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INTRODUCTION: A significant minority of otherwise healthy adults may suffer from disordered breathing during sleep. The commonest problem, known as Obstructive Sleep Apnoea Syndrome (OSAS), results in poor quality sleep, daytime hypersomnolence and excess risk of road traffic crashes. It is also associated with occupational injuries. OSAS can be successfully treated, reducing costs of hospitalisation. There is a gap in the literature regarding the burden of patients with OSAS in primary care, particularly because there is no agreed method for screening. OBJECTIVES: This pilot study was designed to determine the feasibility of screening for OSAS in a UK inner-city multi-ethnic primary care population, to investigate ways in which it might be detected, and to gain an awareness of the potential size of the burden of OSAS METHODS: We tested two methods of screening: firstly, postal questionnaires to a random sample of 240 patients from a subset of the population at highest risk of OSAS (men aged 35-65 years); and secondly, the same questionnaire plus two screening tools for detecting hypersomnolence, given to patients attending the practice for pre-registration health checks. RESULTS: Despite reminders, only 40% of postal questionnaires were returned and there were only 67 (28%) usable responses. The prevalence of snoring was 55%. Almost half of those patients who responded (46%) had a Body Mass Index (BMI) associated with a high risk of OSAS. This was not a positive responder bias because there were no significant differences in BMI between responders and non-responders. 12% had a collar size of greater than 17.5, whilst 34% reported daytime sleepiness, and 24% reported witnessed apnoea. Screening during pre-registration health checks proved both feasible and productive with 38 patients of differing linguistic abilities completing the assessment. CONCLUSION: Screening for OSAS in primary care by means of a postal questionnaire produced a low response. Whilst there was no evidence of a responder bias in terms of BMI, the numbers reporting large collar size, daytime sleepiness and witnessed apnoea suggest that a sizeable proportion of the population is at risk of OSAS. Questionnaires used in this study provide a means of identifying patients with symptoms suggestive of OSAS, although the sensitivity, specificity and positive predictive value of a self-administered instrument needs to be confirmed by a larger study incorporating ventilatory monitoring during sleep. The addition of screening to pre-registration health checks is feasible, but it would take a long time to screen all those at risk for OSAS by this route.

Streptomycin- and sulfonamide-resistant Erwinia amylovora CA3R from California contained an 8.7-kb plasmid, pEa8.7, with a sulII-strA-strB resistance region; furthermore, PCR, sequencing, hybridization, and restriction analyses showed that pEa8.7 was closely related or identical to broad-host-range plasmid RSF1010. Although RSF1010 has been found in a variety of bacteria, this is the first report of its presence in plant pathogenic bacteria.

Our structural studies of nucleosomes necessitated the production of over 100 mg of a 146-bp perfect palindrome DNA for use in the reconstitution of perfectly symmetrical nucleosome core particles for detailed X-ray crystallographic analysis. The propagation of palindromic DNA DNA sequences by bacterial culture is hindered by the instability of these sequences during bacterial replication and recombination. While the loss of some palindrome sequences can be eliminated by the use of sbcB or sbcC mutants of Escherichia coli, not all palindrome-containing plasmids are faithfully maintained by these strains. The production of large quantities of palindrome DNA that involves production of plasmid containing multiple copies of the repeating unit of the palindrome which are isolated by restriction digestion and ligated in vitro to form the palindrome DNA. The procedure has resulted in the production of over 20 mg of a 146-bp DNA fragment in 2 weeks.

