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Aims: To define the immunopathological profile of transfusion associated graft versus host disease (TA-GvHD) to elucidate its pathophysiology and to determine if any features are of diagnostic value., Methods: Nine patients (age range 14-61 years) who developed histologically confirmed TA-GvHD between 1989 and 1992 were studied. Immunohistochemical analysis of frozen and formalin fixed skin biopsy tissue was performed. Sections were stained with antibodies to CD3, CD8, CD4 and HLA-DR, using a routine streptavidin-biotin technique with standard diaminobenzidine development., Results: All biopsy specimens showed aberrant positive expression of HLA-DR by epidermal keratinocytes. In four patients, all of whom died, HLA-DR was diffusely expressed throughout the epidermis; in the other five cases keratinocyte expression of HLA-DR was more focal. In all biopsy specimens T cells had infiltrated the dermis and epidermis. In all nine cases CD4+ T helper/inducer cells were the predominant T cells., Discussion: Immunohistochemical studies are of value in the diagnosis of TA-GvHD. Aberrant keratinocyte expression of HLA-DR and dermal and epidermal infiltration of CD4+ T cells are immunopathological features of TA-GvHD. Immunohistochemical analysis of skin biopsy tissue using antibodies to these markers is thus a useful investigation in pancytopenic patients presenting with unexplained rashes.

Highly purified populations of alveolar epithelial cells (type II pneumocytes) were isolated from human lung specimens. These cells were characterised histochemically, by demonstrating the presence of intracellular alkaline phosphatase, and morphologically, by electron microscopic demonstration of lamellar bodies and microvilli. Expression of the epithelial glycoprotein HEA-125, of MHC class I and class II (HLA-DR, -DP and -DQ) antigens and of the intercellular adhesion molecules ICAM-1, VCAM-1, LFA-3 and B7 was quantified by flow cytometry. Comparison was made between the expression of these molecules by isolated type II cells and by alveolar epithelium in normal human lung tissue after immunocytochemical staining of frozen sections of donor lung. Isolated type II pneumocytes expressed HEA-125 and class I MHC molecules and the class II MHC molecules HLA-DR and -DP; HLA-DQ was not detected. The intercellular adhesion molecule ICAM-1 was expressed constitutively at low levels but there was minimal expression of VCAM-1, LFA-3 and B7. It was not possible to differentiate type II cells from the predominant type I pneumocytes on frozen sections. Alveolar epithelium expressed HEA-125, class I MHC antigens, the class II molecules HLA-DR, and -DP and the intercellular adhesion molecule LFA-3. Expression of the adhesion molecules ICAM-1, VCAM-1 and B7 was variable. As with the isolates, HLA-DQ was not observed on alveolar epithelium. In conclusion, a reproducible method for the isolation of pure populations of human type II pneumocytes has been developed. These cells were not damaged by the isolation procedure. It is not known whether alveolar epithelium can present antigens to T lymphocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

76 first grade children of a special school for learning disabled were tested for specific developmental disorders of motor functions (SDDM). 15 children (19.7%), boys and girls proportionately, had a SDDM. This is a substantial increase compared to the unselected population. 8 children (15.5%) suffered from a specific disorder of body coordination and low finger-eye coordination. 4 children (5.3%) were found to have specific disorders of motor functions and specific language retardations. Isolated disorders of hand coordination were not found. 31% of the children with SDDM suffered from psychiatric disorders. Roughly the same percentage of psychiatric diagnosis was found in children without disorders of motor functions. A total of 24 children (33%) had impaired physical coordination: these children had significantly higher total scores in the Child Behavior Checklist (CBCL). Though this questionnaire was not sensitive for detection of disorders of motor functions.

