Epididymal sarcoidosis.

Sarcoidosis is a multisystem disorder that rarely involves the genitourinary tract. To date only 28 cases of histologically proved sarcoidosis involving the epididymis have been described in the literature. Although uncommon, sarcoidosis should be considered in any differential diagnosis of testicular lesions. We present 2 cases of epididymal sarcoidosis. A 27-year-old asymptomatic black man had multiple nontender scrotal nodules on routine physical examination. A 34-year-old black man was initially diagnosed with sarcoidosis by transbronchial biopsy. He received 10 months of prednisone therapy before noticing a mass in the right testicle. Surgical exploration of both patients demonstrated noncaseating granulomatous inflammation consistent with sarcoidosis.

The diagnosis of acute pulmonary embolism in patients with chronic obstructive pulmonary disease.

The clinical features and noninvasive tests, including ventilation perfusion (V/Q) lung scans, were assessed in 108 patients with chronic obstructive pulmonary disease (COPD) suspected of having pulmonary embolism (PE). Twenty-one (19 percent) of 108 patients had PE. In the majority of patients, it was impossible to distinguish between patients with and without PE by clinical assessment alone. However, when a high clinical index of suspicion was present, PE was confirmed by angiography in three of three patients, but the V/Q scan was of intermediate probability. No roentgenographic abnormalities distinguished between PE and no PE. There was no difference between the alveolar-arterial oxygen gradients in either group, nor was there evidence of a reduction in the PaCO2 in patients with PE who had prior hypercapnia. Among the 108 patients with COPD, high, intermediate, low, and normal/near normal probability scans were present in 5 percent, 60 percent, 30 percent, and 5 percent, respectively. The frequency of PE in these V/Q scan categories was five (100 percent) of five, 14 (22 percent) of 65, two (6 percent) of 33, and zero (0 percent) of five, respectively. In conclusion, in the majority of patients, the V/Q scan diagnosis is usually intermediate and such patients require further investigational studies, including angiography. However, among the few patients who demonstrated a high probability lung scan, there was a high positive predictive value for PE effectively avoiding the need for further studies. In those patients with low probability or near normal/normal V/Q scans, the negative predictive value was not lower than the general hospital population.

Negative symptoms and reaction time in schizophrenia.

This study explored the association of negative symptoms and reaction time. Negative symptoms were specifically associated with reaction time slowing and variability in schizophrenics, but not in affective disorders. The finding of specificity did not extend to other measures of the deficit syndrome nor to motor performance. An abbreviated version of the negative symptom scale was especially effective in separating groups.

Laterality in schizophrenia. A reaction time study.

A laterality study in schizophrenia was carried out by measuring reaction time (RT) in a baseline condition and while subjects were engaged in a concurrent task. In the baseline condition, a clinical measure of psychoticism was associated with differential slowing with the right hand in schizophrenic dextrals but not in a control group of affective dextrals. The concurrent task suppressed the effect of psychoticism on RT performance. The results suggest that left-hemisphere deficits in schizophrenia are state dependent, and so not necessarily due to cortical dysfunction.

Isolated pulmonary artery stenosis: four-year follow-up: case report.

The authors present a four-year follow-up of a patient with a single isolated right main pulmonary artery stenosis without an associated cardiac anomaly. This is an extremely uncommon lesion thought to be congenital. This case illustrates the stability of isolated lesions of the pulmonary vasculature without associated cardiac defects.

Voluntary motor performance in psychotic disorders: a replication study.

Voluntary motor performance was used to investigate the hypothesis of a continuum of psychosis from depression through schizophrenia. 43 schizophrenic, 36 schizoaffective, 50 major depressive, 20 manic, and 25 nonpsychotic patient controls were tested for tapping speed, finger dexterity, hand grip strength, and neuropsychological motor performance. Sex was included as an independent variable, and the effects of psychotropic drugs were evaluated. A continuum of motor dysfunction from depression through schizophrenia was not obtained. A measure of current psychotic symptoms was not associated with motor or neuropsychological performance. Motor performance was significantly worse in schizophrenic, schizoaffective, and psychotic affective disorders, when compared to nonpsychotic affective disorders. In this final analysis, psychoticism was defined by history. The results are discussed in terms of the hypothesis that psychoticism is a trait that is independent of diagnosis.

Reaction time impairment in schizophrenia and affective illness: the role of attention.

A young but chronic group of schizophrenic and affective disorders patients was tested for simple reaction time (RT) and RT while engaged in a concurrent task. The affective disorders patients were subdivided by the presence of psychotic features. The results show that extreme slowing of RT is due to psychoticism and is not characteristic of nonpsychotic affective illness. Extreme intrasubject variability, however, was specific to schizophrenia, and may be a trait marker of the disorder.

Obstructive sleep apnea in amyloidosis treated with nasal continuous positive airway pressure.

