摘要:

Desmoplakin-1 is a 280,000 dalton component of the intracellular portion of desmosomes. Complementary DNA (cDNA) coding for a portion of desmoplakin-1 was obtained by screening a λgt11 cDNA library constructed specifically for this purpose. A388 cells (a human skin squamous cell carcinoma cell line) were found to produce desmoplakin-1 and mRNA from this cell line was used to prepare a random primed cDNA library. Screening 60,000 recombinants of the library with an affinity purified anti-demoplakin-1 antibody resulted in initial identification of four clones from which one 1500 base pair clone was isolated by plaque purification. The identity of this desmoplakin clone was confirmed by demonstrating that antibody affinity purified on the protein product of the clone bound desmoplakins 1 and 2 in Western blots. Thus, the clone appears to code for the shared region of desmoplakins 1 and 2.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This investigation was designed to determine if acute ischemic cardiac injury causes the release of the 98 amino acid (aa) N-terminus of the 126 aa atrial natriuretic factor prohormone (pro ANF). Seventeen patients with acute myocardial infarction, but without clinical evidence of congestive heart failure, had their circulating concentrations of the whole N-terminus (ie, pro ANF 1–98), the midportion of the N-terminus of the ANF prohormone (consisting of aa 31–67; pro ANF 31–67) and creatine phosphokinase (CPK) monitored daily for 14 days. All seventeen patients had elevated plasma pro ANF 1–98 and pro ANF 31–67 concentrations at the time of presentation. Maximal increase on day three post-infarction correlated with the size of infarction estimated by the maximal CPK (r = 0.675; p < 0.05) but did not correlate with the amount of left ventricular dysfunction. Another three patients with acute myocardial infarction were treated with tissue plasminogen activator (tPA). The measured pro ANF 1–98 and pro ANF 31–67 levels in these patients were within our normal range and significantly lower (p < 0.001) than seen in patients with acute myocardial infarction not given thrombolytic therapy. Six patients unstable angina, likewise, had normal circulating pro ANFs 1–98 and 31–67 concentrations during prolonged episodes of chest pain. These data suggest that myocardial necrosis but not ischemia triggers the release of the entire 126 aa prohormone.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The objectives of the study were to evaluate the appropriateness of empiric antibiotic selection by housestaff treating medical patients with bacteremia. The design was a prospective, observational study at a university-affiliated hospital. Seventy-eight patients with bacteremia were evaluated. A clinical grade of acceptable or not acceptable was assigned to each antibiotic prescription by a consensus panel. The consensus panel found that 34.6% of antibiotic prescriptions were unacceptable (clinical grade). At least one flaw in the chain of reasoning was found in 56.4% of the 78 cases evaluated. Assessment of the clinical setting was correct in 94.9% of the cases; the portal of entry was identified in 91%; adequate knowledge of the bacterial flora at the suspected site of infection was found in 69%; the diagnostic workup was appropriate in 81%, and the correct antibiotic susceptibility patterns were given in 72%. A correct chain of reasoning was more likely to result in an acceptable clinical grade than flawed reasoning (p < 0.005). However, an appropriate antibiotic selection was made by some physicians despite flawed reasoning, and inappropriate antibiotic selection occurred in a few cases despite faultless reasoning. In 3.8% of cases, unexpected organisms appeared in blood culture. Prescription of broad spectrum antibiotics may then be learned response. If so, educational efforts that emphasize narrow, rather than broad spectrum prescribing may be inadequate to change physician prescribing habits.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

It is not known if the diabetes-related reduction in blood-brain barrier (BBB) transport of glucose is due to a change in the functional capacity of transporters or to an as yet unidentified mechanism occurring at the plasma membrane or cytoplasm. To increase our understanding of this problem, the cerebral blood flow, the brain uptake index (BUI) of 3–0-methyl glucose and the concentration of3H-cytochalasin B binding sites were determined in diabetic rats and diabetic rats treated with insulin. The BUI of 3–0-methyl glucose was significantly reduced (< 0.001) in diabetic rats (32.7 ± 1.2%) compared to control rats (41.9 ± 1.0%). This change could not be attributed to an alteration in cerebral blood flow or to a non-specific change in BBB permeability. Normalization of blood glucose with insulin therapy corrected the BUI measurements in diabetic rats (42.2 ± 1.4%). The level of measurable glucose transporters measured with3H-cytochalasin B binding assay did not appear to be reduced in the diabetic brain microvessels. The data indicate that the reduced brain uptake of glucose in chronic hyperglycemia can occur in the absence of a change in glucose transporter concentration.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Hypercalcemia has been described in a variety of granulomatous and lymphoproliferative disorders in association with elevated serum levels of 1,25-dihydroxyvitamin D. In such cases, hypercalcemia appears to be the consequence of excessive production of 1,25(OH)2D by the lymphocyte/macrophage line. The authors report a patient with lymphomatoid granulomatosis/angiocentric lymphoma who developed hypercalcemia with extreme elevation in serum 1,25(OH)2D. Therapy with steroids reduced the serum calcium and 1,25(OH)2D levels to normal. Hypercalcemia has not previously been reported in lymphomatoid granulomatosis/angiocentric lymphoma. The distinctive features of this malignancy, and the derangement in the metabolism of 1,25(OH)2D in lymphoproliferative disorders in general, are discussed.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