66 children attending first grade at a special school for educationally subnormal children were examined medically and psychologically. Classification was done according to ICD-10. In addition, the parents were asked to rate their children's behavior with the "Child Behavior Checklist" by Achenbach and Edelbrock. The most common symptoms rated in this group of 6- to 8-year-old children were lack of concentration, speech and language problems, hyperactivity, demand for attention and arguing. The mean total score (cut-off score: 30) and the number of crucial items (cut-off score: at least two crucial items) differed significantly between the children with and those without psychiatric disorders. No significant correlation was found between the mean total score or the number of crucial items and the sex of the children or the other axes of the Multi-axial Classification of Child Psychiatric Disorders.

Isometamidium chloride (Samorin) is the only compound recommended for prophylaxis against bovine trypanosomiasis in sub-Saharan Africa. The fluorescence property of this compound was used to investigate the interaction of the molecule with in vitro-derived bloodstream forms of Trypanosoma congolense IL 1180. Incubation of isometamidium with trypanosomes at 37 degrees C for 180 min resulted in a gradual alteration of the lambda max. with time (from 600 to 584 nm) and an increase in the intensity of trypanosome-associated fluorescence of approx. 2-fold. The alteration in fluorescence was temperature-dependent and inhibited by the addition of N-ethylmaleimide. In contrast, with intact cells addition of digitonin caused a rapid increase in fluorescence intensity to approximately four times that observed with intact cells. Uptake of isometamidium was also determined using radiolabelled drug; the results indicated that the time course of the uptake process resembled the fluorescence profile and was temperature-dependent. The results therefore indicate that the alteration of fluorescence is due to interaction of isometamidium with an intracellular component(s) and that isometamidium is transported across the plasma membrane via a protein carrier. The data also indicate that the described fluorescence technique can be used to investigate the role of membrane transport in resistance to isometamidium.

The frequencies of specific language retardation and deficits in short term memory span are the subject of this epidemiological investigation of children attending the first grade of a special school for educationally subnormal children in Erlangen and München/Rosenheim. The children at the mean age of seven were examined according to the "Multi-axial Classification of Child Psychiatric Disorders". The following prevalences were found: 16 children (21%) of the sample from Erlangen and 24 children (33%) of the sample from München/Rosenheim had an specific language retardation, in both sample the most frequent disorders were retardations of the expressive language (11% and 21%). In both sample most children had substantially deficits in the acoustic short term memory span, while they were better on visual short term memory span. Significant correlations between acoustic short term memory span and specific language retardations were found.

The study was conducted to assess the consequences of multiple diagnoses and handicaps in children aged 6 to 8 years. Children were considered to be "multiply handicapped" if they suffered from two or more disorders or impairments included in the Multi-axial Classification Scheme. To this end children in special schools were compared with a random sample of children from three communities in Bavaria. As expected, all prevalences found in the population of children from special schools were substantially higher than those found in the random sample. Furthermore, the proportion of children with multiple handicaps in the special schools far exceeded what one would have expected based on the findings for the random sample. Most of the disturbances did not differ in respect to their comorbidity. But the mentally retarded children in the special schools were all "multiply handicapped". The importance of "multiple handicaps" for the assignment to special schools is discussed, as are the implications for the planning of services.

The most common technique for preparative labeling of proteins with radioisotopes for experimental purposes utilizes 125I. This isotope has certain limitations, including the emission of gamma- and X-irradiation, the release of gaseous 125I2 from solutions of Na 125I, and the potential for concentration of 125I in thyroid glands. We have discovered a means for labeling proteins rapidly and simply with [35S]methionine. The technique is applicable to a wide variety of proteins. Antibodies labeled by our technique remain functional.