To evaluate the usefulness of ventilation-perfusion scanning when chest radiographic findings are abnormal to decide which patients should initially undergo angiography because of suspected pulmonary embolism.The records of 951 patients who underwent examination between April 1, 1992, and August 24, 1993, were reviewed, and the results of ventilation-perfusion scanning and chest radiography were correlated.Approximately 8% of patients with radiographic findings of no acute disease, pleural effusion, and linear atelectasis had high-probability ventilation-perfusion scans. Pulmonary edema and parenchymal consolidation categories had fewer high-probability studies (3% and 1%, respectively; P.01). The chance of obtaining a nondiagnostic result was similar for the first three categories (12%) but was more likely for pleural effusion and parenchymal consolidation (36% and 82%, respectively; P.01).The results of ventilation-perfusion scanning are not useful with focal radiographic consolidation. It may be appropriate to proceed directly to pulmonary angiography in many of these patients.

We have previously reported the sequence of the integrin alpha 9 subunit, a partner of the beta 1 subunit that is expressed in basal keratinocytes, hepatocytes, airway epithelial cells, and smooth and skeletal muscle. In the present study, we have stably expressed alpha 9 beta 1 on the surface of the human embryonic kidney cell line 293 and the human colon carcinoma cell line SW480 and used these transfected cells lines to identify ligand(s) for this integrin. Transfected cells did not appear to utilize alpha 9 beta 1 for attachment to the extracellular matrix proteins fibronectin, laminin, vitronectin, fibrinogen, thrombospondin, or type I or IV collagen. However, in contrast to mock transfectants, both 293 cells and SW480 cells expressing alpha 9 beta 1 adhered to intact chicken tenascin. By utilizing a variety of recombinant fragments of tenascin, we were able to localize the binding site for alpha 9 beta 1 to the third type III repeat. This repeat contains the arginine-glycine-aspartic acid (RGD) tripeptide that has been shown to serve as a binding site in tenascin for alpha v-integrins. However, the RGD site does not appear to be the binding site for alpha 9 beta 1, as the attachment of alpha 9 transfectants to this fragment was not inhibited by RGD peptide, nor by changing the RGD site to RAD or RAA.

The integrin family of adhesion receptors consists of several heterodimeric glycoproteins, each composed of one alpha and one beta subunit. A novel integrin alpha subunit partial cDNA isolated from TGF- beta stimulated guinea pig airway epithelial cells has previously been reported (Erle, D.J., D. Sheppard, J. Bruess, C. Ruegg, and R. Pytela. 1991. Am. J. Respir. Cell Mol. Biol. 5:170-177). We have now determined cDNA and amino acid sequence for the human homolog of this subunit, named alpha 9, from a human lung cDNA library, a human small intestine cDNA library, and cDNA from the cell lines U937, HL-60 and Tera-2. This sequence is predicted to encode a 1006-amino acid mature protein that shares 39% identity with the previously identified integrin subunit alpha 4. By Northern blot analysis, alpha 9 mRNA was detected in the human carcinoma cell lines Tera-2 and Caco-2. Anti-peptide antibodies against the predicted COOH-terminal sequence of alpha 9 immunoprecipitated a heterodimer (140 kD/115 kD nonreduced; 150 kD/130 kD reduced) from Tera-2 lysates. Immunodepletion of beta 1-containing integrins with Tera-2 lysates removed alpha 9 immunoreactivity, suggesting that beta 1 is the principal beta subunit partner for alpha 9 in these cells. alpha 9 was detected by immunohistochemistry in airway epithelium, in the basal layer of squamous epithelium, and in smooth muscle, skeletal muscle, and hepatocytes.

Acute pulmonary embolus is a common problem requiring evaluation in the emergency setting. Following the initial chest radiograph, the most common imaging test requested is the ventilation perfusion lung scan. We describe a patient with sarcoidosis and a false positive ventilation perfusion lung scan caused by bilateral hilar adenopathy compressing the proximal pulmonary arteries. This case illustrates that patients with hilar adenopathy and suspected pulmonary embolus may have unreliable ventilation perfusion scans, and should be referred to arteriography or CT for evaluation, rather than for a ventilation perfusion lung scan.

