[Aggressive pulmonary metastasectomy for metastatic renal cell carcinoma--6 cases report].
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Adult↗
Biomedical subjects
L M Lee
Publications and source records attributed to L M Lee.
Microdissection and radiographic studies of the arterial vasculature of the human testes.
Conflicting and sparsely detailed reports concerning the arterial vasculature of the testes prompted us to study 51 human cadaveric testicles radiographically in order to document any interarterial communications. Twelve specimens were harvested from the pediatric age group and 39 from adult cadavers. Vascular communication was demonstrated between the testicular, cremasteric, and vasal arteries in all specimens studied. Large-caliber anastomotic channels were demonstrated between the testicular and vasal arteries in 87% of specimens. No discernible differences in these vascular communications were documented among adult, pediatric, and undescended testes.
Adult↗
Testicular torsion in the adult.
Testicular torsion in men more than 21 years old seems to be as common as in prepubertal boys, accounting for 26 per cent of our cases. Of these patients 10 per cent were more than 30 years old. A previous similar episode will have occurred in nearly half of the patients and is the only helpful historical data. A negative urinalysis is the rule and, while not diagnostic, testicular torsion should be the presumptive diagnosis. Doppler examination and radionuclide scans are accurate and reliable but in our series these studies added little to the plan of management. Manual detorsion can be accomplished with local anesthesia in approximately 70 per cent of the patients and always should be attempted. Delay in operation beyond 12 hours resulted uniformly in loss of the testicle, primarily by orchiectomy or secondarily by atrophy. While correction of the torsion before 6 to 8 hours does not ensure success the rate of salvage is higher. Scrotal exploration for testicular torsion is simple and has little morbidity. Exploration should be done in any patient with acute unilateral scrotal swelling and a negative urinalysis, regardless of age.
Adult↗
Testicular pain: an unusual presentation of polyarteritis nodosa.
We report a case in which the initial presentation of polyarteritis nodosa was alternating bilateral orchialgia. The diagnosis was confirmed by testicular biopsy. Testicular biopsy is an uncommonly reported diagnostic procedure despite the high incidence of testicular involvement in polyarteritis nodosa. We emphasize the value of testis biopsy, particularly when biopsy of other sites does not prove the diagnosis in suspect cases.
Adult↗
Colipase and maximally activated pancreatic lipase in normal subjects and patients with steatorrhea.
Human pancreatic lipase in duodenal secretions was studied under conditions of maximal activation by porcine colipase and maximal inhibition by sodium taurodeoxycholate. In almost all samples, total lipase activity in 4 mM sodium taurodeoxycholate was activated by the addition of porcine colipase. Activation was linear until saturation by cofactor was reached, and maximum activity was greater than that obtained in the absence of bile salts. At pH 8.0 in 4 mM sodium taurodeoxycholate, lipase activity was due to pancreatic lipase in samples from normal and steatorrheic individuals and was proportional to the concentration of endogenous colipase in samples that could be activated by exogenous colipase. In these samples, therefore, colipase activity could be conveniently assayed as the lipase activity at pH 0.8 in 4 mM sodium taurodeoxycholate. Colipase to total pancreatic lipase ratios varied widely from individual to individual and on average were significantly lower in steatorrheic patients. In individual samples, colipase secretion was stimulated by pancreozymin and secretin roughly in parallel with total pancreatic lipase, but some variation in the ratio of the two was often seen in successive collection periods. Because pancreatic lipase is usually unsaturated with respect to cofactor, lipolytic activity in duodenal secretions may be finely controlled by modulation of colipase secretion.
Animals↗
Isolation of a detergent-solubilized maltase/glucoamylase from rat intestine and its comparison with a maltase/glucoamylase solubilized by papain.
