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A clinical study of 50 Southern Chinese myasthenic children observed for periods of two to 18 years (six years on average) revealed manifestations different from those of caucasian patients. Onset was early, at an average of 4.8 years. 82 per cent had ocular myasthenia. Ophthalmoplegia followed ptosis between three months and 10 years later. Additional facial and isolated limb-muscle fatigability developed in only 6 per cent within three months to 3 1/2 years. Only 12 per cent developed generalized myasthenia. Although extension from ocular to the generalized form did not occur later than 20 months after onset, a deterioration in ocular symptoms, without extension into generalized myasthenia, occurred in nine of 18 children during adolescence. Ptosis and generalized myasthenia responded better to anticholinesterase and/or prednisone. Ophthalmoplegia was difficult to treat. The natural clinical course was benign. Spontaneous remission occurred in 62 per cent of cases, but 54.8 per cent of these relapsed, all confined to ocular muscles. Although there was no familial occurrence of myasthenia gravis, an association was found between myasthenia and thyroid disorders in some patients and their relatives. The association with HLA BW46 antigen was striking. Acetylcholine receptor antibodies were absent in the majority, but mildly elevated titres were found in three of five patients whose ocular symptoms deteriorated during adolescence, without extension into generalized myasthenia.

Pseudotumours of bone are an uncommon complication of severe haemophilia and only seven cases occurring in the mandible have been reported previously in the English literature. If treated early the condition appears to have a better prognosis and so it should be included in the differential diagnosis of any slowly progressive swelling of hard and soft tissues occurring in a patient with severe haemophilia. However aspiration and biopsy should be avoided if possible. Previous authors have advocated a variety of invasive procedures for this condition. A further case is described which is unique in the age at which the bilateral lesions developed, in the successful outcome of conservative management and in the dental observations.

The hepatitis B virus transcripts in human hepatoma and its adjacent nontumorous liver were examined with probes specific to hepatitis B virus surface antigen, core antigen, X region and pre-S region. The study shows that the patterns of hepatitis B virus transcripts for tumorous tissue and the counterpart in nontumorous liver differ. In most of the tissues examined, the surface antigen gene is transcribed. Most of these transcripts, besides having surface antigen sequences, also have an X region; some also include a pre-S region. The transcripts that hybridized to a core-specific probe were a pair of poly(A+) RNA, 3.5 and 2.2 kilobases in size, present in two of the nontumorous hepatocytes where the virus was actively replicating. The 3.5-kilobase transcript not only hybridized to the core probe, but was able to be hybridized to other hepatitis B virus subgenomic probes and might represent the RNA pregenome involving hepatitis B virus DNA replication. Whereas most of the transcripts hybridizable to hepatitis B virus probe are in the size range of 2.1 to 2.7 kilobases, some transcripts other than the pregenomic RNA appear to be greater than 3.2 kilobases in size and may represent the hybrid RNAs of viral and host sequences.

Moxalactam penetrates cerebral spinal fluid (CSF) and subdural fluid well enough to be a promising antimicrobial for enteric bacterial meningitis in neonates and infants. Clinical trials in adults and children have found few adverse effects. Prolongation of prothrombin time (PT) and partial thromboplastin time (PTT) with or without bleeding was reported in adults. This paper reports this complication in two infants occurring at a time of clinical improvement following addition of Moxalactam to other antibiotics to which the meningitis had failed to respond. It is not certain if this complication was related to the underlying meningitis, the use of Moxalactam together with other antibiotics, or a combination of many factors. Further observation, close hemostatic monitoring, and timely vitamin K administration during its use are warranted.

A review and follow-up study of 21 Chinese infants who had pneumococcal meningitis showed a mortality of 23.8% and high morbidity in survivors. Severe meningitis and delay in treatment as reflected by the presence of coma, pneumonia, disseminated intravascular coagulation, and lumbar CSF protein of over 368 mg% and glucose of lower than 10 mg% at the time of diagnosis were associated with fatality. Although the pneumococcus was sensitive to Penicillins which were given at usually recommended dosages and duration in these infants, the morbidity in survivors was high, and seemed to be associated with the presence of focal neurological abnormalities at the time of diagnosis, slow response in fever to treatment, short duration of afebrile period before discontinuation of antibiotics, and incompletely normal CSF parameters at the time of cessation of antibiotics. Serially sterile lumbar CSF did not guarantee against recrudescence of meningitis after cessation of antibiotics. The lack of uniformity in treating and monitoring these patients and suggested management are discussed.

