Prostacyclin and Thromboxane in Non-Insulin Dependent Diabetes: The Chlorpropamide Alcohol Flush Reaction Revisited

1. Levels of immunoreactive 6-oxo-prostaglandin F1α (6-oxo-PGF1α) and thromboxane B2 (TXB2) were measured in peripheral venous plasma in a group of volunteers and non-insulin dependent diabetic patients (NIDDS). Levels of these eicosanoids were close to the limit of sensitivity of the radioimmunoassays and consequently data are reported as maximal values. Basal plasma levels of 6-oxo-PGF1α did not exceed 5 pg/ml in either group and maximal levels of immunoreactive TXB2 were 125 ± 14 and 128 ± 8 pg/ml for volunteers and NIDDS respectively.

2. Attempts to elicit peripheral vascular prostacyclin biosynthesis in volunteers by using forearm ischaemia produced no increase in plasma 6-oxo-PGF1α levels. Measurement of the combined plasma levels of 6-oxo-PGF1α, 13,14-dihydro-6-oxo-PGF1α, 13,14-dihydro-6,15-dioxo-PGF1α and 6-oxo-PGE1 indicated that these were also low (less than 5 pg/ml) and that failure to demonstrate increased 6-oxo-PGF1α levels was unlikely to have arisen from metabolism of prostacyclin to one or more of these metabolites.

3. Measurement of 6-oxo-PGF1α and TXB2 in peripheral venous plasma before and during chloropropamide alcohol flushing (CPAF) did not provide evidence for a role for these eicosanoids in the etiology of this phenomenon.

4. These findings point to the need for a reappraisal of studies that have described altered plasma levels of 6-oxo-PGF1α and TXB2 in CPAF and other pathophysiological conditions in man.

The role of endogenous opioids in the chlorpropamide alcohol flush

The response of plasma immunoreactive met-enkephalin (IR-met-enkephalin) to ethanol (8 g by mouth) after chlorpropamide (250 mg daily for 14 d) was studied in three groups of non-insulin dependent diabetics (a) six diabetics who showed chlorpropamide alcohol flush (CPAF) and in whom the reaction could be blocked by indomethacin, (b) five diabetics who showed CPAF but in whom the flush could not be blocked by indomethacin and (c) five diabetics who did not show CPAF. A rise in plasma IR-met-enkephalin was observed in all three groups. When the two groups of flushers were re-tested with the addition of an infusion of naloxone a rise in plasma IR-met-enkephalin was still demonstrated in both groups regardless of whether the flush was blocked by naloxone. Naloxone blocked the flush only in those six subjects whose flush could be blocked by indomethacin. In five subjects, all flushers, CPAF was tested using intravenous and oral ethanol in doses producing similar plasma ethanol levels. A facial flush was induced by both intravenous and oral ethanol. In three flushers, plasma IR-met-enkephalin levels were measured during CPAF testing with both intravenous and oral ethanol. None showed a rise in plasma IR-met-enkephalin after intravenous ethanol, despite the appearance of a facial flush, whereas all showed a rise after oral ethanol. We therefore conclude that CPAF is unlikely to be caused by a rise in plasma IR-met-enkephalin.

Tuberculous involvement of a polymicrobial liver abscess

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Prediction of reading disability in twin boys

Thirty-six twin boys aged between nine and 13 were assessed for intelligence and reading disability. Records of their birth status, early language development and social demographic characteristics were also available. 72 per cent of the sample had an accuracy reading age below their chronological age, and 59 per cent had a comprehension reading age below their chronological age, despite above-normal IQ. The best predictor of reading disability was preschool language status, accounting for 33 per cent of the variance in accuracy reading age discrepancy, and 23 per cent in comprehension reading age discrepancy in regression equations. This study shows that male twins are at very high risk for reading disability, and also offers support for the claim that language disability is basic to the development of reading problems.

