Chinese herbal nephropathy and urothelial malignancy.

In Belgium, between 1991 and 1992, seven women under the age of 50 years were admitted to a regional renal dialysis unit with progressive renal failure. All seven had been following the same slimming regimen, prescribed by the same clinic. They had an identical pattern of interstitial fibrosis on renal biopsy. Subsequently it became evident that all were at risk of developing urothelial malignant change. Could there possibly be a link to the prescribed drugs, which included Chinese herbs?

Lessons to be learned: a case study approach. 'Spontaneous' intraperitoneal bladder rupture in a psychiatric patient--with diagnostic difficulties.

The case described here is that of a 34-year-old woman with a psychiatric disorder who was referred to the local surgical receiving unit with abdominal pain and vomiting. She remained well and fully mobile but refused blood investigations until the day following admission. At that time the tests showed a picture of acute renal failure. With the development of increasing abdominal tenderness and pyrexia she was persuaded to have a laparotomy which demonstrated a small tear at the dome of the bladder. Her deranged blood biochemistry returned to normal within 11 h following surgery. The important points demonstrated in this case study are the special clinical difficulties encountered in psychiatric patients, which may consequently lead to delay in diagnosis. This delay allowed significant peritoneal reabsorption of urea and creatinine, which masqueraded as 'acute renal failure' on biochemical testing. The case also highlights the use of procyclidine, commonly used in patients with psychiatric disorders; urinary retention is a recognised side effect of this drug--and it is possible that such retention together with a minor and hence easily overlooked episode of trauma, may have contributed to the patient's condition.

Reversal of vasectomy using a macroscopic technique: a retrospective study.

Eighty-five men underwent vasectomy reversal in our department between 1981 and 1994. All operations were performed without the aid of magnification. The results of semen analysis was available in 66 and the patency rate was 74%. A postal survey was sent to patients we could follow up, and among those who replied the pregnancy rate was 41% (16/39 respondents). These results are similar to those found by others using a macroscopic reversal of vasectomy and since the operator does not rely on the use of a microscope, which both incurs an added cost and requires extra expertise, we feel that the operation as described has a part to play in the management of men seeking reversal of vasectomy.

Perceived risks of radioactive waste transport through Oregon: results of a statewide survey.

Transportation of hazardous materials, and particularly radioactive wastes, on public highways has become an important risk management issue. The unfavorability of public attitudes regarding hazardous and nuclear wastes signals the potential for strong public opposition to programs for transporting these materials. This paper presents the results of a survey conducted to assess public reactions to a long-term nuclear waste transport program planned to follow a route through a portion of rural Oregon. The survey assessed a number of key risk perception issues, including perceived health and safety risks of nuclear waste transport, relative risks of transport vs. storage at an existing site, trust in state officials, and satisfaction with life in communities along the transport route. The survey identified a number of attitudes and concerns that need to be understood and considered by those in charge of designing and implementing the waste-transportation program.

Achalasia evolving from segmental aperistalsis.

A 17-year-old woman was evaluated for dysphagia. Radiologic study revealed a rigid segment 10 cm long in the midesophagus, which was found to be aperistaltic on manometric evaluation. The rest of the esophagus and the lower esophageal sphincter were manometrically normal. Four years later the patient was seen for evaluation of severe dysphagia and symptoms of esophageal overflow. Characteristic radiologic and manometric findings of classic achalasia were noted. The case is discussed as an atypical form of achalasia evolving from a segmental esophageal aperistalsis.

Albumin-IgG complexes in human serum and plasma that inhibit blood platelet adhesion.

Macromolecular albumin-IgG complexes have been isolated from human serum and characterized immunologically. These complexes are shown to be present in plasma also and appear to be normal constituents of blood. The complexes can be demonstrated in normal serum and plasma by immunoelectrophoresis and rocket immunoelectrophoresis, as well as by use of a two-step radioimmunologic binding test. The albumin-IgG complexes inhibit adhesion of human platelets to glass and account for 12-16% of the total protein in serum.

Effects of heparin on platelet aggregation and release and thromboxane A2 production.

Heparin, when added to citrated platelet-rich plasma (PRP), caused potentiation of platelet aggregation and the release reaction induced by the aggregating agents adenosine diphosphate (ADP), arachidonic acid, collagen, and epinephrine. At low concentrations (4.7 x 10(-5) M) arachidonic acid failed to cause aggregation of platelets in citrated PRP. However, in the presence of heparin, the same concentration of arachidonic acid caused aggregation. Examination of PRP for the presence of thromboxane A2 (TxA2) by use of a bioassay revealed that heparin also stimulated release of TxA2. This finding indicated that platelets released more TxA2 when they were challenged by low concentrations of arachidonic acid in the presence of heparin than in its absence. Platelets were labeled with 3H-arachidonic acid and 14C-serotonin, and attempts were made to determine whether heparin stimulated the platelet release reaction first with subsequent increased production of TxA2, or alternatively, whether heparin stimulated TxA2 production first with subsequent enhancement of the release reaction. In view of the demonstrated simultaneous release of 14C-serotonin and 3H-arachidonic acid metabolites, it appeared that either release of 14C and 3H occurs concurrently or, even if one of these events is dependent on the other, both events take place in rapid succession. Timed sequential studies revealed that in the presence of arachidonic acid, the addition of heparin hastened the apparently simultaneous release of both 14C and 3H.