Thirty symptomatic patients with retained gastric antrum proved pathologically and/or by isotopic visualization were studied and treated from 1968 to 1983. The latent periods from the antral exclusion to the occurrence of anastomotic ulcers after a subtotal gastrectomy with Billroth's type II reconstruction varied from a few days to 19 years, with an average of 2.8 years. Fasting serum gastrin levels were normal in 14 of 21 patients and were intermittently high in some patients. The basal to maximal acid-output ratio was greater than 0.6 in 69% of the patients; primary cimetidine treatment was effective in three of five patients. Thirty-five operations on 27 patients were divided into six groups; all of these 27 patients eventually underwent resection of retained gastric antrum. We concluded that resection remains the best treatment for anastomotic ulcer related to retained gastric antrum. Additional truncal vagotomy did not provide additional benefit to these patients. Furthermore, cimetidine can be useful to control the symptoms for preoperative preparation or definitive treatment in high-risk patients.

Two children in a Chinese family with progressive dystonia with marked diurnal variation in symptoms are described. Treatment with L-dopa resulted in complete disappearance of symptoms in one patient and marked improvement in the other patient.

Lack of lymphocyte infiltration into gastric cancer tissue appears to be an ominous prognostic indicator. The effects of gastric cancer cells on PHA-induced lymphocyte proliferation were studied. Peripheral lymphocytes were co-cultured for 72 hours with either gastric cancer cells or normal mucosal cells. Pairs of cancerous and normal mucosal cells from stomachs of eight patients, were separately co-cultured with peripheral lymphocytes either from patients or from normal volunteers. The degree of PHA-induced lymphocyte proliferation was measured by 3H-thymidine incorporation. The lymphocyte proliferation was inhibited by the presence of either gastric cancerous or normal mucosal cells in a dose-related manner. The lymphocytes from the normals proliferated twice as much as did the lymphocytes from the patients. The isotope incorporation occurred in lymphocytes rather than in gastric cells since the later incorporated insignificant amounts of isotope. There was no difference between gastric cancerous or normal mucosal cells inhibiting the proliferation of either normal or patients' lymphocytes (p greater than 0.05). In conclusion, gastric cancerous cells (up to 10(6)/ml) have no enhanced inhibition on lymphocyte proliferation when compared with normal gastric mucosal cells.

The level of c-myc transcript was examined in liver samples from seven hepatoma patients. Transcripts were detected in all the normal liver parts examined; in contrast, in two hepatoma parts, there was a dramatic reduction in c-myc transcripts. The restriction enzyme pattern of c-myc gene appeared the same among samples. The data suggest that c-myc gene expression might not be required for the maintenance of the tumor state in human liver carcinogenesis.

The clinical manifestations, immunological, chromosomal, and multimodal electrophysiological studies of five Chinese patients with ataxia telangiectasia are described. One died of hepatocellular carcinoma not associated with Hepatitis B-antigenaemia. Another died of respiratory failure. Two siblings are free of sinopulmonary infections although they are wheelchair bound. Computed tomography of the brain showed cerebellar atrophy in four cases. Nerve conduction studies showed evidence of axonal neuropathy in all cases with the earliest detection at six years. Electromyography showed mild denervation changes in two cases. Two patients had abnormal somatosensory evoked potentials and one had abnormal visual and brain stem auditory evoked potentials. The level of alpha foetal protein was elevated whereas the serum carcino-embryonic antigen was normal in all patients.

Controlled-release polymeric needle devices containing adriamycin HCL (ADH) were investigated by an in vitro dissolution study in normal saline solution and an in vivo antitumor activity in C3H mice bearing mammary carcinoma and nude mice bearing brain tumor. HPMC was used as a release rate regulator. The ADH released from needle devices was controlled by the types of polymer used and the addition of HPMC. EVA needle devices exhibit a zero order release behavior better than that of PLA needle devices. Tumor growth was markedly inhibited by treatment with needle devices after locally inserted into the solid tumor. The rank of antitumor activity of the needle devices is EVA greater than PLA greater than EVA-HPMC greater than PLA-HPMC. No significant changes in body weight of mice after treatment were found in treated groups as compared to controlled groups. The preliminary results of our study suggest that needle device dosage form shows a controlled release behavior and may be applicable as a drug carrier for delivery of antitumor drug in cancer chemotherapy.

The authors describe a Chinese girl with myasthenia gravis and progressive dystonia with marked diurnal fluctuation. A combination of L-dopa and pyridostigmine therapy resulted in control of the myasthenic symptoms and disappearance of the dystonia.