Technique-related variation in results of FANA tests

We compared the reliability and reproducibility of three tests for fluorescent antinuclear antibodies (FANA) that are routinely performed in our laboratory. Sera from 72 patients, selected according to diagnosis (SLE in 28, RA in 12, and other connective-tissue diseases in 33), and from 32 healthy controls were tested with all three assays. There were wide variations between the results obtained with these tests. The variations did not reflect sensitivity or degree of standardisation (reproducibility on retesting was greater than 95%) and appeared to be inherent in the techniques. Clinicians should be aware of the technique-related differences in FANA assays.

Cutaneous leucocytoclastic vasculitis associated with acute sarcoidosis

A case of acute sarcoidosis associated with the simultaneous appearance of cutaneous leucocytoclastic vasculitis and erythema nodosum is reported. Circulating immune complexes were demonstrated and may have been important in the pathogenesis of both types of skin lesion.

Pathogenesis of insulin-dependent diabetes: a role for activated T lymphocytes

Expression of HLA DR antigens on T lymphocytes indicates that these cells are actively involved in an immune response. Raised levels of activated T lymphocytes were found in 14 of 15 recently diagnosed but in only 7 of 28 long-standing insulin-dependent diabetics. 9 of the recently diagnosed patients retested 6 months later still had high levels of activated T lymphocytes. Even long-standing insulin-dependent diabetics had significantly higher levels of activated T lymphocytes than non-insulin-dependent diabetics and healthy controls. 5 of 7 unaffected co-twins of recently diagnosed insulin-dependent diabetics had high levels of activated T cells; this increase persisted in 2 retested 6 months later, when mildly impaired glucose tolerance had developed. These results confirm that there is an active cellular immune reaction in newly diagnosed insulin-dependent diabetics which may precede the disease and persist for at least 6 months after its appearance.

Increased responsiveness of the hypothalamic-pituitary axis after neurotoxin-induced hypothalamic denervation

Neonatal treatment with monosodium glutamate (MSG) induces severe neuronal damage in selected brain areas, which in turn results in a number of neuroendocrine abnormalities during adult life. The present study was designed to determine what effects this partial and selective denervation of the hypothalamic-pituitary axis may have on the sensitivity of two key components of that axis, the median eminence (ME) and the anterior pituitary (AP). In order to test any changes in response that may occur after MSG treatment, the release of several peptide hormones from either the ME or the AP was evaluated in vitro, employing specific or general secretagogues. Male newborn pups of the Holtzman strain were injected with MSG every other day for 5 days, starting on day 2 of life; littermate controls received an injection of 10% NaCl. All animals were used when adult, at about 5-7 months of age. After decapitation, ME and AP tissues from control and MSG-treated rats were dissected out and incubated in vitro. Release of LHRH, SRIF, arginine vasopressin, and oxytocin from the ME was measured by direct RIA, under basal conditions and after stimulation with high K+ medium (28 mM). The results clearly indicate a marked hyperresponse of the release of each of the four neuropeptides by ME fragments from MSG-lesioned animals. The altered release was not attributable to changes in ME peptide content. In the case of the AP, the release of ACTH, LH, PRL, and GH in response to high K+ or, in some cases, to specific releasing factors, was evaluated in a dispersed cell preparation. The release of all four protein hormones was increased by high K+, and again the MSG-lesioned rats showed a pronounced hyperresponse. Corticotropin-releasing factor, at concentrations of 10(-9) and 10(-8) M enhanced ACTH release from control and MSG-lesioned rats, but the latter presented a marked hyperresponse. A similar observation on LH release was seen after stimulation with LHRH (10(-9) M). The results indicate that the neuronal damage induced by neonatal MSG treatment results in a generalized hyperresponsiveness in vitro to either specific or general secretagogues by ME or AP tissues, which may suggest the development of a denervation-type supersensitivity in the hypothalamic-pituitary axis. Since the release of these peptide hormones is sluggish in MSG-lesioned rats under in vivo conditions, it seems plausible to conclude that the major defect after the neurotoxin damage may reside in the loss of neurotransmitter systems normally innervating and regulating the activity of the peptidergic neurons.

