William R. Bartholomew

The collection and analysis of human fallopian tubal fluid

Abstract A technique for the collection of Human Tubal Fluid (HTF) has been presented. It is a one-time procedure, coincident to other adominal surgery. The procedure has shown itself to be safe on 37 consecutive cases. The greatest quantity of HTF was obtained near the day of ovulation from patients with long fallopian tubes. A specimen with little or no turbidity usually could be withdrawn from the collection bag 24 hours after surgery. Electrophoresis of HTF in agarose resulted in patterns different from those found with the patients serum. An altered albumin peak was noted in 2 cases, while in a third case, the HTF exhibited an increase in the s globulin fraction. Immunoelectrophoresis demonstrated that many serum constituents are present in HTF. The immunoglobulin content presented a distribution similar to that which occurs in serum. Unlike other external secretions, γ G is the major immunoglobulin constituent present in HTF. The sodium, phosphorus and magnesium content of HTF was similar to that of serum. In comparison with patients serum, the potassium and chlorides of HTF were augmented while there was a diminution of HTF calcium. Glucose in tubal fluid was usually a half to a third of the patients serum level. Marked elevations of amylase and lactic dehydrogenase (LDH) were noted in HTF.

Long-term Evaluation of the Hepatitis B vaccine (Heptavax-B) in Hemodialysis Patients

Hemodialysis patients were screened for hepatitis B surface antibody (anti-HBs) prior to immunization at two teaching hospitals. Thirty-one of 111 patients (28%) had baseline sera positive for anti-HBs, while anti-HBs was found in 30 of 420 (7.1%) health care employees (P less than 0.001). A total of 72 hemodialysis patients (mean age, 55.7), received the hepatitis B vaccine (Heptavax-B, Merck Sharp & Dohme, West Point, PA). The responder rates (34 of 72; 47%) and nonresponder (38 of 72; 53%) rates were similar to previous reports. Neither age (P greater than 0.05) nor injection site (P greater than 0.05) appeared to influence results. Nonresponders (16 of 17; 94%) who were given a fourth vaccine dose also failed to mount an antibody response. Of the 34 responders, 18 were followed by serial anti-HBs determinations. Seven transient responders (7 of 18; 39%) were identified, and anti-HBs fell below 10 S/N (sample/control counts per minute) within 12 to 15 months of the first vaccine dose. A fourth dose was administered to this group and it extended the presence of serum anti-HBs (S/N greater than or equal to 10) in four of six patients for another 2, 8, 10, and 15 months, respectively. Antibody persisted but declined over the study period in the remainder of responders followed serially (11 of 18; 61%). When compared with those responders who lost anti-HBs, those with persistent antibody had higher anti-HBs values at 7 (P less than 0.02) and 12 months (P less than 0.005) after the first injection, and were younger (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Pathophysiology of primary meningococcal pericarditis associated with Neisseria meningitidis group C. a case report and review of the literature

Pericarditis associated with Neisseria meningitidis in the absence of meningitis or meningococcemia is an extremely rare event. We report herein a case of a 59-yr-old woman with primary meningococcal pericarditis caused by Neisseria meningitidis group C. The patient responded to a course of penicillin therapy and recovery was uncomplicated. The pathophysiologic features underlying or contributing to the disease are discussed and the pertinent literature is reviewed.

A unique case of kappa light-chain disease associated with cryoglobulinemia, pyroglobulinemia, and hyperviscosity syndrome

Monoclonal gammopathies (paraproteinemias) occur in the settings of Waldenstrom’s macroglobulinemia, plasma cell dyscrasias, and primary lymphoproliferative diseases, as well as in several unrelated entities such as rheumatoid arthritis and chronic infections. Although serum hyperviscosity may occur with any of these disorders, and does occur in 4% of cases of multiple myeloma [l], it has been reported only once in relation to a light-chain myeloma variant but without the accompanying clinical complications [2]. The syndrome often associated with serum hyperviscosity may include any of all of the following manifestations: ocular, neurologic, hemorrhagic, and cardiovascular. Therapy for this disorder usually involves supportive treatment and control of the underlying disease. Measures such as plasmapheresis are designed to reduce the serum concentration of the homogeneous protein and thus the serum viscosity. Zinneman [3] defines a combined cryo-pyroglobulin as an abnormal immunoglobulin molecule that forms both a reversible cryoprecipitate at low temperatures and an irreversible pyrogel at elevated temperatures. This is differentiated from a Bence Jones protein, which will redissolve if heating is continued above 56°C. Only one case of a light-chain protein meeting the criteria for a combined cryo-pyroglobulin [4], but without serum hyperviscosity, has been reported. In fact, only one case of pyroglobulin formation and a small number of cases of cryoglobulin formation have been seen in relationship to light chains [4-91. The molecular mechanisms responsible for these temperature-sensitive precipitates have been discussed [3]. We report the unique instance of a patient with kappa light-chain myeloma whose clinical condition showed a dramatic response to therapy. His light chain was also remarkable for its combined cryo-pyroglobulin properties.