At the time of initial diagnosis, testicular malignancy is usually limited to the testicle and infradiaphragmatic lymph nodes. Metastases initially follow the retroperitoneal lymph channels and subsequently extend to the supradiphragmatic lymph nodes in the mediastinum and supraclavicular fossa. Testicular metastases to the pericardium are rare and usually asymptomatic. These lesions are most commonly identified at autopsy; therefore, the actual incidence is unknown. The authors report a 32-year-old man with testicular carcinoma, who developed asymptomatic pericardial metastases without concomitant supradiaphragmatic nodal or pulmonary metastases. They review the efficacy of echocardiography in diagnosis and follow up or pericardial metastasis.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Marked plasmacytosis is an uncommon clinical finding associated with plasma cell dyscrasias and certain reactive states, particularly serum sickness. Moreover, serum sickness-like reactions are a well-recognized complication of therapy with streptokinase. In this report, the authors describe a patient who developed a transient, but striking, plasmacytosis and an unexplained fever following streptokinase treatment for a pulmonary embolus. An evaluation for multiple myeloma was completely negative except for the occurrence of serum monoclonal-like proteins which largely disappeared over an eight month period.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Prognosis in aplastic anemia is usually linked to the degree of hypoplasia in the bone marrow and pancytopenia in the blood. The authors were, therefore, intrigued when a patient with methimazole-associated aplastic anemia who satisfied criteria for severe disease recovered rapidly and completely once her drug was withdrawn. Review of the English language literature revealed ten fully documented cases of aplastic anemia associated with use of the antithyroid drugs methimazole, carbimazole, and propylthiouracil. Analysis of the ten and of an eleventh case presented here indicated that the disorder is typically characterized by severe pancytopenia and profound marrow hypoplasia, yet surprisingly good prognosis, ie, minimum survival of more than 70% with partial or complete recovery from symptoms and cytopenias in survivors within 2–5 weeks. The only deaths, both in the 1950s, were from brain hemorrhage in patients who were not transfused with platelets. The discrepancy between the clinical and - laboratory severity of antithyroid drug-associated aplasia, on the one hand, and its relatively good prognosis and short term course, on the other, should be kept in mind when considering these patients for bone marrow transplantation or for therapy with antithymocyte globulin.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The metabolic changes which accompany hyperglycemia in a person with diabetes are thought to cause renal hyperperfusion and intraglomerular hypertension, especially in the person with a predisposition to essential hypertension. Intraglomerular hypertension causing deposition of protein in the mesangium leads to glomerulosclerosis and renal failure. Screening for microalbuminuria can predict which type I diabetic patients will develop nephropathy. The decline in renal function in established diabetic nephropathy can be slowed with aggressive treatment of hypertension. The use of ACE inhibitors may also decrease intraglomerular hypertension. Whether similar treatment in the person with preclinical diabetic nephropathy would delay or prevent the onset of diabetic nephropathy is being investigated. Restricted protein intake, anti-platelet and rheolitic drugs may have a role in the treatment of established diabetic nephropathy. In end stage renal failure, renal transplantation is the treatment of choice. When transplantation cannot be performed, chronic ambulatory peritoneal dialysis is preferable to hemodialysis.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Gastrointestinal motility is the function of gastrointestinal smooth muscle. It is controlled by both the intrinsic and extrinsic nerves of the gastrointestinal tract and, to a lesser degree, the gastrointestinal hormones. Therefore, any abnormality of the above factors, theoretically, can cause gastrointestinal dysmotility. In a clinical situation, commonly seen is gastrointestinal dysmotility caused by either smooth muscle or intrinsic and extrinsic nerves dysfunction. Diseases that cause smooth muscle dysfunction include familial visceral myopathies, nonfamilial visceral myopathies, collagen disease, muscular dystrophies, amyloidosis, thyroid disease, and so on. Diseases that cause enteric nerve dysfunction include familial visceral neuropathies, nonfamilial visceral neuropathies, diabetes mellitus, Chagas' disease, ganglioneu-romatosis of the intestine, visceral neuropathy of carcinomatosis, Parkinson's disease, and so on. The patients with neuromuscular disease of the gastrointestinal tract have a wide range of clinical manifestations regardless of the underlying cause. At one end of the spectrum, the patients may be asymptomatic, and at the other end of the spectrum, the patients may have functional obstruction of the gastrointestinal tract. Plain abdominal x-rays, upper gastrointestinal (UGI) and small bowel x-rays, enteroclysis, barium enema, and manometric studies are useful for the work-up of these patients. Enteroclysis is especially helpful in ruling out mechanical obstruction of the small intestine in patients with chronic intestinal pseudo-obstruction. Treatment is mainly symptomatic and supportive. There is no effective drug to improve gastrointestinal motility. Surgery may be helpful in selected cases of severe gastrointestinal dysmotility.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID