Atrial flutter and fibrillation following bee stings.

Atrial tachyarrhythmias following bee stings in 2 patients are described. These have not been previously reported in the absence of anaphylaxis.

Utility of a bedside Doppler in tracking left ventricular dysfunction related to hemorrhagic shock.

Treatment of hemorrhagic shock with fluid resuscitation alone results in diastolic dysfunction as measured by peak systolic pressure/end systolic volume ratio (PSP/ESV). The purpose of this study was to test the ability of a simple Doppler device to track diastolic dysfunction in hemorrhagic shock. In this prospective, controlled crossover study, five adult swine were resuscitated from hemorrhagic shock using fluids. Diastolic dysfunction was confirmed using PSP/ESV ratio. The effect of nitroprusside and dobutamine on this diastolic dysfunction was evaluated. Data (PSP/ESV, Doppler-derived acceleration, and oxygen transport parameters) were collected at each stage of the model. Arterial pressure and oxygen transport parameters corrected to baseline values; however, the PSP/ESV and Doppler-derived acceleration failed to correct with fluid resuscitation alone. Treatment with nitroprusside and dobutamine increased oxygen transport parameters, PSP/ESV ratio, and Doppler-derived acceleration significantly. Doppler-derived acceleration tracks left ventricular dysfunction seen in hemorrhagic shock.

Structural characterization of a novel glycoinositolphospholipid from the parasitic nematode, Ascaris suum.

A novel glycosphingolipid containing inositol phosphate as an acidic group has been demonstrated in whole tissues of the porcine roundworm, Ascaris suum. The thin layer chromatographic pattern of the total acidic glycolipid revealed the presence of several components, of which a major component (named AGL) with positive reactions toward both orcinol-sulfuric acid (sugar) and molybdate (phosphate) spray reagents was isolated and purified by the use of successive column chromatography on DEAE-Sephadex and silicic acid (latrobeads). From structural studies including compositional sugar analysis, hydrogen fluoride degradation, methylation analysis, periodate oxidation, proton magnetic resonance spectroscopy and fast atom bombardment mass spectrometry, the structure of AGL was deduced to be Gal alpha 1-2Ins(1-->)-P-Cer. Aliphatic constituents were lignoceric acid and its 2-hydroxy homologue as the principal fatty acids, and octadecasphinganine and branched heptadecasphinganine as the major sphingoids.

Rectal pH measurement in tracking cardiac performance in a hemorrhagic shock model.

OBJECTIVE AND DESIGN: We evaluated the utility of rectal mucosal pH measurement for tracking cardiac performance in hemorrhagic shock as compared with gastric tonometry. MATERIALS AND METHODS: Hemorrhagic shock was induced in five adult swine to a mean arterial pressure of 45-65 mm Hg. Hypotension was maintained for 30 minutes, resuscitation was accomplished with the shed blood and lactated Ringer's solution (3x blood volume). Gastric tonometry, rectal pH, and oxygen transport data were obtained at baseline, 0, and 30 minutes after onset of hypotension and after resuscitation. RESULTS: Intramucosal pH readings from gastric tonometry and rectal mucosal pH both showed a significant change from baseline to 0 and 30 minutes after onset of hypotension. Data after resuscitation were found to be statistically the same as baseline values. CONCLUSIONS: Rectal mucosal pH tracks cardiac performance as well as does gastric tonometry in hemorrhagic shock without as many limitations.

Load-independent left ventricular function in a hemorrhagic shock model.

Load-independent left ventricular (LV) function has been recently shown to be reversibly depressed in septic shock. The peak systolic pressure to end systolic volume ratio (PSP/ESV) is a load independent measure of LV function. We evaluated PSP/ESV in a porcine model of hemorrhagic shock. Hemorrhagic shock was induced in five adult swine by arterial bleeding to a mean arterial pressure of 45-65 mmHg. This hypotension was maintained for 30 min, and then each animal was resuscitated to baseline mean arterial pressure using shed blood and crystalloid solution. Data (echocardiographically derived ejection fraction and oxygen transport parameters) were collected at baseline, after 30 min of hypotension and postresuscitation. Although the cardiac index, a marker for systolic function, and the mean arterial pressure, as well as oxygen delivery and consumption returned to baseline levels, the PSP/ESV ratio remained low despite adequate fluid resuscitation. This model provides a reproducible hemodynamically stable cardiac dysfunction associated with hemorrhagic shock.

