Lingual hematoma causing upper airway obstruction: an unusual manifestation of dengue fever.

The spectrum of dengue infection varies from dengue fever to more severe forms such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). In DHF bleeding may be overt (external) or internal. At time bleeding can occur at unusual sites. We report one such case of DHF in which bleeding occurred within the tongue manifesting as an intra-lingual hematoma, causing significant upper airway obstruction.

Pregnancy in an untreated case of transverse vaginal septum with vesicovaginal fistula.

An 18-year-old woman presented with history of cyclic hematuria, abdominal pain, and a mass in the hypogastrium. She was found to have transverse vaginal septum in the lower one-third of her vagina with congenital vesicovaginal fistula (VVF) and a dead fetus of approximately 20 weeks gestation. She underwent vaginotomy and removal of the dead fetus. Vaginal repair of VVF was carried out 3 months later.

Adsorption from solutions on synthetic hydroxyapatite: nonaqueous vs. aqueous solvents.

It is useful in restorative dentistry and etiology of bone diseases to know that certain general rules may be derived from a priori considerations of the adsorption of chemicals to synthetic hydroxyapatite (which is the structural prototype of tooth and bone mineral). This article systematically synthesizes the extensive studies on the subject by the author, and rationalizes and extends these rules. Though not a review article, the work of some researchers may not have found an adequate representation here, because they did not determine, in the case of nonaqueous solvents, the reversibility of adsorption; or, in the case of aqueous solvents, the concentration of all constituent ions of the system, thus missing the occurrence of processes other than adsorption. The adsorption of solutes from nonaqueous solvents on hydroxyapatite is mainly regulated by the interplay of hydrogen bonding between adsorbate, adsorbent, and solvent. It does not involve any significant role of ionic nature of the apatite surface, because it is masked by the chemisorbed and physisorbed water. This interplay of hydrogen bonding in conjunction with chemical and structural characteristics of the adsorbed molecules controls their reversibility and the orientation of the adsorbates on the surface. In general, the process may be considered as true adsorption, because no other material exchange process is involved. The "adsorption" of solutes from aqueous solutions generally involves ion-exchange with the apatite surface, and may be affected by the concentrations of potential determining ions (Ca(2+), phosphates, H(+), etc.) in the solution. The solute in aqueous solution may be removed by two other mechanisms, either by formation of a surface complex or by chemically reacting with calcium or phosphate ions to form a new phase that precipitates out of solution. Therefore, the concentration of calcium and phosphate ions in solution should also be monitored to elucidate the mechanism of the process. Adsorption of polymers seems to be determined primarily by their multiple hydrogen bonding, their relative molar mass, and their ability to self-associate. The hydrogen ion concentration plays a decisive role in each one of the above mechanisms.

Maternal plasma leptin is increased in preeclampsia and positively correlates with fetal cord concentration.

OBJECTIVE: We tested the hypothesis that the maternal leptin concentration would be increased in preeclampsia, independent of maternal obesity. STUDY DESIGN: Maternal and cord plasma leptin concentrations were compared in 2 groups of women with either preeclampsia (n = 24) or normal pregnancy (n = 24), matched 1:1 for prepregnancy body mass index and fetal gestational age at sampling. RESULTS: Median leptin concentrations were significantly higher (P <. 03) in women with preeclampsia (45.6 ng/mL) than in normal pregnant women (27.0 ng/mL) and fell rapidly shortly after delivery (26.7 ng/mL and 25.4 ng/mL, respectively). Cord leptin was not significantly different between groups (5.4 ng/mL and 5.8 ng/mL, respectively). Maternal and cord leptin correlated significantly (rho = 0.76, P <.01) only in preeclampsia. CONCLUSION: Preeclampsia is associated with an increase in maternal plasma leptin concentrations that strongly correlates with the fetal cord concentration at delivery.

Human gastric intrinsic factor expression is not restricted to parietal cells.