Passive proton permeability of gastrointestinal apical membrane vesicles was determined. The nature of the pathways for proton permeation was investigated using amiloride. The rate of proton permeation (kH+) was determined by addition of vesicles (pHi = 6.5) to a pH 8.0 solution containing acridine orange. The rate of recovery of acridine orange fluorescence after quenching by the acidic vesicles ranged from 4 x 10(-3) (gastric parietal cell stimulation-associated vesicles; SAV) and 5 x 10(-3) (duodenal brush-border membrane vesicles; dBBMV) to 11 x 10(-3) sec-1 (ileal BBMV; iBBMV). Amiloride, 0.03 and 0.1 mM, significantly reduced the rate of proton permeation in dBBMV and iBBMV, but not gastric SAV. The decreases in kH+ were proportionately greater in iBBMV as compared with dBBMV. The presence of Na+/H+ exchange was demonstrated in both dBBMV and iBBMV by proton-driven (pHi less than pHo) 22Na+ uptake. Evidence was also sought for the conductive nature of pathways for proton permeation. Intravesicular acidification, again determined by quenching of acridine orange fluorescence, was observed during imposition of K(+)-diffusion potential ([K+]i much much greater than [K+]o). In dBBMV and iBBMV, intravesicular acidification was enhanced in the presence of the K(+)-ionophore valinomycin, indicating that the native K+ permeability is rate limiting. In the presence of valinomycin, the K(+)-diffusion potential drove BBMV intravesicular acidification to levels close to the electrochemical potential. In gastric SAV, acidification was not limited by the K+ permeability. Valinomycin was without effect, but the K+/H+ ionophore nigericin enhanced acidification in gastric SAV, illustrating the low proton permeability of these membranes.(ABSTRACT TRUNCATED AT 250 WORDS)

Intracellular calcium [Ca2+]i measurements in cell suspension of gastrointestinal myocytes have suggested a single [Ca2+]i transient followed by a steady-state increase as the characteristic [Ca2+]i response of these cells. In the present study, we used digital video imaging techniques in freshly dispersed myocytes from the rabbit colon, to characterize the spatiotemporal pattern of the [Ca2+]i signal in single cells. The distribution of [Ca2+]i in resting and stimulated cells was nonhomogeneous, with gradients of high [Ca2+]i present in the subplasmalemmal space and in one cell pole. [Ca2+]i gradients within these regions were not constant but showed temporal changes in the form of [Ca2+]i oscillations and spatial changes in the form of [Ca2+]i waves. [Ca2+]i oscillations in unstimulated cells (n = 60) were independent of extracellular [Ca2+] and had a mean frequency of 12.6 +/- 1.1 oscillations per min. The baseline [Ca2+]i was 171 +/- 13 nM and the mean oscillation amplitude was 194 +/- 12 nM. Generation of [Ca2+]i waves was also independent of influx of extracellular Ca2+. [Ca2+]i waves originated in one cell pole and were visualized as propagation mostly along the subplasmalemmal space or occasionally throughout the cytoplasm. The mean velocity was 23 +/- 3 microns per sec (n = 6). Increases of [Ca2+]i induced by different agonists were encoded into changes of baseline [Ca2+]i and the amplitude of oscillations, but not into their frequency. The observed spatiotemporal pattern of [Ca2+]i regulation may be the underlying mechanism for slow wave generation and propagation in this tissue. These findings are consistent with a [Ca2+]i regulation whereby cell regulators modulate the spatiotemporal pattern of intracellularly generated [Ca2+]i oscillations.

