George W. Mitchell

The role of the phagocyte in host-parasite interactions: IV. The phagocytic activity of leukocytes in pregnancy and its relationship to urinary tract infections

Abstract 1. 1. Using Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus albus as test organisms, the phagocytic and bactericidal rates for leukocyte populations from pregnant women at various stages of pregnancy have been determined and compared with results obtained with leukocytes from nonpregnant women. 2. 2. Leukocytes from pregnant women usually were found to demonstrate increased phagocytic and bactericidal activities: the greatest frequency of enhanced leukocyte activity was observed when E. coli was the test organism. 3. 3. Leukocytes from pregnant women with significant bacteriuria generally showed only normal or reduced activity against the test organism which was of the same genus as the predominant organism in the urine. 4. 4. Antibody levels to E. coli and P. aeruginosa were determined in the sera of pregnant and nonpregnant women by the indirect hemagglutination technique. Sera from pregnant patients showed a higher hemagglutinin titer to E. coli when compared to sera obtained from nonpregnant women. No such differences were noted with P. aeruginosa hemagglutinins.

The role of the phagocyte in host-parasite interactions: XXV. Metabolic and bactericidal activities of leukocytes from pregnant women☆☆☆

Abstract The hexose monophosphate shunt (HMS) activity of phagocytizing cells collected from pregnant women is approximately twice that found in nonpregnant women. HMS activity in resting leukocytes from bacteriuric pregnant women was lower than that found in leukocytes from normal pregnant women. Phagocytizing cells showed increased activity. The myeloperoxidase (MPO) activity of leukocytes from pregnant women increased significantly during phagocytosis. This increase was not observed in nonpregnant women. Granules containing 20,000 × g MPO isolated from leukocytes from pregnant women have bactericidal activity in the presence of nonbactericidal concentrations of H 2 O 2 in a chloride medium. These granules also decarboxylate alanine in the presence of H 2 O 2 in a chloride medium. Freshly isolated strains of bacteria are not killed as effectively as stock strains. This appears to be due to decreased phagocytosis and/or resistance of the fresh isolates to the MPO-H 2 O 2 -chloride bactericidal system.

STUDIES ON VAGINAL ENZYMOLOGY

The enzyme P-glucuronidase has held our attention for many years.1a, I n oitro, this enzyme catalyzes two reactions: one, the hydrolysis of glucuronicacid conjugates,* and the other, the transfer of the glucuronyl radical from a donor glucosiduronic acid to an acceptor hydroxylated compound.3g* The hydrolysis of phenolphthalein glucosiduronic acid is employed for purpcses of enzyme assay, the liberated phenolphthalein being measured readily in alkaline solution. The enzyme occurs widely in animal tissues, for example, liver, spleen, and the endocrine tissues, which are especially rich sources.

surgery For Congenital Absence Of The Vagina

The Counsellor modification of McIndoes procedure was used to create a vagina in 12 of 15 patients who presented with Rokitansky-Kuster-Hauser syndrome. Eighty percent of these patients, followed postoperatively from 4 months to 8 years, report satisfactory coital function. Our experience suggests that a malleable stent fashioned to conform to the surgically created neovagina is superior to a preformed, nonmoldable stent to which the endopelvic fascial dissection must conform.

Positive correlation of optical density at 650 nm. with lecithin/ sphingomyelin ratios in amniotic fluid

In this study, we have attempted to correlate optical density measurements of amniotic fluids with L/S ratios. We may conclude, with over a 98 per cent accuracy, that fluids having optical density readings of 0.15 and above, at 650 nm. will have an L/S ratio over 2.0. Fluids having optical density readings up to 0.05 will have L/S ratios of about 1.3. Finally, amniotic fluids having optical densities greater than 0.05 and less than 0.15 will have L/S ratios of approximately 1.5.

