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The complete primary structure of the cytoplasmically synthesized polypeptide IV from beef heart cytochrome oxidase was determined via isolation and sequencing of overlapping methionine, tryptophan, and arginine fragments. The protein consists of 147 amino acids (Mr 17153). It is characterized as a part of a membrane protein complex by a hydrophobic segment consisting of 19 residues. It is suggested that this segment contacts the lipids of the inner mitochondiral membrane. Additional specific contacts may result from pairwise formation of salt bridges between ionic groups of the protein and the phospholipids. The function of this component of the terminal oxidase is yet unknown.

The finding of thrombocytopenia with normal or increased megakaryocytes on bone marrow aspirate supports the diagnosis of ITP. It is essential, however, that every effort be made to exclude other causes of the consumption of platelets. Most cases of chronic ITP are immune in origin; consequently, steroid therapy is the initial treatment of choice, followed by splenectomy if indicated. Twenty-five per cent of patients fail to respond to either treatment modality; however, bleeding manifestations are often mild even when a response in the platelet count is not achieved. Although acute ITP is often self-limiting, exacerbations and remissions may occur in both acute and chronic types of ITP.

The first 25 amino acids of brome mosaic virus (BMV) coat protein include 8 basic and no acidic residues and are implicated in binding the encapsidated RNA. Using infectious transcripts from BMV RNA3 cDNA clones, we modified this region of the coat gene. A coat protein mutant with the first 25 amino acids deleted failed to direct either packaging of viral RNA in protoplasts or systemic infection of whole barley plants. Neither symptoms, virions, nor viral RNA was detectable in plants inoculated with this mutant or a mutant with a frameshift mutation in the coat gene. Mutants with the normal start codon changed to AAG or with the first eight codons deleted allowed translation to start at a downstream AUG, resulting in a deletion of the first 7 amino acids of the mature wild-type coat protein. These mutants not only packaged viral RNA in protoplasts but directed symptomatic, systemic infections that developed with normal speed and degree of spread within the host. The AUG-to-AAG point substitution did not revert to the wild type after long-term culture in planta. Wild-type BMV virions were also found to contain small amounts of a protein that coelectrophoresed with the truncated coat protein produced by the viable AAG and eight-codon-deletion mutants. This minor coat protein species presumably arose by infrequent translation initiation at the second AUG in the wild-type coat protein gene. Absence of encapsidation-competent coat protein appeared to stimulate production of nonstructural proteins in protoplast infections.

A 64-year-old man was found to have a hemolytic anemia with a hematocrit of 0.28 (28%) during a routine evaluation. One month before this his hematocrit had been normal. Further studies revealed a myelodysplastic syndrome and acquired hemoglobin H disease. Eighteen months later this transformed into acute megakaryoblastic leukemia with disappearance of hemoglobin H, and shortly thereafter he had myelofibrosis develop. Acquired hemoglobin H disease, which is an alpha-thalassemia-like syndrome, results in the formation of an unstable hemoglobin composed of beta chain tetramers. This condition has been associated with preleukemia, sickle cell anemia, and hematologic malignancies. Although idiopathic myelofibrosis also has been described as a setting in which this thalassemic syndrome occurs, the present case is unusual in that the myelofibrosis was preceded by refractory anemia with leukemic transformation.

To define the incidence of cytomegalovirus (CMV) infection in infants given transfusions of washed blood cells from random donors, 100 infants who were identified as being CMV seronegative at birth were resampled at hospital discharge and again six weeks after hospitalization. All infants received washed red blood cell products; 37 infants received nonleukodepleted platelets and/or plasma. There were 7.4 donor exposures per infant. Donor units were assayed for anti-CMV IgG and IgM at the time of donation. Seventy-six infants received at least one transfusion from a seropositive donor (mean transfusion volume, 89 mL; mean, 3.7 seropositive donor exposures). Infection was defined by seroconversion to anti-CMV. None of the recipients of exclusively seronegative blood seroconverted. A single infant who received 34 mL of washed cells from a seropositive donor (IgG+, IgM-) and 31 mL of washed cells from a seronegative donor showed IgM anti-CMV 15 days after transfusion and IgG anti-CMV at a six-week follow-up visit. No recipients of IgM+ blood were infected. Our data demonstrate a 1.3% incidence of anti-CMV seroconversion following receipt of washed red cells from seropositive donors. This rate is within background levels for hospitalized neonates and is significantly lower than results of similar studies using unwashed blood.

