Acquired free protein S deficiency associated with multiple myeloma: a case report.

Investigation of recurrent venous thromboembolic events in a 46-year-old man with progressive IgG kappa (total serum IgG, 74.3 mg/ml) multiple myeloma revealed profound reductions in free protein S (PS) antigen (<0.l U/ml) and PS activity (0.

Life-threatening "round pneumonia".

Round pneumonia is a rare manifestation of lower respiratory tract infection in adults. Previous reports emphasize that this entity is typically a mild, easily treatable illness that often masquerades radiographically as a neoplasm. We present two cases of round pneumonia, in patients with abnormal immunity, that progressed rapidly to life-threatening septic shock and respiratory failure.

Unique susceptibility of Helicobacter pylori to simethicone emulsifiers in alimentary therapeutic agents.

Helicobacter pylori is killed in vitro by polyoxyethylene acyl esters and ethers similar to simethicone emulsifiers in therapeutic antifoams. The MBC of these compounds for Helicobacter pylori was less than 20 micrograms/ml, while other gram-negative bacteria were unaffected by much higher concentrations of up to 50 mg/ml.

Effects of renal neutral endopeptidase inhibition on sodium excretion, renal hemodynamics and neurohormonal activation in patients with congestive heart failure.

We investigated the effects of inhibiting endogenous atrial natriuretic factor (ANF) metabolism on renal hemodynamics, sodium excretion and neurohormones in 12 patients with New York Heart Association functional class II congestive heart failure (CHF) due to left ventricular systolic dysfunction. In a randomized, placebo-controlled, double-blinded fashion, 8 patients received a single oral dose of candoxatril, an inhibitor of renal neutral endopeptidase, and 4 patients received placebo. Candoxatril treatment increased plasma ANF by 70 +/- 71 pg/ml (p < 0.

Human vascular smooth muscle cells produce an intracellular form of interleukin-1 receptor antagonist.

Interleukin-1 (IL-1) is a proinflammatory monocyte- and macrophage-derived cytokine that has potent vasorelaxant effects on vascular smooth muscle cells (VSMC). VSMC themselves also express both IL-1 alpha- and beta-genes, suggesting that IL-1 may be an autocrine regulator of VSMC function. The present study demonstrates that human saphenous vein VSMC (HSVSMC) produce IL-1 receptor antagonist (IL-1Ra), a specific inhibitor of IL-1 action.

Cerebrospinal fluid flow waveforms: analysis in patients with Chiari I malformation by means of gated phase-contrast MR imaging velocity measurements.

Purpose: To determine the features of the cardiac cycle-related cerebrospinal fluid (CSF) flow pulsations in with Chiari I malformation before and after decompressive surgery.

Materials And Methods: Fifteen patients and 23 healthy subjects underwent cine phase-contrast magnetic resonance imaging. Ten patients were also examined after decompressive surgery.

In situ hybridization detection of short viral amplicon sequences within cultured cells and body fluids after the in situ polymerase chain reaction.

Using single primer pairs, intracellular gene sequences of cytomegalovirus (CMV-Towne's strain) and alpha-tubulin were amplified (in situ PCR) from cells in human body fluids and in suspensions. Visualization of CMV amplificants was carried out by in situ hybridization (ISH), using both a biotinylated double-stranded DNA probe and a radiolabelled oligonucleotide probe. Visualization of alpha-tubulin amplificants was achieved using both radiolabelled single-stranded cRNA and oligonucleotide probes.

Overview: dietary approaches for reducing cardiovascular disease risks.

Current interest in reducing heart disease risks by diet involves attention to total fat; saturated, monounsaturated, polyunsaturated and trans fatty acids, as well as dietary cholesterol, soluble fiber, salt, alcohol, antioxidants, dietary alterations causing homocysteinemia and other dietary constituents, such as flavonoid compounds in some soy products. Principles to consider in crafting dietary approaches to reducing heart disease risk and some future directions for research are summarized. Public information about dietary approaches for reducing heart disease risk will benefit from the Nutrition Labeling and Education.

Clinical, echocardiographic, and hemodynamic evidence of cardiac tamponade caused by large pleural effusions.

Large pleural effusions are typically associated with dyspnea and potential respiratory compromise. Experimental evidence suggests that with large effusions, increased intrapleural pressure may be transmitted to the pericardial space, resulting in impaired cardiac filling and reduced stroke volume. We report two cases in which large pleural collections were complicated by hypotension.

Cytokines in human renal interstitial fibrosis. II. Intrinsic interleukin (IL)-1 synthesis and IL-1-dependent production of IL-6 and IL-8 by cultured kidney fibroblasts.

We compared cytokine production from transformed human fibroblast cell lines derived from either a kidney with interstitial fibrosis or a normal kidney to that from primary human foreskin fibroblasts. Fibrosis-derived as well as normal renal fibroblasts, but not skin fibroblasts, spontaneously produced the chemokine, IL-8, and the growth promoting cytokine, IL-6. Spontaneous IL-8 and IL-6 synthesis by renal fibroblasts was dependent on the intrinsic release of IL-1, since blocking IL-1 receptors with IL-1 receptor antagonist (IL-1Ra) partially inhibited the constitutive production of these cytokines.

Cytokines in human renal interstitial fibrosis. I. Interleukin-1 is a paracrine growth factor for cultured fibrosis-derived kidney fibroblasts.