Isolated rabbit gastric glands were used to study the nature of the muscarinic cholinergic responses of parietal cells. Carbachol (CCh, 100 microM) stimulation of acid secretion, as measured by the accumulation of aminopyrine, was inhibited by the M1 antagonist, pirenzepine, with an IC50 of 13 microM; by the M2 antagonist, 11,2-(diethylamino)methyl-1 piperidinyl acetyl-5,11-dihydro-6H-pyrido 2,3-b 1,4 benzodiazepin-6-one (AF-DX 116), with an IC50 of 110 microM; and by the M1/M3 antagonist, diphenyl-acetoxy-4-methylpiperidinemethiodide (4-DAMP), with an IC50 of 35 nM. The three antagonists displayed equivalent IC50 values for the inhibition of carbachol-stimulated production of 14CO2 from radiolabeled glucose, which is a measure of the turnover of the H,K-ATPase, the final step of acid secretion. Intracellular calcium levels were measured in gastric glands loaded with FURA 2. Carbachol was shown to both release calcium from an intracellular pool and to promote calcium entry across the plasma membrane. The calcium entry was inhibitable by 20 microM La3+. The relative potency of the three muscarinic antagonists for inhibition of calcium entry was essentially the same as for inhibition of acid secretion or pump related glucose oxidation. Image analysis of the glands showed the effects of carbachol, and of the antagonists, on intracellular calcium were occurring largely in the parietal cell. The rise in cell calcium due to release of calcium from intracellular stores was inhibited by 4-DAMP with an IC50 of 1.7 nM, suggesting that the release pathway was regulated by a low affinity M3 muscarinic receptor or state; Ca entry and acid secretion are regulated by a high affinity M3 muscarinic receptor or state, inhibited by higher 4-DAMP concentrations (greater than 30 nM), suggesting that it is the steady-state elevation of Ca that is related to parietal cell function rather than the [Ca]i transient. Displacement of 3H N-methyl scopolamine (NMS) binding to purified parietal cells by CCh showed the presence of two affinities for CCh, but only a single affinity for 4-DAMP and lower affinity for pirenzepine and AFDX 116, providing further evidence for the parietal cell location of the [Ca]i response. Elevation of steady-state [Ca]i levels with either ionomycin or arachidonic acid did not replicate M3 stimulation of acid secretion or glucose oxidation, hence elevation of [Ca]i is necessary but not sufficient for acid secretion.

The rabbit gastric gland model was used to study the nature of the muscarinic cholinergic and gastrin responses of parietal cells. Carbachol (100 microM) stimulation of acid secretion, as measured by the accumulation of aminopyrine, was inhibited by the M1 antagonist pirenzepine with an IC50 of 13 microM; by the M2 antagonist 11,2-(diethylamino)methyl-1-piperidinyl acetyl-5,11-dihydro-6H-pyrido 2,3-b 1,4-benzodiazepin-6-one (AF-DX 116) with an IC50 of 110 microM; and by the M3 antagonist diphenylacetoxy-4-methylpiperidinemethiodide (4-DAMP) with an IC50 of 35nM. The three antagonists displayed similar IC50 values for the inhibition of carbachol-stimulated production of 14CO2 from radiolabeled glucose, which is a measure of the turnover of the H(+)-H(+)-ATPase. Intracellular calcium levels wer measured in gastric glands loaded with FURA2. Carbachol was shown both to release calcium from an intracellular pool and to promote calcium entry across the plasma membrane. The calcium entry was inhibitable by 20 microM La3+. The relative potency of the three muscarinic antagonists for inhibition of calcium entry was essentially the same as for inhibition of acid secretion or metabolism. However, the rise in cell calcium due to release of calcium from intracellular stores was inhibited by 4-DAMP with an IC50 of 1.7 nM. Image analysis confirmed that the effect of carbachol and of the antagonists on intracellular calcium was occurring in the partial cell. In particular, the high-affinity inhibition of calcium release by 4-DAMP occurs in the parietal cell. Accordingly, it appears that the secretory receptor of the parietal cell is of the M3 type, and acid secretion depends on the entry of calcium rather than on calcium release from intracellular stores. In parallel experiments gastrin (G-17-sulfated) produced a dose-dependent increase in intracellular calcium (EC50, 0.14 +/- 0.013 microM). No stimulation of acid secretion was observed, but pepsinogen secretion was stimulated dose-dependently (EC50 = 1.17 +/- 0.21 microM).

A leukemoid reaction is a complex and poorly understood response by the bone marrow to a variety of stresses; although any peripheral blood cell line may be involved, it is rarely a purely monocytic event. A case is reported of a true monocytic leukemoid reaction in a patient with myelodysplastic syndrome related to the effect of corticosteroids on the underlying marrow disorder.