Idiopathic thrombocytopenic purpura (ITP) occurs more commonly in young women and is one of the commonest immune mediated disorders in pregnancy. It may exist as an incidental finding in an otherwise healthy pregnant woman or may be associated with symptomatic reduction in the platelet count and varying degrees of clinical hemorrhage. The condition termed incidental thrombocytopenia of pregnancy is invariably associated with a platelet count of greater than 100 x 10(9)/L and a very low incidence of fetal thrombocytopenia. Symptomatic thrombocytopenia is more commonly associated with low platelet counts in the fetus (estimated between 20%-40%). It has recently been suggested that the incidence of fetal thrombocytopenia is substantially lower than this figure. The management of ITP in pregnancy is complicated by the fact that fetal thrombocytopenia is difficult to diagnose and carries substantial risks during the delivery process with rare cases of fetal hemorrhage occurring spontaneously in utero. Unfortunately there are no laboratory studies that can be performed precisely in the mother that may predict the occurrence of fetal thrombocytopenia. Maternal management is usually directed towards treatment of maternal symptoms. Maternal treatment or response to treatment is inconsistently associated with predictable changes in the fetal platelet count. Obstetric management is aimed at reducing the risks of life threatening fetal hemorrhage occurring at the time of delivery, and fetal management is directed towards the obtaining of fetal platelet samples in order to plan an appropriate strategy for obstetrical delivery. Fetal blood samples are obtained either by a scalp vein puncture at the time of delivery or earlier in gestation by the use of the newer technique termed percutaneous umbilical blood sampling. Fetuses with platelet counts of less then 50 x 10(9)/L are generally delivered by cesarean section whereas those with counts greater than 50 x 10(9)/L are allowed to proceed with vaginal delivery assuming no obstetrical contraindications exist. The use of IVIgG therapy during pregnancy has theoretical implications on improving platelet counts in the mother in situations of severe hemorrhage, however cannot be considered to be appropriate treatment for the prevention of fetal thrombocytopenia, since the exogenous transport of IVIgG across the placenta appears to be inconsistent and unpredictable.(ABSTRACT TRUNCATED AT 400 WORDS)

Waldenström's or primary macroglobulinaemia has rarely been documented in Black Africans. Six South African Negro patients with Waldenströms macroglobulinaemia were assessed and followed during a 10-year period from 1966 to 1976. The hyperviscosity syndrome was the presenting feature in four patients and one patient each presented with the nephrotic syndrome and a lacrimal mass respectively. On initial evaluation of the six patients, the serum IgM varied from 1.3 to 4.8 g% and in two patients cryoglobulinaemia was found. The patients received supportive treatment, chemotherapy, and when necessary, plasmaphoresis. One patient was lost to follow-up, one patient died 7 years after the onset of his illness, but the remaining four patients are alive 18 months to 5 years after presenting with their disease. Although the disease occurred in a younger age group (mean age 43 years) than in Caucasians it did not differ in clinical features or response to treatment from other parts of the world.

An IgG1 monoclonal antibody, 31D8, that recognizes normal neutrophil (PMN) membranes, was used to study PMN from patients with chronic myelogenous leukemia (CML). Nineteen patients with Philadelphia chromosome positive CML were followed over a ten-month period and compared with 23 normals, six patients with leukemoid reactions, and eight patients with phagocytic cell defects. The percentage of PMN binding of 31D8 among normal subjects was variable about a normal distribution with an average of 95 +/- 2% of cells binding 31D8. In contrast, there were two groups of CML patients: in 14 patients 88 +/- 3% PMN bound 31D8 while in the remaining five patients only 6 +/- 6% PMN bound 31D8. PMN 31D8 binding was normal in the control patient groups. Control antibodies 7C3 (binds to PMN precursors) and OKM1 (binds to the CR3 (iC3b) receptor) bound normally to CML neutrophils. Functionally, CML cells had normal chemotaxis to several stimuli and normal superoxide generation to phorbol myristate acetate. However, superoxide production in response to fmet-leu-phe was significantly less in 31D8 negative CML PMN than both 31D8 positive CML PMN and normal PMN which contained 85% 31D8 positive and 15% 31D8 negative PMN. Clinically, 2 of 14 CML patients with 31D8 positive PMN were in blast crisis (one extramedullary) at the time of study and the other 12 patients remained clinically stable in the chronic phase during the ten months of study. In contrast, one of five patients with 31D8 negative PMN was in blast crisis at the time of study and all four of the remaining patients progressed to either the accelerated phase or blast crisis. Three of these patients died of their disease eight to ten months after their initial study. Thus, failure of CML cells to bind 31D8 may be useful for predicting which patients are likely to progress to the accelerated phase or blast crisis.