We studied the role of interleukin-1 beta (IL-1 beta) and basic fibroblast growth factor (bFGF) in the proliferative response of transformed human renal interstitial fibroblast cell lines established from either a kidney with glomerulonephritis and interstitial fibrosis or a normal kidney in comparison to primary human foreskin fibroblasts. Growth of fibrosis-derived renal fibroblasts was inhibited in the presence of IL-1 receptor antagonist (IL-1Ra) by 35% (P < 0.005), suggesting that these cells produce IL-1 and possess IL-1 receptors as part of paracrine growth.

Hemagglutination and proteoglycan binding by the Lyme disease spirochete, Borrelia burgdorferi.

The ability of the Lyme disease spirochete to attach to host components may contribute to its ability to infect diverse tissues. We present evidence that the Lyme disease spirochete expresses a lectin activity that promotes agglutination of erythrocytes and bacterial attachment to glycosaminoglycans. Among a diverse collection of 21 strains of Lyme disease spirochete, hemagglutinating activity was easily detected in all but 3 strains, and these three strains were noninfectious.

Bladder mast cell expression of high affinity oestrogen receptors in patients with interstitial cystitis.

Objective: To investigate the role of oestrogens in the pathophysiology of interstitial cystitis (IC), specifically with respect to activated bladder mast cells (MC), as well as urine concentrations of MC-derived histamine and methylhistamine, all of which are increased in patients with IC. This goal appeared important because IC is a bladder disorder which occurs almost exclusively in women, and is characterized by polyuria, nocturia and pelvic pain, which worsen perimenstrually.

Patients And Methods: Biopsies from six patients with IC and four control patients were analysed blindly for the presence of oestrogen receptors (OR) using both custom-made and commercially available antibodies against OR.

An aspartate residue of the Yersinia pseudotuberculosis invasin protein that is critical for integrin binding.

The Yersinia pseudotuberculosis invasin protein mediates bacterial entry into mammalian cells by binding multiple beta 1-chain integrins. Invasin binding to purified alpha 5 beta 1 integrin is inhibited by Arg-Gly-Asp (RGD)-containing peptides, although invasin contains no RGD sequence. Fifteen mutations that diminished binding and bacterial entry were isolated after mutagenesis of the entire inv gene.

Glomerular filtration rate and urinary albumin excretion rate in systemic lupus erythematosus.

Our objective was to more precisely determine glomerular function in patients with systemic lupus erythematosus (SLE), without abnormalities in renal function, as determined by standard clinical laboratory tests. Our long-term goal is to identify patients during clinical quiescence who may be at high risk of developing progression to renal failure from lupus nephritis. We studied three groups of subjects: 8 patients with SLE and a history of nephritis, now in remission; 25 patients with SLE, without clinical evidence of nephritis, now or in the past; and 5 healthy women (normal controls).

Heart failure in women.

Observational and other studies suggest gender-related differences in the incidence and prognosis of heart failure. Women appear to live longer after the diagnosis of heart failure when compared with men. After myocardial infarction, women seem more likely than men to exhibit clinical heart failure.

Interleukin-1 in disease.

As outlined in this review, the inflammatory cytokine interleukin-1 (IL-1) mediates a number of pathological processes associated with disease. To prove a role for IL-1, a variety of modalities have been used to block the production and/or activity of IL-1. These include agents which inhibit or reduce 1) IL-1 transcription and/or synthesis, 2) the processing of pro-IL-1 beta into its mature forms, 3) the secretion of IL-1 beta, 4) the activity of IL-1 using neutralizing anti-IL-1 antibodies or 5) soluble (extracellular) IL-1 receptors, 6) the ability of IL-1 to bind to its receptors using receptor blockade, 7) the availability of surface receptors using agents which down-regulate receptor expression or (8) agents which affect IL-1-mediated signal transduction.

Pediatric fungal infections from head to toe: what's new?

This review highlights recent advances in the epidemiology, diagnosis, treatment, and pathophysiology of cutaneous fungal infections in childhood, from tinea capitis to tinea pedis. Emphasis is placed on a practical approach to caring for children with superficial fungal infections. New antifungal agents are reviewed and their potential importance discussed.

Infantile spasms in children with Down syndrome.

The authors retrospectively identified 17 children with Down syndrome who developed infantile spasms, and analysed their etiology, EEG findings, response to medication, development and prognosis. Compared with symptomatic infantile spasms in the general population, which have a poor prognosis, these patients had a relatively benign outcome with regard to seizure control: only three of 16 survivors currently have seizures and seven of the 16 currently receive anticonvulsants. Developmental outcome was poorest in those with a superimposed hypoxic insult and in those who regressed developmentally at the onset of the spasms and did not regain developmental milestones.

Interstitial pneumonitis after low-dose methotrexate therapy in primary biliary cirrhosis.

Interstitial pneumonitis is an uncommon complication of low-dose methotrexate therapy in patients with psoriasis but occurs in 3%-5% of patients with rheumatoid arthritis. We found a higher incidence of interstitial pneumonitis in patients with primary biliary cirrhosis (14%) and describe its clinical manifestations, treatment, and possible etiology. Blood tests, arterial blood gas determinations, chest radiographs, bronchoscopy, tear production, autoantibody tests, and serum immunoglobulin levels were obtained in six women who developed interstitial pneumonitis while receiving methotrexate in a double-blind prospective trial of methotrexate vs.

A search for mycobacterial DNA in sarcoidosis using the polymerase chain reaction.

The etiology of sarcoidosis is unknown, but mycobacteria have been considered as a possible etiologic agent. The authors used the polymerase chain reaction (PCR) to search for mycobacterial DNA in paraffin-embedded granulomatous tissues from patients with sarcoidosis. The target sequence used for PCR amplification is a 383-base pair segment of the gene encoding the 65 kD mycobacterial surface antigen.