Corticosteroid - induced avascular necrosis of head of femur in a patient with pemphigus vulgaris

Corticosteroid - induced avascular necrosis of head of femur is reported in an elderly woman patient with pemphigus.

Personality disorders among subjects recovered from eating disorders

OBJECTIVE

Personality disorders are common in symptomatic eating disorders subjects. Because personality symptoms could be exaggerated by malnutrition or Axis I disorders, we studied women who had recovered from eating disorders for at least 1 year to see if personality disorder symptoms persisted in the well state.

METHOD

Personality disorders were evaluated in 10 women recovered from anorexia nervosa (AN), 28 women recovered from bulimia nervosa (BN), and 16 women recovered from AN and BN, using the Structured Clinical Interview for DSM-III-R personality disorders.

RESULTS

Fourteen of 54 subjects (26%) met the criteria for at least one personality disorder, such as self-defeating, obsessive-compulsive, or borderline personality disorder. Cluster B personality disorders were closely associated with bulimic subtypes.

CONCLUSIONS

While a recovery from eating disorders may have an attenuating influence on the symptoms of personality disorders, such personality disorder diagnoses persist after recovery in some recovered subjects.

Estradiol/progesterone substitution in the luteal phase improves pregnancy rates in stimulated cycles--but only in younger women

Innumerable studies have attempted to demonstrate that hormonal support of the luteal phase during ovulation induction cycles improves pregnancy rates. None has, however, so far been able to confirm the validity of such treatment conclusively, possibly because most studies only utilized progesterone substitution. Since luteal phase endometrium also requires estradiol support, this study attempted to investigate whether hormone substitution with progesterone and estradiol would be more successful in improving pregnancy rates. Amongst approximately 7500 consecutive ovulation induction cycles were identified prospectively which were characterized by a precipitous drop of luteal phase serum estradiol levels by more than 50% over a 48 hour period within 10 days from hCG administration. Those cycles were prospectively randomized to oral micronized estradiol substitution (Group I) or not (Group II), while both groups received routine progesterone substitution of the luteal phase. Cycles were then evaluated in regards to the occurrence of chemical, ectopic and clinical pregnancies. One hundred sixty-three Group I cycles resulted in 34 pregnancies (20.9%), which compared favorably to 21 pregnancies in 167 Group II patients (12.6%) (x2[1] = 4.06; p < 0.04). The advantage for Group I cycles (29/95 pregnancies, 31%) vs. Group II cycles (16/105, 15%) became even more pronounced when only women up to age 35 years were evaluated. Estradiol substitution maintained a significant advantage until age 38 (x2 [1] = 6.87; p < 0.009). While gravidity did not affect pregnancy success, estradiol substitution in Group I benefited nulliparous (23% pregnancy rate) over multiparous women (12% pregnancy rate) (x2 [2] = 6.86; p< 0.03). This association was, however, age-dependent. A combined estradiol and progesterone substitution of the luteal phase of ovulation induction cycles increases the overall pregnancy rate. Since estradiol substitution was initiated in this study only once a precipitous drop in serum estradiol levels had already taken place, an even larger improvement in pregnancy rates could conceivably be possible if earlier estradiol substitution of the luteal phase is initiated. A further expansion of investigations of similar protocols for routine ovulation induction and in vitro fertilization (IVF) cycles may be indicated, especially in women below age 38 years and in nulliparous females.

Antiproliferative activity of conditioned medium from lymphocytes of neuroblastoma (NB) patient and inhibition with NB serum