The HLA antigen distribution and thyroid autoantibody status of 27 Chinese children in Hong Kong with juvenile onset myasthenia gravis have been compared with 110 healthy university students from the same population. Twenty-four of the patients had ocular myasthenia. There was a significantly increased prevalence of HLA BW46 in the patients compared with controls (67% vs 26.4%, p less than 0.005) indicating that BW46 confers a relative risk of 5.6 for juvenile onset myasthenia gravis in Chinese children. The increased prevalence of BW46 was not associated with thyroid autoimmunity in the patients although the antigen is known to be associated with thyrotoxicosis in Chinese. The possibility that BW46 confers protection against the development of acetyl-choline receptor antibodies in Chinese patients is discussed. One patient had the Caucasian antigen B8 and the question whether defective immune response genes were introduced into the Chinese through Caucasian admixture is raised.

Glucocorticoid and progesterone receptors, tyrosine aminotransferase, gamma-glutamyltransferase and alpha-fetoprotein levels were determined in human hepatocellular carcinoma (HCC) and adjacent liver tissues. Glucocorticoid receptor was present in seven of ten HCC samples, values ranged from 1.9 to 66.8 fmol/mg protein. Progesterone receptor was present in two of ten HCC samples with values of 1.7 and 7.2 fmol/mg protein, respectively. In the adjacent liver tissues, no measurable progesterone receptor was found and only one sample had glucocorticoid receptor with a value of 3.0 fmol/mg protein. The increase of glucocorticoid receptor in HCC samples was coincident with a decreased level of tyrosine aminotransferase and an increased level of gamma-glutamyltransferase. No correlation was found among glucocorticoid receptor level, serum or tissue alpha-fetoprotein levels. The presence of glucocorticoid receptors in HCC suggest that hormones may play an important role in the formation of hepatoma, and hormonal therapy may be useful for patients with HCC.

Gastric stump cancer has a low resection rate and poor response to systemic chemotherapy. This study attempted to achieve higher drug concentrations in target tissues by way of regional arterial injection instead of systemic venous administration. A total of 12 male mongrel dogs that had undergone post-Billroth II gastrectomies were randomly divided into two groups: in group A, 1.27 mg/kg adriamycin (ADM) was injected through the left gastric artery; in group B, the same dose of ADM was injected into a vein in the left front leg. Blood samples were taken at various time intervals, and the dogs were sacrificed 2 h after drug administration. Tissues were removed from various parts of the gastric stump for measurement of the ADM concentration. The ADM content in the jejunum, heart, liver, spleen, and pancreas was also determined. The results were as follows: (1) the ADM concentration in the gastric stump near its lesser curvature and stomal mucosa was significantly higher in group A than in group B (P less than 0.05). (2) The ADM concentrations in the adjacent organs (heart, liver, and pancreas) were also significantly higher in group A than in group B (P less than 0.05). (3) The ADM levels in the venous blood were significantly higher in group B than in group A (P less than 0.05). These results indicate that a chemotherapeutic drug given through the left gastric artery provides a higher drug concentration in the area where gastric stump cancer frequently occurs and that a lower systemic blood level may cause fewer adverse drug effects. The high concentration of ADM in the heart may not be a good indication, but it may serve as an important signal either to select a less cardiotoxic drug or to monitor heart function cautiously during drug therapy.

We studied multimodal evoked potentials (EPs) longitudinally in a series of children with Friedreich's ataxia and ataxia telangiectasia to determine both their diagnostic utility and their correlation with clinical regression. The auditory brainstem responses (ABRs) were abnormal only in the children with Friedreich's ataxia. The abnormality seen in these patients was a rostral-caudal loss of the ABR waves. The visual EPs (VEPs) were abnormal in many of the patients; those with ataxia telangiectasia had unusually low amplitude or absent VEPs, occasionally with increased latencies, whereas those with Friedreich's ataxia had normal amplitude VEPs, often at increased latencies. The somatosensory EPs were usually of increased latency or absent in these patients. Unlike the ABR and VEPs, they did not serve to differentiate the groups. Changes in the EPs appeared to reflect clinical deterioration; patients with little change in their EPs over several years were regressing very slowly, whereas others had rapid deterioration in both EPs and clinical status. We suggest that the EPs are diagnostically of value in degenerative ataxias and may be of value in monitoring these patients and their response to therapy.

