Autoregulation of B cell growth by an immunoglobulin M autoantibody.

This study documents the autoregulation of B cell growth by an IgM autoantibody. This autoantibody is secreted by B lymphocytes upon stimulation by polyclonal activators and is identified by its potent inhibition of B cell growth induced by these agents (endotoxin, Fc fragment of human gamma-globulin, Mycoplasma bovirhinis, and anti-mouse Ig). The autoantibody specifically affects B cells: there was no effect on mitogen- or antigen-induced T cell proliferation and of responses to interleukin 1, interleukin 2, or interferon.

Vulnerability to ventricular fibrillation in patients with clinically manifest ventricular tachycardia.

Ventricular vulnerability may be assessed by measuring the threshold current for the induction of ventricular fibrillation (VF). This technique has been widely utilized in animal experimentation and has been safely applied in a small number of clinical studies. We measured the VF threshold (VFT), using the single stimulus technique in 10 patients with coronary artery disease just prior to the institution of cardiopulmonary bypass.

Reinduction chemotherapy for acute nonlymphocytic leukemia.

Twenty-four patients who had a relapse after successful treatment of acute nonlymphocytic leukemia were re-treated with a chemotherapeutic program similar to that which produced the initial remission. Eight of the nine patients who achieved a second remission had received a three-drug reinduction regimen consisting of cytosine arabinoside, an anthracycline, and 6-thioguanine. An increased duration of initial remission before relapse (more than 26 weeks) predicted a greater likelihood of achieving a second remission.

Age at death used to assess the effect of interhospital transfer of newborns.

In New York City, newborn units classified as level 1 (no intensive care) frequently transfer low-birth-weight infants to units classified as level 3 (complete intensive care), but level 2 units (those with intermediate levels of care) transfer rarely. As deaths occurring in the first hours of life are unlikely to be affected by infant transport services, early (first four hours), late (four hours to 28 days), and overall neonatal death rates were separately examined at each of the three levels of care for singleton live-births weighing 501 to 2,250 g. As previously reported, overall neonatal mortality (adjusted for birth weight, gestational age, sex, and race) for births at level 1 units (163.

Carbamazepine-induced hemolytic anemia.

A patient who had recently undergone craniotomy for a meningioma experienced carbamazepine (Tegretol)-induced hemolytic anemia. To our knowledge, this is the first reported case of hemolytic anemia clearly induced by carbamazepine.

Concomitant myelofibrosis with agnogenic myeloid metaplasia and malignant lymphoma.

The concomitant occurrence of non-Hodgkin's lymphoma and agnogenic myeloid metaplasia with myelofibrosis in one patient is described for the first time. Oral therapy with an alkylating agent resulted in partial remission.

Social class indicators and mortality in low birth weight infants.

This study examines the utility of birth weight-specific neonatal mortality rates in removing the confounding effects, in comparisons of mortality in low birth weight infants, of several factors that influence crude neonatal mortality. For this purpose, the effects of social, demographic, and biological attributes of mothers on the mortality of their low birth weight babies were examined in the total population of infants weighing 501-2000 gm born in New York City in 1976, 1977, and the first 11 months of 1978 (N = 10,187). The results confirm previous observations that race, sex, and gestational age-for-weight all exert significant influences on mortality even within narrow (250 gm) birth weight bands.

Newborn intensive care and neonatal mortality in low-birth-weight infants: a population study.

We examined the neonatal mortality rates of low-birth-weight infants (501 to 2250 g) born between 1976 and 1978 in three kinds of hospitals in New York City: those with newborn-intensive-care units (Level 3), those with capabilities for the care of most premature infants (Level 2), and those without any special facilities for premature newborns (Level 1). Among 13,560 singleton low-birth-weight infants, the adjusted neonatal mortality rate for Level 3 hospitals was 128.5 per thousand live births - significantly lower (P less than 0.

Primary lymphoma of the central nervous system.

Primary intracranial lymphoma usually remains localized to the central nervous system, and aggressive radiotherapy will prolong some patients' remission and perhaps cure them. Although the lesion is usually believed to arise from histiocytes or reticulum cells, at least some of the neoplasms are of B-lymphocyte origin. Provisional diagnosis occasionally may be possible by identifying lymphoma cells in the cerebrospinal fluid by using the cytocentrifuge.

