The morphology of immune reactions in normal, thymectomized and reconstituted mice: I. The response to sheep erythrocytes

The response to sheep red blood cells has been studied in the lymph nodes draining their site of injection in normal mice, and in thymectomized, irradiated, bone-marrow injected mice with and without a reconstituting thymus graft. By using a chromosome marker to differentiate between cells derived from the bone-marrow and thymus graft it has proved possible to show that the immune response should be thought of in terms of at least two cell populations. Cells of thymic origin are stimulated to mitotic activity in the interfollicular cortex, and their activity precedes both antibody production and morphological signs of activity in the follicular regions. Mitotic divisions of cells of bone-marrow origin reached a peak a day later than did the thymic cells and their activity was sustained. Follicular enlargement and germinal centre production were coincident in time both with antibody production and bone-marrow cell mitotic activity. Lymph nodes of animals lacking a thymic influence showed only minor changes after antigenic stimulation and these were restricted to the follicular regions. There appeared to be only a small quantitative difference between the responses of normal and of reconstituted animals.     

Rapid isolation of bacteria from septicemic patients by use of an antimicrobial agent removal device.

The new Antimicrobial Removal Device increased the efficacy of conventional methods for isolating bacteria from the blood of septicemic patients. The device removes as much as 100 microgram of antibiotics per ml from whole blood without a significant decrease in bacteria. Of 51 patients studied, 31 yielded positive cultures, and the Antimicrobial Removal Device permitted earlier isolation of the causative agent from blood. Subcultured within the first 12 h yielded 12 positive isolates, as the 31 agents were isolated more rapidly after Antimicrobial Removal Device permitted earlier isolation of the causative agent from blood. Subcultures within the first 12 h yielded 12 positive isolates, as compared to 2 when subcultured without processing in the device. Overall, 21 of the 31 agents were isolated more rapidly after Antimicrobial Removal Device treatment, and four samples were positive only after such treatment. One agent was not isolated in the treated culture.     

Histopathologic analysis of atypical lesions in image-guided core breast biopsies.

Appropriate follow-up of patients with needle core breast biopsies (NCBB) showing atypical hyperplasia remains unclear because previous studies show that subsequent open biopsies in variable proportions of these patients reveal ductal carcinoma in situ (DCIS) or even invasive carcinoma, indicating significant sampling artifact. NCBB with diagnoses of atypia were morphologically classified into groups as follows: I, ALH (n = 24); II, ADH with minimal cytologic atypism (n = 90); III, atypia, other (9 columnar, 2 apocrine, 11 atypical papillary); IV, severe ADH/borderline DCIS (n = 31). Mammographic and histologic features, including the number of foci of atypia in the NCBB and the calcification span, were then correlated with presence of DCIS or invasive tumor in subsequent open excisions. Open excisional biopsies showed more severe lesions in 12% of Group I-III cases (8% in Group I, 9% in Group II, and 27% in Group III), of which 15 were DCIS and one was an invasive tubular carcinoma (0.3 cm). Of the DCIS, 60% (n = 9) were < or =5 mm, and 13 of 15 (87%) were low grade. The NCBB cavity was immediately adjacent to the more severe lesions in 88% (n = 14) of cases, in keeping with sampling error. The subset showing severe ADH with borderline nuclear features in contrast was associated with a high likelihood (63%) of DCIS in follow-up excisions. NCBB with atypical papillary features also showed a high frequency of DCIS (4/11, 36%) in subsequent open excisions. Other factors associated with more severe lesions on open biopsy included the number of atypical foci in the NCBB (>4, P <.05) and the mammographic calcification span (>2.0 cm, P <.0001). Atypical lesions diagnosed in NCBB samples are radiographically and morphologically heterogeneous, accounting for the variable frequency of DCIS or invasive neoplasm identified in subsequent open excisions, which are usually focal, low grade, and a consequence of sampling artifact (i.e., adjacent to the NCBB cavity). DCIS is more likely if microcalcifications are mammographically extensive or if atypia is multifocal or is associated with borderline cytologic features.     

Enterotoxin production by Salmonella typhimurium strains of different virulence

Six strains of Salmonella typhimurium (TML, W118, LT7, SL1027, M206 and Thax-1) of known virulence and ability to induce fluid secretion when inoculated into the rabbit ileum were examined for enterotoxin production. Enterotoxic activity, assayed in the rabbit ileal-loop test, was detected in polymyxin-B extracts from all strains (with the possible exception of Thax-1) cultured for 6 h in casamino acid-yeast extract medium. The extracts were inactive in tissue-culture assays with CHO, Y-1 adrenal and Vero cells, and in the infant mouse assay for enterotoxin. There was no correlation between enterotoxigenicity in vitro and the ability of whole organisms to induce fluid secretion in vivo. The significance of these results in relation to salmonellosis is discussed.     