A human model for study of blood-vascular wall interactions. Effects of enzymatic treatment of intima.

A human umbilical cord vein model was used to study the interaction of human blood with vein intima after treatment with certain enzymes. Treatment of the intima with neuraminidase produced little in the way of morphologic change, and studies showed no increase in the retention of platelets labeled with chromium 51. Treatment of vein intima with collagenase produced severe morphologic changes, with exposure of coarse and fine subendothelial fibers, but with the retention of platelets little enhanced, as determined morphologically or radiometrically. On the other hand, treatment of vein intima with trypsin resulted in loss of endothelium in some areas, with exposure of coarse subendothelial fibers that produced a marked increase in platelet retention, as determined both morphologically and radiometrically. Exposure of the vein intima to thrombin produced apparent contraction of endothelial cells, with focal exposure of subendothelium and platelet adhesion.

Hemoglobin Milledgeville (alpha 44 (CD2) Pro leads to Leu): a new variant with increased oxygen affinity.

Hemoglobin Milledgeville, a new hemoglobin structural variant, was identified in three members of a black American family. The oxygen affinity of blood and hemoglobin samples from the affected individuals was markedly increased (p50 O2 of whole blood 11-15 mmHg at 37 degrees C, pH 7.4), and the abnormality was associated with mild erythrocytosis. The variant hemoglobin did not separate from Hb A by electrophoresis or by chromatography or isoelectric focusing, and efforts to isolate an abnormal globin chain were also unsuccessful. The Hb A2 fraction as well as Hb A from erythrocytes of affected individuals exhibited increased oxygen affinity, indicating that the altered oxygen equilibrium was the result of a hemoglobin alpha chain abnormality. Fractionation of trypsin and chymotrypsin digests of isolated alpha chains demonstrated a single abnormal peptide representing a Pro leads to Leu substitution at alpha 44 (CD2). Properties of Hb Milledgeville include low cooperativity (n = 1.1-1.4), a normal alkaline Bohr effect (delta logp50/delta pH = -0.62), and normal interaction with 2,3-diphosphoglycerate. The alpha CD2 proline residue normally participates in the formation of the alpha 1 beta 2 subunit interface in the deoxy quaternary conformation, but not in oxyhemoglobin; the leucine substitution may produce destabilization of the deoxy conformation with a resulting shift in equilibrium toward the oxy conformation.

A human model for study of blood-vascular wall interactions. I. Description and demonstration of use of the model.

We fashioned a model for the study of interactions of human blood cells with human vascular wall components. It consists of a segment of human umbilical cord vein formed into a closed loop. The lumen of the vein is filled with anticoagulated platelet-rich plasma propelled through the loop by a peristaltic pump. The results of the present study demonstrated that various degrees of mechanical injury to umbilical vein intimal components result in adhesion and aggregation of platelets. Platelet adhesion can be measured by use of radioisotope-labeled platelets in the model. Other injuries to vascular wall components, such as those produced by occlusive hemostats or punctures of the vascular wall by stylets or needles, demonstrated a striking retention of platelets at the sites of injury as measured by gamma-ray counting and as viewed by scanning electron microscopy.

Two new sickle cell syndromes: HbS, Hb Camden, and alpha-thalassemia; and HbS in combination with Hb Tacoma.

Hemoglobin variants having electrophoretic mobility more rapid than that of HbA were identified in combination with sickle hemoglobin in two patients at the Cook County Hospital. Neither individual had symptomatic hematologic disease. In one patient, the rapidly migrating hemoglobin had the amino acid substitution characteristic of Hb Tacoma (beta-40 arg leads to ser), a mildly unstable variant. In the other patient, Hb Camden (beta-131 gln leads to glu) was identified, and the hematologic findings also indicated that he has alpha-thalassemia trait. In the patient with HbS-Camden--alpha-thalassemia, globin synthesis was unbalanced (alpha/beta 0.66), and HbS represented only 19.5% of the total hemoglobin. The latter finding suggests that under conditions of limited alpha-chain availability beta Camden may combine with alpha subunits at least as efficiently as does betaA. HbS represented 56% of the hemoglobin of the patient with HbS Tacoma, although the rate of synthesis of beta Tacoma by her reticulocytes was consistently greater than that of betaS. A time-course synthesis study demonstrated a progressive increase in the specific activity of beta Tacoma in relation to that of betaS, suggesting that the unstable beta-chains of Hb Tacoma underwent selective intracellular degradation. This process appears to explain the disparity between the rates of synthesis of the two beta chains and the relative representation of HbS and Hb Tacoma in the patient's erythrocytes.