[Myocardial metabolism in angina with angiographically normal coronary arteries]

Myocardial metabolism was studied during rapid atrial pacing in 22 patients with angina and angiographically normal coronary arteries. Pyruvate, non esterified fatty acid and lactate levels were measured in the coronary arteries and veins under basal conditions, at the peak of atrial pacing and during the recovery phase. A control group of 8 patients had neither angina, ST depression, or lactate production during atrial pacing. A correlation was observed between the coronary arterio-venous difference and arterial pyruvate and non esterified fatty acid levels in the 22 patients during the 3 periods of study. The control patients did not differ significantly from the rest of the population. There was a correlation between the coronary arterio-venous difference and arterial lactate levels under basal conditions in all of the study and control groups. This correlation remained significant during atrial pacing and the recovery period only in the control group. It was possible to distinguish a group of 14 patients (64 p. 100) (Group A) with a correlation coefficient of lactate production similar to the control group (+/- 2 standard deviations) during atrial pacing, from a second group of 8 patients (36 p. 100) (Group B) with abnormal myocardial metabolism. The arterial lactate concentrations were similar in both groups in the 3 periods of study. A coefficient of lactate extraction less than 10 p. 100 was observed in 2 patients in Group A and in 7 patients in Group B (88 p. 100, p less than 0.01). One patient in Group B had a coefficient of lactate extraction greater than 10 p. 100 (+ 13 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)

Synthesis and migration of 3H-fucose-labeled glycoproteins in the ciliary epithelium of the eye: effects of microtubule-disrupting drugs

3H-fucose was injected intravenously or intravitreously into albino rats. After time intervals of 10, 40, and 50 min, 1, 1.5, and 4 hr, 1, 3, and 7 days, and 1, 2, and 4 weeks after injection, the animals were sacrificed by intracardiac perfusion with glutaraldehyde. Samples of the ciliary body were prepared for light and electron microscope radioautography. Light microscope autoradiographs showed that the cells of both the inner and outer layers of ciliary epithelium actively incorporated 3H-fucose label in a reaction that peaked in intensity at 4 hr after injection, and then progressively declined. Electron microscope radioautographs revealed that, at early time intervals, most of the label was localized to the Golgi apparatus. With time, the plasma membrane of both cell types became increasingly labeled, and accounted for 60-70% of the total silver grains at 4 hr after injection. Adjacent to the basal cell surface of the inner layer cells, the fibers of the zonula became increasingly labeled from 1.5 hr onwards, providing strong evidence that these cells secrete glycoproteins to the zonula. When vinblastine was administered 30 min before 3H-fucose injection, followed by sacrifice 1.5 hr later, a much larger proportion of label remained localized to the Golgi apparatus than in controls, and the plasma membrane and zonula were much less labeled. These results suggest that, as documented in other cell types, microtubules may play a role in the intracellular transport of membrane and secretory glycoproteins in these cells.

Management of the undescended thyroid

Ectopic thyroid can occur throughout the neck but is found most commonly at the tongue base. Management includes Tc99m radionuclide scanning to confirm the presence and location of the thyroid tissue. Dysfunction should be assessed by T4, TSH, and thyroid antibody testing. Hormonal therapy is the primary treatment but surgery may be necessary in cases of airway obstruction. Six children with undescended thyroid are presented and a management protocol based on the presence or lack of symptomatology is proposed.

Chenodeoxycholic and ursodeoxycholic acids alter motility and fluid transit in the canine ileum

We examined the effects of chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA) on fasting motility patterns and transit in ileocolonic loops of 5 dogs. Animals were prepared with isolated loops (40 cm ileum and 5 cm colon) which maintained neuromuscular continuity with the intact bowel through a bridge of tunica muscularis. Myoelectrical activity was recorded from multiple serosal, monopolar electrodes and muscle contractions recorded from serosal strain gauges; fluid transit was assessed by continuous perfusion (1.4 ml min-1) of solutions containing polyethylene glycol 4000 marker, with or without bile acids. Saline perfusion did not disturb the fasting cycle of motility and mean cycle length in unperfused (106 +/- 7 min) loop was the same as during perfusion of saline (108 +/- 9 min). Bile acids abolished interdigestive cycles in 11 of 12 experiments, fasting patterns returned 64-106 min after bile acid perfusion was stopped. The fasting pattern continued to cycle normally in the proximal small bowel during bile acid perfusion. CDCA (15 mM) stimulated the occurrence of propulsive contractions of long duration. Bile acids shortened transit time through the loops and altered the pattern of flow towards a more continuous, steady stream. These effects of bile acids on ileal motility, like those described previously in the colon, could play a role in bile acid diarrhea.