The depolarizing action of 5-hydroxytryptamine on rabbit vagal primary afferent and sympathetic neurones and its selective blockade by MDL 72222

Summary MDL 72222 (1H,3,5H-tropan-3-yl-3,5-dichlorobenzoate) is a novel compound with potent and selective blocking actions at certain excitatory 5-hydroxytryptamine (5-HT) receptors on mammalian peripheral neurones. In the present study, the sucrose-gap technique has been used to record depolarizing responses to 5-HT from the cells of the rabbit nodose and superior cervical ganglia and to investigate the potency and selectivity of MDL 72222 as an antagonist of these responses.On nodose ganglia, responses to 5-HT were inhibited surmountably by MDL 72222 at concentrations up to 100 nmol/l. The threshold for antagonism was 2–10 nmol/l and the apparent pA₂ value (Schild 1947) was 7.7±0.2,n=10. Blockade was selective since responses to GABA and noradrenaline were unaffected by MDL 72222, 100 nmol/l. With concentrations of MDL 7222 higher than 100 nmol/l, antagonism was concentration-related but not in a manner consistent with simple competitive antagonism and even a concentration of 1 mol/l failed to abolish the response to 5-HT.The results from the superior cervical ganglion were essentially similar to those obtained from the nodose ganglion. The threshold concentration of MDL 72222 for inhibition of 5-HT was 1–10 nmol/l and blockade was selective in that depolarizing responses to dimethylphenylpiperazinium (DMPP) was unaffected by a concentration of MDL 72222 of 1 mol/l.The data provide direct evidence that MDL 72222 is a potent and selective antagonist of the receptors for 5-HT which mediate depolarizing responses in vagal primary afferent cell bodies and in sympathetic ganglion cells.     

Analysis of the actions of 5-hydroxytryptamine on the rabbit isolated vagus nerve

Summary Depolarization and reduction in the C fibre compound action potential (C spike) in response to 5-HT were recorded simultaneously from rabbit isolated vagus nerve. 5-HT (0.1–100 mol/l) was applied either as single concentrations or cumulatively and EC₅₀ and IC₅₀ values measured from individual concentration-response curves. The EC₅₀ values for depolarization (cumulative curves: 2.33, 1.64–3.33 mol/l, geometric means and 95% confidence limits, n = 31; non-cumulative curves: 3.99, 2.89 – 5.52 mol/l, n = 9) were significantly higher than IC₅₀ values for C spike reduction (cumulative curves: 1.25, 0.91–1.74 mol/l, n = 30; non-cumulative curves: 1.41, 0.72–2.76 mol/l, n = 8). Complex effects on the C spike were observed, suggesting a susceptible group of C fibres and a 5-HT-resistant component to the C fibre action potential. The motor nerve C fibres in the vagus nerve appear insensitive to 5-HT, whereas the sensory C fibres were sensitive to 5-HT. Phenylbiguanide had a similar selective effect on the C spike, while the depolarizing agents, 1,1-dimethyl-4-phenylpiperazinium (DMPP) and gamma-aminobutyric acid (GABA) did not. Cumulative concentration-response curves for depolarization and C spike reduction could be repeated reproducibly if an interval of 90 min was left between determinations. Up to 6 curves could be generated from one preparation. The 5-HT uptake inhibitor, citalopram (0.1 and 1 mol/l), had no effect on cumulative concentration-response curves. Concentration-response curves from pooled data, when 5-HT was applied non-cumulatively, showed higher maxima for both depolarization and C spike reduction compared to similar curves for cumulative application of increasing concentrations of 5-HT. It is concluded that although the two actions of 5-HT on the rabbit vagus nerve (depolarization, C spike reduction) closely parallel each other in respect of their cumulative and non-cumulative concentration-response curves, the repeatability of concentration-response curves, and, as reported in a companion paper, blockade by metoclopramide or BRL 43694 and involvement of 5-HT₃ receptors, some differences remain which may or may not indicate an independent genesis of the two responses.Send offprint requests to D. I. Wallis at the above address     

Isolated intrathoracic injury with air bag use

The restrained (air bag and seatbelt) driver of a vehicle involved in a high-speed motor-vehicle accident sustained a tear of the thoracic aorta with no signs of external injury. Air bag deployment may mask significant internal injury, and a high index of suspicion is warranted in such situations.     

Screening for complement deficiency in bacterial meningitis

Seventy-seven children with bacterial meningitis were screened for complement deficiency. Both the classical and the alternate pathways were normal in 75 patients. Transiently reduced total haemolytic activity of the classical pathway was documented in a boy with meningococcal meningitis. Total haemolytic activity of both the classical and the alternate pathways were reduced in another patient with pneumococcal meningitis: individual complement components determination indicated predominant activation of the alternate pathway.     

An unusually severe phenotype for familial adenomatous polyposis

Familial adenomatous polyposis (FAP) is a dominantly inherited predisposition to the development of many hundreds to thousands of adenomatous polyps of the colon. The mean age of onset is around 15 years, symptoms may arise in the third decade, and the median age for the development of colonic cancer is 35-40 years. Prophylactic colectomy reduces the risk of death from colorectal cancer to such an extent that late sequelae such as upper gastrointestinal tumours have become the main cause of mortality in appropriately managed patients. The age at which colonic surveillance begins reflects the natural history of the disease. Onset of polyp formation and cancer in childhood is very unusual, but has recently been associated with a specific mutation at codon 1309 in exon 15 where a more severe phenotype is sometimes observed. The case histories of two families are reported in which there is childhood onset of polyps in the youngest generation and in one case a carcinoma, in whom mutations have been identified in exon 11 of the APC gene. Several other affected relatives were diagnosed at ages ranging from 5-48 years, some already with a cancer at the time of first screening. Since the aim of screening for colonic polyps is prevention of colonic cancer, family members at risk should be offered genetic assessment and direct mutation testing where this is possible, usually in the early teens. In the absence of a genetic test (the situation in about one third of families) or in a known gene carrier, annual colonoscopy examination is advised from the same age. Clinicians should take note of the family history and be prepared to consider much earlier intervention if symptoms occur in a child with a family history of FAP. Where childhood onset of polyps has occurred, other children at risk in the family must be offered earlier genetic testing and endoscopic surveillance.