Neuroblastoma (NB) is a pediatric malignancy and results in high mortality rate. Cellular immunity has been shown to play an important role in killing tumors 'in vitro'. Human lymphocytes were activated in vitro with phytohaemagglutinin (PHA) and the effect of supernatants collected at 24, 48, 72 and 96 h were tested on proliferation of human NB cell line-SK-N-MC and glioma cell line U87-MG. The SK-N-MC cells were observed to be more susceptible to the supernatants compared to U87-MG with higher inhibition of proliferation as evaluated by [3H]thymidine incorporation (P < 0.05 for 24 and 72 h and P < 0.0005 for 48 and 96 h). Conditioned medium from lymphocytes of NB patient collected at 48 and 96 h after activation inhibited proliferation (P < 0.005) of SK-N-MC cells. The presence of serum from NB patient decreased the antiproliferative activity of supernatants from normal lymphocytes and NB patient's autologous lymphocytes (P < 0.01). This preliminary data demonstrates the capability of the activation of lymphocytes from NB patient undergoing aggressive multiagent chemotherapy and controlling proliferation of tumor cells on one hand and the role of serum from NB patient in abrogating to a certain extent the effect of activated immune cells thereby protecting tumor cells, on the other hand. Both these aspects need to considered with equal importance to study mechanisms in designing strategies for immune therapies.

Detection of Polarized CO Emission from the Molecular Outflow in NGC 1333 IRAS 4A

We report the first interferometric detection and mapping of linearly polarized spectral line emission due to the Goldreich-Kylafis effect. Our polarization maps of the CO J=2-->1 line in the molecular outflow powered by the very young stellar system NGC 1333 IRAS 4A make it possible to define the direction of the magnetic field in the outflow. Comparison with theoretical predictions implies that the magnetic field is parallel to the polarization. Our data suggest that the deflection of the outflow may be the result of the interaction between the outflow and the magnetic field. We also detect and map the linearly polarized dust continuum emission at 1.3 mm. The polarization map of the dust continuum is roughly consistent with an hourglass magnetic field morphology; i.e., it is in agreement with theoretical models of interstellar cloud contraction with a frozen-in magnetic field. The two techniques for mapping magnetic field morphologies agree. In general, the two techniques sample different column densities, and together they allow the study of magnetic field morphology over wider areas than either technique by itself would permit.

An N-terminal EF hand-like motif modulates ion transport by Pmr1, the yeast Golgi Ca(2+)/Mn(2+)-ATPase

Pmr1, a novel member of the family of P-type ATPases, localizes to the Golgi compartment in yeast where it provides Ca(2+) and Mn(2+) for a variety of normal secretory processes. We have previously characterized Ca(2+) transport in isolated Golgi vesicles, and described an expression system for the analysis of Pmr1 mutants in a yeast strain devoid of background Ca(2+) pump activity [Sorin, A., Rosas, G., and Rao, R. (1997) J. Biol. Chem. 272, 9895-9901]. Here we show, using recombinant bacterial fusions, that an N-terminal EF hand-like motif in Pmr1 binds Ca(2+). Increasing disruptions of this motif led to progressive loss of pump function; thus, the single point mutations D51A and D53A retained pump activity but with drastic reductions in the affinity for Ca(2+) transport, while the double mutant was largely unable to exit the endoplasmic reticulum. In-frame deletions of the Ca(2+)-binding motif resulted in complete loss of function. Interestingly, the single point mutations conferred differential affinities for transport of Ca(2+) and Mn(2+) ions. Further, the proteolytic stability of the catalytic ATP-binding domain is altered by the N-terminal mutations, suggesting an interaction between these two regions of polypeptide. These studies implicate the N-terminal domain of Pmr1 in the modulation of ion transport, and may help elucidate the role of N-terminal metal-binding sites of Cu(2+)-ATPases, defective in Wilson and Menkes disease.

Primitive reflexes in cerebrovascular disease: a community study of older people with stroke and carotid stenosis

OBJECTIVES

To determine the prevalence of primitive reflexes (frontal release signs) in elderly community residents with cerebrovascular disease and to examine their relationship with neuropsychological and mood-related variables.

METHODS

Three groups of 25 people over 65 with anterior circulation stroke, transient ischaemic attack (TIA) and a control group were assessed using measures of generalized cognitive impairment, frontal lobe dysfunction, frontal release signs and mood-related variables. Predictors of cerebrovascular disease were examined further in stroke and TIA groups.