Effects of morphine and atropine on motility and transit in the human ileum

We examined motility of the ileocecal region, pressures at the ileocecal sphincter, and ileal flow after therapeutic doses of morphine and atropine. Using a factorial design in two cells of 8 (2(3] subjects, drugs were given during fasting and postcibally. Morphine (100 micrograms/kg body wt as a bolus intravenously) and atropine (7 micrograms/kg body wt as a bolus) stimulated migrating bursts of phasic activity (similar to phase III of the migrating motor complex). Morphine initially stimulated ileal flow, but atropine could not be shown to have this effect. Atropine reduced markedly the occurrence of sporadic pressure waves in the ileum, but morphine did not. Whereas atropine delayed mouth-to-ileum transit of polyethylene glycol, given in a mixed meal, morphine did not. Naloxone, in the dosage used (40 micrograms/kg body wt as a bolus, followed by 10 micrograms/kg body wt X h) had no independent effects on motility or flow, but did blunt the stimulatory effects of morphine and atropine on migrating motor complexes. We could not demonstrate an effect of any drug on the transit of lactulose from terminal ileum to cecum. Neither morphine nor atropine had impressive effects on tone at the ileocecal sphincter. These observations, while not specifying the mechanisms for constipation after opiates or anticholinergics, highlight the complexities of small bowel transit in humans and point out that the antidiarrheal effects of drugs are probably multifactorial.

[Detection of anterior interventricular involvement after primary posterior wall infarct]

Forty-five patients (average age 53.3 +/- 9.4 years) underwent exercise stress testing coupled with exercise myocardial scintigraphy and right heart catheterisation on exercise during the 3rd week after primary posterior wall infarction. Coronary angiography and ventriculography were carried out 24 to 48 hours later. Significant (greater than or equal to 75%) left anterior descending disease was present in 9 patients (Group I) and absent in 36 patients (Group II). Tolerance of maximal exercise stress testing was good in all patients. The results were uninterpretable in on third of the cases because the theoretical maximal heart rate was not attained. No significant difference was noted between groups I and II with respect to: mean age, percentage of theoretical maximal heart rate attained, mean pulmonary capillary pressures at rest and during exercise, basal and exercise cardiac index, end diastolic index and angiographic left ventricular ejection fraction. The sensitivity and specificity for the detection of LAD disease were 80% and 84% for the exercise stress testing (n = 30), 44% and 75% for exercise right heart catheterisation (n = 30), 60% and 92% for exercise myocardial scintigraphy (n = 30), 100% and 75% for combined exercise stress testing and myocardial scintigraphy (n = 30) and 78% and 64% for combined exercise stress testing and myocardial scintigraphy and exercise right heart catheterisation (n = 45). These results show that in patients capable of performing maximal exercise stress tests, the best method of early detection of significant LAD disease after primary posterior infarction was combined exercise stress testing and exercise myocardial scintigraphy. These investigations are useful for the selection of candidates for coronary angiography.

Angioedema of the head and neck

A group of 143 patients with angioedema was reviewed. Women in their third and fourth decades were most commonly affected. Head and neck involvement was found in 94% of cases and this was the only anatomical site in 24%. Twenty-one patients had swelling of the oropharynx while four presented with laryngeal edema. A diagnosis of hereditary angioedema (HAE) was confirmed in one case. Asthma, allergic rhinitis, and drug sensitivity were significantly associated, while smaller numbers of patients had underlying vasculitis or active ongoing infection. The pathophysiology and management of angioedema are discussed.

Motility of the terminal ileum and ileocecal sphincter in healthy humans

Factors controlling the transit of contents between the ileum and cecum should be important determinants of intestinal function; however, the dynamics of the ileocecal region remain largely unexplored in healthy humans. Accordingly, prolonged recordings of intraluminal pressure were obtained from the distal ileum, across the ileocecal sphincter, and from the proximal colon of healthy adults. In one set of studies, 16 subjects each contributed 6 h of basal, fasting recordings; in 2 of the 16, postprandial patterns were also recorded. In a second set, 6 fasting subjects were studied for a total of 120 h. Less than 10% of interdigestive cycles (migrating motor complexes) reached the ileocecal sphincter. The remainder faded out and merged into an active, apparently random pattern of pressure waves that became more intense closer to the sphincter. Discrete, short bursts of phasic pressures migrated rapidly for long distances in the distal ileum and a unique peristaltic wave also migrated rapidly, though infrequently, through the region. Tonic pressures were recorded across the ileocecal sphincter but were present only during the passage of phasic pressure waves; basal tone was minimal. We believe these are the first prolonged observations of motility from the ileocecal sphincter of healthy humans. These descriptions provide insights into and a basis for further studies of a largely unexplored area of the human bowel.

