A prospective, double-blind, randomized study of high-versus low-dose OKT3 induction immunosuppression in cadaveric renal transplantation.

We undertook a prospective, double-blind study of high-(5-mg) versus low-(2-mg) dose OKT3 for induction immunosuppression (12 days) in cadaveric renal allograft transplantation. Maintenance immunosuppression was identical in both groups and consisted of azathioprine and prednisone initially, with cyclosporine beginning on the 5th postoperative day. Twenty-six patients were randomized.

The high-resolution crystal structure of a parallel-stranded guanine tetraplex.

Repeat tracts of guanine bases found in DNA and RNA can form tetraplex structures in the presence of a variety of monovalent cations. Evidence suggests that guanine tetraplexes assume important functions within chromosomal telomeres, immunoglobulin switch regions, and the human immunodeficiency virus genome. The structure of a parallel-stranded tetraplex formed by the hexanucleotide d(TG4T) and stabilized by sodium cations was determined by x-ray crystallography to 1.

Axonal injury and membrane alterations in Alzheimer's disease suggested by in vivo proton magnetic resonance spectroscopic imaging.

We used spin-echo magnetic resonance imaging and proton magnetic resonance spectroscopic imaging in 8 patients with probable Alzheimer's disease and in 10 age-matched elderly control subjects to assess the effects of Alzheimer's disease on the brain. On magnetic resonance images the patients showed significant ventricular enlargements relative to the control subjects. We measured the distribution and relative signal intensities of N-acetylaspartate (a putative neuronal marker), of choline residues representing lipid metabolites, and of creatine-containing metabolites in a large section of the centrum semiovale containing white and mesial gray matter.

Prospective risk stratification in renal transplant candidates for cardiac death.

In previous studies to predict future cardiac death of patients undergoing evaluation for renal transplantation, noninvasive or invasive testing of all, or nearly all, patients has been used. In an attempt to decrease the cost of cardiac risk assessment, we prospectively used a two-tiered cardiac risk assessment algorithm on 189 consecutive patients referred for renal transplant evaluation. First, patients were stratified by clinical characteristics of age > or = 50 years, history of angina, insulin-dependent diabetes, congestive heart failure, or abnormal electrocardiogram (excluding left ventricular hypertrophy).

Mechanism of the impaired T-cell proliferation in adult rats exposed to alcohol in utero.

Although attempts have been made to assess the effect of ethanol on the immune responses in individuals with fetal alcohol syndrome, there is no consensus as to the effect of ethanol on the immune system. Evidence that fetal alcohol-exposed (FAE) humans and animals have diminished proliferative response of T-cells to mitogenic lectins is well established. However, little is known about the mechanism of a toxic effect of ethanol on T-cell growth.

HLA-DR mismatching correlates with early cardiac allograft rejection, incidence, and graft survival when high-confidence-level serological DR typing is used.

To determine if cardiac allograft outcome is improved among patients with fewer HLA-DR mismatches with their donors, we studied 132 recipients of a primary cardiac allograft who were transplanted between December 1985 and December 1991. These recipients and their donors all had high-confidence-level serological HLA-DR typing, previously shown to correlate highly with DNA DR typing. Patients were divided in two groups based on the HLA-DR mismatch with their donors.

Aortic valve replacement with pulmonary homografts. Early experience.

The increasing use of the aortic homograft as aortic valve substitute and the limited availability of donor valves prompted us to consider the pulmonary homograft as an alternative substitute for aortic valve replacement. The aim of our study is to compare the ultrastructural and biomechanical properties of pulmonary homograft leaflets with those of their aortic counterpart and to present the early results of using the pulmonary homograft for aortic valve replacement. Light and transmission electron microscopy have shown that pulmonary homograft leaflets are thinner than the aortic with a lesser content of elastic tissue in the ventricularis layer.

Organochlorine contaminant assessment in great blue herons using traditional and nonlethal monitoring techniques.

A nonlethal method is discussed for the evaluation of contaminant concentrations in whole eggs. Concentrations of pentachlorobenzene, hexachlorobenzene, DDE, and the PCB congeners, BZ-60, BZ-118, BZ-138, BZ-180, and BZ-170 were quantified in tissue samples from great blue herons (Ardea herodias). All tissues within whole eggs from two colonies were homogenized together and analysed for these chlorinated contaminants.

Heart transplantation in patients with previous cardiac operations. Excellent clinical results.

A significant proportion of potential transplant recipients have undergone previous cardiac procedures and may be subject to an increased risk because of technical and other factors inherent in a reoperation. Between December 1985 and June 1991, 155 orthotopic heart transplantations were carried out in 146 patients. Eighty-five transplantations (54.

Cardiac allografts from high-risk donors: excellent clinical results.

Rising waiting list mortality and increasing demand for donor organs have led to extension of traditionally accepted criteria for evaluation of cardiac grafts. From December 1985 to June 1992, 188 cardiac grafts were orthotopically transplanted into 178 recipients. Of these grafts, 38.

The specificity of normal qualitative angiography in excluding cardiac allograft vasculopathy.