Maltase/glucoamylase from the rat intestinal brush-border membrane was solubilized by homogenization of the intestinal mucosa in buffer containing 0.5% Triton X-100. After removal of the detergent with butan-1-ol, the enzyme was purified by chromatography on Sepharose 4B and DEAE-cellulose. The final specific activity was 70.3 units/mg of protein in six preparations, comparing favourably with the specific activity of 65.0 units/mg of protein of a pure papain-solubilized maltase/glucoamylase previously isolated and characterized by us [Flanagan & Forstner (1978) Biochem. J.173, 553-563]. The two enzymes were compared. Both migrated as single bands with the same mobility on sodium dodecyl sulphate/polyacrylamide-gel electrophoresis, were eluted at the same volume from Sepharose 4B, and had the same sedimentation pattern in mannitol gradients. The amino acid composition was similar; content of total apolar residues differed by 1.0mol%. Antibodies prepared against either enzyme gave identical precipitin lines with each. Neither enzyme bound tritiated Triton X-100. The only difference noted was the tendency of the detergent-solubilized enzyme to aggregate on storage, whereas the papain-solubilized enzyme remained unchanged. Both enzymes had two N-termini, glycine and arginine. When the two enzymes were dissociated by boiling in sodium dodecyl sulphate, each exhibited the same five species on sodium dodecyl sulphate/polyacrylamide-gel electrophoresis. Single N-termini were found in the two smaller species, 1 (glycine) and 2 (arginine), whereas larger species (3-5) had both N-terminal amino acids. Both the Triton- and papain-solubilized enzymes appear to be oligomers of species 1 and 2, indicating that the native enzyme contains two subunit types. Aggregation in aqueous solutions does not depend on a proteolytically susceptible peptide fragment at the N-terminus of either subunit.
Amino Acids↗
Tissue antigens in seminal secretions. I. Precipitin reactions of rabbit antiserum to human seminal plasma.
Precipitating antibodies prepared in rabbits with human seminal plasma (HSP) have been used in a preliminary study to define the antigenicity of HSP by use of gel precipitin methods. Also, a method for evaluating and preserving liquid precipitates of acid phosphatase in polyacrylamide is described. Some ten or eleven antigens were demonstrated by Ouchterlony agar immunodiffusion (ID). Eight of these appeared to be HSP-specific and two or three were also found in normal human serum (NHS). Five of the HSP-specific antigens were shown by agar immunoelectrophoresis (IEP) and by ID to be acid phosphatase. Four of these constituted the basic isoenzyme pattern and were shown by IEP and ID to be shared by prostatic fluid (HPF). Titration of HPF by ID yielded antigen titres of 46, 33, 17 and 3 for the four isoenzymes. IEP patterns obtained with HSP and HPF showed two isoenzymes migrating to the alpha-globulin zone. The third isoenzyme migrated to the alpha-2-fast beta area, while a fourth was seen as a slow beta precipitin arc formed consistently by HPF, and variably by HSP. HSP contained a fifth isoenzyme which also migrated to the slow beta area. Human prostate extract (HPE) showed only two, sometimes three, of these components, one of the slower components being frequently faint in appearance or absent. In HSP and HPF isoenzyme migrating to the alpha-2-fast beta zone exhibited two distinct characteristics: biphasic migration and limited diffusion, suggesting a heterogeneous high molecular weight isoenzyme or an isoenzyme complex. However, observed differences between HSP, HPF and HPE in migration rate, relative concentrations of subfractions, lateral diffusion, etc. leave open the question of the nature of the heterogeneity.
Acid Phosphatase↗
An unusual alkaline phosphatase isoenzyme in a patient with concomitant marked elevation of acid phosphatase without clinical evidence of prostatic carcinoma.
An 81-year-old male with congestive heart failure and prostatic hypertrophy was found to have markedly elevated serum acid phosphatase (EC 3.1.3.2) and moderately elevated serum alkaline phosphatase (EC 3.1.3.1). Alkaline phosphatase isoenzyme analysis was performed to determine the organ source of the enzyme. There was an unsual slow-migrating alkaline phosphatase isoenzyme band in the serum of this patient suggestive of hepatic origin by a variety of biochemical tests.