From Jan. 1980 to Dec. 1987, 53 patients with symptomatic intrahepatic stones were treated with hepatic resection. The indications for hepatic resections in our patients include: 1) stones located in an anatomic area, 2) extensive liver tissue damage or fibrosis, and 3) strictures of the intrahepatic bile ducts in the involved portion. The stones are located mainly on the left side. Lateral segmentectomy was performed in 31 patients. There was no operative mortality, and fourty-six patients were followed up for an average of 25 months. Results show that 67.4% were symptom free, 23.9% had occasional mild symptoms of cholangitis and 8.7% had severe cholangitis requiring further surgical intervention. The low morbidity and mortality of the operation and the good results reveal that hepatic resection is a safe and rewarding procedure in the treatment of some primary intrahepatic stones.

A review of twelve Southern Chinese children whose myasthenic symptoms started within the first two years of life and followed up for one to sixteen years showed that, unlike some previous reports on non-Chinese children, the majority had only ocular myasthenia. Response to pyridostigmine was satisfactory and spontaneous remissions were frequent. Although more boys than girls were affected, familial myasthenia occurred in none. Serum acetylcholine receptor antibodies were not elevated in the majority. An association with HLA A11 and BW 46 needs further confirmation.

Injury of the superior mesenteric vein from blunt abdominal trauma is an uncommon but frequently fatal injury. A 63-year-old man was injured in a motorcycle accident. He was admitted to our hospital in profound shock. Immediate celiotomy revealed superior mesenteric vein injury which was repaired by end-to-end anastomosis. Rapid fluid resuscitation and expeditious exploration are the key in saving patients with this condition. Indications for exploration of retroperitoneal hematomas, techniques of exposure, modes of reconstruction of the injured vein and the importance of a second-look operation are discussed.

A case of carcinoid tumor of the pancreas with the watery diarrhea, hypokalemia, and hypochlorhydria syndrome in association with hyperparathyroidism and the amenorrhea-galactorrhea syndrome is presented. Resection of the three grossly enlarged, hyperplastic parathyroid glands restored eucalcemia in this patient. A subsequent excision of the 370 gm pancreatic carcinoid tumor resulted in a cure of the watery diarrhea and a return of the gastric acid secretion to normal. Immunocytochemical studies of the pancreatic tumor demonstrated a positive stain only for serotonin, and negative results for vasoactive intestinal polypeptide, pancreatic polypeptide, glucagon, insulin, cholecystokinin, gastrin, and calcitonin were obtained. These studies suggest that in this patient, serotonin was a causative agent of the watery diarrhea syndrome.

Hepatocellular carcinoma (HCC) was treated with transcatheter arterial chemoembolization (TACE) in a sample of 129 patients. The cumulative survival rate was 49% at 1 year and 22% at 2 years. The median survival time was 11.9 months. The survival rates at 1 year of 84 patients in Child's group A and 27 in Child's group B were 56% and 40%; out of 52 HCC patients with portal vein patent and 77 with portal vein invasion 75% and 40% survived, and the 1-year survival rates for 33 HCC patients with capsule intact, 14 with capsule broken and 82 with no capsule were 85%, 65% and 40% respectively. From the above results there were statistically significant differences in survival time in those with good clinical performance status by Child's classification, those showing patency of the portal vein and those where the capsule was present. Therefore, we would like to recommend, TACE of HCC in well-selected patients presenting with good clinical status, patency of the portal vein and without broken capsule, in order to achieve better clinical results.

Monoclonal antibodies with selectivity for human hepatoma cell lines were produced by immunizing BALB/c mice with human hepatoma cell lines, HA22T/VGH or Hep 3B, and fusing sensitized mouse spleen cells with mouse myeloma cells. Two monoclonal antibodies recognizing antigens present only on human hepatoma cell lines were investigated. The monoclonal antibody IB1 was found to react with 3 of 9 hepatoma cell lines. Monoclonal antibody 9B2 reacted with all nine hepatoma cell lines. None of the other 20 cell lines tested was bound by IB1 and 9B2. The immunoperoxidase staining of monoclonal antibodies on frozen sections of paired hepatoma and normal liver tissues from the same individuals were studied. Antibody IB1 reacted with 3 of 13 hepatoma tissues, but with none of the normal liver and other tissues, and antibody 9B2 was reactive with antigens appearing on the bile canalicular domain of hepatoma and normal liver tissues. The antibody 9B2 stained no normal tissues with the exception of proximal tubules of kidney. Radioimmunoprecipitation tests identified two antigens reacting with 9B2. The major antigen had an apparent molecular weight of 140,000 and a minor one of 130,000. Therefore, antibody IB1 seems to be specific for antigens present on a group of human hepatoma cells and may be useful for classification and diagnosis of human hepatomas. Antibody 9B2 is quite specific to human liver cells and may be used to provide clues for the characterization of tumor cell lines, identification of metastatic tumors with hepatocytic origin, and study of the structure and function of bile canaliculi.