Obstructive sleep apnea can occur in patients with a variety of upper airway anatomic abnormalities including macroglossia. We present a case of macroglossia secondary to amyloidosis causing obstructive sleep apnea that was successfully treated with low pressures of nasal continuous positive airway pressure (5 cm of water).

Treatment of massive acute pulmonary embolism. The use of low doses of intrapulmonary arterial streptokinase combined with full doses of systemic heparin.

The efficacy of low-dose, locally administered streptokinase (SK) combined with full therapeutic systemic doses of heparin was investigated. Seven patients with angiographically proven massive acute pulmonary embolism were treated. Streptokinase, 10,000-20,000 units/hour, was administered directly into the left or right pulmonary artery for 9 to 24 hours. Heparin was administered concurrently. The number of unperfused segments of the infused lung shown on the lung scan decreased from 5 +/- 2 to 2 +/- 1 after 12-24 hours (p less than .01). No change was shown in the contralateral lung. The angiographic index of severity score in the infused lung decreased from 16 +/- 1 to 9 +/- 4 (p less than .01). The partial pressure of oxygen in arterial blood improved within four hours. In spite of the low doses of streptokinase, however, two major bleeding episodes occurred that required blood transfusion. In conclusion, low dose intrapulmonary streptokinase, combined with intravenous heparin, may provide a therapeutic option in patients with life-threatening massive acute pulmonary embolism in whom full dose lytic therapy may be hazardous, although even low dose lytic therapy was associated with risk.

Identical twins with hereditary hemorrhagic telangiectasia concordant for cerebrovascular arteriovenous malformations.

Central nervous system arteriovenous malformations are uncommon in hereditary hemorrhagic telangiectasia. Identical twins are described with hereditary hemorrhagic telangiectasia and concordance for central nervous system arteriovenous malformations identified by angiography. One twin had a central nervous system hemorrhage in the seventh month of pregnancy and also had a pulmonary arteriovenous malformation. The other was asymptomatic. A previously reported association between HLA type A2 BW17 and hereditary hemorrhagic telangiectasia was not confirmed. Two recombinations were identified between the loci for HLA and hereditary hemorrhagic telangiectasia. The loci for HLA and hereditary hemorrhagic telangiectasia are not closely linked. Stroke in a young person should prompt an inspection for manifestations of hereditary hemorrhagic telangiectasia.

An assay for the measurement of the protein content of cells immobilized in carrageenan.

A reliable and reproducible method for the estimation of the protein content of fungal cells immobilized in a carrageenan gel is described. The procedure depends upon the acid lability of the polysaccharide gel at 90 degrees C and on the acetone solubility of accumulated phenolics. Freeze-dried gel beads (2-3 mm) containing entrapped cells of Penicillium urticae were ground to a fine powder and samples of powder (approximately 20 mg) were sequentially extracted with hot 1 N HCl - 0.9% NaCl and acetone. The precipitated residue contained the cell protein, which was then solubilized with 1 N NaOH at 90 degrees C and quantitated by the Folin-Lowry method. Interferences from both carrageenan and phenols were thus eliminated. The presence of carrageenan (20-25 mg) did not affect the recovery of varying amounts (0-2500 micrograms) of bovine serum albumin. The recovery of radiolabeled protein from immobilized cells was parallel to that of Folin-Lowry positive material over a range of 0-60 beads (0-60 mg powder). Cycloheximide (0-100 micrograms/mL) was shown to progressively inhibit the incorporation of L-[U-14C]leucine so that the radioactivity present in the initial HCl-NaCl extract (i.e., [14C]leucine) increased as that in the final NaOH extract (i.e., 14C-labeled protein) decreased. Using this new assay for cell protein, free and immobilized cell cultures were found to exhibit virtually identical kinetics of glucose utilization, growth, and patulin production. In addition to providing a means of comparing the specific productivity of free versus immobilized cell preparations, this assay accurately measures the incorporation of [14C]leucine into cellular protein and could be used as a measure of cell viability.

Alexithymia: examining the development of a psychological concept.

Alexithymia is a clinically derived concept that refers to difficulty patients have with verbal expression of emotions and with fantasy elaborations. Since its recent introduction into the literature, it has been discussed in various contexts and has been considered by some to be a useful concept in integrating data from a variety of disciplines. The authors contend that many of the speculations about alexithymia are based on an inadequately researched data base and that its application in some areas is premature. They recommend careful investigation of any newly introduced psychological concept to avoid either its premature rejection or its reification.

Identification of nonhistone chromosomal proteins binding specifically to cloned alpha-fetoprotein DNA sequences.