Metastases to the breast

Metastases to the breast are uncommon, with about 250 cases reported from clinical and autopsy series. The mammographic findings in 16 new cases revealed a spectrum of changes that included solitary or multiple lesions, well demarcated or poorly marginated masses, and diffuse involvement of skin or parenchyma or both. Diffuse disease was seen more frequently in this series (4/16), at times simulating inflammatory breast cancer. Although diagnosis of a primary malignancy usually preceded detection of the breast lesion, 40% (6/16) had no history of malignancy. Prognosis remains poor; however, it has improved in the lymphoma-leukemia group due to improved immunotherapeutic and chemotherapeutic regimens. The clinical, radiologic, and pathologic features are discussed. Some of the lesions encountered can be confused with a primary breast malignancy or a benign lesion, necessitating prompt and accurate biopsy to preclude unnecessary major surgery and to improve survival in cancers amenable to current therapy.

Muscular rehabilitation after orthognathic surgery

There is both a biologic and a clinical foundation for the use of therapeutic exercise after othognathic surgical procedures to restore normal function of the jaw muscles. This can be accomplished by a systematic plan Of occlusal and muscular rehabilitation after release of maxillomandibular fixation. Through the diligent application of physical therapy principles, the function of the masticatory muscles can be more efficiently rehabilitated after orthognathic surgery and maxillomandibular fixation.

Low serum C4 concentrations: an inherited predisposition to insulin dependent diabetes?

Twenty two out of 86 insulin dependent diabetics had serum C4 concentrations below the normal range. None of 41 non-insulin dependent diabetics tested had low concentrations. Low C4 values were seen in insulin dependent diabetes irrespective of the duration of the disease and did not appear to correlate with complement activation. There was a close correlation in C4 values between identical cotwins, even when only one was diabetic. These results suggest that a low serum C4 concentration is an inherited phenomenon and may predispose towards the development of insulin dependent diabetes.

Lumbar spine x-rays: a multihospital study

To define the usefulness of the lumbar spine x-ray series in the emergency department and to generate clinical criteria for optimizing its application, we retrospectively studied 552 consecutive emergency department patients for whom lumbar spine x-rays were ordered. Patients were divided into traumatic (47.6%) and nontraumatic (52.4%) groups. Three subgroups were created based on radiological findings: 1) "negative" (55.8%), 2) "possibly significant" (37%), and 3) "positive" (7.2%). The "positive" subgroup was compared with the other two subgroups in an attempt to define physical markers that correlated with positive radiological findings. Four clinical findings were present in significantly different frequencies between the positive group and others: an abnormal physical examination (90% vs 61.5%, respectively) (P less than .0001), tenderness (72.5% vs 41.2%) (P less than .0005), multiple positive findings (42.5% vs 20.7%) (P less than .005), and contusion or abrasion (15% vs 2.7%) (P less than .0005).

HLA-DR typing in identical twins with insulin-dependent diabetes: difference between concordant and discordant pairs

A total of 106 pairs of identical twins, of whom 56 were concordant and 50 discordant for insulin-dependent diabetes, were typed for HLA-DR. In both the concordant and discordant groups there was a high prevalence of the antigens DR3 and DR4, a low prevalence of DR5 and DR7, and a virtual absence of DR2. The heterozygous phenotype DR3,DR4 was more prevalent in concordant than discordant pairs. This was therefore the first demonstration of a genetic difference between concordant and discordant identical twin pairs. These findings suggest that possession of both DR3 and DR4 antigens confers a greater genetic predisposition to insulin-dependent diabetes than does the possession of either antigen alone.

