Protective effect of muramyl dipeptide analogs against infections of Pseudomonas aeruginosa or Candida albicans in mice.

Two analogs of N-acetylmuramyl-L-alanyl-D-isoglutamine (muramyl dipeptide) were found to give better protection than muramyl dipeptide against intraperitoneal Pseudomonas aeruginosa infection or intravenous Candida albicans infection in mice. The analogs tested were N-acetyl-nor-muramyl-L-alanyl-D-isoglutamine and N-acetylmuramyl-L-alpha-amino-butyryl-D-isoglutamine. The optimum treatment was 80 mg/kg per day given once daily for 4 consecutive days before infection by the intraperitoneal, intravenous, or subcutaneous route. Dose response was limited. The compounds were not orally active. Synergism was seen between N-acetyl-nor-muramyl-L-alanyl-D-isoglutamine and gentamicin. No postinfection protection was observed. A nonspecific stimulation of macrophage cells by muramyl dipeptide analogs may contribute to the protection because antiinfective activity against Listeria monocytogenes given intraperitoneally was achieved with CBA mice.     

The management of intransigent desquamative gingivitis with Dapsone

Fifteen patients suffering from intransigent desquamative gingivitis due to lichen planus or benign mucous membrane pemphigoid were treated with dapsone (diphenylsulphapyridine) over a 3-month period. Twelve patients completed the trial. Therapeutic benefit was estimated clinically with the aid of 35mm color transparencies taken at 4-week intervals; and subjectively by the patients estimating their progress as worse, no change, some improvement or complete recovery. Taken as a whole, some 58% of patients had some benefit from therapy. Of the 7 patients with lichen planus, 1 showed complete recovery and 3 showed some improvement. In the 5 patients with desquamative gingivitis due to mucous membrane pemphigoid, 3 showed some improvement and 2 received no benefit. Three patients withdrew from the trial due to side effects of the dapsone such as headaches and nausea. It is concluded that dapsone therapy may be of some use in the management of desquamative gingivitis when traditional treatments have failed. Patients should be warned of the possibility of side effects.     

Experiences with three distinct types of total knee joint arthroplasty

Experience with three different designs of total knee systems indicates that generally excellent knee function can be afforded the majority of patients for many years. The identification of patients who presently cannot expect satisfactory long-term function (the young, muscular, or obese, yet otherwise normal, individual, for instance) and their exclusion as candidates is important for long-term success. The importance of postoperative limb alignment and component position is emphasized. Gross instability and great metaphyseal bone loss are identified as the indications for linked, primary, or revision total knee arthroplasty. The role of the dynamic behavior of trabecular bone is hypothesized to be of major importance in long-term prosthetic knee joint function.     

Regulation of uterine smooth muscle bradykinin receptors by bradykinin levels and angiotensin converting enzyme inhibitor in the rat

1. Bradykinin infusion (0.1 microgram/min i.v.) decreased the number of uterine bradykinin receptors by 20% at Day 2. Bradykinin receptors returned to control levels at Day 7. 2. Captopril infusion (1.7 micrograms/min i.v.) induced prolonged decreases in the number of uterine bradykinin receptors of 15% at Day 2 and of 13% at Day 7, respectively. 3. The number of uterine bradykinin receptors was increased in two-kidney, one clip hypertensive rats by 19%. 4. These results suggest that endogenous bradykinin participates in the regulation of uterine bradykinin receptors. 5. Decreased uterine bradykinin receptors induced by captopril might reflect increased endogenous bradykinin.     

Acute community-acquired pneumonias

Of 81 adult patients with community-acquired pneumonia, bacterial infections were found in 37%, mycoplasma and viral infections in 21%, and tuberculosis in 6%; no pathogen could be identified in 46% of cases. More than one agent was identified in 12% of patients. Streptococcus pneumoniae, the most common pathogen, was found in 63%, Haemophilus influenzae in 26,7%, Staphylococcus aureus in 6,7%, and other Gram-negative organisms in 10% of patients with proven bacterial pneumonia. Most clinical and radiographic features were of little value in differentiating between different aetiological agents, but Gram-stained sputum gave a valuable early guide to therapy in 60% of cases of proven bacterial pneumonia. Blood culture was positive in 13,6% of cases. All the organisms conformed to their usual sensitivity patterns. Since Strept. pneumoniae is the predominant pathogen, penicillin should be the drug of choice in the immediate 'blind' treatment of community-acquired pneumonia.     

Blood pressure variability and the type a behavior pattern in adolescence

The present investigation assessed the relationship between Type A behavior and blood pressure variability in a sample of 211 adolescents. Consistent with the adult literature, analyses revealed an association between Type A behavior and both systolic blood pressure variability and peak systolic pressure. The measures of diastolic blood pressure, however, were unrelated to Pattern A. The association with systolic variability remained when controlling for initial blood pressure level, sex, weight, and age. Subsidiary analyses of the components of Pattern A showed that high systolic variability teenagers are characterized by Type A speech characteristics (quick response latencies) and high levels of hostility. These findings support the validity of the Type A construct in adolescence.     

Effects of passive enhancement on graft and host. Graft adaptation by alloantibody as the mechanism of prolonged skin allograft survival

The cellular response to passively enhanced allogeneic skin grafts in mice was investigated using alloantiserum raised in hyperimmunized (C57BL/6 X A/J)F1 (B6AF1) against B10.D2oSn (B10.D2) mice. B6AF1 mice given B10.D2 skin grafts and passively enhanced with B6AF1 anti-B10.D2 alloantiserum (anti-31) showed delayed development of the ability to generate high levels of specific cytotoxicity in vitro. This delayed responsiveness was not transferable in vivo to freshly skin grafted mice, nor could cell-mediated suppression of development of in vitro responses be demonstrated in mixing experiments. These results suggested that alloantiserum acted on the graft. When skin grafts from passively enhanced animals were transferred to naive recipients prolonged graft survival was seen. Our results suggest that the mechanism of prolonged graft survival of the passively enhanced murine skin graft was through alteration of inherent graft immunogenicity, rather than a direct effect on the host.