Detection of clonal platelet antibodies in immunologically-mediated thrombocytopenias: association with circulating clonal/oligoclonal B cells

Aware that T and B cells in autoimmune thrombocytopenia are abnormal, including the existence of clonal B cell populations, we sought to characterize this clonal phenomenon in various immunological thrombocytopenias using platelet antibody light chain analysis, flow cytometry, Southern blot analysis, and PCR. Using a monoclonal antibody-antigen capture ELISA, we analysed sera from 21 of 26 patients with autoimmune, alloimmune, or drug-induced immunological thrombocytopenia for the light chain phenotypes of their platelet antibodies. Alloantibodies and drug-dependent antibodies from four and 14 patients, respectively, were found that expressed a predominant type of light chain, suggesting that these platelet-reactive antibodies were monoclonal or oligoclonal in nature. 14 of the 26 patients were available for light chain B cell phenotyping studies. Of these 14 patients, thrombocytopenia was due to autoimmunity in two, drug-induced immunity in four, and alloimmunity in eight. We detected clonal populations of B cells in all 14 patients by flow cytometry. Although six of these latter patients possessed platelet antibodies with clonal characteristics, light chain phenotypes of antibodies in five patients were opposite to those of their B cells. Eight of these patients were further examined for immunoglobulin gene rearrangement using Southern and/or polymerase chain reaction analysis. In all eight patients we detected clonal or oligoclonal B cell populations. Only two of these patients had malignancies (chronic lymphocytic leukaemia) that would be expected to have detectable clonal B cells, and thus the mechanism for clonal expansion in the other six patients did not appear to be related to an obvious neoplastic process. Prior to these studies, detection of clonal B cells in thrombocytopenic patients without known malignancies was limited to individuals with autoimmune thrombocytopenia, prompting the speculation that this particular autoimmune disorder arises from B cell dysregulation, rather than from expansion of specific autoantibody producing B cell clones. In contrast, the current studies provide evidence that clonal B cells are common to patients with any form of immunologically-mediated thrombocytopenia. Moreover, the majority of the platelet antibodies (86%) present in these disorders exhibited monoclonal characteristics in that there was an apparent restriction in light chain usage.     

Osteosyntheses in fractures of the lower leg (1969-1971)]

The premixed cholesterol reagent (acetic acid, sulphuric acid, ferric chloride and phosphoric acid) employed in a spectrophotometric method for serum cholesterol determinations was applied to frozen sections of various rat and rabbit tissues. The histochemical reaction was compared with the results obtained by the classical Schultz reaction. The same bluish-green color was observed after treatment of formalin-fixed and fresh cryostat sections incubated in 2.5% iron alum at 37 C for 3 days. The premixed cholesterol reagent is stable for years at room temperature if stored in a brown bottle and is thus readily available for routine use.     

Effect of motilin on the lower esophageal sphincter of the opossum

We have studied the effect of Yajima's synthetic motilin on the lower esophageal sphincter (LES) of the opossum and compared its potency to that of gastrin and its interaction with secretin. Dose-response curves for the LES were constructed from the intravenous bolus injection of graded doses of motilin and gastrin alone and motilin given against a background infusion of secretin. The smallest dose of motilin that elicited a significant response was 0.05 microng/kg, and the highest response was observed with the highest dose used in this study (1.0 microng/kg). Over a wide dose range, both motilin and gastrin were found to be equally potent in stimulating the LES of the opposum, and secretin caused inhibition of the LES pressure to motilin. Therefore, we conclude that (1) motilin is a potent stimulant of the LES; (2) this response is dose dependent; (3) motilin's potency is similar to that of gastrin; and (4) secretin counteracts the effect of motilin on the LES.     

Postprandial blood glucose and its relation to diabetic gastroparesis--a comparison of two methods

A group of 44 individuals were re-evaluated at a median follow up time of 19 years after radiotherapy for childhood cancer involving some part of the vertebral column. The median age at diagnosis was 2.6 years. The diagnosis included Wilms' tumour (n = 24), neuroblastoma (n = 9) and other solid tumours (n = 11). Scoliosis with or without kyphosis was the most common spinal deformity and was found in 40/44 patients. The apex of the major curvature was on the lumbar vertebral body 1-3 in 23 cases. The kyphosis and lordosis were greater in the subjects with tumour other than Wilms' (P = 0.04 both). Of the subjects restudied, 35 had detectable local soft tissue atrophy in the region of irradiation. Scoliotic deformity often enhanced cosmetic handicap/defect. Five subjects reported some symptoms related to the back; they had more severe scoliotic and kyphotic deformity (P = 0.02). Spinal abnormalities were common in these survivors, but subjective complaints were unusual.     

Nurse-midwifery service model in an academic environment

Chiral high performance liquid chromatography was used for the enantiometric separation of leucovorin. The optimal separation conditions recommended after optimizing the mobile phase composition, flow rate, and temperature are described. Achiral reversed-phase chromatographic method was applied for the simultaneous separation of methotrexate and leucovorin in clinical samples. Column-switching system including achiral short pre-column and chiral analytical column based on immobilized bovine serum albumin were used for simultaneous determination of leucovorin and methotrexate patients treated at the National Cancer Institute.     

Development of a model angiography informed consent form based on a multiinstitutional survey of current forms

PURPOSE: To develop an informative consent form for angiography that can be read and understood by a patient with an eighth-grade level of education. MATERIALS AND METHODS: Consent forms from 125 medical centers were evaluated with RightWriter 4.0 software. The readability index, a measure of educational grade level needed to understand a document, was determined for each form. Features of forms and discussion of complications were evaluated. A model consent form was developed. RESULTS: Analysis of 27 consent forms revealed a mean readability index of 14.2; to adequately understand the documents, an average of 2.2 years of college were required. Alternatives to the procedure were listed in 14 forms (52%). All consent forms listed potential complications, but only 15 (56%) identified specific numeric risks, and attempts to classify complications according to severity were made in only five (18%). CONCLUSION: An angiography consent form has been developed that can be understood with an eight-grade level of education. It should allow patients to more easily understand the procedure and its risks, benefits, and alternatives. It remains the obligation of the physician to tailor the discussion for each procedure to meet the needs of each patient.