Effects of gold compounds on the function of phagocytic cells. II. Inhibition of superoxide radical generation by tripeptide-activated polymorphonuclear leukocytes

The effect of sodium aurothiomalate and triethylphosphine gold on the generation of superoxide radicals by chemotactic tripeptide-activated polymorphonuclear leukocytes has been investigated using a cytochrome C reduction technique. Neither gold compound inhibited the binding of the tripeptide to cells. Sodium aurothiomalate in concentrations ranging from 1 to 100 micrograms/ml produced mild, nonsignificant inhibition of the generation of superoxide radicals. In contrast, triethylphosphine gold at a concentration of 0.25 microgram/ml was associated with a mild enhancement of superoxide radical production, but the enhancement was not statistically significant. At concentrations of 1.25 micrograms/ml and above, there was a profound inhibition of superoxide radical production by these activated cells. Since the products of the respiratory burst, including superoxide, are thought to be inflammatory mediators, it is postulated that the inhibition of superoxide radical generation by gold compounds may be another mechanism by which the compounds modulate their antiinflammatory effects in patients with rheumatoid disease.

A comparison of the mother-child interactions of younger and older hyperactive and normal children

The mother-child interactions of both younger (means age = 4.11) and older (means age = 8.4) hyperactive children were compared and contrasted with those observed in comparable age groups of normals. Interactions were observed in an unstructured-play and structured-task situation. Mothers of hyperactives were generally more directive and negative during play and less responsive to child-initiated interactions. Hyperactive children asked more questions and were generally more negative and noncompliant during play, particularly younger hyperactives. Hyperactives did not differ from normals in their reactions to mother-initiated behavior during play but engaged in less independent activity when their mothers were noninteractive. During the structured-task situation mothers of hyperactives were more directive and negative and less interactive and approving, even when their child was interacting appropriately. In general, between-group differences in mother-child interactions were greatest when comparing dyads with a younger hyperactive child with the other 3 groups, especially during the structured-task situation.

Obstructive sleep apnea in Treacher-Collins syndrome

Studies of the Treacher-Collins syndrome have emphasized hearing and surgical considerations. Although craniofacial anomalies have been associated with respiratory disorders in infancy, the presence of such problems in older children has not been emphasized. An eight-year-old with Treacher-Collins syndrome presented a history of recent behavioral problems at home, poor attention span and performance in school, daytime somnolence, and sleep apnea with relatively long periods of chest movement but no airflow. He also had abnormal sleep behavior consisting of rocking to and fro on his hands and knees, often to such an extent that his nose became abraded. ICU monitoring with observation and recording of sleep patterns and sounds, and fluoroscopy of his upper airway utilizing cineradiography while asleep confirmed the diagnosis of obstructive sleep apnea. The patient subsequently underwent an orthognathic surgery consisting of insertion of rib bone grafts after anterior advancement of his mandible. This procedure resulted in disappearance of the obstructive sleep apnea and associated symptoms. Because of micrognathia, patients with Treacher-Collins syndrome are at high risk for developing obstructive sleep apnea. Surgical correction of their deformities can result in improvement in cosmetic appearance as well as in resolution of the obstructive episodes with improvement in performance and behavior.

DNA binding proteins in chromatin structure and function

The binding of chromosomal proteins to cloned mouse and human globin genes can be determined by transferring proteins from one dimensional electrophoretic separations on to nitrocellulose paper and exposing them to nick translated cloned globin DNAs. The usefulness of this technique is assessed in the case of RNA polymerases isolated from mouse Ascites tumor cells where a specific initiation site for transcription of mouse beta globin DNA can be demonstrated.

The isolation and partial characterization of low-molecular-weight phosphorylated component of the non-histone proteins of mouse nuclei

After labelling of mouse liver nuclei with [gamma-32P]ATP in vitro, 10-20% of the radioactivity incorporated into the saline-soluble nuclear and HAP2 chromatin fractions was located in a low-molecular-weight component (component 10) with pI near 4.5 in urea. By using combinations of ion-exchange chromatography, preparative thin-layer isoelectric focusing and gel filtration, this component was isolated from both nuclear fractions. Recovery from the saline-soluble fraction was poor under conditions that allow endogenous phosphatases to be active. Component 10 was shown to be a phosphoprotein on the basis of enzyme-digestion experiments and the detection of phosphoserine and phosphothreonine. The 32P radioactivity did not appear to be associated with phosphorylated basic amino acids. Its molecular weight was determined by gel chromatography and electrophoresis in sodium dodecyl sulphate/polyacrylamide gels as approx. 10000, and tryptic digestion of the reduced carboxymethylated protein in urea yielded two 32P-labelled peptides. It has not been possible as yet to assign a function to component 10, though its similarity to other low-molecular-weight acidic proteins is discussed.