Gastric parietal cells have been accepted as the only site of intrinsic factor production in the human stomach. In animals, however, intrinsic factor has been localised to various other cell types of foregut origin, including chief and enteroendocrine cells in gastric mucosa, and duct cells from salivary glands and pancreas. The availability of recombinant human intrinsic factor has led to production of high titre, monospecific antiserum which was used to reexamine the distribution and subcellular localisation of intrinsic factor in the human stomach. Immunolight microscopy revealed that most positively stained cells were gastric parietal cells, but at the margins of the anatomical regions (e.g. cardia/fundus, body/antrum) clusters of gastric chief cells and individual enteroendocrine cells were found to contain intrinsic factor. Immunoelectron microscopy demonstrated the highest antigen density on endocytic and apical membranes of parietal cells. Exocrine secretory granules of a subpopulation of chief cells, the secretory granules of some enteroendocrine cells, and the plasma membranes and smooth vesicles of endothelial cells of the lamina propria capillaries underlying enteroendocrine cells were also positive for the antigen. Labelling in all cells was specific, as it was abolished by preabsorption of the antisera with purified recombinant human intrinsic factor. These findings demonstrate a potential for cellular expression of human intrinsic factor in nonparietal cells. Because such expression occurs normally at the margins of anatomical gastric regions, it suggests that local factors may influence expression of intrinsic factor.

Interaction of citric acid with hydroxyapatite: surface exchange of ions and precipitation of calcium citrate.

The use of citric acid is efficacious and distinctive in the demineralization of dentinal root surfaces for periodontal regeneration and in the etching and conditioning of enamel or dentin for bonding restorative resins. To decipher the role of citric acid in these applications, it is important that one have a basic understanding of its interaction with synthetic hydroxyapatite. The uptake or removal of citrate ions from aqueous solutions of citric acid (4 to 100 mmol/L, 10 mL) by hydroxyapatite (1 g) was studied at 22 degrees C after a given reaction period (from 3 hr to 11 days) by immediate spectrophotometric monitoring of the concentrations of the filtrates (214 nm). The concentrations of calcium, phosphate, and hydrogen ions were also determined in the same solutions. The interaction: (i) is a time-independent ionic-exchange process with the substrate when the initial acid concentrations are dilute (4 to 12.5 mmol/L), and (ii) is a reactive process that is time-dependent for higher acid concentrations. The exchange process shows an adsorption of about one citrate ion per (100) face of the unit cell of hydroxyapatite for a maximally exchanged surface. The curves representing the reactive process may be quantitatively or qualitatively explained on the basis of the supersaturation of the solutions with respect to calcium citrate and its slow precipitation. The physico-chemical analysis of the needle-shaped birefringent crystals of the precipitate from the supersaturated solutions confirms the precipitate to be Ca3(citrate)2.4H2O.

Indolent course of advanced neuroblastoma in children older than 6 years at diagnosis.

BACKGROUND: An early observation suggests that children older than 6 years of age at diagnosis of neuroblastoma constitute a favorable prognostic group. METHODS: Kaplan-Meier plots of survival of all such patients diagnosed at the Children's Hospital of Pittsburgh 1975-1992 were compared with curves of concurrently treated patients with Stage IV disease who were 1-6 years of age at diagnosis ("younger patients"). Known prognostic features, including stage and primary site of disease, pattern of metastases, histopathology, MYCN gene amplification, and urinary catecholamine metabolite ratios, were reviewed. RESULTS: Of 17 children diagnosed after the age of 6 years ("older patients"), 13 patients had Evans' Stage IV disease and 4 had Stage III disease. The median survival was 3.24 years (range, 0.63-15.04 years) for the entire cohort and 3.07 years for those children with Stage IV disease. This compared with a median survival of 1.05 years in 34 concurrent younger patients (P < 0.01). In most cases, disease in these older patients was characterized by a short-lived complete or partial remission followed by aggressive recurrent disease that was partially and only transiently chemo- or radiosensitive. Only 3 patients (2 with Stage IV disease) are in continuous complete remission at 3, 5 10/12, and 14 1/2 years from diagnosis. Although poor prognostic factors were common, including the presence of bony metastases (12/17), biopsy material from pretreatment tumor specimens demonstrated a single MYCN gene copy number in all patients and favorable histology in 15 of 16 samples. CONCLUSION: Older children with neuroblastoma have a more indolent course than do younger patients, a finding that appears to be related to favorable histology and the absence of MYCN amplification. Examination of larger numbers of such patients from cooperative groups should lead to a better understanding of what appears to be a subset of pediatric patients with neuroblastoma who may benefit from specifically tailored treatment protocols.