The isolation and chemical characterization of polypeptide IV from beef heart cytochrome oxidase is described. The protein is one of the main (stoichiometric) components of the oxidase. It is the largest polypeptide of the enzyme synthezised in the cytoplasm and has, as such, also been identified in enzyme preparations from yeast and Neurospora. A partial sequence, consisting of 105 amino acid residues which give a frame work of the covalent structure of the polypeptide is obtained from N- anc C-terminal sequencing and from the cyanogen bromide fragments of the chain. The isolation and sequencing of the fragments of this membrane protein are discussed.

Intolerance reactions of the skin in which a decision is made on allergic and toxic genesis have increased in significance in recent years. Whereas antibodies blocking bacterial or viral antigens are formed in the normergic immune reaction, nonblocking antibodies to animal, plant or chemical heterologous substances are formed in an allergy as a result of an misdirected immunological reaction. Sensitization is favored by a) large structure and protein affinity of the allergen, b) irritation of the affected part of the skin by fungi or chemicals and c) genetic predisposition. Depending on the clinical manifestation, a distinction is made between inhaled allergens (bronchial asthma, hay fever), allergens ingested with the food (food allergy) and allergens which have come in contact with the skin (immediate reaction - urticaria, late reaction - contact eczema). Intolerance reactions of the skin which can be ruled out as the cause of an allergy are designated as toxic. Acute toxic reactions are based on violent or intensively physical (heat, cold, radiation), chemical (acids, alkalis, heavy metal salts, oils, solvents) or microbial damage to the skin (infection by fungi, bacteria, viruses). The degenerative eczema as the most important form of chronic toxic intolerance reaction arises by weak but continuously acting longterm mechanical or chemical exposures.

Thrombocytopenia may accompany variant (type IIB) von Willebrand's disease (vWD) and is thought to result from binding of the abnormal von Willebrand factor (vWF) to the patient's platelets with subsequent platelet aggregate formation and clearance. We have studied a patient with type IIB vWD who became thrombocytopenic during two pregnancies. During the third trimester of pregnancy, her platelet counts dropped to 20,000 to 30,000/microL, and an increase in the intermediate-sized vWF multimers was seen on agarose gel electrophoresis. During this time her platelet-rich plasma showed spontaneous platelet aggregation, and her plasma caused spontaneous aggregation of normal washed platelets. Antibody to platelet glycoprotein Ib completely blocked the spontaneous platelet aggregation, while antibody to platelet glycoprotein IIb/IIIa did not block the response at the concentrations used. Inhibitors of platelet function that elevate platelet cyclic AMP also blocked the response, but aspirin had no effect on the spontaneous platelet aggregation. The patient illustrates that the platelet counts in one individual can vary greatly in type IIB vWD and that the thrombocytopenia that occurs can appear under physiologic conditions that stimulate the endogenous production of the patient's abnormal vWF. The mechanisms leading to spontaneous platelet aggregation and thrombocytopenia appear to be similar to those described for other patients with type IIB vWD.

