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Objective: Serum alpha 1-antitrypsin (alpha 1AT) is an acute-phase glycoprotein which contains three carbohydrate side chains, N-glycosidically linked to the asparagine molecules (Asn46, Asn83 and Asn247) of the single polypeptide unit. "Microheterogeneity", which is a varying proportion of bi- or triantennary heteroglycans attached to the glycosylation sites, has been observed in various inflammatory states including rheumatoid arthritis (RA), and may influence the properties of alpha 1AT., Methods: In this study, we used affinity immunoelectrophoresis with the lectin concanavalin A (ConA) to investigate the possible role of alpha 1AT microheterogeneity in IgA-alpha 1AT complex formation. The concentrations of alpha 1AT and its glycosylation variants, the level of immunoglobulin A (IgA), and concentration of IgA-alpha 1AT complex were determined in the sera of 43 patients with RA., Results: In seven patients, high concentrations of the IgA-alpha 1AT complex were found. This group did not differ from the remaining patients in sex, age, or disease activity. However, significantly higher concentrations of both the alpha 1AT variant 1a+1b (with a predominance of triantennary heteroglycan side chains) and IgA were found in patients with an elevated complex compared to those with low serum levels of IgA-alpha 1AT complex (p < 0.05 for both variables). In the entire group, there was a significant correlation between the IgA-alpha 1AT complex level and both serum IgA and the concentrations of alpha 1AT variants 1a+1b and 2 (r = 0.3473, p < 0.05; r = 0.4604, p < 0.005; r = 0.3176, p < 0.05, respectively)., Conclusion: The results suggest that the microheterogeneity of alpha 1AT may play a part in the formation of the IgA-alpha 1AT complex in RA.

Most patients with carcinoma of the esophagus present with progressive, unrelenting dysphagia, malnutrition, and weight loss. Palliation is the primary treatment, since these patients are not candidates for curative surgical resection. Surgery, radiotherapy, and endoscopic modalities have been used for palliation. Recently, self-expanding, metallic stents have been used with considerable success. This type of stent can dislodge into the stomach during or after deployment. We report an approach to retrieve an expandable, silicone-coated stent using a double-channel endoscope, an esophageal dilating balloon, and a polypectomy snare.

Health Care: The small-business lobby says Clinton's mandatory plan will kill off jobs. But Mom and Pop may end up breathing easier.

An antiserum, obtained by immunising rabbits with a human peptide-protein conjugate, was shown to inhibit histamine release from rat mast cells both in vitro and in vivo. Immunisation of sensitised rats with the same peptide reduced IgE antibody formation and serum histamine concentration, and abolished systemic anaphylactic reactions in response to allergen challenge. This peptide may form the basis of a vaccine in a new approach to the immunotherapy of atopic disease.

Sodium pentosan polysulfate (PPS), a negatively charged polymer of beta-D-xylopyranose units, was evaluated for its anti-HIV effects in normal human peripheral mononuclear cells (PMNC) and its possible synergism with AZT. In the presence of 25 nM AZT, 2.0 micrograms/ml of PPS reduced HIV-1 replication 110-fold, compared with a 3.9- and 7-fold decrease in the presence of either drug individually. Surprisingly, at low (below 1 microgram/ml) concentrations of either PPS or dextran sulfate, an enhancement of virus production was observed. PPS was nontoxic, had a proliferative effect on uninfected and a protective effect on infected PMNC. Virus enhancement at low concentrations of PPS appeared to be linked to its lymphoproliferative effect. These findings suggest that the use of PPS and others such agents as monotherapy for AIDS might have deleterious effects. However, due to its marked synergism with AZT and its lymphoproliferative activities, PPS might prove to be a useful agent in therapeutic trials of AIDS if used in combination with less than the usual dosage of AZT.

The effect of continuous release of microquantities of cyproterone acetate from subcutaneously implanted silastic capsules on the fertility of surgically manipulated seminal vesicles of rat has been studied. The experimental animals showed infertility for 3 weeks, as a consequence of removal of seminal plasma, following which normal fertility returns as efficiently as that operated control. However, a significant decrease in weight of the testes and epididymides, were recorded. It appears that seminal vesicles can synthesize seminal plasma even at very low levels of androgen in the presence of cyproterone acetate.

The various causes and differential diagnosis of carotid cavernous fistula are discussed as well as the description of the use of radionuclide angiography in the diagnosis and evaluation of patients with carotid cavernous fistulas. Radionuclide angiography has proven extremely useful in the diagnosis and follow-up of patients with carotid cavernous fistulas. The procedure is of maximum benefit in situations where repeat studies are required at frequent intervals. Five cases are described in which the nuclear medicine technique was instrumental in primary diagnosis and follow-up.