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Biomedical subjects

J L Curtis

Publications and source records attributed to J L Curtis.

At least 55 records · Page 3Linked to original sources

Requirement of CD4-positive T cells for cellular recruitment to the lungs of mice in response to a particulate intratracheal antigen.

To determine whether CD4+ T cells participate in the recruitment of other lymphocyte subsets to the lungs, we examined pulmonary immune responses in C57BL/6 mice treated in vivo with the MAb GK1.5, either intact (which depletes CD4+ cells) or as F(ab')2 fragments (which block CD4 molecules). After intratracheal challenge with sheep erythrocytes, antigen-primed mice treated with intact GK1.5 had marked decreases in lymphocytes and macrophages in bronchoalveolar lavage fluid and minimal parenchymal inflammation, compared to primed mice treated with an isotype-matched irrelevant antibody or with no antibody. At 7 d after challenge, flow cytometric analysis showed that numbers of Thy 1.2+ and B220+ cells, but not of CD8+ cells, were markedly decreased in lavage fluid of CD4-depleted mice. Similar suppression of the pulmonary immune response to intratracheal challenge was found in primed mice injected repeatedly with F(ab')2 fragments of GK1.5, which did not deplete CD4+ T cells, and in athymic mice. These findings indicate that, in response to a single intratracheal antigen challenge, recruitment to the lungs of leukocytes other than CD8+ T cells depends largely on CD4+ T cells, possibly because of signals requiring T cell activation via interactions with antigen-presenting cells.

Animals↗

Oral mucosa pigment changes in heavy drinkers and smokers.

The preliminary observation that heavy drinking and smoking produced oral mucosal changes consisting of splotchy areas of depigmentation surrounded by hyperpigmentation was tested. The study population was comprised of 52 patients from an alcohol detoxification ward, who were compared with 54 patients from psychiatric inpatient and day hospital services. Structured interviewing was developed for both samples of patients who met either diagnostic criteria for alcohol abuse or dependence, or criteria for alcoholism on the Short Form of the Michigan Alcohol Screening Test, and were identified as nonsmokers or as those who smoked one to three or more packs of cigarettes a day. Photographs of the inner surface of the lips, oral mucosa, and gingivae independently were rated for severity of oral pigment change by two raters blind to a patient's alcohol or smoking history. This study demonstrates that reported observable oral pigment changes identify patients who are heavy smokers and drinkers, and may be a useful diagnostic sign.

Alcoholism↗

Recovery of biologically active enzymes after HPLC separation.

The mass and activity recovery of eight different enzymes (two monomeric, six oligomeric) with molecular masses between 25,000 and 240,000 daltons were tested after HPLC separation on three different HPLC instruments (two with stainless steel and one with titanium flow paths). Most of the tested proteins are known to be sensitive to heavy metal ions. Eight wide pore, ion-exchange columns, two size-exclusion columns and two hydrophobic-interaction columns were used. Both stainless steel and glass column hardware were used in all three separation modes. The elution times were between 8 and 12 minutes. In almost all cases, the activity recovery was between 90% and 100% compared with a control sample incubated in the chromatographic elution buffer for the same time at the same temperature. A severe activity loss (about 30%) was observed with only one ion-exchange column and one enzyme. Neither the column hardware nor the material of the HPLC equipment had any negative effect on the activity recovery of the enzymes tested.

Alcohol Dehydrogenase↗

Central airway obstruction due to cytomegalovirus-induced necrotizing tracheitis in a patient with AIDS.

Cytomegalovirus (CMV) infection in patients with the acquired immunodeficiency syndrome (AIDS) can present as either disseminated disease, pneumonitis, retinitis, gastroenteritis, neuropathy, or a subclinical infection. We report a patient whose initial manifestation of CMV infection was severe central airways obstruction due to necrotizing tracheitis. At bronchoscopy, the lesion appeared deeply ulcerated, distinctly different from previously described airway lesions in patients with AIDS. Mucosal biopsies showed characteristic intranuclear and intracytoplasmic inclusions and cultures yielded only CMV. The patient responded partially to ganciclovir, steroids, and antibiotics against suspected anaerobic superinfection but died as a result of central nervous system disease believed due to toxoplasmosis or lymphoma. CMV infection of the upper airway should be considered in the patient with AIDS presenting with atypical cough or stridor and ulcerated endobronchial lesions.

Acquired Immunodeficiency Syndrome↗

Histologic analysis of an immune response in the lung parenchyma of mice. Angiopathy accompanies inflammatory cell influx.

To determine the histologic changes occurring during a pulmonary immune response, the lungs of antigen-primed C57BL/6 mice were examined on various days after intratracheal challenge with 10(8) sheep erythrocytes. The response was characterized by 1) dense perivascular aggregates composed largely of mononuclear cells; 2) endothelial cell hypertrophy and subendothelial inflammatory cell collections in vessels of a variety of sizes; 3) variable degrees of focal, reversible vascular injury (angiopathy) of both muscular arteries and small veins; and 4) increased cellularity of alveolar walls. Inflammatory cells appeared to emanate from small veins and venules and from minute thin-walled vessels adjacent to large arteries. The reaction peaked at 3 to 4 days and then gradually declined over a period of 6 weeks, never quite reaching baseline. We believe that this experimental model will be an important means of further defining both the mechanisms of lymphocyte entry to the lungs in response to antigen and the factors controlling the pathogenesis of related angiopathies.