The purpose of this study was to determine whether shoulder rotational strength was greater in the plane of the scapula or the frontal plane. Isokinetic shoulder rotational strength was evaluated in 20 subjects. Using the Merac (Universal Gym Equipment, Inc., Cedar Rapids, IA), test data was gathered in the right shoulders, in 45 degrees abduction, at a speed of 60 deg/sec, in the plane of the scapula and the frontal plane. Each subject returned within 1 week for retests to establish reliability. The average correlational coefficient across tests was 0.87. The Merac computer system was used to analyze data. Mean and standard deviations for peak torque to body weight were calculated. A paired t-test was used to examine the difference in the means for internal and external rotation between the two positions. The results indicated no significant difference between the two positions for shoulder internal rotational strength values. However, shoulder external rotational strength values in the plane of the scapula were statistically significantly higher than in the frontal plane (P less than 0.001). These preliminary results suggest isokinetic strength training and testing may be preferable in the plane of the scapula rather than the frontal plane.

Rocker immunoelectrophoresis was used to estimate aldehyde oxidase cross-reacting material (AO-CRM) in larval hemolymph and adult fly extracts in mutants with reduced AO enzymatic activity. Hemolymph of larvae homozygous for Aldoxn, which is a mutation of the presumed structural gene for AO, contains 30% of the wild-type CRM. The demonstration of AO-CRM in Aldoxn larval hemolymph is surprising since this genotype has been reported to lack CRM. By contrast, adult Aldoxn flies lack detectable CRM. The other AO-deficient mutants that were examined are cin, mal, and lxd; each has appreciable levels of CRM in both larval hemolymph and adult extract. Detection of CRM in these mutants helps to clarify conflicting reports in the literature.

Serologic responses to a 14-valent pneumococcal vaccine were measured in 20 children with steroid-responsive idiopathic nephrotic syndrome. All patients were free of proteinuria and receiving either daily (five patients) or alternate-day (15 patients) prednisone in a dosage of 1-2 mg/kg/day at the time of vaccination. Patients on alternate-day steroids received the vaccine on a day prednisone was not given. The mean fold rise in antibody titer was found to be normal in these children when antibody levels measured 3-6 wk post-vaccination were compared to prevaccination levels. This serologic response has correlated well with a 3-yr follow-up of the patients, none of whom has developed peritonitis secondary to any pneumococcal types in the vaccine. Also described are three patients who developed pneumococcal peritonitis during this period despite prior vaccination; in two of these patients, the pneumococcal type was not included in the vaccine (types 6b and 10a) and in one patient the organism was not typed. It is concluded that in children with nephrotic syndrome pneumococcal vaccination confers good protection against types included in the vaccine despite the concomitant administration of steroids. However, the patients who developed peritonitis secondary to other pneumococcal types remind us that pneumococcus must still be considered as an etiologic agent for peritonitis in nephrotic children who have been vaccinated.

Between the years 1960 and 1985, 499 children were treated at Rancho Los Amigos Hospital for residuals of head trauma. Of these, 35 had fractures of the clavicle (38 total fractures). Two of the patients had lateral physeal injuries and subsequently developed a "double" clavicle. All of the clavicle fractures healed without immobilization and exhibited excellent remodeling. All patients recovered complete range of motion of the shoulder. Only one of the patients required surgery (for removal of a tender bony prominence after the formation of a "double" clavicle).

Serious illness or hospitalization of a parent is potentially destructive to the mental health of the child. Stress is caused by both the separation and the illness itself. If the physician does not ensure that the situation is explained to the child, it is likely the child will be confused and frightened and any attempts at clarification will be blocked in the attendant family dysfunction. The general principles of prevention are to share the facts of the situation with the child and to allow him his natural and varied reactions. The family interview is useful in clearing up misunderstandings, sharing feelings and working out family roles.