Fluorescence in situ hybridization (FISH) detection of MYCN oncogene amplification in neuroblastoma using paraffin-embedded tissues.

The expression and degree of amplification of the MYCN oncogene in neuroblastoma provide an important indicator of disease prognosis. Detection of MYCN amplification has been described using Southern blotting or polymerase chain reaction (PCR) on DNA from fresh or frozen tissue samples, and using in situ hybridization mainly on metaphase spreads or smears of cultured neuroblastoma cells. In this article, we describe fluorescence in situ hybridization (FISH) results on detection of MYCN amplification in formalin-fixed, paraffin-embedded samples of 25 neuroblastoma and 20 nonneuroblastoma pediatric tumors. MYCN amplification was readily detectable by FISH in eight of the neuroblastomas; correlation with results obtained by Southern analysis was perfect. Of the nonneuroblastoma tumors, only one of three retinoblastoma cases showed MYCN amplification. In contrast to the Southern blot technique, FISH demonstrated the state of amplification heterogeneity of the tumor cells as well as the nature of the amplification units: double-minute chromosomes (DMs) or homogeneously staining regions (HSRs). The results indicate that FISH is a rapid and reliable method for detection of MYCN oncogene amplification in routinely processed samples and may be used to supplant the Southern blot technique.

Interaction of chlorhexidine digluconate with and adsorption of chlorhexidine on hydroxyapatite.

It is well known that chlorhexidine digluconate provides an effective microbicidal activity during oral rinsing, and therefore, it was considered worthwhile to investigate its interaction with hydroxyapatite on a fundamental level. The kinetics of uptake (or reaction) of the compound from aqueous solutions by synthetic hydroxyapatite was studied at 23 degrees C for four time periods by monitoring its concentration. There was no uptake at low concentrations for any time period. The uptake curves for higher concentrations shifted towards the lower concentrations as the period increased and became more and more vertically oriented to the concentration axis. The concentrations of calcium ions increased, phosphate ions decreased and hydrogen ions decreased a little for a given period as the concentration of the compound was increased. All of these experimental facts can be qualitatively explained on the basis of the solubility considerations of hydroxyapatite and of chlorhexidine phosphate, the reaction product that slowly precipitates out of the solution. The needle-shaped birefringent crystals of the phosphate salt are clearly visible in the apatite matrix under a microscope, and its refractive index and differential Fourier transform infrared spectra match almost exactly with those of a well-characterized, synthesized phosphate salt. To explore the nature of interaction, the uptake of chlorhexidine base was studied from p-dioxane and it is irreversible. The uptake is total below a threshold equilibrium concentration and constant above it.

Genomic structure and organization of a Q-like gene in the GRC-G/C region of the rat.

In the rat homologue of the mouse Q/TL region, grc-G/C, a TL-like gene (RT1.N) has been identified recently. This paper reports on a Q-like gene, designated RT1.0, that maps in the same region. It contains a 5' untranslated region (UT), signal peptide, alpha 3 domain, transmembrane region, cytoplasmic domain (three exons) and 3'UT region. Comparison with mouse class-I genes shows that the greatest similarity is to the H-2Q, K, D and L genes; it is very different from the TL genes of the mouse and rat. A sequence that includes many CT repeats occurs in the 3'UT region of RT1.0 and in three to five other class I-hybridizing fragments. Thus, the MHC-linked region of the rat contains both Q-like and TL-like class-I genes.