Essential to the two distinct cellular events of genetic recombination and SOS induction in Escherichia coli, RecA protein promotes the homologous pairing and exchange of DNA strands and the proteolytic cleavage of the LexA repressor, respectively. Since both of these activities require single-stranded DNA (ssDNA) and ATP, the inter-relationship between these reactions was investigated and found to display many parallels. The extent of active complex formed between RecA protein and M13 ssDNA, as measured by both ATP hydrolysis and LexA proteolysis, is stimulated in a similar manner by either a reduction in magnesium ion concentration or the presence of single-stranded DNA binding (SSB) protein. However, unexpectedly, SSB protein inhibits both LexA proteolysis and ATP hydrolysis (in assays containing repressor) at concentrations of RecA protein that are substoichiometric to the ssDNA, arguing that LexA repressor affects the competition between RecA and SSB proteins for limited ssDNA binding sites. Additionally, attenuation of LexA repressor cleavage in the presence of double-stranded DNA or by an excess of ssDNA suggests that interaction of the RecA nucleoprotein filament with either LexA repressor or a secondary DNA molecule is mutually exclusive. The significance of these results is discussed in the context of both the regulation of inducible responses to DNA damage, and the competitive relationship between the processes of SOS induction and genetic recombination.

This study was conducted to determine if pleural effusion size affects ventilation/perfusion (V/Q) scan interpretation algorithms for acute pulmonary embolus (PE).Retrospective analysis identified 163 consecutive patients undergoing angiography for PE with radiographic evidence for pleural effusion. V/Q scanning was performed in 94 (58%) of cases and reported using original Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) criteria. Effusions were classified as small, large and/or bilateral. Radiographic and scintigraphic results were compared with regard to size and location of abnormalities.Of the 163 patients, 57 (35%) had angiographically-proven PE, 77 (47%) had at least one large pleural effusion and 86 (53%) had a small effusion; 33 (43%) with large effusions and 24 (28%) with small effusions had emboli at angiography. Thirty-six of 119 patients (30%) with clear chest radiographs (a control group) had PE. Thus, large effusions were associated with a higher incidence of PE than those with small effusions or clear lungs (p0.05). Of those with V/Q scanning, 26 of 94 (28%) had a solitary large effusion, with 12 (46%) positive for emboli. V/Q-matched abnormalities limited to effusion size were found in 16 with a solitary large effusion and 10 with a solitary small effusion. In both groups, 50% were angiographically positive for emboli. Twenty-three (66%) of 35 with bilateral effusions had corresponding V/Q-matched defects at one (n = 11) or both (n = 12) lung bases, and 9 (39%) were positive for emboli. In total, 45% with a V/Q-matched defect of equivalent size to the effusion were angiographically positive for PE.Pulmonary emboli are associated with pleural effusions of all sizes. Matched V/Q defects corresponding to radiographically-evident pleural effusions are of intermediate probability for PE. Thus, revision of the traditional lung scan interpretive criteria based upon pleural effusion size is not warranted.

Nucleosome core particles containing a DNA palindrome and purified chicken erythrocyte histone octamer have been reconstituted and crystallized. The dyad symmetry of the palindrome extends the dyad symmetry of the histone octamer to result in a twofold symmetric particle. This ensures that the structure determined by X-ray diffraction will yield a true representation of the DNA strand rather than the twofold averaged structure which would result from using a non-palindromic DNA sequence. The crystals provide isotropic diffraction to 3.2 A with observed reflections extending to d spacings of about 2.8 A using a rotating-anode Cu Kalpha X-ray source. Although the DNA palindrome is a factor contributing to the quality of the diffraction data, another significant factor is an improved preparative technique which enriches for correctly phased nucleosome core particles.