A transient but considerable rise in serum creatine phosphokinase (CPK) levels occurred in six boys aged between 8 and 11 years and suffering from phenothiazine-induced dystonia. In one boy (Case 4), after the CPK level had returned to normal after withdrawal of the drug, its reintroduction orally at lower dosage caused a slight increase in the level of CPK in the absence of any recurrence of the dystonia.

Two types of polymeric needle devices (reservoir type and matrix type) were prepared. The release behavior and mechanism of adriamycin HCl from these needle devices were investigated and deduced. Adriamycin HCl released from reservoir type needle devices exhibited a zero order release kinetic, but a Higuchi membrane-diffusion controlled model was shown in matrix type needle devices. A lag time and burst effect were obtained in reservoir type and matrix needle devices, respectively. The release of adriamycin HCl from these needle devices was controlled and can be monitored by adding a hydrophilic or hydrophobic additive.

The multitest CMI system, a disposable device that simultaneously applies seven standardized preloaded antigens and diluent control, is a major advance for measurement of delayed type hypersensitivity (DTH) in assessment of cell-mediated immunity (CMI). The system was tested in 84 healthy volunteers, 42 in each sex, aged 4-62 years, to determine normal values for incidence and size of DTH responses to each of seven antigens. Incidence of positive responses to individual antigens varied from 84.5% to 11%, more than half of volunteers were reactive to Tuberculin, Candida and Diphtheria, and a third to Tetanus, Streptococcus and Tricophyton. 95.3% of volunteers to one or more antigens, and about two thirds to three or more. To better assess CMI, a two-part score based on 48-hour readings was employed. The mean number of positive antigens ranged between 2.2 and 3.3, the mean sum of their millimeter induration ranged between 10.8 and 18.2, the average sum of diameters were 16.7 mm in males and 15.2 mm in females. There was no statistic significance to sex and age during scoring, although there was somewhat higher in males, young and mature age groups. In our series, Tuberculin reaction is the highest one in this seven antigens, about 4.76% of volunteers are anergy. A statistical zone (95% confidence limits) of reduced DTH scores (hypoergy) was identified, it reveals sum of diameters less than 9mm in males and 7mm in females, number of positive antigens are less than 2 in each sex.(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective survey of primary hepatocellular carcinoma (PHC) was conducted in a rural area of Taiwan using a two-site enzyme immunoassay for alpha-fetoprotein (AFP) in dried blood samples collected on filter paper. Of 1894 men over 40 years of age who were tested, 20 (1%) had AFP levels of greater than 20 ng/ml of blood on screening. Nineteen of these men received ultrasound examinations, and small PHCs were detected in 4 (21%). The remaining 15 cases had other types of hepatobiliary tract diseases, and 6 (40%) were also serum HBsAg positive. They should all be closely followed up by AFP determination and ultrasound examination of the liver. In contrast to the low resection rate of PHC in symptomatic patients who were admitted through the outpatient clinic during the period of this survey, the four cases with small PHC discovered by AFP screening had their tumors successfully removed (5/57 vs. 4/4, p less than 0.005). Our preliminary results showed that this method is a simple, sensitive and convenient assay for AFP and may be used as a first-line screening test in mass population surveillance programs for PHC, particularly in areas where PHC is highly prevalent.

Arginase, a potent immune inhibitor, is studied in gastric cancer for its possible role in immunosuppression. Aqueous extracts (n = 12) from gastric cancer tissue inhibited PHA-induced lymphocyte proliferation more than those from normal gastric mucosal tissues (p less than 0.05). The inhibition was not due to cytotoxic effect of the extracts. Gastric arginase was isolated from gastric extracts by an affinity column conjugated with an anti-arginase antibody. The arginase from both normal and cancer gastric tissues strongly inhibited lymphocyte proliferation. By using enzyme-immunoassay, the arginase contents in cancer tissues were determined and showed 3 times as much as that in normal gastric mucosal tissues (n = 14) (p less than 0.005). The increased arginase content in cancer tissue was further confirmed by immunohistochemistry study. Arginase exists abundantly amounts in the cytoplasm of cancer cells, much more than that of normal cells (n = 30). It is conceivable that the depressed cellular immunity in gastric cancer patients might be partly due to the abundant amount of arginase in cancer cells.