It has been frequently stated that qualitative coronary angiography is insensitive in the diagnosis of cardiac allograft vasculopathy because the disease can be diffuse without observable luminal irregularities. However, the specificity of otherwise normal qualitative coronary angiography for excluding cardiac allograft vasculopathy has not been prospectively studied. Accordingly, 28 patients who underwent transplantation from June 23, 1989 to July 9, 1990 underwent coronary angiography within 3 weeks (predischarge) after transplantation and at 1 year.

Noninvasive cardiac testing in the end-stage renal disease patient.

Renal transplant candidates are at increased risk for future cardiac death--approximately 5-10% per year. Invasive testing by coronary angiography has been used to assess the cardiac risk. However this is expensive and carries its own risks to residual renal function as well as cardiac morbidity and mortality.

Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder.

Objective: Although attention deficit hyperactivity disorder is a common disorder of childhood, its status as a disorder in adults is not clear. The authors reasoned that if the adult diagnosis of the disorder is a valid clinical entity, it should be similar to the childhood disorder with regard to patterns of psychiatric and cognitive findings.

Methods: Eighty-four adults with a clinical diagnosis of childhood-onset attention deficit hyperactivity disorder confirmed by structured interview who were referred for treatment were studied.

Intellectual performance and school failure in children with attention deficit hyperactivity disorder and in their siblings.

We made psychiatric and intellectual assessments of 140 children with attention deficit hyperactivity disorder (ADHD), 120 normal controls, and their 303 siblings. The index children were white, non-Hispanic boys. ADHD children were more likely to have had learning disabilities, repeated grades, been placed in special classes, and received academic tutoring.

Antibiotic therapy: what to consider when treating geriatric patients.

The epidemiology, etiology, clinical manifestations, diagnostic approach, and therapeutic choices may be quite different for infections that occur in elderly patients compared with those that occur in younger adults. Given these variables, it is essential for clinicians who care for older patients to understand how to prescribe antibiotics appropriately for this population. This article examines the unique characteristics of infections in the elderly as well as provides recommendations on the use of specific antibiotic agents commonly used to treat infections in geriatric patients.

Impaired cytosolic free calcium response in splenic T-cells from mice fed with ethanol-containing diet.

Calcium-dependent signal transduction pathways of T-cell proliferation have been extensively studied in the past years. However, little is known about effects of ethanol on the calcium-dependent signal transduction pathway in T-cell proliferation. Thus, a murine model was used to determine effects of ethanol in vivo on T-cell proliferation and the intracellular free calcium concentration [Ca2+]i in response to Concanavalin A (Con A) and recombinant IL2 (rIL2) in T-cells.

The hemodynamic effects of intraoperative injection of muromonab CD3.

During anesthesia 5 mg of muromonab CD3 (OKT3), an anti-CD3 monoclonal antibody, was administered prophylactically to twelve patients undergoing cadaveric renal transplantation. Preoperatively, all patients were at or near their dry body weights. Methylprednisolone 500 mg on call to or in the operating room, azathioprine 2 mg kg-1 and diphenhydramine 50 mg were administered intraoperatively to reduce the probability and severity of reported effects of OKT3.

Solution structure of a DNA-binding domain from HMG1.

We have determined the tertiary structure of box 2 from hamster HMG1 using bacterial expression and 3D NMR. The all alpha-helical fold is in the form of a V-shaped arrowhead with helices along two edges and one rather flat face. This architecture is not related to any of the known DNA binding motifs.

Solution structure of a pair of complement modules by nuclear magnetic resonance.

A portion of human complement factor H spanning the 15th (H15) and 16th (H16) of its 20 modules, has been expressed in a yeast vector and subjected to structure determination in solution using two-dimensional 1H-NMR. The structure of H15 is very similar to that already established for the fifth module of factor H and H16, consistent with the view that all such complement control (C-) modules share a common overall topology. In addition, the tertiary structures of the component modules of the H15-16 pair are very similar to those of the modules when expressed individually, implying that each folds entirely autonomously within intact factor H.

Evidence for the independent familial transmission of attention deficit hyperactivity disorder and learning disabilities: results from a family genetic study.

Objective: The purpose of the study was to clarify the relationship between attention deficit hyperactivity disorder and learning disabilities.

Method: The authors assessed learning disabilities in a sample of 140 children with attention deficit hyperactivity disorder and in 120 normal comparison children. They also assessed a sample of the probands' 822 first-degree relatives.

Comparison of the Accu-CulShure system and a swab placed in a B-D Port-a-Cul tube for specimen collection and transport.

We compared the Accu-CulShure guarded specimen collection device and a swab inserted into a B-D Port-a-Cul transport tube in terms of their efficacy under ideal conditions for recovery of bacteria from 10 decubitus ulcer specimens. Cultures yielded 57 aerobes and 21 anaerobes; 76 isolates were recovered with use of Accu-CulShure, and 72 isolates were recovered with use of Port-a-Cul. Both systems were comparable for recovery of organisms in terms of quantitative and qualitative results.