PURPOSE: To optimize the performance of artificial neural networks in the prediction of pulmonary embolism from ventilation-perfusion (V-P) scans. MATERIALS AND METHODS: Neural networks were constructed with a set of V-P scan criteria that included sharpness and completeness of perfusion defects and involved quantification of abnormalities by using a continuous numeric scale. Several network parameters were systematically varied. Networks were trained with 150 cases and tested with 30 different cases. Findings were compared with those of pulmonary angiography. RESULTS: Networks capable of performing as well as experienced nuclear medicine physicians could be constructed with few V-P scan features. A brief training period was optimal (50-100 iterations). Further training diminished network performance. CONCLUSION: Effective neural networks can be constructed by using a limited number of unconventional V-P scan features. Several parameters can be adjusted to optimize performance.

We have previously reported the sequence of the integrin alpha 9 subunit, a partner of the beta 1 subunit that is expressed in basal keratinocytes, hepatocytes, airway epithelial cells, and smooth and skeletal muscle. In the present study, we have stably expressed alpha 9 beta 1 on the surface of the human embryonic kidney cell line 293 and the human colon carcinoma cell line SW480 and used these transfected cells lines to identify ligand(s) for this integrin. Transfected cells did not appear to utilize alpha 9 beta 1 for attachment to the extracellular matrix proteins fibronectin, laminin, vitronectin, fibrinogen, thrombospondin, or type I or IV collagen. However, in contrast to mock transfectants, both 293 cells and SW480 cells expressing alpha 9 beta 1 adhered to intact chicken tenascin. By utilizing a variety of recombinant fragments of tenascin, we were able to localize the binding site for alpha 9 beta 1 to the third type III repeat. This repeat contains the arginine-glycine-aspartic acid (RGD) tripeptide that has been shown to serve as a binding site in tenascin for alpha v-integrins. However, the RGD site does not appear to be the binding site for alpha 9 beta 1, as the attachment of alpha 9 transfectants to this fragment was not inhibited by RGD peptide, nor by changing the RGD site to RAD or RAA.

Several algorithms have been devised to assist in the interpretation of ventilation-perfusion (V/Q) scans performed to diagnose pulmonary embolism. The degree to which adherence to a single algorithm facilitates diagnostic homogeneity among different readers, however, has been little investigated. We evaluated the individual variability in V/Q lung scan interpretation in a large, academic nuclear medicine division to determine the degree of interpretive heterogeneity among a group of physicians all using the same image interpretation algorithm. Ventilation-perfusion scan interpretive patterns and the diagnostic accuracy of individual physicians were evaluated using quantitative parameters to establish group norms and to detect variations from these norms. The performance of each reader was tracked over a 4 yr period. There was a significant variation in V/Q interpretive patterns and diagnostic accuracy between readers despite the attempted use of a uniform diagnostic algorithm. Subgroups of interpretive styles could be defined based on the percentage of intermediate (including both indeterminate and intermediate categories) scans read. Although there was significant variation in diagnostic accuracy among readers, there was no obvious correlation between accuracy and reading style except that the most nonstandard diagnostic patterns were associated with the most variable diagnostic accuracy. These data show a measurable variation in interpretive patterns and accuracy among multiple readers of V/Q scans despite attempted group adherence to an established diagnostic algorithm.

A neural network model was constructed to interpret ventilation-perfusion (V/Q) lung scans. This model was trained with data from 100 consecutive V/Q scans with pulmonary angiographic correlation. The network was constructed from 28 input parameters that described various standard V/Q findings, which were fed into a single hidden layer that contained 10-20 nodes. The network output indicated the percentage probability of pulmonary embolism for each set of findings on V/Q scans. This network was then used to classify 28 new scans; the resultant classifications were compared with the rankings of an experienced observer who read the scans without knowledge of the correlative angiographic data. The network with 15 hidden nodes outperformed the experienced observer in prediction of the likelihood of pulmonary embolism in the 28-case test set (P = .039). The neural network has several advantages over current algorithms for interpretation of V/Q scans, including the ability to synthesize many variables into a single conclusion and to learn, or modify itself, at exposure to additional data.

