Multicentric osteolysis: report of the second successful renal transplant

A patient with end stage renal disease due to sporadic idiopathic multicentric osteolysis (type 3 multicentric osteolysis) is described. His pre-transplant course was similar to those of previously described patients, while his post-transplant course has been uncomplicated. The pathology and pathogenesis of the nephropathy of sporadic idiopathic multicentric osteolysis is not well characterized. The short term outcome of renal transplantation is excellent in our patient and in the other similar case known to have been transplanted.     

Sites of rhinovirus recovery after point inoculation of the upper airway

Spread of rhinovirus infection in the nose was studied after point inoculation of 25 microL of rhinovirus suspension either under the right inferior turbinate via the test duct (26 volunteers) or onto the posterior nasopharyngeal wall (through the mouth under direct vision) (six volunteers). Epithelial brush samples obtained daily from the anterior and posterior portions of the inferior turbinate in both nasal cavities and the nasopharynx were cultured for rhinovirus. Point inoculation of rhinovirus produced a high infection rate, but the entire nasal lining was not infected at the time of peak symptoms. Virus was usually first detected at the nasopharyngeal site, with subsequent spread of infection anteriorly to one or both inferior turbinates. Spread to the left turbinate was not detected in seven of 17 volunteers during the first five days after right eye inoculation. Virus recovery from the mucosa declined by day 16 and ceased by day 21.     

Characterization of the vasoactive intestinal peptide receptor in rat submandibular gland: radioligand binding assay in membrane preparations

The vasoactive intestinal peptide (VIP) receptor in membranes from rat submandibular gland was studied using radioligand binding assays with 125I-VIP and various unlabeled competing ligands. In addition to the necessity of working within the parameters under which all radioligand binding assays should be performed, binding studies with 125I-VIP, as with other peptide hormones and neurotransmitters, are subject to additional technical difficulties. Specific problems that were addressed included radioligand proteolysis, the identification of an effective protease inhibitor (leupeptin) and the deleterious effects of a commonly used inhibitor (bacitracin); avid radioligand absorption to incubation tubes that was eliminated by precoating of the tubes with a combination of polyethylenimine and an organosilane; and a disproportionate effect of increasing membrane protein concentration on affinity estimates. Under optimized conditions, the affinity (Kd) and density Bmax values for 125I-VIP obtained from saturation assays (76 pM, 2.0 pmol/mg) were in excellent agreement. Membrane protein (or receptor) levels beyond the linear portion of the receptor concentration curve are often used in radioligand binding assays. Results from 125I-VIP binding studies at elevated receptor concentrations revealed the predicted marked decrease in receptor affinity. In addition, the rank order potency of unlabeled ligands in inhibition binding assays was changed. The optimization of the assay for measuring VIP receptors in submandibular gland membrane provides a reliable method for studying the role of receptor regulation in stimulus-secretion coupling for this neuropeptide.     

3% NaCl and 7.5% NaCl/dextran 70 in the resuscitation of severely injured patients.

Cardiovascular resuscitation of the severely injured patient in the field remains unsatisfactory because large volumes of intravenous fluid are needed to keep up with ongoing blood losses and because only small volumes of fluid can be given. In the first study reported here, small volumes (less than or equal to 12 mL/kg) of 3% NaCl were given to patients who were having surgery for severe injuries. The 3% NaCl restored blood pressure, pH, and urine output with approximately one half of the cumulative fluid requirement of patients who received isotonic fluids (p less than 0.05). In a second study, 7.5% NaCl/dextran 70, 250 mL, was given in a prospective, randomized, and double-blinded trial to injured patients in the field. Blood pressure in the hypertonic/hyperoncotic group increased 49 mmHg during transport (p less than 0.005); blood pressure in patients given lactated Ringer's solution increased 19 mmHg (NS). Survival favored the hypertonic/hyperoncotic group. The 7.5% NaCl/dextran 70 solution appears particularly promising for treatment of injured patients in the field.     

Severe gingival overgrowth associated with cyclosporine therapy

A case of severe gingival overgrowth secondary to cyclosporine therapy in a 19-year-old black male who received a liver allograft transplant is reported. Clinical examination revealed a severely overgrown and inflamed gingiva. Surgical excision of the excess tissue was accomplished under general anesthesia. Healing occurred uneventfully, with acceptable contours; however, some regrowth was evident as early as 2 months. Spontaneous repositioning of the teeth was also seen postoperatively. Examination of the excised tissues revealed alternating areas of dense collagen and myxomatous change. An inflammatory infiltrate primarily of plasma cells was present. There was no evidence of an increased number of fibroblasts in the specimens examined.