A clonally distinct recurrence of Burkitt's lymphoma at 15 years

A human immunodeficiency virus-negative male was successfully treated for two occurrences of Burkitt's lymphoma, 15 years apart. As consolidation of his second remission, he underwent high-dose chemotherapy with peripheral blood stem cell transplantation. In an effort to prove whether the second lymphoma was a relapse of the first or a second primary lymphoma, we obtained paraffin-embedded material from both lymphomas. DNA was extracted from this material and amplified by polymerase chain reaction (PCR) using consensus JH and VH region primers. Analysis of the PCR products, which mostly reflects VDJ joints, showed two sharp bands of different molecular size, proving the monoclonal nature of the lymphomas and suggesting that each had different Ig gene rearrangements. Sequencing of both PCR products showed a marked dissimilarity in nucleotide sequence in the clonally unique VDJ joint region, providing strong evidence for the separate cellular genesis of each lymphoma. These results suggest that late relapses of Burkitt's lymphoma should be examined for clonal distinctiveness. If the second lymphoma is distinct from the primary one, it might be treated as a primary lymphoma rather than as recurrent disease.     

Glycemic control and cardiovascular mortality in hemodialysis patients with diabetes: a 6-year cohort study

Previous observational studies using differing methodologies have yielded inconsistent results regarding the association between glycemic control and outcomes in diabetic patients receiving maintenance hemodialysis (MHD). We examined mortality predictability of A1C and random serum glucose over time in a contemporary cohort of 54,757 diabetic MHD patients (age 63 ± 13 years, 51% men, 30% African Americans, 19% Hispanics). Adjusted all-cause death hazard ratio (HR) for baseline A1C increments of 8.0-8.9, 9.0-9.9, and ≥10%, compared with 7.0-7.9% (reference), was 1.06 (95% CI 1.01-1.12), 1.05 (0.99-1.12), and 1.19 (1.12-1.28), respectively, and for time-averaged A1C was 1.11 (1.05-1.16), 1.36 (1.27-1.45), and 1.59 (1.46-1.72). A symmetric increase in mortality also occurred with time-averaged A1C levels in the low range (6.0-6.9%, HR 1.05 [95% CI 1.01-1.08]; 5.0-5.9%, 1.08 [1.04-1.11], and ≤5%, 1.35 [1.29-1.42]) compared with 7.0-7.9% in fully adjusted models. Adjusted all-cause death HR for time-averaged blood glucose 175-199, 200-249, 250-299, and ≥300 mg/dL, compared with 150-175 mg/dL (reference), was 1.03 (95% CI 0.99-1.07), 1.14 (1.10-1.19), 1.30 (1.23-1.37), and 1.66 (1.56-1.76), respectively. Hence, poor glycemic control (A1C ≥8% or serum glucose ≥200 mg/dL) appears to be associated with high all-cause and cardiovascular death in MHD patients. Very low glycemic levels are also associated with high mortality risk.     

Site-specific fascial defects in the diagnosis and surgical management of enterocele

Objective: The aim of this study was to assess the surgical feasibility and clinical outcomes of a vaginal enterocele repair that was based on the theory of site-specific defects in the vaginal fascia. Study Design: Seventeen patients during a 2-year period with a diagnosis of enterocele and vaginal vault descensus with or without coexisting rectocele underwent surgical correction with a site-specific fascial defect repair. An enterocele was defined as vaginal wall prolapse seen during the operation in which the peritoneum was found to be in direct contact with the vaginal epithelium, with no intervening fascia. Patients were examined at 4 weeks after the operation and then at 6-month intervals, with site-specific analysis of pelvic prolapse at the vaginal apex and posterior vaginal segment. Results: Identification and site-specific fascial defect repair of the enterocele were successfully performed in all 17 cases. All patients also underwent a uterosacral ligament vaginal vault suspension, and 15 patients (88%) underwent concurrent posterior colporrhaphy. There were no intraoperative complications. At a mean follow-up of 6.3 months (range 1-17 months), 2 patients (12%) had mild, asymptomatic vaginal vault descensus but no patients (0/17) had evidence of a recurrent enterocele or rectocele. Conclusion: Enterocele correction through a fascial defect repair is easily performed through the vaginal route and is associated with excellent surgical outcomes on short-term follow-up. (Am J Obstet Gynecol 1998;179:1418-23.)     