Animals↗

HIV screening and counseling for intravenous drug abuse patients. Staff and patient attitudes.

At least one third of patients enrolled in a methadone maintenance treatment program are willing to comply voluntarily with screening for and counseling about human immunodeficiency virus (HIV). A questionnaire about knowledge, attitudes, and behavior concerning acquired immunodeficiency syndrome was answered anonymously by 79% (46) of the clinical staff and 67% (868) of the enrolled patients. On their own initiative, 21% of the patients had already received voluntary anonymous HIV screening and brief counseling, seldom discussing the result with the staff. Approximately 90% of the staff and a majority of the patients (72%) thought a voluntary HIV screening program should be offered to all patients. Almost all staff (98%), but only 50% of the patients, felt the HIV test results should be known to physicians, nurses, and counselors at the clinic. Few staff members (15%) believed that patients had changed their sex behavior; more (48%) felt that needle sharing was reduced. Patients believed methadone patients in general had changed their sex behavior (49.2%) and reduced needle sharing (62%) to prevent becoming infected. Patients reported statistically significant reductions both in number of sex partners and in personal needle sharing during the past year.

Adult↗

Characterization of bronchoalveolar lymphocytes during a specific antibody-forming cell response in the lungs of mice.

The goal of this study was to characterize the total numbers and phenotypes of lymphocyte subpopulations recovered by bronchoalveolar lavage during an experimental immune response in the lung parenchyma. Inbred mice (C57BL/6) were primed systemically and then challenged intratracheally with sheep red blood cells, a T-cell-dependent antigen. At various days later, we performed differential cell counts, measured the concentrations of specific antibody-forming cells, and determined lymphocyte phenotypes in bronchoalveolar lavage fluid by flow cytometry, distinguishing lymphocytes by light scatter parameters. We found that the numbers of lymphocytes recovered by bronchoalveolar lavage increased significantly in primed mice challenged with the priming antigen but not in three control groups: unprimed mice challenged intratracheally with the same dose of sheep red blood cells, primed mice challenged with hydrochloric acid, and primed mice challenged with a non-cross-reacting erythrocyte. At all times tested the concentrations of antibody-forming cells in bronchoalveolar lavages were identical to those of cells from minced lungs. Helper T-cells (L3T4-positive) increased earliest and constituted the majority of lymphocytes in bronchoalveolar lavage fluid throughout the immune response. We conclude: first, that there is a major influx of lymphocytes into the lungs during the development of a specific pulmonary immune response; second, that this lymphocyte influx occurs only in the presence of an antigen-driven response; third, that lymphocytes specific for the challenging antigen are in equilibrium between the bronchoalveolar and interstitial compartments; fourth, flow cytometry can be used to determine surface phenotypes of bronchoalveolar lymphocytes in mice.

Animals↗

Expression of Ia by murine alveolar macrophages is upregulated during the evolution of a specific immune response in pulmonary parenchyma.

These studies were performed to test the hypothesis that the evolution of a specific immune response in lung parenchyma upregulates the expression of Ia on surface membranes of murine alveolar macrophages. A secondary antibody-forming cell response to sheep erythrocytes was generated in lung parenchyma by intratracheal antigen challenge of systemically primed mice. During the immune response, alveolar macrophages were retrieved by bronchoalveolar lavage, and the percentages and total numbers of Ia-positive macrophages were measured by indirect immunofluorescence. The expression of Ia on surface membranes of lavaged alveolar macrophages increased in association with the generation of antibody-forming cell responses in lung tissue. This increase in Ia expression was antigen specific; intratracheal challenge with noncrossreacting antigen did not increase Ia expression. Nonspecific inflammation of the lung, induced by intratracheal hydrochloric acid, elicited increases in total numbers of macrophages that were similar in magnitude to those induced by specific immune responses, but increased Ia expression only modestly. In unprimed mice, intratracheal antigen challenge did not increase Ia expression by alveolar macrophages unless the mice had received immune splenocytes by adoptive transfer at the time of challenge. The results show that the generation of a specific immune response in pulmonary parenchyma upregulates the expression of Ia by murine alveolar macrophages in vivo and suggest that the accumulation of antigen-reactive lymphocytes in the lung plays an important role in this upregulation.

Animals↗

The mechanism of appearance of specific antibody-forming cells in lungs of inbred mice after immunization with sheep erythrocytes intratracheally. II. Dose-dependence and kinetics of appearance of antibody-forming cells in hilar lymph nodes and lungs of unprimed and primed mice.