A sequential nitrocellulose filter binding assay has been used to quantitate specific binding by nonhistone proteins of a cloned DNA fragment coding for the 3' end of the mouse alpha-fetoprotein gene. Nonhistone proteins from fetal mouse liver, from adult liver, and from kidney, all bind this fragment specifically; there is no significant difference in binding by proteins isolated from these three tissues. The proteins responsible for specific binding have been isolated by sucrose density gradient ultracentrifugation of DNA-protein complexes and characterized by sodium dodecyl sulfate - polyacrylamide gel electrophoresis and electron microscopy. The majority of the specific binding proteins from adult liver consists of two polypeptides of molecular weights 53 500 and 51 000; three or four minor bands in the molecular weight range 43 000-48 000 are also observed. Similar specific binding proteins exist among the fetal liver nonhistone proteins. The native binding proteins as visualized by electron microscopy are very large and appear to bind specifically to a site near the centre of the alpha-fetoprotein DNA fragment, as well as nonspecifically to the ends of all DNA molecules.

Dependence on androgens of the specific DNA-binding activity of rat ventral-prostate non-histone chromosomal proteins.

Interactions between rat prostate non-histone chromosomal proteins and DNA were studied by using a nitrocellulose-filter-binding technique to monitor the formation of DNA--protein complexes. The total binding activity of the non-histones, as measured by binding of proteins to a trace quantity of labelled DNA, displays no preference for rat DNA relative to Escherichia coli DNA. Sequestration of non-specific binding proteins by preincubation with unlabelled bacterial DNA enables detection of a fraction of rat prostate non-histones that binds preferentially to labelled rat DNA relative to labelled E. coli DNA. After castration of adult male rats, both total and specific binding activities decrease. Administration of 5 alpha-dihydrotestosterone to castrated rats stimulates both total and specific DNA-binding activities of prostate non-histones; specific binding is stimulated to a greater extent than total DNA, indicating that the specific binding proteins constitute a larger fraction of the non-histone proteins in the presence of androgens. The specific DNa-binding activity is dependent on the dose of steroid administered.

Nuclear proteins. VI. Fractionation of chromosomal non-histone proteins using hydrophobic chromatography.

Mouse liver non-histone proteins, isolated by hydroxyapatite chromatography, were fractionated by hydrophobic chromatography using omega-amino-decyl-agarose omega-amino butyl-agarose, decyl-agarose, butyl-agarose, phenyl-Sepharose, and CPAD-Sepharose. Two column loading techniques were used. In the 0.35 M NaCl technique, the proteins were dialized into 0.35 M NaCl, applied to the column and initially eluted with 0.35 M NaCl. In the 40% (NH4)2SO4 technique, the non-histone proteins were mixed with the hydrophobic agarose, dialized against 40% (NH4)2SO4, and initially eluted with 40% (NH4)2SO4. In both cases the columns were subsequently eluted with 10 mM Tris-HCl, pH 7.5, 0.35, 1.0 and 5.0 M LiBr, and finally with 1% sodium dodecyl sulfate. The 0.35 M NaCl technique, using decyl-agarose and phenyl-Sepharose, resulted in a single step marked enrichment of the major hnRNA proteins (1 M LiBr fraction). The 40% (NH4)2SO4 technique resulted in a single step isolation of a pair of 15-20 000 dalton polypeptides.

Specific interaction between mouse liver non-histone chromosomal proteins and mouse DNA demonstrated by a sequential DNA-protein binding procedure.

The binding of mouse liver chromosomal proteins to DNA has been investigated using the nitrocellulose filter binding technique. Careful purification of the DNA involving nuclease S1 digestion and prefiltration through a nitrocellulose filter is used to reduce background binding in the absence of protein to less than 1%. Procedures involving direct binding of protein to labeled DNA, competition of binding of labeled DNA by unlabeled DNA, and dissociation of DNA . protein complexes with time do not indicate significant preference for binding to mouse DNA relative to Escherichia coli DNA. This specificity is demonstrated much more clearly by a novel type of procedure, which we call a sequential binding procedure. In this procedure non-specific binding proteins are sequestered by incubation with an excess of unlabeled E. coli DNA prior to addition of labeled DNA. Under these conditions, labeled mouse DNA is bound to filters to a 3- to 4-fold greater extent than labeled E. coli DNA.

Control of proliferative growth in androgen responsive organs and neoplasms.

Growth of a normal androgen-responsive organ appears to be ordered by the function of three constraint mechanisms which are sensitive to the intranuclear concentration of androgens. For the complete expression of these constraint mechanisms, several properties underlying hormonal responsiveness must be manifest by the cell, including the presence of cytoplasmic receptor, the ability to transfer androgens into the nucleus, the competence to form nuclear receptor, and the fidelity of the interaction between androgens and chromatin. Cytoplasmic receptor alone is not an exclusive indication of hormonal dependence in vivo, but its presence is associated with enhanced ability of the cell to incoropate androgens into the nucleus. Androgens are required for the initiation of DNA synthesis and cell proliferation, and nuclear receptor may not be required for these responses. On the other hand, it is possible that the function of the latter molecule is concerned with negative feedback or cellular autolysis.