Structural elucidation of two novel amphoteric glycosphingolipids from the earthworm, Pheretima hilgendorfi.

The novel amphoteric glycosphingolipids containing a choline phosphate were purified from whole tissues of the earthworm, Pheretima hilgendorfi. Their chemical structures were completely characterized as cholinephosphoryl-->6(Man alpha 1-4)Gal beta 1-6Gal beta 1-1Cer (cholinephosphorylmannosylneogalabiaosylceramide, named PGL3a) and cholinephosphoryl-->6Gal beta 1-6Gal beta 1-6Gal beta 1-1Cer (cholinephosphorylneogalatriaosylceramide, named PGL3b) by compositional sugar, fatty acid and sphingoid analyses, hydrogen fluoride degradation, partial acid hydrolysis, methylation analysis, exoglycosidase degradation, proton magnetic resonance spectroscopy and fast atom bombardment mass spectrometry. The ceramide moieties of these lipids consisted of 22:0, 23:0 and 24:0 acids as major fatty acids, and branched octadeca- and nonadeca-4-sphingenines and octadeca-4-sphingenine as main sphingoids. Since the oligosaccharides and the ceramide moieties of PGL3a and PGL3b were identical with those of neutral glycosphingolipids found in this organism, the biosynthesis of the amphoteric glycolipids may occur by the addition of a choline phosphate residue to the corresponding neutral glycolipids, Man alpha 1-4Gal beta 1-6Gal beta 1-1Cer or Gal beta 1-6Gal beta 1-6Gal beta 1-1Cer.

Left atrial myxoma: a case presentation and review of the literature.

Cardiac myxomas account for 24% of all primary cardiac tumors. The majority occur in the left atrium and are attached via a pedunculated stalk. The presentation may mimic primary myocardial dysfunction or obstructive valvular disease. Frequently, the diagnosis is delayed secondary to only vague constitutional symptoms. In this article, we present a case of a left atrial myxoma discovered after thoracic surgery in a patient with elevated pulmonary pressures thought to be secondary to mitral stenosis, and demonstrate how transesophageal echocardiography is useful in the evaluation of critically ill patients with cardiac tumors.

Effect of amines on erythropoietin-stimulated heme synthesis in fetal mouse liver cells.

Amines, diamines and polyamines inhibit the erythropoietin-stimulated incorporation of 59Fe into newly-synthesized heme by fetal mouse liver cells in short-term culture. As assessed by cellular retention of lactic dehydrogenase, most of these compounds affect the viability of the cells very little at concentrations that substantially inhibit heme synthesis. In the families of amines tested, compounds of chain length greater than five carbons are more effective inhibitors the longer the chain, and monoamines are more inhibitory than diamines. The naturally-occurring polyamines spermine and spermidine are among the most potent amine inhibitors tested.

Location of double bonds in two unsaturated forms of phytanic acid from Refsum disease as determined by mass spectrometry.

A monounsaturated and a triunsaturated form of phytanic acid (3,7,11,15-tetramethylhexacosanoate) were isolated from plasma lipids of a patient with Refsum disease. Both were converted to their methyl esters, oxidized to polyhydroxy acids by treatment with OsO4 and converted to their vicinal trimethylsilyl ethers. These derivatives were analyzed by gas chromatography-mass spectrometry using both electron impact ionization (at 21 and 70 eV) and chemical ionization conditions to obtain clear evidence to establish the structure of the monounsaturated form of phytanic acid as 3,7,11,15-tetramethylhexadec-15-monoenoic acid and that of the triunsaturated form of phytanic acid as 3,7,11,15-tetramethylhexadec-6,10,14-trienoic acid. The possible metabolic and dietary sources for these novel fatty acids are discussed.