Human T cell leukemia virus type II (HTLV-II) has been isolated from a patient (Mo) with features of leukemic reticuloendotheliosis (LRE) and from a patient with acquired immunodeficiency syndrome (AIDS). We have obtained another isolate of HTLV-II from a patient (CM) with severe hemophilia A, pancytopenia, and a 14-year history of staphylococcal and candidal infections but no evidence of T cell leukemia/lymphoma, AIDS, or LRE. Fresh mononuclear cells and cultured lymphocytes from CM express retroviral antigens indistinguishable by molecular criteria from HTLV-IIMo. Leukocyte cultures from CM yield hyperdiploid (48,XY, +2, +19) continuous lymphoid lines; human fetal cord blood lymphocytes (CBL) are transformed by cocultivation with these CM cell cultures but retain normal cytogenetic constitution. Electron microscopic examination of the CM cultures and transformed CBL reveals budding of extracellular viral particles, intracellular tubuloreticular structures, and viral particles contained within intracellular vesicles. CM cell cultures and the transformed CBL do not require exogenous interleukin 2, have T cell cytochemical features and mature T helper phenotypes, and exhibit minimal T helper and profound T suppressor activity on pokeweed mitogen-stimulated differentiation of normal B cells. These characteristics, which are similar to those observed with the first HTLV-II isolate, may represent properties of all HTLV-II-infected T cells.

Perfusion lung scans are occasionally characterized by focal zones of apparent hyperperfusion ("hot spots"). To investigate the frequency and significance of this phenomenon, ventilation-perfusion lung scans and pulmonary arteriograms were reviewed in 72 patients who underwent both procedures for the evaluation of suspected pulmonary embolism. Hot spots were present in the scans of 13 patients and usually occupied less than one pulmonary segment. Most hot spots were detected within a region of atelectasis identified on chest radiographs (38%). A substantial number of the remaining hot spots were located in the lung adjacent to regions of embolus. In patients with massive embolus, hot spots actually represented normally preserved perfusion in the presence of globally reduced perfusion elsewhere.

A full-length molecular clone of human immunodeficiency virus (HIV) proviral DNA was transferred to human rhabdomyosarcoma (RD) cells by gene transfer method. RD cells released infectious virus within 12 hours after transfection and the viral particles present in the culture medium could be quantitated by monitoring reverse transcriptase activity. Chronic low level viral producer cell lines of RD were also established. Southern hybridization analysis revealed the presence of HIV sequences in transfected RD cells. Electron microscopic studies of the transfected cell revealed intracellular budding of HIV and also showed structural abnormalities such as giant cell phenotype and vacuolation. These features qualify RD cells as a useful system for studying the regulation and cytopathic effects of HIV.

Ultrastructural studies of glutaraldehyde-fixed viruses of the Bunyaviridae were performed by negative-stain electron microscopy. The surface structure of viruses of each genus was compared with that of the other genera and with Hantaan virus, the prototype of a proposed new genus of Bunyaviridae. Viruses of each genus had a surface structure distinct for that genus. In addition, Hantaan virus had a surface structure composed of a grid-like pattern of morphologic subunits not previously described for animal viruses. Careful morphologic studies of suspected Bunyaviridae may be used in considering preliminary generic assignment. This study also supports the assignment of Hantaan-related viruses to a separate generic status within the Bunyaviridae.

Summary The nucleocapsid structures of Tacaribe virus, a member of the Arenaviridae, were purified from detergent-treated virus particles by equilibrium density gradient centrifugation. Negative-contrast electron microscopy indicated that they were coiled, circular filaments. They had a mean diam. of 5 to 10 nm and two predominant length classes of 640 nm and 1300 nm were found.

A poxvirus isolated from the respiratory tract of raccoons in a forest and swamp area near Aberdeen, Maryland, was characterized by biological, serological, and biophysical methods. The virus was shown to be related to the vaccinia-variola subgroup by serological and biophysical methods, but measurably different from the other viruses of this group by biological methods. It causes flaccid paralysis in 1-day-old suckling mice and does not grow well on CAM after two or three passages.