A theoretical model using a decision tree is used to compare three alternative strategies: extract all third molars prior to complete root formation; extract only those third molars that become impacted; and extract only those impacted third molars that develop some associated pathology. The model used to determine the expected value of these alternative strategies depends on the probability of eruption, the type of impaction, and likelihood of developing preoperative pathology. The decision tree can be used to identify a preferred strategy either for an individual patient or for a policy recommendation under a variety of clinical conditions.

A method is described for the purification of the enzyme phosphoenolpyruvate carboxykinase (PEPCK) from the cestode Hymenolepis diminuta. When purified to electrophoretic homogeneity, the enzyme had a molecular weight of 70,600 and an isoelectric point of 7.5. Kinetic studies indicated that the pH 5.6 was optimal for the carboxylation reaction and that Mn++ was the preferred divalent cation; there was no activity of the enzyme in the presence of Mg++. Apparent Km values for the carboxylation reaction were determined; those for GDP (20.6 muM) and PEP (38.9 muM) were lower than the values previously reported. GTP, GMP, ITP, IMP, fumarate, succinate and alpha-ketoglutarate were found to be competitive inhibitors and their Ki values determined.

This paper investigates acid disposal by gastric and duodenal mucosa with particular reference to the mechanisms of acid-stimulated luminal alkalinization in the duodenum. The bulk of solute flux across duodenal epithelium occurs by paracellular permeation, and passive diffusion of HCO3 via shunt pathways contributes substantially to luminal alkalinization by this tissue in vitro. Effects on epithelial permeability of two treatments which stimulate mucosal alkaline secretion (PGE2 and low luminal pH) were studied in vivo by measuring transmucosal fluxes of radiolabeled urea (mol wt 76) and inulin (mol wt approximately 5000). Rats were anesthetized and rates of alkalinization in segments of distal duodenum perfused with saline were monitored by continuous titration. PGE2 (10 microM, topically) increased alkaline secretion from 1.63 +/- 0.34 to 3.07 +/- 0.54 microeq/cm/hr (mean +/- SEM, N = 5). Luminal acid exposure (10 mM HCl for 10 min) increased alkalinization rate from 1.54 +/- 0.43 to 2.69 +/- 0.76; subsequent addition of PGE2 induced a further rise to 3.27 +/- 0.54. Recovery of inulin in the luminal perfusate following intravenous injection was less than 10% of that of urea. Topical PGE2 had little or no effect on recovery of either marker. Luminal acidification increased the rate of appearance of urea by 130 +/- 30% (P less than 0.01, N = 6); recovery of inulin rose slightly but did not achieve statistical significance compared with control. Thus stimulation of mucosal alkaline secretion by luminal PGE2 or acid are associated with differential effects on mucosal permeability.(ABSTRACT TRUNCATED AT 250 WORDS)

Brush-border membrane fractions were isolated from rat duodenum. Purity and integrity of the fraction was confirmed by electron microscopy, enzymic analysis and demonstration of Na+-dependent glucose uptake. The membranes were enriched 15-fold in alkaline phosphatase and alpha-glucosidase and 6-fold in HCO3--ATPase activities. Assays of latent activity indicated that these enzymes were predominantly localised to the external aspect of the microvillus membrane. The enzymes were solubilised and subjected to analysis by gel filtration, ion exchange and phenylboronate chromatography. No separation of alkaline phosphatase and HCO3--ATPase was obtained and it is suggested that they reflect the same enzyme activity. The apparent activation by HCO3- was investigated, and was found to be due to shifts in the pH dependency of the activity due to changes in ionic strength.