Synthesis of membrane and secretory glycoproteins by the acinar pancreatic cells as visualized by radioautography

Young rats were injected with 3H-fucose and killed at 10 min, 1, 4 and 24 h thereafter. Samples of the pancreas were processed for light- and electron-microscopic radioautography and then analyzed quantitatively. Fucose label was taken up in the supranuclear region of acinar pancreatic cells that were maximally labeled at 1 h after injection. Between 1 and 24 h after injection there was a very marked decrease in the concentration of label in the pancreatic acini. Radioautography at the ultrastructural level demonstrated that the earliest time interval the silver grains indicating the sites of newly synthesized glycoproteins were predominantly observed over the Golgi apparatus of the acinar cells. The quantitative analysis indicated that condensing vacuoles were labeled from 10 min to 4 h after injection. At 1 h the concentration of label in the Golgi apparatus was greatly diminished while it was significantly higher in the secretory (zymogen) granules. At this interval the secretion product visualized in the lumen of the acini and of the ducts was found to be labeled. At 4 h both the zymogen granules and the plasma membrane were significantly labeled. Further analysis carried out on the zymogen granules indicated that fucose-labeled glycoproteins were located in the granule membrane as well as in the granule content. In conclusion, 3H-fucose is added to glycoproteins in the Golgi apparatus of the acinar cells. Then, labeled glycoproteins are collected within condensing vacuoles and zymogen granules and released into the acinar lumen as secretion products. This latter event, which almost certainly is a consequence of exocytosis, may also account for the addition of granule-membrane glycoproteins to the plasma membrane.

Glycoprotein synthesis and migration in beta cells of the islets of Langerhans as shown by quantitative light- and electron-microscopic radioautography

L-3H-fucose was injected intravenously into rats that were killed from 10 min to 7 days after isotope administration. Semi-thin and thin sections of the islets of Langerhans were processed for light- and electron-microscopic radioautography, respectively, and analyzed quantitatively. L-3H-fucose was incorporated into newly synthesized glycoproteins in the Golgi apparatus of the beta cells and subsequently labeled glycoproteins migrated to secretory granules and plasma membrane. Therefore, some of the glycoproteins synthesized by the beta cells of the islets of Langerhans are destined for the renewal of plasma membrane. Although the labeling of the secretory granules was clearly demonstrated, it was not possible to decide if the newly formed glycoproteins are incorporated into the content or into the membrane of the granule. Thus, the fate as well as the function of secretory-granule glycoproteins could not be determined precisely. Several hypothesis concerning the presence of glycoproteins in the secretory granules in relation with insulin metabolism are considered.

Glycoprotein secretion in the hypothalamo-neurohypophyseal system of the rat

Although the secretory products of the hypothalamo-neurohypophyseal system are not glycoproteins, synthesis and migration of these macromolecules occur within its secretory neurons. After being labeled with 3H-fucose in the Golgi apparatus, newly synthesized glycoproteins migrate to secretion granules, lysosomes and the plasma membrane of the secretory neurons, as demonstrated by quantitative electron-microscopic radioautography. Secretion granules bearing newly synthesized glycoproteins migrate to the pars nervosa, the labeling pattern of which was studied in rats killed from 4 h to 14 days after the isotope injection. Most of the silver grains were observed to overly the secretory axons. Labeling of pituicytes was negligible and the number of silver grains over the perivascular spaces was about 10% of the total at certain postinjection intervals. In the secretory axons, most of the silver grains over the different portions of the secretory axons changed with time. At the longer intervals, the percentage of silver grains increased over the nerve swellings (including Herring bodies) and decreased concomitantly in the undilated portions of the axons and in the nerve endings. This labeling pattern conforms with observations of the secretion products. Water deprivation increased the release of neurosecretion as well as glycoproteins from the pars nervosa. However, glycoproteins inside the Herring bodies were not easily releasible. There was a parallel decrease in the amount of secretion granules and 3H-fucose-labeled glycoproteins indicating that the glycoproteins are predominantly a constituent of the granule content. Some newly synthesized glycoproteins were probably also used in the renewal of the axonal membrane. The labeling of smooth vesicles in nerve endings was discussed. In conclusion, most of the glycoproteins synthesized in the perikarion of the hypothalmic secretory neurons migrate inside secretion graules along the axon to the pars nervosa where they are secreted.