Summary Three forms of infantile gastroenteritis virus (IGV), each representing the exposure of a different surface layer, were studied by negative-contrast electron microscopy and compared with analogous forms of a reovirus and an orbivirus. Although major structural similarities were found in each of the three main layers of these viruses, differences were sufficient to clearly distinguish the member genera of the Reoviridae family. IGV particle morphology was stable to most physical and chemical agents commonly used to evaluate virus lability. Virions were stable under all test conditions except when treated with versene-trypsin or held at pH < 3.

In 1958 Kubelka et al reported the isolation of an agent from the pooled sera of 2 brothers hospitalized with infectious hepatitis. The serum mixture was inoculated into the allantoic cavity of chick embryos, and after 4 days incubation the allantoic fluid was inoculated onto monkey kidney cells. A cytopathic agent, termed the Motol virus, was isolated from the tissue culture fluid. The virus produced lethal hepatitis in mice but was not pathogenic for any other host. Kubelka and others have since performed extensive studies in attempts to identify the agent and establish its relationship to infectious hepatitis (Kubelka, 1960, 1964; Schon et al, 1964; Spies, 1965), but the agent has not yet been identified. Attempts to relate Motol virus to mumps virus by demonstrating 4-fold or greater rises in hemadsorption inhibition titer against the agent in human sera during clinical parotitis have been described by Trlifajova et al, 1966. However, these workers noted that the Motol material with which they obtained this data contained 2 agents: a cytopathogenic virus and a noncytopathogenic hemagglutinin-producing agent. They indicated that studies with 5-iododeoxyuridine showed the agents to have different nucleic acids. The noncytopathogenic virus was described as parainfluenza SV5 myxovirus; the cytopathogenic virus was not identified.

We report a case of myositis associated with human immunodeficiency virus (HIV) reactivity which was demonstrated on bone scan in the presence of normal muscle enzymes, contrast computed tomography, and electromyography. The diagnosis was confirmed by muscle biopsy. Radionuclide bone scanning may be a valuable diagnostic tool in HIV positive patients who present with muscle pain and an otherwise normal diagnostic evaluation.

Perivascular abscess in the aortic root is a serious complication of infective endocarditis and is recognized infrequently with noninvasive techniques. This report describes a patient with sepsis who was imaged with 67Ga and magnetic resonance (MR) in order to locate a site of infection. The 67Ga image showed increased activity in the substernal region. Magnetic resonance correctly detected the multilocular aortic root abscess, which had extended into the interatrial septum. The combination of the sensitive 67Ga with the high-resolution MR image provided a useful method to locate aortic root abscesses and to identify contiguous spread.

The hexagonal surface structure believed to be characteristic for influenza C virus was not initially observed for a newly isolated virus of this type. After a few additional egg passages of the virus, however, the hexagonal structure could be readily seen on many virions.

Human T cell leukemia virus type II (HTLV-II) has been isolated from a patient (Mo) with features of leukemic reticuloendotheliosis (LRE) and from a patient with acquired immunodeficiency syndrome (AIDS). We have obtained another isolate of HTLV-II from a patient (CM) with severe hemophilia A, pancytopenia, and a 14-year history of staphylococcal and candidal infections but no evidence of T cell leukemia/lymphoma, AIDS, or LRE. Fresh mononuclear cells and cultured lymphocytes from CM express retroviral antigens indistinguishable by molecular criteria from HTLV-IIMo. Leukocyte cultures from CM yield hyperdiploid (48,XY, +2, +19) continuous lymphoid lines; human fetal cord blood lymphocytes (CBL) are transformed by cocultivation with these CM cell cultures but retain normal cytogenetic constitution. Electron microscopic examination of the CM cultures and transformed CBL reveals budding of extracellular viral particles, intracellular tubuloreticular structures, and viral particles contained within intracellular vesicles. CM cell cultures and the transformed CBL do not require exogenous interleukin 2, have T cell cytochemical features and mature T helper phenotypes, and exhibit minimal T helper and profound T suppressor activity on pokeweed mitogen-stimulated differentiation of normal B cells. These characteristics, which are similar to those observed with the first HTLV-II isolate, may represent properties of all HTLV-II-infected T cells.

