Biomedical subjects
Publications and source records attributed to M I Sachs.
Exercise-induced wheezing developed in a previously healthy 14-year-old boy. Chest radiographs revealed hyperlucency of the left lung. Bronchial tomography and bronchoscopy revealed a mass in the left mainstem bronchus, identified as a carcinoid tumor after surgical excision. The patient is now asymptomatic. Exercise-induced wheezing as the sole manifestation of this tumor has not been previously reported.
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We studied four patients with recurrent attacks of angioedema, urticaria, and fever. During attacks, body weights increased up to 18 per cent, and leukocyte counts reached 108,000 per microliter (88 per cent eosinophils). The disease did not appear to threaten the function of vital organs. The two children received prednisone intermittently; the adults did not require treatment or were given alternate-day prednisone. Glucocorticoid therapy caused defervescence and diuresis and decreased total leukocyte and eosinophil counts. No patient had evidence of cardiac involvement (follow-up, 2 to 17 years). One patient remained in spontaneous remission for 20 years before symptoms recurred. Histologic studies showed that eosinophils localized and degranulated in the dermis, and they appeared to induce edema. Although this syndrome might be classified as a variant of the hypereosinophilic syndrome, we believe it is a separate entity because of its distinctive characteristics and its benign course.
A 13-year-old boy was hospitalized with gastrointestinal obstruction. During evaluation, the total eosinophil count was as high as 3,332/mm. A biopsy specimen of the small bowel obtained at laparotomy revealed an intense eosinophilic infiltrate of the muscularis. Symptoms were controlled with glucocorticoid therapy. The case is unusual in that the eosinophilic gastroenteritis presented as childhood gastrointestinal obstructive disease with involvement of the colon but sparing of the stomach.
Four patients with recurrent attacks of angioedema, urticaria, and fever were seen. During attacks, body weights increased up to 18% and leukocyte counts reached 108,000/microliters (88% eosinophils). Glucocorticoid therapy caused defervescence, diuresis, and decreased total leukocyte and eosinophil counts. The two children received prednisone intermittently; the adults did not require treatment or their conditions were controlled by alternate-day prednisone administration. No patient had evidence of cardiac involvement (follow-up, 2-17 years). The disease does not threaten the function of vital organs. One patient remained in spontaneous remission for 20 years before symptoms recurred. Although it might be classified as a variant of the hypereosinophilic syndrome, we believe that this syndrome is a separate entity because of its distinctive characteristics and its benign course.
Puncture skin tests with crude food extracts correlate well with proved IgE-mediated food allergy. The RAST may be effective in the diagnosis of IgE-mediated food hypersensitivity when purified allergens are used and when crude food extracts are used. A positive RAST to a food may demonstrate IgE antibody directed to that food but not necessarily implies clinical sensitivity. The RAST may not be efficacious for diagnosing in food allergy if the total IgE value is greatly elevated.
We isolated and partially characterized a major peanut allergen (Peanut-I) using the radioallergosorbent test (RAST) to monitor the allergenicity of various fractions. Raw peanuts were pulverized, defatted, and extracted; the resulting crude extract (CPE) was fractionated by diethylaminoethyl (DEAE) cellulose anion-exchange chromatography using a linear salt gradient. Peak allergenic fractions were further purified by a second DEAE cellulose chromatography step, followed by a preparative polyacrylamide gel electrophoresis (PAGE) step. The final product, Peanut-I, contained 11% nitrogen and 8.7% carbohydrate and was homogeneous by both analytical PAGE and immunoelectrophoresis against rabbit anti-CPE. Peanut-I was heterogeneous by thin-layer electrofocusing and by PAGE in 1% sodium dodecyl sulfate. Biologic activity of Peanut-I was demonstrated by positive skin tests and leukocyte histamine release assays in patients with peanut allergy. By RAST inhibition assay Peanut-I did not account for all of the allergenic activity of CPE.
Ten peanut-sensitive patients were enrolled in a double-blind crossover trial to determine whether ingestion of peanut oil can induce adverse reactions in such individuals. All patients had experienced prior allergic reactions to peanut ingestion, including any of the following: generalized urticaria, angioedema, abdominal cramps, vomiting, diarrhea, bronchospasm, or shock. All patients had elevated levels of serum IgE antibodies to both crude peanut extract and the purified peanut allergen, Peanut-I, by RAST assay; binding values ranged from 2 to 26 times that of negative control serum. All patients demonstrated negative puncture skin tests to both peanut oil and olive oil (control). At 30-min intervals, patients ingested 1, 2, and 5 ml of either oil contained in 1 ml capsules while under constant observation. These quantities exceed the maximum estimated dose of peanut oil that would occur in single meals. Patients returned 2 wk later for ingestion challenge with the remaining oil. No untoward reactions were observed with either peanut oil or olive oil. Peanut oil ingestion does not pose a risk to peanut-sensitive individuals.
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Eggs of the sea urchin Arbacia punctulata were artificially activated with hypertonic seawater. The artificially activated eggs undergo the cortical reaction which is not distinguished by a wavelike progression as in the case of inseminated eggs. The cortical granules are released at random loci at the surface of the egg and result in spaces separated by large cytoplasmic projections. Unreacted cortical granules and ribosomes are found within the matrix comprising the large cytoplasmic projections. No "fertilization cone" is formed. The subsequent release of additional cortical granules results in the formation of a continuous perivitelline space, 15 min following activation. 85 min postactivation, an organization of annulate lamellae, endoplasmic reticulum of the smooth variety, and microtubules around a centriole is observed prior to nuclear division. Before the breakdown of the nuclear envelope a streak stage is formed. The streak is composed of a central core of annulate lamellae and is encompassed by endoplasmic reticulum and vesicular components. Condensation of chromatin is followed by the establishment of the mitotic apparatus. Centrioles were not found in the mature egg; however, they are present after activation prior to the first nuclear division, in the four-cell embryo, multicellular embryo, and at blastula. Artificially activated eggs have been observed to develop to the pluteus stage in more than 50% of the eggs treated.