RESULTS

Both stroke and TIA groups showed a higher mean score on the Frontal Release Signs Scale and a higher prevalence of most reflexes than the control group. Verbal fluency and DSM-IV depressive disorder were independent predictors of frontal release signs.

CONCLUSION

TIAs may predispose to subtle neurological impairment, which may be mediated by frontal lobe damage. Their role in the pathogenesis of depression in later life requires further exploration.

Obsessive-compulsive disorder symptoms before and after recovery from bulimia nervosa

OBJECTIVE

Obsessive-compulsive disorder (OCD) symptoms are common in people who are ill with bulimia nervosa. However, little is known about whether OCD symptoms persist after long-term recovery from bulimia.

METHOD

Thirty-one female patients with bulimia nervosa, 29 women who had been recovered from bulimia for more than 1 year, and 19 healthy female comparison subjects completed the Yale-Brown Obsessive Compulsive Scale, which measures OCD-like symptoms. Items related to symptoms of core eating disorders were omitted from the Yale-Brown scale.

RESULTS

The Yale-Brown scale scores of the women with bulimia (mean = 13.1, SD = 10.6) and those who had recovered from bulimia (mean = 7.9, SD = 7.0) were significantly higher than the scores of the normal comparison subjects (mean = 1.9, SD = 2.6). Women with bulimia and those who had recovered from bulimia had similar Yale-Brown scale scores and endorsed similar Yale-Brown scale target symptoms, such as obsessions related to symmetry and exactness.

CONCLUSIONS

OCD symptoms persist after recovery from bulimia. Moreover, the types of OCD symptoms experienced by bulimia patients do not vary dramatically with improvement in bulimic symptoms. Persistent OCD symptoms after recovery from bulimia raise the possibility that these behaviors are trait-related and contribute to the pathogenesis of bulimia.

Neuropsychological impairment in stroke, carotid stenosis, and peripheral vascular disease, A comparison with healthy community residents

BACKGROUND AND PURPOSE

An increasing body of literature suggests a role for clinically "silent" cerebrovascular disease in the pathogenesis of cognitive impairment. Such pathology commonly occurs in the absence of stroke. The main aim of the study was to examine neuropsychological impairment associated with cerebrovascular and peripheral vascular disease (PVD) and to compare cognitive deficits with a nonvascular control group. The main hypothesis was that older people with both transient ischemic attack (TIA) and PVD would demonstrate greater cognitive impairment than controls.

METHODS

A battery of neuropsychological tests was administered to 4 groups of community residents older than 65 years. The groups comprised 25 patients with carotid stenosis and TIA, 25 nonamputees with PVD, 25 patients with stroke, and 25 matched (with the stroke group) controls.

RESULTS

Stroke patients showed greater impairment than controls in all tests. PVD patients did not perform significantly worse (P<0.05 after Bonferroni correction) than control subjects on any of the neuropsychological tests. However, 25% of PVD patients had scores lying within the bottom 5% of control group scores for attention, calculation, and 1 test of frontal lobe function. TIA patients were more impaired in general intellectual impairment and frontal lobe function than controls. Frontal lobe impairment, suicidal thinking, and age were all independent predictors of global cognitive impairment in the TIA group. Frontal lobe impairment was the only predictor of global cognitive impairment in the PVD group.

CONCLUSIONS

TIA and PVD patients showed similar patterns of neuropsychological impairment, but TIA may result in more prolonged cognitive impairment, particularly in frontal lobe function. This group may be at increased risk of vascular dementia as well as impulsivity and suicide.

Malignant oncocytoma of the nasal cavity: a case report

Malignant oncocytoma is a rare clinical entity and is most commonly seen in the salivary glands. Its occurrence in the nasal cavity is extremely rare, and only 4 such cases have been reported in the literature. The authors report one such case in a 60-year-old woman, which presented as a slow-growing nasal mass arising from the nasal septum, with no lymph node metastasis, which was successfully managed by a combined modality of treatment-surgery followed by radiation therapy. The relevant literature has been reviewed. The case is discussed as a possible differential diagnosis for a mass in the nose.