Adsorption of low-molecular-weight sodium polyacrylate on hydroxyapatite.

Adsorption of low-molecular-weight sodium polyacrylate from aqueous solution onto synthetic hydroxyapatite was studied at room temperature so that the mechanism of adhesion of polyacrylate cements to tooth mineral could be elucidated. The adsorption isotherm of sodium polyacrylate was Langmuirian in shape and was thus qualitatively different from that of polyacrylic acid (Misra, 1991), which exhibited an adsorption maximum. The self-association of the molecules that probably causes the maximum to occur with polyacrylic acid was effectively absent for the relatively well-ionized, electrostatically repelling polyacrylate ions of the salt. With the adsorption of acrylate ions, the concentration of phosphate ions increased monotonically, while the concentration of calcium ions showed a minimum. The adsorption of sodium polyacrylate was irreversible, as it was for polyacrylic acid.

An esthetic glass-ceramic for use in composite restoration inserts.

The objective of the preliminary work reported here was to prepare an improved formulation of intrinsically colored microcrystalline glass-ceramic. Applications could include "megafillers" for direct composite restorations, precision castings, and CAD-CAM prostheses. The experimental glass-ceramic reported here contained SiO2 56.9, AI2O3 19, LiO2 7, ZnO 6, MgO 5, TiO22, ZrO22, P2O52, and CeO20.1 mole%. The batch materials were melted and stirred at 1,610 degrees C for 2 h, quenched in water and also formed into a block of a clear, slightly yellow glass. To identify the crystalline phases that developed during transformation of the glass to the ceramic, x-ray diffraction was used on ten aliquots taken during 15 h of stepwise heating from 750 to 1050 degrees C. With heating, the yellow color deepened to a very translucent "dark yellow" dental shade, then lightened with gradually increasing opacity during formation of secondary crystalline phases. X-ray opacity was approximately equivalent to that of dental enamel. The refractive index of the glass, nD1.554, increased during nucleation and growth of the crystalline phases to a maximum of 1.586. Intrinsic coloration of these glass-ceramic materials can be controlled by varying the heat treatment and/or composition to match typical dental shades.

Adsorption and orientation of tetracycline on hydroxyapatite.

Adsorption of tetracycline from separate solutions of ethanol, p-dioxane, and chloroform onto synthetic hydroxyapatite (containing about 1.5 monolayer of physisorbed water) was studied in order to understand its interaction with bone and teeth. The adsorption isotherms of tetracycline are reversible and Langmuirian from ethanol and p-dioxane and are almost identical. The isotherm is irreversible from chloroform, and a constant amount of adsorbate is removed from the solutions above a certain concentration. The irreversibly adsorbed compound is completely desorbed by prolonged repeated washing with ethanol. An analysis of the reversible isotherms showed that at maximum coverage the ring or polycyclic structure of the molecule stands perpendicular to the surface with appropriate hydroxyl groups and keto-oxygens hydrogen bonded to the surface. However, the adsorption from chloroform is irreversible and at maximum adsorption is about one and half times larger than that from either ethanol or p-dioxane. The process of adsorption does not affect the chemical integrity of tetracycline.

Biochemical analysis of the rat MHC class I antigens RT1.Aa, RT1.Fa and Pa.