Design of a Computer System to Assist in Differential Preoperative Diagnosis for Pelvic Surgery

Abstract To help in making nine common differential diagnoses for pelvic surgery, a computer system has been designed in three parts: a data-collection procedure, based on a checklist of symptoms obtained on admission, each with a weight between 1 and 9; a statistical diagnostic algorithm, for which medical records of over 500 patients were used to calculate the necessary coefficients; and a computer-based information output, which, using the first two parts, gives the physician a condensed history and the most probable diagnoses, before surgery. The system has been shown to be 66 per cent accurate —equal to results in major teaching hospitals. It is designed for further improvements by making very complete data collection and retrieval easy. It was developed for easy implementation at minimal cost.

Bicornuate uterus and partial atresia of the fallopian tube.

Partial atresia of the fallopian tube was discovered in two patients with double uteri of the bicornuate variety. The abnormal tube in each case was ipsilateral to a noncommunicating, nonfunctioning, rudimentary uterine horn. A normal fimbriated end led to a short, patent ampullary portion that ended blindly in the mesosalpinx. Realization of the potential for the coexistence of congenital malformation of the fallopian tubes with various uterine malformations suggests that extreme caution be exercised during adnexal surgery in patients with anomalous development of the müllerian ducts.

Surgery, chemotherapy and supervoltage radiotherapy for carcinoma of the ovary

Abstract One hundred forty-three postoperative patients with adenocarcinoma of the ovary were treated between 1968 and 1974. Fourteen %were Stage I, 24.5% were Stage II, 51% were Stage III and 8% were Stage IV. They were divided into 3 treatment groups: (1) pelvic or abdominal-pelvic irradiation with no chemotherapy (23 patients); (2) triethylenethiophosphoramide (Thiotepa), 45 mg intraperitoneally followed by 2–3 courses of 0.3 mg/kg intravenously prior to abdominal-pelvic irradiation of 2700–3000 rad and a pelvic boost of 1500–2000 rad (60 patients); and (3) four weekly doses of concurrent combination of Actinomycin-D (500 mcg), cyclophosphamide (Cytoxan) (7.5 mg/kg), 5-fluorouracil (7.5 mg/kg), and vincristine sulfate (Oncovin) (0.017 mg/kg), given intravenously followed by abdominal-pelvic irradiation, as in the second group, by moving strip technique, and then by maintenance chemotherapy (2 or 4 drugs) for up to 1 year (60 patients). Despite the more intensive therapy of the third group, the 3-year survival rate did not differ from that in the second group (38% for all stages). The 3-year survival rates for Stages I–IV were 94%, 64%, 28% and 18% respectively. The patients also were analyzed by residual tumor at surgery, stage and histology and consistently showed no difference between the triethylenethiophosphoramide group and the 4-drug combination group.

Chlorination, Decarboxylation and Bactericidal Activity Mediated by the MPO-H2O2-Cl− System

1. MPO, H2O2 and C1- form a complex that undergoes intramolecular rearrangement yielding the chlorinium ion. 2. The chlorinium ion can interact with MPO, bacteria and amino acids. 3. The reaction can occur at a wide range of pH, H2O2 concentration and C1- concentration. 4. The chlorinium ion can attack different protein molecules to cause structural changes. 5. Preincubation of MPO with bacteria results in greater bactericidal activity. 6. Diffusible bactericidal agents are also produced by the MPO-H2O2-C1- system.

Ovarian carcinoma: management of stress in patients and physicians.

A discussion of the management of ovarian cancer invariably involves the problems of death and dying faced by the patient, her family, and her physician. This paper attempts to deal with the general fears, anxieties, and problems of terminality, and also places attention on specific issues involved in living with the ongoing disease and its treatments. Focus is on the effects of the disease on the womans self-image, on her family and relationships, on life outside the hospital, and on her relationship with her attending physician. Specific problems relating to the periods of (1) diagnosis, (2) operative management and treatment, and (3) terminality are discussed. Understanding the psychosocial realities of the patient provides the physician with added insights into methods to assist the patient in adaptation and coping with this ultimately fatal disease.