Anti-cancer activity of targeted pro-apoptotic peptides

We have designed short peptides composed of two functional domains, one a tumor blood vessel 'homing' motif and the other a programmed cell death-inducing sequence, and synthesized them by simple peptide chemistry. The 'homing' domain was designed to guide the peptide to targeted cells and allow its internalization. The pro-apoptotic domain was designed to be nontoxic outside cells, but toxic when internalized into targeted cells by the disruption of mitochondrial membranes. Although our prototypes contain only 21 and 26 residues, they were selectively toxic to angiogenic endothelial cells and showed anti-cancer activity in mice. This approach may yield new therapeutic agents.

Familial aggregation of eating disorders: results from a controlled family study of bulimia nervosa

OBJECTIVE

While familial aggregation of bulimia nervosa (BN) is known to occur, the extent to which aggregation of a broader spectrum of eating disorders (ED) occurs in the families of individuals with BN is less certain.

METHOD

Direct interviews and blind best-estimate diagnostic procedures were used to assess lifetime histories of EDs among first-degree relatives (n = 177) of probands with BN (n = 47) and first-degree relatives (n = 190) of non-ED control probands (n = 44).

RESULTS

Forty-three percent of sisters and 26% of mothers of BN probands had a lifetime ED diagnosis, with eating disorder not otherwise specified (ED-NOS) diagnoses being most common. These rates were significantly higher than among sisters (5%) and mothers (5%) of controls. Few male relatives of either cohort had an ED.

CONCLUSIONS

Diagnostic assessment using contemporary family-epidemiology methodology revealed very strong familial aggregation of a broad spectrum of EDs among female relatives of women with BN.

Factors associated with the development of substance use disorder in depressed adolescents

OBJECTIVE

To document rates of substance use disorders (SUD) in adolescents with unipolar major depressive disorder and to examine demographic, clinical, and biological factors associated with the development of SUD.

METHOD

Twenty-eight adolescents with unipolar major depression and no SUD history and 35 group-matched normal controls who participated in a cross-sectional sleep polysomnography and neuroendocrine study were reassessed clinically 7 years later.

RESULTS

The risk for SUD was high in both groups (34.6% in the depressed group and 24.2% in the controls). Depressed adolescents had earlier onset of SUD than controls. Depressed adolescents who developed SUD had more significant psychosocial impairment than depressed adolescents who did not develop SUD. More anxiety traits and elevated cortisol secretion near sleep onset were associated with SUD in depressed teenagers, whereas less emotional responsiveness to exciting stimuli and higher density of eye movements during REM sleep were related to depression without SUD.

CONCLUSIONS

Depressed adolescents who have anxiety traits and whose hypothalamic-pituitary-adrenal axis is active when the system is normally quiescent may be at risk for developing SUD. Co-occurrence of depression and SUD is associated with serious psychosocial morbidity. Identification of risk factors for SUD in depressed teenagers may be helpful in developing more effective treatment and prevention programs.

Psychopathological characteristics of recovered bulimics who have a history of physical or sexual abuse

We sought to clarify the influence of a history of sexual or physical abuse on a variety of psychopathologies in subjects with bulimia nervosa (BN). To avoid confounding effects, the presence of a history of sexual or physical abuse, lifetime axis I disorders, and personality disorders were assessed through direct structured interviews in 44 subjects recovered from BN for at least 1 year. Twenty abused subjects (45%) were significantly more likely than 24 subjects without abuse to have severe general psychopathology and eating disturbance. Compared with nonabused subjects, abused subjects showed a trend toward more frequent lifetime diagnoses of posttraumatic stress disorder and substance dependence. These results suggest that abusive experiences may be associated with some psychopathology of BN, particularly related to anxiety, substance abuse, and more severe core eating disorder pathology.

