Biplane arteriography in ischemia of the lower extremity

A technique for simultaneous bilateral biplane arteriography of the abdomen, pelvis, and lower extremities is described. The biplane views provided clinically significant information in approximately 40% of cases.     

The specificity of T-cell helper factor in man

Supernates of human T cells stimulated with TT antigen contain a factor that induces mitogenesis and immunoglobulin synthesis in autologous as well as allogeneic B cells. A fraction of the IgG produced has specificity against TT. The T-cell-derived LMF-TT eluted after albumin on Sephadex G 200 and did not contain immunoglobulin heavy chain determinants. LMF-TT was active on B cells from TT immune as well as TT- nonimmune individuals but in the latter instance the IgG secreted had no specificity against TT. B cells incubated with LMF-TT in the presence of a second antigen (DT) made IgG with specifity to that antigen provided the B-cell donor was immune to that second antigen. LMF-TT-containing supernates were depleted of TT antigen by Sephadex G 200 chromatography followed by passage over anti-TT immunosorbent columns. The antigen-free supernates were able to induce mitogenesis and IgG synthesis in B cells but the IgG produced failed to exhibit specificity against TT unless the TT antigen was readded to the B-cell cultures. The optimal concentration of LMF-TT (50 percent) inducing B-cell mitogenesis was different from the optimal concentration (20 percent) causing IgG synthesis by B cells. At low LMF concentrations (less than or equal 10 percent) addition of a second antigen to which the cell donor was immune caused an increase in the degree of B-cell mitogenesis. Submitogenic concentrations of LMF-TT (less than or equal to 5 percent) were still capable of inducingimmunoglobulin synthesis in B cells At these low concentrations of LMF-TT the proportion of anti-TT IgG over total IgG increased sharply. B cells from TT immune donors were separated on TT immunosorbent columns. Cells that bound to the column were more sensitive to the mitogenic and IgG synthetic effects of LMF-TT than unfractionated B cells. Thus, LMF is a nonspecific human T-cell helper factor which behaves like a polyclonal B-cell activator. However, in the presence of specific antigen (TT) the antigen-specific B cell is preferentially triggered by LMF. The experimental design of the present study does not rule out the additional presence of an antigen-specific helper factor in the supernates of TT-stimulated human T cells.     

Forearm rotational profile in obstetric brachial plexus injury

Children with obstetric brachial plexus palsy (OBPP) most commonly have weakness of supination. There is little previous information on later progress of forearm rotation movements, although severe supination contracture has been reported in a small proportion of children. The aims of this study were to evaluate forearm rotation after initial recovery from OBPP, to define the relationship with the severity of disease, and to assess which factors might limit rotation. Measurements of active and passive pronation and supination were recorded in 56 children (37 boys and 19 girls) who had had OBPP and did not have full recovery. The mean age was 8 years (minimum, 2.5 years). Care was taken to measure forearm rotation in isolation from shoulder movements. According to the Narakas classification for severity of the original brachial plexus lesion, there were 23 group I cases, 16 group II cases, 11 group III cases, and 6 group IV cases. Twenty-one children underwent reconstructive procedures for shoulder deformity. Mallet scores for shoulder function were available for all patients. Overall pronation was more limited than supination. Active movements were more limited than passive movements. Active pronation was less than normal in 48 children, active supination was less than normal in 36, passive pronation was less than normal in 22, and passive supination was less than normal in 9. Active pronation and active and passive supination were significantly limited in children with worse Mallet scores and in Narakas group IV children. Both active supination and passive supination were decreased in children with more severe elbow flexion contractures. No significant relationship was found between forearm rotation movements and the time of biceps recovery. Many children have persisting limitation of forearm rotation after OBPP. Despite the initial weakness of supination, pronation is more often reduced in the longer term. Patients with more severe OBPP and poorer recovery of shoulder function have greater limitation of forearm rotation.     

Effects of fibroblast growth factor-4 (k-FGF) on long-term cultures of human bone marrow cells

Fibroblast growth factor-4 (FGF-4), a highly mitogenic protein encoded by the k-fgf/hst oncogene, stimulates the growth of a variety of cells of mesenchymal and neuroectodermal origin. Addition of FGF-4 to human long-term bone marrow cultures increased both the cell density of the stromal layer and the number of hematopoietic colony forming cells in the cultures in a dose-dependent manner. Hematopoiesis in the stromal layer persisted for up to 8 months. Erythropoiesis was maintained for up to 4 weeks, but granulocytes were the predominant nonadherent cell type. Cultures treated with FGF had increased numbers of monocytes compared with control cultures and some CD14+, CD45+ monocytes could still be detected after 8 months of continuous culture. The addition of the growth factor increased the rate of growth of the stromal layer and appeared to delay its senescence. Subcultures made in the presence of FGF-4 had up to 10-fold increases in plating efficiency and grew as relatively uniform monolayers. These subcultures retained the capacity to support hematopoiesis for several months, while untreated subcultures, made without FGF-4, grew erratically and generally lost the capacity to support hematopoiesis within 4 to 6 weeks. The improved growth after subculture greatly enhanced the reliability of limit- dilution assays of multipotential hematopoietic stem cells that use stromal cell monolayers. The primary effect of FGF-4 appeared to be on the stromal cells of the long-term bone marrow cultures, but a direct effect on hematopoietic progenitors could not be ruled out.     

Characterization of antibody and selection of alternative drug therapy in hydrochlorothiazide-induced immune hemolytic anemia

The authors report the clinical and laboratory findings of a patient who had severe immune hemolytic anemia due to hydrochlorothiazide (HCTZ). In this case, the HCTZ antibody reacted not only with other thiazide and thiazide-like drugs, but also with a chemically unrelated diuretic, ethacrynic acid. These results indicate that HCTZ antibody activity is not restricted solely to the thiazides and imply that therapy with any of the reactive drugs would be contraindicated for this patient. The serologic screening for drug reactivity may be useful for selecting alternative therapy for patients with drug-induced immune hemolytic anemia.