Sarcoidosis presenting as multiple pulmonary nodules and nephrotic syndrome

A 56 year old man presented with thrombophlebitis, nephrotic range proteinuria and multiple pulmonary nodules. A renal biopsy showed membranous glomerulonephritis, and after a thoracotomy a diagnosis of sarcoidosis was established. A pulmonary nodular pattern is unusual in sarcoidosis and is often mistaken for malignant disease. The association of this type of pulmonary involvement and membranous glomerulonephritis as the presenting form of sarcoidosis has not previously been described.     

Interaction of AChE with Lens culinaris agglutinin reveals differences in glycosylation of molecular forms in sarcoplasmic reticulum membrane subfractions.

Fractionation of muscle microsomes rich in sarcoplasmic reticulum (SR) by isopicnic centrifugation yielded three types of membranes. Heavy (HM), intermediate (IM), and light membranes (LM), with isopicnic points of 38, 33, and 25% w/w sucrose, were rich in terminal cisternae/triads, longitudinal SR, and T-tubules, respectively. All membrane subfractions displayed acetylcholinesterase (AChE) activity. About 60, 80, and 50% of total AChE in HM, IM, and LM was extracted with a Tris-saline-Triton buffer. AChE molecular forms of 4.5 S (G1), 10.5 S (G4), and 16 S (A12) were found in all membranes but their relative proportion varied among the several membranes. Asymmetric and tetrameric forms were partly sedimented with Lens culinaris agglutinin (LCA), but most of the monomeric AChE failed to interact with the lectin. However, some of the monomers, exclusively found in LM, reacted with LCA. The data suggest that monomeric AChE is classified in rough endoplasmic reticulum. A subset is destined to SR, a second one converted into oligomeric forms, and a third one is associated to external membrane after passing through the Golgi system.     

Mitral valve replacement in postinfarction mitral insufficiency. Immediate and long-term results apropos of a series of 39 surgically-treated patients]

Thirty nine patients, mainly males (84.6%) with an average age of 66 years underwent mitral valve replacement for postinfarction mitral regurtation between March 1971 and December 1987. Twenty four were in Class IV of the NYHA Classification, 9 in Class III and 6 in Class II. All had a history of myocardial infarction predominantly of the inferior wall. The 33 preoperative coronary angiogrammes showed 13 patients with triple vessel disease, 15 with double vessel disease and 5 with single vessel disease. At operation, 13 patients had ruptured papillary muscles; acute dysfunction was observed in 16 and chronic in 10 patients. The hospital mortality was 36%; over three quarters of deaths were due to myocardial dysfunction. Twenty two patients had an associated myocardial revascularisation procedure with mitral valve replacement. All 25 survivors were followed up for an average of 2.3 years (94 patient-years). The 5 year actuarial survival (operative mortality included) was 55% and 77% of the 17 survivors are in Stages I or II of the NYHA Classification. The quality of these long-term results justifies surgery despite the high operative risk.     

Survival and recovery of human platelets stored for five days in a non- plasma medium

Human blood platelets were stored for five days as concentrates in 60 mL of: (a) plasma; (b) non-plasma medium with anticoagulant; and (c) non-plasma medium without anticoagulant. All preparations were equally functional when tested for platelet aggregation and release reaction in response to single agonist or synergistic pairs of agonists in vitro. Platelets stored in non-plasma medium with anti-coagulant had lower kallikrein, fibrino(gen)peptide A, lactate, and beta-thromboglobulin than did plasma controls after five days. In vivo recovery and survival of platelets stored in non-plasma medium with anticoagulant were 51.2% +/- 4.3% and 8.7 +/- 0.3 days, respectively, which were not statistically different from plasma controls of 39.2% +/- 4.9% and 7.2 +/- 0.8 days, respectively. It is concluded that platelets can be stored for five days in a non-plasma medium and still have good in vivo recoveries and survivals.     

Dissociation of glucose-regulated protein Grp78 and Grp78-IgE Fc complexes by ATP.

Recent studies have shown that ATP can dissociate dimers of the glucose-regulated protein Grp78 to monomers. In the present study, we have used purified recombinant Grp78 from Escherichia coli to investigate this reaction in more detail. During the course of the Grp78 dimer-monomer conversion, a stable Grp78 monomer-ATP complex is formed. Upon removal of the ATP, the Grp78 dimer is reformed. ADP, nonhydrolyzable ATP analogues, and GTP do not effect the dissociation of Grp78 dimers. A cell line that overproduces IgE Fc has been used to examine the nature of the Grp78-IgE Fc complexes present and the effect of ATP on them. Grp78-IgE Fc complexes ranging from 100 kDa to 300 kDa were observed by sucrose gradient analysis, suggesting that aggregate forms of Grp78 may be present in some of these complexes. Treatment of the extracts with ATP resulted in release of a Grp78 monomer from the complex. These results suggest that the dissociation of Grp78 oligomers by ATP may be involved in the function of Grp78 in protein translocation through the endoplasmic reticulum.     

Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy.

PURPOSE: To investigate the impact of dietary counseling or nutritional supplements on outcomes in cancer patients: nutritional, morbidity, and quality of life (QoL) during and 3 months after radiotherapy. PATIENTS AND METHODS: A total of 111 colorectal cancer outpatients referred for radiotherapy, stratified by staging, were randomly assigned: group 1 (G1; n = 37), dietary counseling (regular foods); group 2 (G2; n = 37), protein supplements; and group 3 (G3; n = 37), ad libitum intake. Nutritional intake (diet history), status (Ottery's Subjective Global Assessment), and QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0) were evaluated at baseline, at the end, and 3 months after radiotherapy. RESULTS: At radiotherapy completion, energy intake increased in G1/G2 (P < or = .04), G1 more than G2 (P = .001), and decreased in G3 (P < .01). Protein intake increased in G1/G2 (P < or = .007), G1 less than G2 (not significant), and decreased in G3 (P < .01). At 3 months, G1 maintained nutritional intake and G2/G3 returned to baseline. After radiotherapy and at 3 months, rates of anorexia, nausea, vomiting, and diarrhea were higher in G3 (P < .05). At radiotherapy completion, in G1 all QoL function scores improved proportionally to adequate intake or nutritional status (P < .05); whereas in G2 only three of six function scores improved proportionally to protein intake (P = .04), and in G3 all scores worsened (P < .05). At 3 months, G1 patients maintained/improved function, symptoms, and single-item scores (P < .02); in G2, only few function and symptom scales improved (P < .05); in G3, QoL remained as poor as after radiotherapy. In G1/G2, respectively, improvement/deterioration of QoL correlated with better or poorer intake or nutritional status (P < .003). CONCLUSION: During radiotherapy, both interventions positively influenced outcomes; dietary counseling was of similar or higher benefit, whereas even 3 months after RT, it was the only method to sustain a significant impact on patient outcomes.