Induction of vacuolar Ca2+-ATPase and H+/Ca2+ exchange activity in yeast mutants lacking Pmr1, the Golgi Ca2+-ATPase

We have analyzed Ca2+ transport activity in defined subcellular fractions of an isogenic set of wild-type and mutant yeast. The results, together with measurements of polypeptide expression levels and promoter::reporter gene activity, show that the Golgi Ca2+-ATPase, Pmr1, is the major Ca2+ pump under normal growth conditions. In the absence of Pmr1, we show a massive, calcineurin-dependent compensatory induction of the vacuolar Ca2+-ATPase, Pmc1. In addition, H+/Ca2+ exchange activity, that may be distinct from the vacuolar exchanger Vcx1, is also increased.

Clinicopathological correlation of diaphragmatic contraction band necrosis in a neonatal and infantile population--an autopsy study

Contraction band necrosis' is a lesion widely studied in myocardial fibres (Heart) and to some extent in skeletal and smooth muscles. The phenomenon of Diaphragmatic Contraction Band necrosis (D-CBN) occurring in the diaphragms of 53 neonates and infants removed at autopsy were studied microscopically. Of these D-CBN was present in 19 (35.85%) cases. D-CBN presented in two morphological patterns (I) solid ('Block-like') segmental necrosis in 31.58% cases or (ii) Ribbon-like transfiber (shredded appearance) bands in 15.79% cases. A combination of both the above lesions were observed in a vast majority of cases, i.e. 52.63% cases. A clinicopathological correlation was attempted as regards cause and mode of death with occurrence and severity of D-CBN. It was found that severe D-CBN was present in the group of birth asphyxia (26.92%) and infant infections (20.0%). The presence and frequency of D-CBN in autopsied subjects proved useful in interpreting the cause and mode of death.

Ocular torticollis and facial asymmetry

OBJECTIVE

Ocular torticollis secondary to congenital superior oblique palsy can be associated with facial asymmetry. The purpose of this study was to determine if other ocular causes of head tilting also carry the same association.

DESIGN

The study design was clinical evaluation of patients.

PARTICIPANTS

Fifteen patients with marked, moderate, or mild head tilts associated with dissociated vertical deviation (DVD), and 3 patients with nystagmus and a torsional null point. A control group was comprised of 3 patients with congenital superior oblique palsy, 3 with traumatic superior oblique palsy, and two normal patients.

INTERVENTION

A masked observer analyzed full-face photographs of the subjects.

MAIN OUTCOME MEASURE

The presence of facial asymmetry.

RESULTS

Facial asymmetry due to bending in/of the sagittal plane of at least two degrees was found in 3 of 4 patients with a marked head tilt from DVD, in 2 of 5 five patients with a moderate head tilt from DVD, in one of 3 patients with a head tilt due to nystagmus, and in one of 3 patients with a head tilt due to congenital superior oblique palsy. None of the patients with a mild head tilt from DVD, traumatic superior oblique palsy, or the normal controls had clinically noticeable facial asymmetry.

CONCLUSION

Facial asymmetry can be associated with abnormal head postures, specifically, large head tilts from DVD or nystagmus.

Inhibition of oxidant-induced barrier disruption and protein tyrosine phosphorylation in Caco-2 cell monolayers by epidermal growth factor