Acid Phosphatase↗
Nonchromatographic radioimmunoassay of plasma 11-deoxycortisol, for use in the metyrapone test, with polyethylene glycol as the precipant.
We have developed a simple, reliable radioimmunoassay for plasma 11-deoxycortisol. The method does not require chromatography but instead makes use of a simple extraction procedure which, in combination with the antibody characteristics, is highly specific for the metyrapone test. Polyethylene glycol was used to separate free and antibody-bound steroid. The smallest amount measurable is 15 pg (2.0 mug/liter of plasma). The method is shown to be precise and accurate. Intraassay precision of the method for two plasma pools was 26.7 plus or minus 2.5 mug/liter (CV equals 9.4%) and 61.2 plus or minus 3.7 mug/liter (CV equals 6.0%). The respective inter-assay precision was 27.0 plus or minus 1.7 mug/liter (CV equals 6.3%) and 59.9 plus or minus 2.3 mug/liter (CV equals 3.8%). The validity of the assay was further verified by evaluating the plasma 11-deoxycortisol response to metyrapone administration. The relative simplicity of the method and the commercial availability of all reagents, including antisera, makes this radioimmunoassay procedure practical for use in clinical laboratories.
17-Hydroxycorticosteroids↗
Electrophoretic method for assessing the normal and pathological distribution of alkaline phosphatase isoenzymes in serum.
We describe a simple, reproducible, discontinuous system for polyacrylamide disc gel-electrophoresis, with which the alkaline phosphatase isoenzymes in human serum can be fractionated. No sample preparation is needed. The isoenzymes are classified according to their electrophoretic mobilities (R-F values) and quantitated by peak area measurements from spectrophotometric scans. The four alkaline phosphatase isoenzymes usually present in normal sera, in order of descending mobilities (and designated according to principal tissue of origin) are: "fast" liver, "slow" liver, bone, and intestine. Sera of diseased patients show a greater variety of isoenzyme distribution patterns, but the most frequently observed patterns are the same as normal patterns. We conclude that the finding of "fast" liver only is not pathognomonic, as previously reported by others, and that information on relative distributions per se is not diagnostically useful, although information on specific increases in activity is useful. With this system, hepatobiliary disorders can be differentiated from other forms of liver and bone diseases.
Alkaline Phosphatase↗
Cooperativity in human erythrocyte phosphofructokinase.
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Adenosine Monophosphate↗
Purification and some properties of phosphofructokinase from human erythrocytes.
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Ammonium Sulfate↗
Serum phospholipids in neoplastic disorders.
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Acid Phosphatase↗
Isolated bladder rupture after minor trauma in a patient with alcohol intoxication.
We report the case of an intoxicated male patient who presented with an isolated intraperitoneal urinary bladder rupture, with a history of minor trauma. A review of the literature reveals that isolated bladder rupture after minimal or no trauma in association with alcohol or drug ingestion is an infrequently reported, but recognized, injury. The diagnosis of bladder rupture should be considered in an intoxicated patient with lower abdominal pain, even without a history of trauma. A history of voiding or bladder dysfunction should increase the suspicion for this injury. If suspected, a retrograde cystogram should be obtained promptly. Failure to consider and recognize this injury may lead to significant morbidity.
Alcoholism↗
Low molecular weight protamine: a potent but nontoxic antagonist to heparin/low molecular weight protamine.