Colloidal gold was complexed with monoclonal IgG to the inner capsid of human rotavirus. The complex was then used as an immunoelectron microscopic marker to identify the location of the group-specific antigen of rotavirus.

The scintigraphic findings from eight patients who underwent splenectomy for splenomegaly secondary to diffuse large-cell lymphoma are described. Large focal photopenic areas were found in all cases, either solitary or multiple. The appearance is relatively typical for large-cell lymphoma, which should be strongly considered in a nontraumatized patient who presents with painful splenomegaly of unknown origin.

In Atlanta, from January to April 1975, reovirus-like agents (RLAs) were detected by a simplified electron-microscopic technique in the stools of 16 of 29 children with acute enteritis. Complement fixation tests with purified RLA antigens demonstrated antibody titer rises in seven children with RLA in their stools and in two mothers (one symptomatic) from whom acute and convalescent sera were available. Complement fixation tests performed on 207 individuals of varying ages and 60 laboratory workers indicated a high frequency of past infection with RLA, the highest frequency being in children 6 months to 4 years of age. These results corroborate the high rate of RLA detection in the stools of children with acute enteritis in other parts of the world and suggest that such infections can also occur in adults.

Lymphocytes infected with human T-lymphotropic virus type III/lymphadenopathy-associated virus were examined by thin-section and immunoelectron microscopy, with horseradish peroxidase as an electron-dense marker. There was no evidence of an intracytoplasmic virion precursor, but viral antigen accumulated at the plasma membrane. Particles formed at the plasma membrane, and most virus was found in extracellular spaces. Mature virus had an envelope with fuzzy surface projections surrounding a centric core and an electron-dense eccentric nucleoid.

Radionuclide imaging is the diagnostic procedure of choice for evaluation of acute disorders of the scrotum, permitting rapid differentiation of torsion of the spermatic cord from inflammatory processes. The method is less successful in diagnosing torsion of the testicular appendages. In the majority of reported cases of torsion of the appendix testis the scan appears normal. In a very limited number of cases increased perfusion to the affected side has been noted. We report a case of metachronous torsion of both the appendices testis. In each instance, there was decreased tracer uptake on the affected side, suggestive of early torsion of the testicle. The sequential involvement of each testis with a nine month interval between respective torsions provides a unique example where each testis serves, sequentially, as a normal control for the torsed contralateral appendage.

Human T cell leukemia virus (HTLV) type I has been isolated from the cultured T cells of several patients with adult T cell leukemia (ATL) and has been etiologically linked to ATL. However, HTLV-type II has been isolated only once, from the T cells of a patient with a T cell variant of hairy-cell leukemia. We report here the isolation of HTLV-II-related virus from the cultured T cells of a hemophilia-A patient with pancytopenia. The T cell line (CM) grows in the absence of T cell growth factor. Cord blood T cells were rapidly transformed when co-cultivated with irradiated CM cells. Heterologous competition radioimmunoassays using purified HTLV-I p24 showed the expression of HTLV-IIMO-related protein in these cells. Electron microscopy of the CM cells showed the presence of intracellular and extracellular type C viral particles. Comparison of the proviral genome in the CM cell line and the prototype HTLV-IIMO-containing cell line (MO) by molecular hybridization with probes specific for HTLV-IIMO indicated that restriction cleavage sites were identical. The fresh peripheral blood leukocytes of the patient contained two complete copies of the proviral genome, despite the lack of HTLV-II p24 expression. The virus from the cell line CM is designated as HTLV-IICM to distinguish it from the original HTLV-IIMO isolate.