The effect of epidermal growth factor (EGF) on the H202-induced increase in paracellular permeability in Caco-2 and T-84 cell monolayers was evaluated to examine the role of EGF in intestinal mucosal protection from oxidative stress. Oxidative stress was induced by exposing cell monolayers to H2O2 or a mixture of xanthine oxidase + xanthine (XO + X). Paracellular permeability was assessed by measuring transepithelial electrical resistance (TER), sodium chloride dilution potential, and unidirectional flux of [3H]mannitol. H2O2 (0.1 to 5.0 mM) reduced TER and dilution potential and increased mannitol flux. Administration of EGF delayed H2O2 and XO + X-induced changes in TER, dilution potential, and [3H]mannitol flux. This protective effect of apically or basally administered EGF was concentration-related, with A50 (95% confidence limits) values of 2.1 (1.17 to 4.34) and 6.0 (4.37 to 8.34) nM, respectively. The EGF-mediated protection was prevented by treatment of cell monolayers with genistein (10 microM), a tyrosine kinase inhibitor. H2O2 and XO + X also induced tyrosine phosphorylation of a number of proteins in Caco-2 and T-84 cell monolayers. EGF treatment inhibited the oxidant-induced tyrosine phosphorylation of proteins, particularly those with a molecular mass of 110-220 kDa. Treatment of Caco-2 cells with anti-transforming growth factor-alpha antibodies potentiated the H2O2-induced changes in TER, dilution potential, and mannitol flux. These studies demonstrated that an EGF receptor-mediated mechanism delays oxidant-induced disruption of the epithelial barrier function, possibly by suppressing the oxidant-induced tyrosine phosphorylation of proteins.

C8-Arylguanine and C8-aryladenine formation in calf thymus DNA from arenediazonium ions

Arylhydrazides, arylhydrazines, and N-alkyl-N-arylnitrosamines are metabolized to arenediazonium ions which yield C8-arylpurine adducts in calf thymus and cellular DNA. The mechanism of adduct formation has not been fully elucidated. C8-Arylguanine adducts likely form from direct aryl radical (Ar*) addition to the C8 position of guanine. However, the amounts of C8-aryladenine adducts measured here are inconsistent with direct radical attack at the C8 position of adenine. An intermediate product, an aryltriazene, is likely formed which then decomposes to the C8-aryladenine adduct. We have demonstrated that N1-aryl-N3-purinyltriazene adducts are formed from a variety of para-substituted arenediazonium ions with adenine. Decomposition of the N1-aryl-N3-purinyltriazene, at high pH and elevated temperatures, has been shown to give C8-aryladenine derivatives, and a free radical mechanism for this process has been proposed. Here we show that this process can occur under physiological conditions and that the C8-aryladenine adduct can be quantitated by HPLC. ESR studies, in which DMPO was used as a spin trap, have been used to demonstrate the intermediacy of aryl radicals during the decomposition of the N1-aryl-N3-purinyltriazenes and to demonstrate that this process also occurs in calf thymus (ct) DNA treated with arenediazonium ions. These results suggest the involvement of an aryl radical in the formation of the observed DNA adducts. Finally, we have found that the treatment of ct DNA with arenediazonium ions produces a significant amount of depurination. Both the formation of C8-arylguanine and C8-aryladenine adducts and the generation of apurinic sites may contribute to the genotoxicity of arylhydrazides, arylhydrazines, N-alkyl-N-arylnitrosamines, and arenediazonium ions.

Prospective randomized trial comparing the outcome and cost of in vitro fertilization with that of a traditional treatment algorithm as first-line therapy for couples with infertility

OBJECTIVE

To determine whether IVF or a standard infertility treatment algorithm results in better outcome and/or lower cost when used as first-line therapy for couples with infertility.

DESIGN

Prospective, randomized clinical study.

SETTING

University-affiliated infertility clinic.

PATIENT(S)

Couples with newly diagnosed infertility and no prior treatment.

INTERVENTION(S)

Couples were randomized to undergo either IVF (group 1, n = 46) or a standard infertility treatment algorithm (group 2, n = 50) as initial therapy for infertility.

MAIN OUTCOME MEASURE(S)

Pregnancy rates and costs per couple, per month of treatment, and per pregnancy.

RESULT(S)

Pregnancy rates were higher in group 2 than in group 1. Costs per couple were not statistically different, although a trend toward higher costs was apparent in group 1, reflected by a higher median cost per clinical pregnancy established and a higher cost per month of treatment. Whereas cost differences between the groups diminished over time, pregnancy rates remained the same.

CONCLUSION(S)

In vitro fertilization currently does not represent an appropriate first-line treatment option for couples with infertility. The use of a standard infertility treatment algorithm results in a higher pregnancy rate and lower cost and therefore should be the preferred treatment approach.