Positive direct antiglobulin tests associated with intravenous gamma globulin use in bone marrow transplant recipients.
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Biomedical subjects
Publications and source records attributed to J A Pierce.
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Recent reports have suggested that the alpha-1-antitrypsin allele PiZ, which in homozygotes results in severe deficiency of this important protease inhibitor, is maintained at a relatively high gene frequency through the mechanism of segregation distortion. We report here on 121 nuclear families selected because only one parent was segregating the Z allele. After correcting for ascertainment, no evidence of preferential transmission was observed in 278 informative offspring.
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Isoelectric focusing has replaced acid starch-gel electrophoresis for the routine determination of antitrypsin phenotypes in recent years. We observed increased sharpness of antitrypsin bands and decreased background stain following the addition of DTE to serum before isoelectric ofcusing in polyacrylamide gels. DTE and DTT were the only sulfhydryl reducing agents which produced this effect. Electrophoretic mobility of antitrypsin bands was increased very slightly. Decreased background stain resulted from the precipitation of albumin. Precipitation (coagulation) of albumin was complete in serum after 60 min incubation at 37 degrees C at concentrations of 30 mM DTE or DTT. Optimal pH for denaturation was 7.6 to 8.8. Ionic concentrations reduced the strength of the coagulum at 2.5M sodium chloride but had little effect at lower concentrations. Marked temperature effects were noted. As a result of these studies, we recommend examination of native and reduced (30 mM DTE) serum on isoelectric focusing in polyacrylamide gel for all samples submitted for routine antitrypsin phenotype determinations. It also seems possible that the nontoxic DTE (DTT) precipitation of albumin could prove useful for studies of serum proteins other than alpha 1-antitrypsin.
Twenty-three cases of acute spinal cord injury in persons with cervical ankylosis are presented. Certain characteristics of major sub-groups are described: ankylosing spondylitis (N = 8), degenerative spondylosis (N = 9) and congenital fusion (congenital non-segmentation) (N = 6). The ankylosing spondylitic group presented a grim prognosis for survival (death rate 50 per cent within 60 days) and for loss of neurological function. Five out of eight cases had permanent neurological loss subsequent to their injuries. Both the ankylosing spondylitic and degenerative spondylotic groups presented problems in diagnosis and medical management. The basic principle is immobilisation of the fracture and mobilisation of the patient. The halo is the technique of choice for fracture immobilisation. An integrated intensive respiratory management programme is essential. Patients with ankylosed spines, particularly those with ankylosing spondylitis, should be educated in simple measures to prevent fracture of their spines.
Purified human leukocyte elastase was injected into the tracheas of 46 hamsters. Thirteen animals died spontaneously within 1 week, with extensive lung hemorrhage. The elastin content of the lungs was only slightly less than control values 3 hours after injection. At 2 months, the lungs of the remaining animals showed mild, patchy emphysema and morphometric changes consistent with emphysema. These results contrasted with the effects of a similar elastolytic dose of pancreatic elastase administered to 26 other hamsters in that only one animal died spontaneously, the lung elastin content 3 hours after injection was substantially decreased, and severe emphysema was present 2 months later. Leukocyte elastase appears to be capable of causing emphysema; but unlike pancreatic elastase, leukocyte elastase produces emphysema that is mild, even at a dose sufficient to produce intense lung hemorrhage and a high mortality.
A total of 161 patients with chronic obstructive pulmonary disease (COPD) plus 100 control subjects (identified during a study of heart disease in 6,860 Japanese-American men aged 52 to 75 years who were residing in Hawaii) were analyzed for phenotype in search of the antitrypsin gene Z, which has been shown to be associated with pulmonary emphysema in other racial groups. No carriers of the Z gene were found, and the question of whether the rarity or absence of this gene relates to a low frequency of COPD among Japanese-Americans is reviewed.
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Failure to surgically correct incontinence usually results from inadequate screening of patients with hyperreflexic incontinence, improper fixation of the urethra or yielding of tissues that have supported the repair. A surgical approach is described which fixes the bladder neck to the rectus tendon and adjacent pubic periosteum, under direct vision, through a cystotomy incision. The procedure achieves good continence in more than 90 per cent of the cases. Temporary postoperative voiding dysfunction occurred in about half of the patients.
Antitrypsin phenotypes were determined from 2,285 donors at the Barnes Hospital Blood Bank in St. Louis . Results resembled those obtained from Central Europeans: there were fewer proteinase inhibitor (Pi) Z alleles in St. Louis than in Scandinavian test groups. Interestingly, major antifrypsin variants occurred only 40% as frequently in black as in the balance of the study group.
The Gm-Piota linkage group is firmly established. A heterogeneity of recombination fraction amongst males of different Piota types has now become very likely. The major differences seem to be between the Piota (z) and other alleles of the Pi system. A chromosomal deletion, inversion or a regulatory (rec) locus in linkage disequilibrium with the Piota locus offer possible explanations.
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