In DA strain rats, there are two other MHC class I loci (Pa and RT1.Fa) in the vicinity of the classical class I locus RT1.Aa. The Pa antigen is the pregnancy-associated antigen, and it was detected by antibodies elicited in WF females pregnant by DA males without any other immunization. The Fa antigen was detected by a monoclonal antibody raised by alloimmunization. In the present work, the Aa, Fa and the Pa antigens have been compared by HPLC peptide mapping and by isoelectric focusing after their isolation by appropriate monoclonal antibodies. All the three antigens are identical in primary structure with respect to lysine, methionine, asparagine and the aromatic amino acid residues, but they differ from one another with respect to glutamic acid and/or aspartic acid residues. The pI values of the antigens differ slightly. All three antigens have two identical N-linked glycans, but the Fa antigen has an additional N-linked glycan. Based on the available amino acid sequence of the Pa antigen, it can be concluded that both Aa and Pa antigens are devoid of glycosylation in the second domain. This lack of glycosylation of the classical antigen Aa is unique for the rat, since classical class I antigens of the mouse show glycosylation in the first and second, and sometimes in the third domain, and those in the human, in the first domain only. The high degree of similarity among the Aa, Fa, and Pa molecules that this study indicates is also unique for the rat, since antigens encoded by different class I genes of the same haplotype are quite disparate in the mouse and human.

Major histocompatibility complex class I antigens expressed on rat trophoblast cells.

There is controversy about the size of the major histocompatibility complex antigens of trophoblast cells from placenta. There are some reports that the heavy chains of these molecules are smaller (39-43 kd) than those of the classical class I antigens (45-46 kd), while there are others which show that both the light and the heavy forms of class I antigens occur in the trophoblast cells. In order to investigate this problem, we studied the classical class I antigen (RT1.Aa) and the pregnancy-associated class I antigen (Pa) of the rat from 125I-labeled basal trophoblast cells, isolated from the placenta of WF females pregnant by DA males, using very mild conditions. These antigens were compared with those of the syngeneic (DA x DA) trophoblast cells or paternal (DA) lymphocytes by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Both the Aa and Pa antigens, precipitated from the two trophoblast preparations, showed a heavy chain of 46 kd associated with a 12 kd beta 2-microglobulin component, as did the same molecules precipitated from the lymphocytes. Heavy chains in the range of 39-43 kd could not be detected in any of the samples. The results suggest that the smaller molecular weight heavy chains are methodological artifacts and could arise from loss of a glycan(s) during isolation.

A unique antigen, RT11, in the placenta of the rat.

In the course of exploring the antibody response in the unsensitized WF (u) female pregnant by a DA (a) male, we prepared a hybridoma that secreted an antibody (mAb 213) that was specific to the a haplotype but identified an antigen different from Pa. This antigen was designated RT11. It is present from the twelfth day of gestation on the collagen fibers of the placenta and of all organs in fetal and adult rats. It is particularly prominent on red blood cells; in the yolk sac epithelium; in the walls of the endodermal sinus, blood vessels and bronchioles; and in capsules and trabeculae. A very small amount is present on DA lymphocytes, since 17-20% of them react with mAb 213 by cytofluorimetry. The RT11 antigen is absent from the basal and labyrinthine trophoblast cells, from the parenchymal cells of all organs, and from T and B cells. This distribution pattern is completely different from that of the Aa and Pa antigens. Inhibition and absorption studies showed that RT11 is not an integral part of the collagen molecule. The SDS-PAGE analysis of the immunoprecipitates of RT11 from radioiodinated whole-membrane extracts of red blood cells and from the glycoprotein fraction thereof showed that it is an unglycosylated protein of molecular weight 29,000. The evidence to date suggests that RT11 is a blood group antigen. Studies on the genetic control of the expression of RT11 were undertaken to determine whether a gene linked to the MHC was involved and whether the control mechanism was unigenic or polygenic. Backcrosses generated using inbred strains--(DA x BN)F1 x DA-- and using complementary congenic strains--(DA.1N x BN.1A) F1 x BN.1A--showed that the expression of RT11 was under polygenic control, and that both an MHC-linked gene (1.2 cM from RT1.Aa) and genes not linked to the MHC are involved. By contrast, the expression of the Pa antigen is under the control of an MHC gene only.