For better understanding of the alterations of humoral immunity in gastric cancer patients, IgG, IgA, IgM, complement C3, C4, CH50, natural antibody (isohemagglutinin-IgM class), ESR, CRP, albumin and globulin were quantitated in sera taken preoperatively from 81 patients with gastric cancer and from 29 control patients with hernia. The results from patients with gastric cancer were grouped according to pTNM staging (including stage I + II, III, and IV). Serum globulin and IgG levels in all stages of cancer patients were significantly lower than that of the controls (p less than 0.05). The CRP and ESR levels in stage III and IV cancer patients were significantly higher (p less than 0.05). There was no difference between cancer and hernia patient groups in IgA, IgM, isohemagglutinin-IgM class, C3, C4, CH50, albumin, WBC and total lymphocyte counts. In conclusion, the significant changes in humoral immunity in patients with gastric cancer include: (1) decrease in serum IgG and globulin levels, and (2) increased levels of acute phase reactants (ESR, CRP). These results imply that patients with gastric cancer have lower acquired humoral immunity and have acute phase reactions.

A sudden increase in Salmonella gastroenteritis affecting infants and children in Hong Kong in 1971 prompted a clinical review of 200 such patients seen over a 6 year period. It showed unprecedented prevalence of Salmonella johannesburg infections and unusually protracted diarrhoea. Only 3.5 per cent of patients were breast fed. Factors causing this chronicity are discussed. All 8 fatal cases were under 7 1/2 months old, with protracted diarrhoea starting within 1 month after birth in 7. The invasiveness of Salmonella johannesburg is low although its infectivity high. Bacteraemia occurred in only 1 patient and focal infections other than gastroenteritis in none. Antibiotics did not improve diarrhoea nor eliminate faecal excretion in the majority of those treated. Prolonged and intermittent faecal excretion of Salmonella was common. Nineteen per cent of patients acquired diarrhoea in hospital; some after a course of antibiotics given for other infections. Experience from this series does not recommend administration of antibiotics to patients with uncomplicated Salmonella johannesburg gastroenteritis. As chronicity of diarrhoea seemed to be the major prognostic factor with regard to mortality and morbidity in this series, further search for causes and control measures of this chronicity is required.

The content of glucocorticoid receptor (GR) and arginase in human gastric cancer and the corresponding normal gastric mucosal tissues was determined. Among the 25 patients studied, the GR content in gastric cancer tissues was 33.2 +/- 10.2 fmol/mg protein versus 7.6 +/- 3.4 fmol/mg protein in gastric mucosal tissues. This difference is statistically significant (P less than 0.005). Of the 25 paired samples, 19 cancer tissues contained GR, whereas only seven of the normal mucosal tissues had GR. The level of arginase in gastric cancer tissues in 19 patients was assayed, it was 26.6 +/- 4.2 ng/mg protein which is also significantly higher than that in normal gastric mucosal tissues (13.5 +/- 1.8 ng/mg protein) (P less than 0.005). Since glucocorticoids and arginase are potent immune suppressive agents, the increased level of GR and arginase in gastric cancer tissue suggest that these glucocorticoid-related factors in gastric cancer tissue may play a partial role in regulating cellular immunity.

A chemically synthesized gene for human interferon-gamma has been cloned into a prokaryotic expression vector under the regulation of a synthetic constitutive transcriptional-translational control unit that contains a strong bacteriophage T5 early promoter and a strong ribosome-binding site. Cells harboring the recombinant plasmid express high levels (4 X 10(9) units per liter of culture) of antiviral activity specific for interferon-gamma. Analysis of total cell lysates on NaDodSO4/polyacrylamide gels revealed a 17,200-dalton protein, expected for the nonglycosylated form of human interferon-gamma, that constitutes greater than 15% of total cell protein.

Despite adequate treatment, mortality and morbidity were high among the 13 cases of Salmonella meningitis in this series. Chloramphenicol, being a bacteriostatic agent against Salmonella species, is not a suitable antibiotic for the treatment of Salmonella meningitis. Treatment for 4-6 weeks is recommended with use of an antibiotic capable of achieving an adequate bactericidal concentration in the cerebrospinal fluid such as moxalactam. Intraventricular antibiotic treatment should be considered if there is a delay in the eradication of the Salmonella organisms from the cerebrospinal fluid after starting treatment.