To avoid bleeding complications, protamine is routinely used after cardiovascular surgery to neutralize the anticoagulant function of heparin. However, its clinical use is associated with adverse and sometimes fatal reactions. Based on literature review of the mechanism of heparin neutralization and protamine induced immunologic toxicity, we propose the following hypothesis: If a chain shortened low molecular weight protamine (LMWP) containing the heparin neutralizing domain could be derived from native protamine, it could be a potent and yet nontoxic heparin antagonist. In this study, we present results to validate this hypothesis. LMWP fragments containing an intact arginine sequence and an average molecular weight of approximately 1,100 daltons were successfully prepared by enzymatic digestion of protamine with thermolysin. In vitro studies show that such LMWP fragments completely neutralized the anticoagulant functions of heparin and LMWH, based on the anti-Xa chromogenic and aPTT clotting time assays. In vivo results reveal that although injection of protamine to mice led to obvious production of anti-protamine antibodies, injection of LMWP did not elicit any detectable immunogenic responses. In addition, these LMWP fragments exhibited a markedly reduced antigenicity and cross-reactivity toward the mice anti-protamine antibodies.
Animals↗
Studies on human anti-rabies immunization in Brazil. I--Evaluation of the 3 + 1 pre-exposure vaccination schedule under field conditions.
The currently used pre-exposure anti-rabies immunization schedule in Brazil is the one called 3+1, employing suckling mouse brain vaccine (3 doses on alternate days and the last one on day 30). Although satisfactory results were obtained in well controlled experimental groups using this immunization schedule, in our routine practice, VNA levels lower than 0.5 IU/ml are frequently found. We studied the pre-exposure 3+1 schedule under field conditions in different cities on the State of São Paulo, Brazil, under variable and sometimes adverse circumstances, such as the use of different batches of vaccine with different titers, delivered, stored and administered under local conditions. Fifty out of 256 serum samples (19.5%) showed VNA titers lower than 0.5 IU/ml, but they were not distributed homogeneously among the localities studied. While in some cities the results were completely satisfactory, in others almost 40% did not attain the minimum VNA titer required. The results presented here, considered separately, question our currently used procedures for human pre-exposure anti-rabies immunization. The reasons determining this situation are discussed.
Antibodies, Viral↗
Studies on human anti-rabies immunization in Brazil. II--Preliminary evaluation of the 2-1-1 schedule for human pre-exposure anti-rabies immunization, employing suckling mouse brain vaccine.
This study reports preliminary results of virus neutralizing antibody (VNA) titers obtained on different days in the course of human anti-rabies immunization with the 2-1-1 schedule (one dose is given in the right arm and one dose in the left arm at day 0, and one dose is applied on days 7 and 21), recommended by WHO for post-exposure treatment with cell culture vaccines. A variant schedule (double dose on day zero and another on day 14) was also tested, both employing suckling mouse brain vaccine. A complete seroconversion rate was obtained after only 3 vaccine doses, and almost all patients (11 of 12) presented titers higher than 1.0 IU/ml. Both neutralizing response and seroconversion rates were lower in the group receiving only 3 doses, regardless of the sample collecting day. Although our results are lower than those found with cell culture vaccines, the geometry mean of VNA is fully satisfactory, overcoming the lower limit recommended by WHO of 0.5 IU/ml. The 2-1-1 schedule could be an alternative one for pre exposure immunization, shorter than the classical 3+1 regimen (one dose on days 0, 2, 4 and 30) with only three visits to the doctor, instead of four.
Adult↗
Expression of cyclooxygenase-2 in prostate adenocarcinoma and benign prostatic hyperplasia.
Elevated expression of cyclo-oxygenase (COX)-2 has been found in several human cancers, including prostate adenocarcinoma. To evaluate the potential prognostic role of COX-2 in prostate cancer, we assessed the expression of COX-2 in benign prostatic hyperplasia (BPH) and prostate cancer samples employing immunohistochemistry. COX-2 was over-expressed in 15 out of 18 (83%) prostate cancer samples whereas it was detected in only 22% (4 of 18) paired benign tissues. The intensity of immunostaining correlated with the tumor grading. In addition, COX-2 was expressed in 7 of the 22 (32%) BPH samples examined. The significance a COX-2 expression in the BPH samples is not known at present. This data suggest that COX-2 is over-expressed in prostate cancer and COX-2 inhibitors may be useful in combination chemotherapy or chemoprevention for prostate cancer.
Adenocarcinoma↗