We are conducting studies designed to define the cellular basis for the appearance and accumulation of specific antibody-forming cells (AFC) in lung parenchyma of mice after intrapulmonary deposition of sheep erythrocytes (SRBC). This study was performed: to compare qualitatively the AFC responses to intratracheally administered antigen among unprimed mice and among mice primed either by adoptive transfer of sensitized lymphocytes or by systemic immunization, and to define quantitatively the relationship between the appearance of AFC in hilar lymph nodes (HLN) and in lung parenchyma in these 3 groups of mice. Both antigen dose-response and kinetic analyses of the appearance of AFC in the HLN and lung parenchyma were performed. There was a direct relationship between the dose of SRBC administered intratracheally and the magnitude of the AFC-responses in HLN and lungs; AFC appeared in HLN at substantially lower intratracheally administered doses of SRBC than in lungs. The major effect of adoptive transfer or of systemic priming was to shift the dose-response curves significantly to the left, such that AFC appeared in HLN and lungs at lower antigen doses than in unprimed mice. Kinetic analyses showed that the initial appearance and the peak concentrations of AFC occurred earlier in HLN than they did in lung parenchyma. Priming shifted the kinetic curves to the left, accelerating the appearance of AFC; the sequential relationship between AFC appearance in HLN and in lungs was preserved.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Essential thrombocythemia and leukemic transformation.

Alkylating agents and 32P have been widely employed in the treatment of patients with essential thrombocythemia (ET). During a four-month period, we observed 3 cases of ET that had transformed into leukemia. Two patients had been treated with uracil mustard: One developed acute myelogenous leukemia 79 months after institution of therapy, and the other patient developed chronic myelomonocytic leukemia 24 months after the start of therapy. The third patient had been treated with busulfan, and ET evolved into myelofibrosis and eventually into acute undifferentiated leukemia with myelofibrosis. The patient who developed acute myelogenous leukemia was asymptomatic at the time of diagnosis of ET but was treated because his platelet count was greater than 1,000,000/mm3. He died 1 month after leukemic transformation, during induction chemotherapy. The other 2 patients presented with symptoms referable to their thrombocythemia. Review of the English literature revealed 12 other definite or probable cases of ET with leukemic transformation, all but 1 having been treated with alkylating agents and/or 32P. We propose that the natural history of ET may be similar to that of polycythemia vera, with evolution into leukemia being an unusual occurrence except in the setting of previous chemotherapy. Therefore, the current practice of treating asymptomatic patients with ET may not be justified, since administration of alkylating agents or 32P may increase the risk of subsequent development of leukemia.

Adult↗

The usefulness of induced sputum in the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome.

Thirty-two patients with or suspected of having the acquired immunodeficiency syndrome were evaluated for opportunistic lung infection using examination of sputum induced by inhalation of 3% saline. The specimens obtained were stained with Giemsa stain and examined for Pneumocystis carinii. Smears of sputum were also appropriately stained and examined for acid-fast organisms and fungi, as well as cultured for these organisms. Patients whose sputum did not contain P. carinii had bronchoscopy within 24 h of sputum induction. Twenty-five of the 32 patients were ultimately determined to have P. carinii pneumonia. Of these, 14 were detected by examination of sputum (sensitivity, 56%). Of 18 patients whose sputum did not contain P. carinii, 11 had the organism detected in specimens obtained by bronchoscopy (negative predictive value, 39%). There were no clinical features that identified patients more likely to have a positive sputum examination. No additional treatable lung pathogens appeared to be missed by sputum examination. In this select population, examination of induced sputum establishes the diagnosis of P. carinii pneumonia in a significant proportion of patients, thereby decreasing the need for more invasive procedures.

Acquired Immunodeficiency Syndrome↗

Prevalence rates for alcoholism, associated depression and dementia on the Harlem Hospital Medicine and Surgery Services.

Current prevalence rates for alcoholism, and associated depression and dementia, were determined on random samples of approximately 200 patients admitted to the Medicine Service, and a similar sample to the Surgery Service, of the Harlem Hospital Center. The Medicine patients averaged 51 years of age, significantly older than the Surgery sample's average age of 44 years. Surgery patients also had a significantly greater proportion of patients (46.8 percent) who had achieved at least a high school education compared to Medicine (32.1 percent). The alcohol prevalence rate of 30.2 percent for Medicine was significantly greater than the 18.3 percent Surgery prevalence. Both Medicine and Surgery patients showed that a progressively serious pattern of drinking was associated with progressively serious depression. Progressive dementia was associated with progressive severity of drinking in the Medicine sample, but this finding was not demonstrated in the Surgery patients. Medicine and Surgery patients demonstrated dissimilar profiles of principal admitting diagnoses. Patient management is seriously handicapped by problems of alcoholism and associated problems of depression and dementia.

Adolescent↗

Helium-oxygen gas therapy. Use and availability for the emergency treatment of inoperable airway obstruction.

Inoperable obstruction of the upper airway due to extrinsic malignancy may present as respiratory failure. We treated such a patient for 48 hours with 80 percent: 20 percent helium-oxygen delivered by a nonrebreathing mask while chemotherapy and radiation therapy reduced the tumor size. The need for intubation, mechanical ventilation, and high risk surgical intervention was avoided through the use of this gas therapy. We then surveyed San Francisco Bay area hospitals and found that fewer than one half could provide this potentially lifesaving gas therapy in an emergency situation. Physiologic basis of helium-oxygen gas therapy is reviewed and recommendations made for its use and availability.

Adolescent↗