In its clinical presentation, malignant histiocytosis may mimic infections or hematologic neoplasms, and pathologically it may be mistaken for Hodgkin's disease, histiocytic lymphoma, or viral lymphadenitis. The case histories of three patients in whom malignant histiocytosis clinically and pathologically simulated granulomatous diseases are reported. Erythrophagocytosis was not present in the initial bone marrow aspirates from two of the patients. One patient was considered to hve sarcoidosis or Wegener's granulomatosis; the second patient, Weber-Christian disease, and the third patient, a granulomatous disease of infectious origin. Granulomas have been found in tissues of patients who have Hodgkin's disease, but have been found only rarely in association with malignant histocytosis. An explanation for the presence of granulomas in association with malignant histiocytosis is offered: they may represent a phase in the evolution of the disease.

Interferon alfa-2b (Intron A; Schering Plough) has been shown to be active in advanced previously treated multiple myeloma (MM). Recent in vitro evidence has suggested synergy between cytotoxic agents and interferon alfa-2b. This phase I-II protocol was initiated to study interferon alfa-2b in combination with melphalan and prednisone. Groups of five patients received interferon alfa-2b twice-weekly for two weeks at dose levels of 0.5, 1.0, 2.0, 5.0 and 10.0 X 10(6) IU/m2. During week 2, melphalan (9 mg/m2) and prednisone (40 mg/m2) were administered concurrently with interferon alfa-2b followed by a rest period during nadir myelosuppression, the cycles being repeated every 28 days. Thirty patients were entered of whom 21 were Stage III, 3 Stage II and 6 Stage I. Median nadir WBC/mm3 and platelets/mm3 at the various dose levels are given in the table. Serious adverse reactions while on study included myocardial infarction, renal failure and leukopenia-related sepsis. Early response information is available. Twenty-six patients are evaluable for response. Seven have had progressive disease and 19 (69%) a partial response, the median duration was 11+ months. Interferon alfa-2b does not appear to antagonize melphalan/prednisone effectiveness and may be additive or synergistic. Full evaluation of this combination will be undertaken in randomized controlled trials which are now underway.

Tomato (Lycopersicon esculentum Mill. cv New Yorker) plants subjected to 100 millimolar NaCl plus Hoagland nutrients exhibited a pattern of wilting, recovery of turgor, and finally recovery of growth at a reduced level, which required 3 days. During the nongrowing, adaptation phase there were immediate increases in free hexoses and sucrose which declined to near control levels as growth resumed. There was a steady increase in myo-inositol content which reached its maximal level at the time of growth resumption. The myo-inositol level then remained elevated for the remainder of the experiment. Myo-inositol constituted two-thirds of the soluble carbohydrate in leaves and three-fourths of the soluble carbohydrate in roots of salt-adapted plants. Plants which were alternated daily between salt and control solutions accumulated less myo-inositol and exhibited less growth than the continuously salt-treated plants. In L. pennellii and in salt-tolerant and salt-sensitive breeding lines selected from L. esculentum x L. pennellii BC(1) and F(8), myo-inositol content was highest in the most tolerant genotypes, intermediate in the normal cultivar, and lowest in the sensitive genotype after treatment with salt.

Essential to the management of the sick, low birth weight infant is maintenance of a neutral thermal environment by use of convection incubators and radiant warmers. Manipulation of the infant in preparation for transfusion and the transfusion of cold blood could theoretically lower the infant's body temperature, subsequently contribute to cold stress, and concomitantly increase metabolic demands and oxygen requirements. The authors evaluated different pretransfusion manipulations of syringe aliquots and bags of blood in an effort to provide a clinically acceptable product for transfusion to sick, very low birth weight infants.

Alpha-2-interferon (IFN) has demonstrable activity in advanced, relapsing, or refractory multiple myeloma. Because of the in vitro synergism between the IFNs and cytotoxic agents, we conducted a trial of 30 previously untreated patients with multiple myeloma utilizing various doses of alpha-2-IFN in combination with standard oral doses of melphalan and prednisone. The combination was well-tolerated without unusual or unexpected toxic effects. The limiting toxicity included dose-related myelosuppression, and alpha-2-IFN induced flu-like symptoms and fatigue. Response was seen in at least as many patients as would be expected with melphalan and prednisone alone. The maximal tolerated dose for a phase II-III trial was 5.0 X 10(6) IU/m2 of alpha-2-IFN in combination with standard doses of melphalan and prednisone. Future trials should utilize this dose of alpha-2-IFN with dose de-escalation according to tolerance.