Incorporation of L-(3H)-fucose into glycoproteins of the adrenal gland of mice. Light microscope radioautographic study on semi-thin sections

To study the biosynthesis and intracellular migration of glycoproteins in the adrenal gland, adult mice were injected intravenously with L-(3H)-fucose and killed from 10 min to 14 days after injection. Semi-thin sections of the adrenal glands were then processed for radioautography. Incorporation of labeled fucose occurred in the steroid-secreting cells of the three zones of the cortex as well as in the adrenalin (A) and noradrenalin (NA) cells of the medulla. At short intervals after injection, the main site of incorporation was the paranuclear region of the cells, suggesting uptake by the Golgi apparatus. Subsequently, labeled glycoproteins migrated from the paranuclear region to other cell sites. The labeling pattern observed in the adrenocortical parenchyme strongly suggests that the glycoproteins are transferred to lysosomes, lipofuscin granules and the cell coat (glycocalyx). Counts of silver grains clearly indicate that these glycoproteins undergo renewal. The qualitative and quantitative analysis of the radioautographs also suggest that glycoproteins, acting as intracellular carriers of steroids, may be released to the extracellular environment together with the hormones. Most of the glycoproteins synthesized by the A and NA cells of the adrenal medulla seem to be transferred to secretion granules in which they may play some role in the cytophysiology of these structures. It is likely that glycoproteins are released from the cells during exocytosis of secretory granules.

Radioautographic and biochemical studies of secretion of venom protein in the South American rattlesnake Crotalus durissus terrificus

Protein secretion was investigated in the main venom gland of the South American rattlesnake, using radioautographic and biochemical techniques after a single intracardiac injection of L-(3,5-3H)tyrosine. All the snakes were injected at the fourth day of the secretory cycle and killed at 1/2, 1, 2, 4, 8 and 24 hours after injection. Most of the radioactive amino acid is cleared from the blood stream up to four hours after injection. On the other hand the specific activity (c.p.m./mg of protein) of the intracellular proteins reaches a peak at the 4-hour time interval decreasing afterwards. There was a good correlation between the values of the specific activity of the intracellular proteins and those of the silver grain density over the secretory cells at the several time intervals after the injection of 3H-tyrosine. The results of the quantitative analysis carried out in light- and electron-microscope radioautographs led to the conclusion that venom proteins are synthesized in the rough endoplasmic reticulum of the secretory cells, transferred to the Golgi apparatus from where they are carried to the secretory tobule lumen by the secretion granules. The fact that the values of the relative concentration of the radioactivity of he intracisternal granules double at the last three time intervals, strongly suggests that these structures are formed by the aggregation of the amorphous material present inside the cisternae of the rough endoplasmic reticulum.

Glycoprotein secretion in the mouse submandibular gland as revealed by radioautography after L-3H-fucose injection

Glycoprotein secretion in the mouse submandibular gland was investigated by light microscope radioautography of semi-thin sections after the administration of L-3H-fucose. The incorporation of the precursor in the acini was negligible. 3H-fucose was taken up in the paranuclear region of the cells lining the intercalated, secretory, striated and excretory ducts. This labeling pattern was interpredted as addition of the precursor to glycoproteins within the Golgi apparatus. Incoropration in the intercalated duct was restricted to the cells with fine cytoplasmic granules. The glycoproteins synthesized by the intercalated and secretory ducts were transported to the saliva by the secretion granules. It is assumed that the glycoproteins synthesized in the striated and excretory ducts are plasma membrane glycoproteins which seem to renew continuously. Quantitation of the radioautographs supplied data concerning the incorporation of 3H-fucose into newly synthesized glycoproteins as well as the renewal of the labeled macromolecules in each duct.

Radioautographic study of glycoprotein biosynthesis and renewal in the ovarian follicles of mice and the origin of the zona pellucida

L-fucose-3H was injected intravenously into mice which were killed at several time intervals after injection and semi-thin sections of their ovaries were processed for radioautography and analysed quantitatively; At the same time the specific activity of serum glycoproteins was determined. Glycoprotein biosynthesis was demonstrated in the oocytes, granulosa and stromal cells. The silver grain density of the follicular fluid in large follicles reached a peak at 4 h, remained high at 8 h after injection and decreased steadily at the subsequent intervals. It was demonstrated that the labeling pattern of the follicular fluid depends on the secretory activity of the granulosa cells and also on the specific activity of serum glycoproteins. The collapsed zonae pellucidae which represent the highest degree of follicular atresia are able to take up glycoprotein macromolecules. Based on this finding and also on the labeling pattern of the large follicles it was shown that there is very little synthesis of specific glycoproteins for the zona pellucida in large follicles. A more specific labeling of the zona pellucida occurred in the medium follicles. Following the growth of these follicles having a previously labeled zona pellucida, it was demonstrated that this extracellular structure is secreted by the oocyte.