Association between high concentration of antibodies to insulin and some diseases common in the elderly.

Antibodies to insulin (IA) were measured by graded hemagglutination in 164 patients and in 90 control subjects aged 18-65 years. The greatest prevalence of these antibodies was found in patients with the organic mental syndrome, of whom 70% (n = 110) had an antibody concentration above the normal 95th percentile. Among patients with diabetes, hypertension and cerebrovascular accidents, 42% had a high concentration of IA, while in all other geriatric patients (n = 21) the concentration of these antibodies was within the normal range.

Holter monitoring in the evaluation and rehabilitation of post-cerebrovascular accident patients.

Coronary artery disease, overt or silent, is frequently present in patients who have suffered a cerebrovascular accident (CVA). Rehabilitation therapy of CVA patients is based mostly on physical activity, which may be limited by fear of overloading the cardiovascular system. Therefore, assessment of the severity of coronary heart disease in CVA patients is of utmost importance. In this study we assessed the usefulness of 24-hour electrocardiographic Holter monitoring in the evaluation of post-CVA patients during daily activities and rehabilitation. Of the 43 post-CVA patients, 24 (55.8%) revealed pathological changes on Holter monitoring and 17 (71%) had a history of coronary artery disease prior to CVA. Holter monitoring revealed mainly ventricular and atrial arrhythmias and in three patients detected transient ischaemic episodes. Only six patients (14%) showed aggravation of arrhythmia during rehabilitation therapy, without aggravation of ST-T changes. The mean maximum heart rate during regular daily activities was 104 +/- 20 beats/min, which was significantly higher than the mean maximum heart rate during physical therapy (100 +/- 18 beats/min; p less than 0.01) and during occupational therapy (87 +/- 18 beats/min; p less than 0.001). These findings indicate that more vigorous physical and occupational therapy can be prescribed to these patients. The performance of Holter monitoring in post-CVA patients is a valuable substitute to exercise testing, and is useful for cardiovascular evaluation during daily activities and rehabilitation therapy.

Fetal hemoglobin screening in whole blood and in plasma of cancer patients.

Fetal hemoglobin (HbF) screening was performed on 296 cancer patients. In almost 80% of the patients with active disease (n = 197) and 35-60% of those with inactive disease (n = 99), the concentration of HbF in the blood was above the normal range. Among patients with metastatic breast carcinoma (n = 27), 89% had a high HbF concentration. The HbF level was significantly higher (p less than 0.001) in patients with active disease than in those with inactive disease. There is evidence of an ectopic production of HbF into the plasma of patients, but it will be necessary to develop a method for the prevention of hemolysis in order to establish this claim.

Evaluation of fetal hemoglobin in various malignancies with reference to the patients' age.

Concentration of fetal hemoglobin (HbF) was measured in the blood of 172 cancer patients with solid tumors. The patients' age groups were compared with matched age groups of normal controls. Above the age of 50, a significant difference was found between patients and normal controls. In 70% of the patients with active disease, the concentration of HbF was above the normal range. There were indications that by reducing HbF concentrations irradiation of patients interferes with the evaluation of the results. In addition to whole blood, HbF was also measured in the plasma of 35 patients; the average HbF concentration in this group was found to be twice as high as that of the controls.

Improved haemagglutination reagent for detecting antibodies to insulin in diabetic and non-diabetic young and old patients.

A stable reagent of insulin-coated erythrocytes was developed for easy measurement of antibodies to insulin. For this measurement, the principle of graded haemagglutination (GH) was successfully applied. All of 100 healthy, young- to middle-aged controls, had no detectable antibodies. The incidence of antibodies was not higher in diabetic patients injected with highly purified porcine insulin, than in those not injected. A high incidence of antibodies to insulin was found among chronic elderly patients, amounting to 41% of the symptomatically non-diabetic and 77% of the diabetic.

Graded hemagglutination inhibition for quantification of human fetal hemoglobin.

We describe a hemagglutination system for quantification of fetal hemoglobin (HbF), especially at low concentrations. This system consists of three components: (a) sheep erythrocytes coated with purified HbF, (b) sheep antiserum of human HbF made specific for the gamma-chain, and (c) human blood lysate with a known concentration of HbF as the standard. We can measure the whole range of HbF proportions in human blood, from 100% down to 0.01%. Statistical analysis showed that our measurements agreed with those made by the methods of alkali denaturation and radial immunodiffusion. Reproducibility of the method is shown by the low CVs for six repeated measurements. Low concentrations of HbF not measurable by other methods are easily assayed. We offer examples of the clinical utility of data on low concentrations of HbF.

Extravascular circulation in the pituitary of Mugil cephalus (Teleostei).

Extravascular circulation in the pituitary of Mugil cephalus was investigated by injecting live fish with horseradish peroxidase and studying the distribution of the enzyme in the gland. The principal components of the extravascular circulatory system are the pericapillary spaces, and, arising from them, the interlobular and circumhypophyseal spaces. Extensions of these spaces penetrate the glandular parenchyma of the pars distalis, where they merge with pericellular spaces. In the neurohypophysis, pericapillary spaces are connected to the periaxonal spaces. Capillaries penetrating from the proximal neurohypophysis into the pars distalis are accompanied by neurosecretory axons. These axons form a mass of tissue which is limited near the capillaries by the pericapillary spaces and near the adenohypophysis by the interlobular spaces. Toward the interior of the adenohypophysis the amount of nervous tissue accompanying the capillaries progressively diminishes, thus reducing the distance between pericapillary and interlobular spaces. Within the pars distalis, the neurosecretory axons accompanying the capillaries are sparse, and the secretory and stellate cells are mostly located directly adjacent to the pericapillary spaces. In the neurointermediate lobe, interlobular spaces outline the neuro-adenohypophyseal boundary. The relationship between extravascular spaces and hormone-secreting cells varies in the different regions of the adenohypophysis depending upon the type of neurosecretory innervation in the respective region. In the regions of prolactin and gonadotropin cells, where neurosecretory axons are in direct contact with the secretory cells, the hormone-secreting and stellate cells are adjacent to the pericapillary spaces. In the regions of ACTH and STH cells, secretory and stellate cells are found adjacent to the interlobular spaces, which are interposed between the cells and the neurosecretory axons.

The extravascular channel system in the rostral pituitary of Mugil cephalus (Teleostei) as revealed by use of horseradish peroxidase.

The interlobular spaces, separating the neuro- and the adenohypophysis can be visualized in the pituitary of the Grey Mullet by using the horseradish peroxidase technique. On the one hand, these spaces communicate with the pericapillary spaces. On the other, they are linked with the pericellular spaces in the adenohypophysis and the periaxonal spaces in the neurohypophysis, thus providing a pathway for the exchange of metabolites and hormones between blood system, epithelial cells and the terminal region of the neurosecretory axons. The interlobular spaces branch off between the tips of the corticotrop cells and form a network adjacent to the adeno- and neurohypophyseal interface. It is possible that branches of this network penetrate into the interior of the corticotrops. The probable role of the network is to permit close contact between neurosecretory hormones and the corticotrops and also to enable the corticotrop hormone to reach the capillaries.