences. Although some materials appear to hold out promise of improvement, no combination better than cobalt-base alloy/UHMWPE has yet appeared. In addition, the very long service times now expected routinely (greater than 10 years) for total joint replacement increase the problem of new materials' selection owing to the well-known disparities between in vitro wear tests and in vivo performance and the absence of any consensus on correlation between accelerated testing and real-time performance, either in vitro or in vivo. For these reasons, extreme caution is counseled in the early clinical trials of newer materials and combinations of materials. The clinical "rule of thumb" for publication of clinical results, 2-year minimum follow-up, is necessary but highly insufficient for materials' qualification. Good to excellent results, with no signs of progressive failure for 5 to 7 years of prospective study, combined with high-yield follow-up to 10 years, will probably be necessary for safe introduction of such materials into general clinical use. An excessively rapid introduction could predispose to clinical failure, through lack of knowledge of critical design and manufacturing parameters, and prove an impediment to improvement of TKR arthroplasty.     

Maroteaux-Lamy syndrome in a large consanguineous kindred: biochemical and immunological studies

We describe a large consanguineous German-Acadian ("Cajun") family from a rural area in Louisiana in which 11 persons in two generations had the Maroteaux-Lamy syndrome. The mutant arylsulfatase B enzyme in this family was similar to the mutant enzyme in previously studied families in its cross-reactivity with specific antibodies to the enzyme, but it differed in both its electrophoretic mobility and its residual enzymatic activity. These findings indicate that a different mutational event leading to Maroteaux-Lamy syndrome occurred in this family.     

Delayed pressure urticaria

Delayed pressure urticaria is a mechanical urticaria in which pressure causes whealing. Delayed cutaneous erythema and edema occur in association with marked subcutaneous swelling after the application of a sustained pressure stimulus to the skin. The earliest reports and theories of the pathogenesis of delayed pressure urticaria are summarized. Detailed attention is given to making the diagnosis by taking a history and provoking the lesions. The clinical features and natural history are considered. The effects of the disorder on quality of life are delineated, and management strategies are suggested.