Near-fatal heat stroke during the 1995 heat wave in Chicago.

BACKGROUND: In July 1995, Chicago sustained a heat wave that resulted in more than 600 excess deaths, 3300 excess emergency department visits, and a substantial number of intensive care unit admissions for near-fatal heat stroke. OBJECTIVE: To describe the clinical features of patients admitted to an intensive care unit with near-fatal classic heat stroke. Patients were followed for 1 year to assess delayed functional outcome and mortality. DESIGN: Observational study. SETTING: Intensive care units in the Chicago area. PATIENTS: 58 patients admitted to the hospital from 12 July to 20 July 1995 who met the case definition of classic heat stroke. MEASUREMENTS: The data collection tool was designed to compile demographic and survival data and to permit analysis of organ system function by abstracting data on physical examination findings, electrocardiography and echocardiography results, fluid resuscitation, radiography results, and laboratory findings. Data on functional status at discharge and at 1 year were collected by using a modified Stanford Health Assessment Questionnaire. RESULTS: Patients experienced multiorgan dysfunction with neurologic impairment (100%), moderate to severe renal insufficiency (53%), disseminated intravascular coagulation (45%), and the acute respiratory distress syndrome (10%). Fifty-seven percent of patients had evidence of infection on admission. In-hospital mortality was 21%. Most survivors recovered near-normal renal, hematologic, and respiratory status, but disability persisted, resulting in moderate to severe functional impairment in 33% of patients at hospital discharge. At 1 year, no patient had improved functional status, and an additional 28% of patients had died. CONCLUSIONS: Near-fatal classic heat stroke is associated with multiorgan dysfunction. A high percentage of patients had infection at presentation. A high mortality rate was observed during acute hospitalization and at 1 year. In addition, substantial functional impairment at discharge persisted 1 year. The degree of functional disability correlated highly with survival at 1 year.

Phosphorylation of pp62 and pp54 src-like proteins in a rat intestinal cell line in response to gastrin.

Intracellular mechanisms that mediate mitogenic effects of gastrin remain largely unknown. The present studies were designed to examine if protein tyrosine kinases (PTKs) mediate growth effects of gastrin on a rat intestinal epithelial cell line (IEC-6 cells). Gastrin (< 10 nM) was mitogenic for IEC-6 cells. PTK activity of cell membranes was stimulated in response to 0.01-10.0 nM and 0.05-10.0 microM gastrin in a double biphasic manner. Cells labeled with H3(32)PO4 were stimulated with gastrin and cellular proteins immunoprecipitated with phosphotyrosine antibodies. Endogenous proteins were phosphorylated in a dose- (100% effective dose = 0.1-1.0 nM) and time-dependent manner; at > 10 nM gastrin, the second peak of response was not measured in intact cells. Thus the growth and phosphorylation response of intact cells to gastrin was similar. Both high [dissociation constant (Kd) = 1 nM]- and low (Kd = approximately 0.1 microM)-affinity gastrin binding sites are present on IEC-6 cells. The results of the present study suggest that occupancy of both high- and low-affinity gastrin-binding sites can potentially activate membrane-associated PTKs. However, in intact cells, occupancy of low-affinity sites apparently attenuates kinase activity resulting in reduced protein phosphorylation. Eight protein bands [with relative molecular weight (M(r)) of 32-145 kDa] were tyrosine phosphorylated in intact cells in response to 0.1-1.0 nM gastrin, including two pp60 src-like proteins (with M(r) of 54 and 62 kDa). Thus the growth response pattern of a target cell to gastrin may depend on the stimulation of kinases and other factors (phosphatases?) that phosphorylate and/or dephosphorylate several proteins including c-src-like proteins in a dose-dependent manner.

Serological responses in primary neuritic leprosy.

The serological responses to 2 Mycobacterium leprae specific epitopes and one common mycobacterial antigen were examined in 46 untreated patients with primary neuritic (PN) leprosy. M. leprae specific antibodies to the terminal disaccharide of phenolic glycolipid and/or the ML-04 defined epitope on the 35 kDa protein were detected in 41% of PN patients and 47% responded to one of the 3 antigens. This serological response mirrored that observed in paucibacillary leprosy patients. There was a significant increase in the level of antibody response when more nerve trunks were involved. Changes in antibody levels in seropositive PN patients may prove useful in monitoring the response to chemotherapy.

Heterogeneity of serological responses in paucibacillary leprosy--differential responses to protein and carbohydrate antigens and correlation with clinical parameters.

We have examined the serological responses of 154 untreated paucibacillary (PB) leprosy patients to two carbohydrate and one protein antigens of Mycobacterium leprae. There was a heterogeneous response with 20% of PB patients having IgM anti-PGL-I antibodies and a similar proportion with IgG anti-LAM antibodies, while 33% had antibodies to the M. leprae-specific epitope on the 35-kDa protein. There was overlap in the responses such that 43% of the patients were seropositive in one of the two M. leprae-specific assays, while 49% were positive in any assay. There was a gradation in seropositivity with increasing extent of disease for each of the clinical parameters measured. Those with established disability at the time of presentation were more likely to be seropositive in each assay.

Primary dapsone resistant leprosy in Nepal.

Mouse foot pad testing for primary dapsone resistant leprosy was performed in 15 patients. 13 were resistant (87%). Two patients below 10 years were living with lepromatous leprosy mothers, one male aged 21, was born in Kokana leprosarium and ten others gave no history of known contact of leprosy.

Prevalence of secondary dapsone resistance in Nepal.

Between 1980-1982, 56 patients suspected of developing dapsone resistant leprosy were seen at the skin clinic of Anandaban Leprosy Hospital and Kokana Leprosarium. Out of 56, 16 control mice had no growth. 29 patients (72.5%) were proved resistant by Mouse foot pad tests.

[Lagophthalmos and posterior synechiae of the iris during treatment of leprosy with diaminodiphenylsulfone]. / Lagophthalmus und hintere Synechien der Iris bei der Behandlung der Lepra mit Diamino-diphenyl-sulfon.

Four years after controlled and standardized chemotherapy with diaminodiphenylsulfone (DDS), 316 patients in the leprosarium at Khokana, Nepal were re-examined for ophthalmological findings. Patients who, 4 years earlier, had not had lagophthalmos in either eye, nor posterior synechiae of the iris, had only developed these complications in the meantime if they were suffering from DDS-resistant leprosy. New posterior synechiae of the iris were only found in patients with inactive leprosy who had already had a posterior synechia in the fellow eye four years previously. In cases of inactive leprosy there was also a tendency for existing posterior synechiae to increase. It is emphasized that the development of lagophthalmos or posterior synechiae of the iris indicates that a previously inactive leprosy may have become reactivated in spite of treatment with DDS.