Duodenal and jejunal brush border membrane vesicle integrity was studied after in vitro treatment of rabbit tissue with ethyl, benzyl or octyl alcohol. The effects of the alcohols on gastric parietal cell apical and microsomal membrane vesicle integrity was also studied. Membrane vesicle integrity was determined from the enclosed volume of the vesicle preparations, measured as [14C]glucose space at equilibrium. Exposure of vesicles to the three alcohols caused concentration dependent decreases in enclosed volume. The rank order of potency of the alcohol was octyl greater than benzyl greater than ethyl. Concentrations greater than or equal to 10 mM benzyl alcohol significantly reduced the enclosed volume of duodenal or jejunal vesicles; jejunal vesicles were disrupted by 625 mM ethanol, whereas 2 M ethanol was required to disrupt the duodenal vesicles. Gastric apical membrane integrity was reduced with 0.25 M ethanol, the vesicles being approximately an order of magnitude more sensitive to ethanol than gross estimates of gastric mucosal damage, but 1 M ethanol was required to significantly damage gastric microsomes. All concentrations of benzyl or octyl alcohol tested (greater than or equal to 5 mM) reduced the enclosed volume of both gastric apical membrane vesicles and gastric microsomes. As determined by shrink-swell techniques, benzyl alcohol permeated duodenal vesicles at a faster rate than NH4Cl (apparent rate constant of 9.89 (0.71) X 10(-3)s-1 compared with 4.48 (0.23) X 10(-3)s-1). Therefore, reductions in enclosed volume in response to alcohol treatment could not be explained by alcohol induced osmotic shrinkage. The enclosed volume of the vesicles after alcohol treatment was negatively correlated with membrane fluidity suggesting a common causal effect, the increased fluidity increasing membrane fragility. Duodenal vesicles were more resistant to disruption by the alcohols compared with gastric and jejunal vesicles.

Rocket immunoelectrophoresis was used to estimate xanthine dehydrogenase cross-reacting material (XDH-CRM) in strains containing the cin and cin mutant genes, which are deficient in XDH enzymatic activity. CRM levels were determined as percentages of CRM in the Oregon-R wild-type strain. The mutant strains contain 72 and 76% of Oregon-R CRM, respectively. CRM levels in strains containing the XDH-deficient mutant genes lxd and mal are 93 and 105%, respectively. The high levels of CRM in these four mutant strains indicate that the primary effects of the mutant genes are on the function of XDH protein rather than its accumulation.

The current tendency to avoid at all cost the separation of children from their own homes can have a destructive effect on casework practice.

Granuloma annulare is a cutaneous disorder, which may be associated with subcutaneous fibrosis. Subcutaneous granuloma annulare lesions may occur without the cutaneous manifestations, and often biopsy is required for diagnosis. We report subcutaneous granuloma annulare of the index finger without cutaneous manifestations, in a 19-year-old woman. Diagnosis was confirmed by excision and histologic examination. In the natural history of granuloma annulare, a spontaneous resolution can be expected. No other specific treatment is necessary.

An aqueous solution of 5'-amino-5'-deoxythymidine 5'-triphosphate, prepared by incubation of equimolar solutions of 5'-amino-5'-deoxythymidine and sodium trimetaphosphate, stimulates synthesis of acid-precipitable polynucleotides in a system containing single-strand phiX174 DNA template, random oligonucleotide primers, dATP, dCTP,dGTP, Escherichia coli DNA polymerase I, and either magnesium or manganese ion. Approximately onefold synthesis on the template can be achieved and each of the indicated reagents is essential for extensive synthesis. The reaction is slower than the corresponding reaction of dTTP as a consequence of a lower V max and a higher Km for the amino analogue. That aminodeoxythymidine phosphate is incorporated into the synthetic polynucleotides was shown by a double-labeling experiment with [14C]dATP and [32P]-5'-amino-5'-deoxythymidine 5'-triphosphate and by the unusually high lability of the phosphoramidate polynucleotides toward acid. The phosphoramidate polynucleotides range in size from about 100 nucleotide units to well over a thousand nucleotide units, and the size is increased by addition of DNA ligase to the system. These experiments indicate that synthetic polynucleotides in which oligonucleotide blocks have been joined by means of phosphoramidate bonds should prove useful as primers for enzymatic syntheses with DNA polymerase I.