Urinary cytokines following photodynamic therapy for bladder cancer. A preliminary report

This preliminary study was undertaken to test for the presence of urinary cytokines whose detection would provide evidence in support of the theory that photodynamic therapy (PDT) produces an immunologic response in patients treated for bladder cancer. Gamma interferon, interleukin 1-beta, interleukin 2, and tumor necrosis factor-alpha were assayed for in the urine of 4 patients treated with photodynamic therapy for bladder cancer, in 7 control patients undergoing transurethral surgical procedures, and in 5 healthy control subjects. Quantifiable concentrations of all cytokines, except gamma interferon, were measured in urine samples from the PDT patients with the highest light energies, while no urinary cytokines were found in the PDT patient who received the lowest light energy nor in any of the control subjects. These findings suggest that a local immunologic response may occur following PDT for bladder cancer.     

Legionella in cooling towers.

Legionellosis (Legionnaires' disease and Pontiac fever) outbreaks have been associated with aerosols ejected from contaminated cooling towers--wet-type heat rejection units (WTHRUs) used to dissipate unwanted heat into the atmosphere. The Vermont Department of Health undertook a program to inventory, inspect, and sample all WTHRUs in Vermont from April 1981 to April 1982. All WTHRUs were sampled for Legionella pneumophila and data were obtained for location, design, construction, and operating characteristics. Of the 184 WTHRUs operating, statistical analyses were performed on those 130 which were sampled for L. pneumophila only once during the study period. Of these, 11 (8.5%) were positive for L. pneumophila. Sources of makeup water and period of operation had significant association with the recovery of L. pneumophila. Five out of 92 towers (5.4%) utilizing surface water sources for cooling were positive for L. pneumophila, in contrast to 6 positive towers of the 38 units (15.8%) which obtained makeup water from ground water sources (p = .054 by chi-square test). Nearly 15% of the 54 units which operated throughout the year were positive, compared to less than 4% of the 76 towers operating seasonally (p = .03 by chi-square test). The mean pH of the cooling water in units where L. pneumophila was recovered (8.3) was significantly higher than the mean pH of 7.9 in units testing negative (p less than .05 by t-test). In addition, the mean log-transformed turbidity of positive towers, 0.03 nephelometric units (ntu), was significantly lower than the mean of log turbidity of negative towers, 0.69 ntu (p less than .02 by t-test).     

Enterocutaneous fistula: A reconstructive dilemma

Summary  Surgical repair of enterocutaneous fistulae in Crohn’s disease may result in large skin defects of the anterior abdominal wall. We present a case in which a large defect was managed with reconstruction using a pedicled rectus abdominis mycocutaneous flap in a single procedure. The case highlights the technical challenge of such a case and the value of a joint surgical approach between plastic and colorectal services.     

Differential effects of kindling and kindled seizures on place learning in the morris water maze

There is some controversy about the role of long-term potentiation (LTP) in spatial learning. The authors have found that triggering generalized kindled seizures with stimulation of the perforant path disrupts spatial learning in the Morris water maze but that kindling per se does not affect spatial learning. It is suggested that abnormal electrical activity induced by high-frequency stimulation of the perforant path may have been responsible for the disruption of spatial learning previously attributed to LTP saturation.     

Management of patients supported on the Hemopump cardiac assist system

The Hemopump Cardiac Assist System is a relatively new intraarterial, axial-flow circulatory assist device that offers temporary left ventricular support to patients in refractory cardiogenic shock, without requiring major surgery for insertion. Use of the Hemopump is associated with a low complication rate. Device-related morbidity is extremely rare. Because the Hemopump is safe for use in community hospitals, the number of patients supported by this device is expected to increase. In this report, we present general guidelines for the care of patients supported by the Hemopump. We describe techniques for the management of afterload reduction, supravalvular dislodgement, device malfunction, ventricular ectopy, intracardiac shunting, and inflow cannula obstruction.     

Mode and speed specificity of eccentric and concentric exercise training

This research was supported by a Duke University Research Council Grant. The purpose of this study was to examine mode and speed specificity of strength training by comparing concentric and eccentric isokinetic exercise of the quadriceps. Forty-eight healthy men (mean age = 23.9 years) were randomly assigned to one of three groups: concentric training (C), eccentric training (E), or control (K). Average force (in Newtons) of 3 concentric and of 3 eccentric quadriceps contractions on the KIN-COM(R) dynamometer at 60, 120, and 180 degrees /sec was evaluated prior to and following a 6 week period during which only the C and E groups trained. Training sessions (3/week) included 4 submaximal and 1 maximal warm-up followed by 10 maximal effort isokinetic contractions of the quadriceps at 120 degrees /sec for each leg. Group C subjects trained concentrically only while Group E subjects trained eccentrically only. A t-test for independent means showed no significant right/left differences. ANOVA and Scheffe's F-tests were then used to assess the differences in training effects among the 3 groups for the left leg only. Results showed that although Group C increased slightly in both concentric and eccentric force at all speeds, the gains were significant only for concentric force at 180 degrees /sec. Group E showed significant gains (p < 0.05) in eccentric force at all speeds but not in concentric force. The K group had no significant change in concentric or eccentric force at any speed. We conclude that the eccentric mode of isokinetic exercise has highly specific strength training effects while the concentric mode has less specific training effects. In addition, speed of exercise does not appear to have specific training effects. J Orthop Sports Phys Ther 1989;11(2):70-75.     

Characterization of enterotoxin purified from Clostridium perfringens type C.

Enterotoxin produced by a sporulating culture of Clostridium perfringens type C, which had been isolated from a case of severe necrotic enteritis, was purified. The molecular weight was estimated to be 36,000 by gel chromatography on Sephadex G-100 and 33,400 by ultracentrifugation. The sedimentation coefficient S20,W was 2.92. The toxin protein exhibited unusual behavior on sodium dodecyl sulfate gels, and toxin aggregates having molecular weights of 68,000, 85,000, 105,000, and 140,000 were obtained. The purified enterotoxin often separated, apparently due to slight charge differences, into two protein bands on 7% polyacrylamide gels. Electrofocusing of enterotoxin on polyacrylamide gels gave an approximate isoelectric point of 4.3, with the enterotoxin being fractionated into four distinct protein bands. The specific toxicity of the enterotoxin was about 1,900 mouse mean lethal doses per mg of calculated nitrogen. The data obtained indicate that the enterotoxin from C. perfringens type C is identical in most respects to that obtained from type A strains. Whether or not this toxin plays a role in the necrotic enteritis caused by type C strains is unknown at present.     

C3d binding to the circumsporozoite protein carboxy-terminus deviates immunity against malaria

The immunogenicity of recombinant protein or anti-viral DNA vaccines can be significantly improved by the addition of tandem copies of the complement fragment C3d. We sought to determine if the efficacy of a circumsporozoite protein (CSP)-based DNA vaccine delivered to mouse skin by gene gun was improved by using this strategy. Instead, we found that C3d suppressed the protective immunity against Plasmodium berghei malaria infection and deviated immunity, most notably by suppressing the induction of antibodies specific for the CSP C-terminal flanking sequence and by suppressing the induction of CSP-specific IL-4-producing spleen cells. We further showed that C3d bound to the C-terminal flanking sequence of the CSP, which may explain the immune deviation observed in CS/C3d chimeric antigen. We have thus identified C3d-mediated epitope masking and shifting of both the humoral and cellular immune responses as a potential novel escape mechanism, which plasmodia may use to divert the induction of protective immunity.