Enzymatic studies of urinary isomeric chondroitin sulfates from patients with mucopolysaccharidoses. The application of high performance liquid chromatography.

The high-performance liquid chromatographic (HPLC) method for the determination of unsaturated sulfated disaccharides is a comprehensive and reliable method which expedites ensymatic studies of isomeric chondroitin sulfates. Responses for these unsaturated disaccharides derived from urinary chondroitin sulfates were linear from 100 ng to 10 micrograms injected and good quantitation was obtained for 25 microliters or less of samples placed on the column. This method which is more sensitive and accurate than methods now being used has considerable potential for the chemical diagnosis of patients with mucopolysaccharidoses and for the clarification of glycosaminoglycan structure. The isomeric chondroitin sulfates in urines from patients with mucopolysaccharidoses were studied by enzyme digestion with chondroitinases followed by HPLC determination of the sulfated unsaturated disaccharides produced. Evaluation by HPLC of the unsaturated 4-sulfated disaccharide produced by digestion of the urinary GAG with chondroitinases ABC and AC revealed rapidly and quantitatively the large amounts of dermatan sulfate present in Hurler, Hunter, and Maroteaux-Lamy urines. Chondroitin 4-sulfate predominated in Sanfilippo urinary isomeric chondroitin sulfates whereas chondroitin 6-sulfate and chondroitin 4-sulfate were shown to be present in nearly equal amounts in Morquio urine. An oversulfated chondroitin sulfate was detected in small amounts in some of these urines. This was demonstrated by the detection of an unsaturated disulfated disaccharide after digestion with chondroitinase ABC but not with chondroitinase AC.

Prenatal diagnosis of Farber's disease.

Two pregnancies at risk for Farber's disease were monitored with amiocentesis at 15 and 16 weeks' gestation. In the first pregnancy tested, cultured amniotic-cell ceramidase activity was 7.8% of the control mean and an affected fetus was predicted. The pregnancy was terminated at 22 weeks' gestation and the diagnosis was confirmed by the demonstration of considerably elevated renal and hepatic ceramide concentrations and severe reduction of ceramidase activity in fetal brain and cultured fibroblasts. In the second pregnancy tested, cultured amniotic-cell ceramidase activity was within the control range, and the prediction of an unaffected fetus was confirmed in the newborn.

Binding interactions of glycoproteins with lectins.

Since plant lectins were used to help define differences between normal and transformed cell surfaces (reviewed in References 1-4), they have been employed in many other situations where their sugar-recognition specificities could be used to advantage. One of these applications has been the purification and characterization of enzymes and other proteins; this work is reviewed here in order to define some of the variables that affect binding of glycoproteins to lectins, as well as to demonstrate how this technique has been profitably exploited for isolation of purified glycoproteins, and for their better understanding.

Occurrence of novel branched-chain fatty acids in Refsum's disease.

Two novel branched-chain fatty acids, which appear to be unsaturated analogs of phytanic acid, have been observed in sera and urine of patients with Refsum's disease. They occur in both phospholipids and neutral lipids, and have been isolated and characterized.

Diagnosis of lipogranulomatosis (Farber disease) by use of cultured fibroblasts.

The enzyme defect in Farber disease, a deficiency of acid ceramidase, has been demonstrated in cultured skin fibroblasts, which provides a means of confirming the diagnosis during life. The assay can also be performed using cultured amniotic fluid cells and is a potential tool for detection of carriers of the disease.

Detection of the carrier state of Hurler's syndrome by assay of alpha-L-iduronidase in leukocytes.

The mean specific activity of alph-L-iduronidase in leukocytes from six obligate heterozygotes for Hurler's syndrome was found to be slightly less than one-half of the mean in normal controls; no overlap of normal and known heterozygote values was encountered. The assay has been applied with success to six potential heterozygotes, siblings of a child with Hurler's syndrome. Thus heterozygote detection of Hurler's syndrome is clearly possible; this finding, as well as the ready availability of leukocytes for screening tests, recommends their use for examination of potential carrier status in this disorder.