Nodular glomerulosclerosis associated with multiple myeloma: Role of light chain isoelectric point☆

A 68-year-old female patient with multiple myeloma exhibited advanced nodular glomerulosclerosis. Immunofluorescence of the kidney showed kappa light chain deposition in the mesangium and in glomerular and tubular basement membrane. Isoelectric focusing and immunofixation of urinary proteins revealed an isolated kappa light chain with an unusually high isoelectric point of 8.4. Most light chain proteins have isoelectric points in the 4.6 to 6.7 range. Since loss of fixed negative charges may precede experimental glomerulosclerosis, it is proposed that this cationic circulating kappa chain may have interacted with glomerular polyanion, thereby inducing a nodular sclerotic reaction leading to irreversible renal damage.

Immunochemical detection of a human species--specific esterase in interspecies hybrid cells.

Abstract An esterase isoenzyme detected by enzymo-immunoelectrophoresis served as a species marker for human and monkey tissue culture cells. Interspecies hybrids of human-mouse or monkey-mouse were examined for this isoenzyme in order to relate the esterase to the primate chromosome complement.

Anti-Phospholipid Antibody Profiles of Different Specificities in Syphilis and Systemic Lupus Erythematosus

Controversies exist as to the differences in the specificities of phospholipid antibodies in SLE and syphilis. We report an ELISA assay that could distinguish phospholipid antibodies associated with SLE and syphilis based on their differential reactions with phosphatidyl choline and VDRL antigens. Antibodies to phospholipid from patients with SLE reacted equally well when tested with these two antigens in the ELISA assay whereas phospholipid antibodies present in syphilis patients exhibited little or no binding to phosphatidyl choline. There were no differences in the binding of phospholipid antibodies to other phospholipids such as cardiolipin and phosphatidyl serine. In addition, there was no association of anti-phospholipid antibodies with the presence of either DNA or RPR antibodies suggesting their distinctness from each other.

Neisseria meningitidis and Moraxella osloensis: Dual infection in blood and peritoneal fluid

The clinical course of a malnourished alcoholic in which Neisseria meningitidis was isolated from the blood and Moraxella osloensis from the peritoneal fluid is described. Following bacteriologic diagnosis, the patient was treated and responded to a course of penicillin therapy. To our knowledge, this represents the first case of peritonitis associated with M. osloensis. Clinical reports of the isolation of this organism are rare; its pathogenicity is not clearly established, and the presence of the organism may often be unrecognized.

Effect of Irradiation and Depletion of C3-Complement Component on the Course of Treponema pallidum Infection in a Resistant Guinea Pig Strain

The role of complement and ionizing radiation in the natural resistance to Treponema pallidum infection of Albany guinea pigs was explored. Depletion of C3 by cobra venom factor for a period of 14 days affected neither the hosts susceptibility to infection nor the humoral response. Total body irradiation with 420 or 800 R was fatal within 20-30 days and there was no multiplication of treponemes in the infected host. Animals showing lethal signs were euthanized and tissues removed for examination. Exposure to a nonlethal dose of 300 R increased the susceptibility to infection (46% symptomatic lesions) and facilitated multiplication of treponemes at the site of inoculation and in the lymphoid organs, but the humoral response was not different from that of non-irradiated controls. The results seem to suggest a defect in antigen recognition by the immunocompetent cells in the resistant Albany guinea pigs.

Evaluation of the modified Visuwell Strep-A enzyme immunoassay for detection of group-A Streptococcus from throat swabs☆

The modified Visuwell Strep-A enzyme immunoassay (EIA) was compared with culture for detection of group-A Streptococcus from throat swabs. Throat swabs in modified Stuarts medium obtained after culture at two institutions were tested in Visuwell. Cumulative results were n = 417, sensitivity 87.8%, specificity 89.9% predictive value positive (PVP) 67.9%, predictive value negative (PVN) 96.8%, and accuracy 89.5%. At another site, swabs were delivered to the laboratory without transport medium, cultured, and subsequently tested by Visuwell (n = 202, sensitivity 79.6%, specificity 84.5%, PVP 65.2%, PVN 91.9%, accuracy 83.2%). When 1+ culture-positive specimens were considered negative, the sensitivity and PVN increased from 79.6% to 90.2% and 91.9% to 97.1% respectively. Overall performance of the modified Visuwell was comparable with that of the initial assay for throat swabs transported with or without modified Stuarts medium. Cross reaction with organisms other than group-A Streptococcus normally found in the oropharynx was negligible in Visuwell and the limit of detection of group-A Streptococcus was 5 x 10(4) colony-forming units.