Equilibrium reaction of pyrazolodiazepinones in aqueous solution

This study of the behavior of some pyrazolodiazepinones in aqueous solution at near ambient temperature indicated that they form stable equilibrium mixtures consisting of ring and opened forms. Under isothermal conditions, mixtures are produced whose composition is dependent on pH and may vary from that corresponding to essentially complete ring opening to complete closure. Ring closure equilibrium constants were calculated, and the influence of methyl substitution was determined. Substitution of a methyl group for an amido hydrogen in the open form results in a fivefold increase in this constant. Methylation of the terminal amino group, however, did not cause a corresponding increase and may not significantly affect equilibrium.

An analysis of the binding of fluorescence probes in mitochondrial systems

Measurements of the binding of the fluorescent probes 8-anilinonaphthalene-1-sulfonate (ANS) and ethidium ions to whole and disruped mitochondria and submitochondrial particles suggest that the inner mitochondrial membrane is freely permeable to the two probes. Equations relating the binding of permeant probes to the electro-chemical balance across the membrane of vesicular systems are derived and these equations used to analyze Scatchard plots of the binding of the two probes to energized and nonenergized mitochondria and EDTA particles.

Effects of dibutyryl cyclic adenosine 3',5'-monophosphate and parathyroid extract on calcium and phosphorus metabolism in hypoparathyroidism and pseudohypoparathyroidism

It has been proposed previously that the metabolic defect in pseudohypoparathyroidism which accounts for parathyroid hormone unresponsiveness is an absence or abnormal form of the adenyl cyclase system in kidney and presumably in bone. To determine whether there is an associated defect in the response mechanism to cyclic adenosine 3',5'-monophosphate (cyclic AMP), the effects of parathyroid extract (PTE), and dibutyryl cyclic AMP were compared in patients with either surgical hypoparathyroidism or pseudohypoparathyroidism. PTE and dibutyryl cyclic AMP both increased serum and urinary calcium, lowered the serum phosphorus, and increased urinary phosphorus in patients with hypoparathyroidism. PTE also increased urinary cyclic AMP in these patients. PTE increased serum and urinary calcium and urinary phosphorus but did not alter serum phosphorus or urinary cyclic AMP in the patients with pseudohypoparathyroidism. Dibutyryl cyclic AMP increased the serum and urinary calcium, lowered the serum phosphorus, and increased urinary phosphorus in all the patients with pseudohypoparathyroidism. The results indicate that (a) dibutyryl cyclic AMP can reproduce the effects of parathyroid hormone on calcium and phosphorus metabolism in man, (b) the response mechanism to cyclic AMP appears to be intact in pseudohypoparathyroidism, and (c) PTE apparently produces some of its characteristic effects on calcium and phosphorus metabolism in pseudohypoparathyroidism in the absence of an increase in urinary cyclic AMP.

The Synacthen test of adrenal cortical function in children

Adrenal cortical function was assessed in a dozen children by measurement of plasma cortisol rise after a single injection of the synthetic polypeptide Synacthen (β1-24 cor ticotropin), and by measurement of urinary 17 hydroxycorticosteroid response to a three- day stimulation with ACTH.

Statistically significant correlation between the results of these two tests indicates that the Synacthen test is a valid and useful ap proach to appraising adrenal cortical funç tion in children.

The Synacthen test possesses a number of advantages over the ACTH test—the test substance is purer, the results are obtained much more quickly, and the risk of ana phylactic shock is eliminated.

Parathyroid adenoma

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