Cerebral palsy and newborn care. III: Estimated prevalence rates of cerebral palsy under differing rates of mortality and impairment of low-birthweight infants.

To maintain a stable over-all prevalence of handicap, the rate of handicap among survivors must decline in parallel to the decline in mortality among live births. The 24 per cent decline in mortality among low-birthweight infants in New York City between 1962 and 1976 requires a 35 to 39 per cent decline in the rate of neurological impairment among low-birthweight survivors simply to avoid the production of an increased number of handicapped children in the population as a whole. Such evidence as we have suggests that the declining morbidity may not be keeping pace with the recent declines in mortality: thus, although more healthy survivors will result from newborn intensive care, a modest increase in the prevalence of handicap may also ensue.

Cerebral palsy and newborn care. II: Mortality and neurological impairment in low-birthweight infants.

In recent years, neonatal mortality rates for low-birthweight infants have declined both in neonatal intensive care units and in several populations in the industrialized world. With regard to impairment among surviving low-birthweight infants, studies from newborn intensive care units show considerable variation in the reported rates of handicaps. Much of this variation arises from a lack of uniform criteria for diagnosis, sample selection and follow-up, factors further compounded by small sample size.

Characterization of resident glomerular cells in the rat expressing Ia determinants and manifesting genetically restricted interactions with lymphocytes.

The existence of a subpopulation of rat glomerular cells bearing Ia determinants has been demonstrated with the aid of techniques for the enzymatic isolation and culture of glomerular cells. The Ia-positive cell is normally resident in the uninflamed glomerulus. It resembles a mononuclear phagocyte and consists of a functionally heterogeneous cell population with the capacity of Fc receptor display and phagocytosis, both in vivo and in vitro.

Cerebral palsy and newborn care. I: secular trends in cerebral palsy.

Reports of cerebral palsy prevalence rates per live births in recent decades in western nations show a mixed pattern. Declining rates were noted in Bristol, England, and in Denmark; but more recently a rising rate was noted in Ireland. In Western Sweden a decline has been followed by a recent rise, and in Western Australia a rise has been followed by a decline.

Ambulatory ECG recordings: a spectrum of technology.

A four-tiered approach to data reduction-observer analysis, semi-automated scanning, automated scanning, and computer applications-of ambulatory electrocardiographic recordings is now possible as a result of refinements in technology. Clinical circumstances, cost, and requirements of the involved institution or laboratory will dictate to what extent more advanced technology is needed. Although computer application will increase the detection sensitivity of ectopic beats, sophisticated, costly systems are still required for the analysis of high-frequency ectopic activity tapes.

Series on pharmacology in practice. 12. Antineoplastic agents.

Drug treatment for cancer is now widely utilized and in selected neoplasms offers the opportunity for prolonged remission or even cure. Knowledge of the clinical pharmacology of these agents is critically important to successful therapy. Severe and potentially fatal toxicity may occur unless these agents are administered with meticulous attention to details by physicians experienced in their use.

Medical education and health care in Uganda.

Health care and medical education in Uganda, once the best in Black Africa, have been adversely affected by the economic, political, and social upheavals in this developing country during the past decade. Crop failures, inadequate public health measures, shortage of medical equipment and essential drugs, and lack of sufficient medical school faculty have resulted in a major crisis. Substantial aid from the medical profession in developed countries will be necessary to help restore medical practice and education to the level present before the regime of Idi Amin.

Regulation of macrophage populations. I. Preferential induction of Ia-rich peritoneal exudates by immunologic stimuli.

The amounts of Ia-positive and -negative macrophages were studied in peritoneal exudates of normal mice or of mice injected with various inflammatory materials, infected with Listeria monocytogenes, or injected with hemocyanin. Ia-negative macrophages predominated in exudates from normal mice or from mice given mineral oil, peptone, thioglycollate, culture media, or endotoxin. Infection with Listeria caused a very marked increase in Ia-positive macrophages.

Efficacy of undecylenic acid-zinc undecylenate powder in culture positive tinea pedis.

One hundred fifty-one patients with tinea pedis participated in a double-blind study to assess the efficacy and safety of a powder containing undecylenic acid 2% and zinc undecylenate 20% versus a placebo powder. Patients were assigned to apply twice-daily applications of either active powder or placebo for a period of 4 weeks. Trichophyton rubrum or Trichophyton mentagrophytes were isolated from pretreatment cultures of 85 patients.