SIDE REACTIONS IN PEPTIDE SYNTHESIS

The base catalyzed ring closure in t-Boc-Asp-X β-naphthylamides was examined in a series of 2-peptide derivatives in which position X was occupied by the neutral and acidic amino acid residues that occur in proteins. Bulkiness and functional groups in the side chain of X have a major effect on the rate of cyclization, e.g. acidic groups slow down the formation of aminosuccinyl derivatives. Rate-enhancing effect can be observed in serine and threonine, while the side reaction is unexpectedly slow when X is methionine.     

Distribution of immunoreactive metorphamide (adrenorphin) in discrete regions of the rat brain: Comparison with met-enkephalin-Arg-Gly-Leu

The distribution of immunoreactive (ir)-metorphamide (adrenorphin) in 101 microdissected rat brain and spinal cord regions was determined using a highly specific radioimmunoassay. The highest concentration of metorphamide in brain was found in globus pallidus (280.1 fmol/mg protein). High concentrations of ir-metorphamide (>120 fmol/mg protein) were found in 9 nuclei, including central amygdaloid nucleus, lateral preoptic area, anterior hypothalamic nucleus, hypothalamic paraventricular nucleus, interpeduncular nucleus, periaqueductal grey matter and nucleus of the solitary tract. Moderate concentrations of the peptide (between 60 and 120 fmol/mg protein) were found in 47 brain nuclei such as nucleus accumbens, bed nucleus of stria terminalis, several septal and amygdaloid nuclei, most of the hypothalamic nuclei, ventral tegmental area, red nucleus, raphe nuclei, lateral reticular nucleus, area postrema and others. Low concentrations or ir-metorphamide (<60 fmol/mg protein) were measured in 41 nuclei, e.g., cortical structures, hippocampus, caudate nucleus, thalamic nuclei, supraoptic nucleus, substantia nigra, vestibular nuclei, cerebellum (nuclei and cortex). The olfactory bulb has the lowest metorphamide concentration (5.8 fmol/mg protein). Spinal cord segments exhibit very low peptide concentrations.     

Measles virus antibodies in serum and cerebrospinal fluid in patients with multiple sclerosis and other neurological disorders,with special reference to measles antibody synthesis within the central nervous system

Measles virus hemagglutination-inhibiting (HI) and gel precipitating (GP) antibodies were determined in sera and cerebrospinal fluids (CSF) from 65 patients with multiple sclerosis (MS) and 65 patients with other neurological diseases. The serological results were correlated to content of immunoglobulin-G (IgG) and electrophoretic patterns of sera and CSF.Measles GP antibodies, identified as directed against measles virus ribonucleoprotein antigens, were detected in sera and in CSF from a significantly higher proportion of MS than of non-MS patients. No significant difference between the 2 groups of patients was found for measles HI antibodies.Reduced serum/CSF HI and/or GP antibody ratios were found in about one half of the MS patients and in 2 patients with chronic myelopathy. All patients with reduced antibody ratios had evidence of IgG synthesis within the central nervous system (CNS), as inferred from oligoclonal IgG patterns of the CSF. Reduced ratios of measles GP antibodies were 3 times as common as reduced ratios of HI antibodies. Immuno-electrophoretic assays indicated that the CSF GP antibodies were electrophoretically restricted in a number of MS patients.The results indicate that measles virus may be an active immunogen within the CNS in many MS patients and in some patients with chronic myelopathy, giving rise to an oligoclonal IgG antibody response.     

The Effect of Tp-5 and its Analogs on Skin Grafts in Mice:

The immunostimulatory action of oligopeptides RGH-0205 (Arg-Lys-Asp), RGH-0206 (Arg-Lys-Asp-Val) and TP-5 (4rg-Lys-Asp-Val-Tyr) was measured using the B10LP to C57BL skin graft system and the determination of splenic T cell ratio.

While thymectomy increased the period between skin grafting and rejection, each of the oligopeptides increased the number of spenic T cells and in same extent restored the rejection capacity of thymectomised C57B1 mice, presumably by restoration of thymic hormone function.     

Distribution of cholecystokinin (CCK) in the rat lower brain stem nuclei

The cholecystokinin (CCK) concentration in individual brain stem nuclei of rat was determined using the Palkovits punch method¹⁹ and the CCK RIA³. CCK has a unique distribution in the brain stem, unlike other neuropeptides and biogenic amines^8,19. In general, the CCK levels in the brain stem are 5–20% of rat cerebral cortex. The colliculi, midbrain central gray, nucleus of the solitary tract, and the interpeduncular nucleus had the highest CCK content (2.7-1 ng CCK mg protein).