[Sympathetic nervous activity in cirrhosis: the relationship between peripheral hemodynamics and renal function changes]

The relationship between the activity of the sympathetic nervous system and the systemic and peripheral hemodynamic and renal function changes and the antinatriuretic activity in a group of 30 cirrhotic patients and 8 healthy subjects (control group) was investigated. Plasma catecholamines (noradrenaline, adrenaline and dopamine), plasma renin activity, plasma aldosterone concentrations, mean arterial pressure, cardiac output, blood volume, right femoral arterial flow (RFAF) and renal function parameters were determined in all the participants. Cyclic GMP urinary excretion (cV-UGMP) was used as an indirect index of systemic nitric oxide production. The plasma concentration of noradrenaline was greater in the patients than in the control group and was directly correlated with other vasopressor and antinatriuretic systems, RFAF, cV-UGMP, the degree of hepatic failure studied by the Pugh score and was inversely correlated with creatinine clearance and urinary sodium excretion. On Cox regression analysis, only the RFAF, creatinine clearance and plasma adrenaline concentration remained independently associated with plasma noradrenaline levels. Furthermore, plasma noradrenaline was significantly higher in patients with greater hyperdynamic circulation. These results indicate that extrasplanchnic vasodilatation substantially contributes to sympathetic nervous hyperactivity which may significantly influence in the renal function changes observed in these patients.

Otolaryngologic manifestations of multiple pterygium syndrome

Escobar Syndrome, or Multiple Pterygium Syndrome (MPS), is a rare syndrome with multiple congenital anomalies involving the head and neck area and limbs. Affected individuals have multiple pterygia, camptodactyly and/or syndactyly as the main features of this syndrome. Patients with MPS have a characteristic facies, including ptosis, antimongoloid slant of the palpebral fissures, hypertelorism, micrognathia, neck pterygia, and a sad flat, emotionless look to the face. We present a case of MPS recently treated at our institution for the purpose of further describing the clinical features of this syndrome, emphasizing the otolaryngologic manifestations. Increased awareness of MPS will facilitate appropriate management of this syndrome.

A mutation in the ATP binding domain of rho alters its RNA binding properties and uncouples ATP hydrolysis from helicase activity

The Escherichia coli mutant rho201 was originally isolated in a genetic screen for defects in rho-dependent termination. Cloning and sequencing of this gene reveals a single phenylalanine to cysteine mutation at residue 232 in the ATP binding domain of the protein. This mutation significantly alters its RNA binding properties so that it binds trp t', RNA 100-fold weaker than the wild type protein, with a Kd of approximately 1.3 nM. Rho201 binds nonspecific RNA only 3-4-fold less tightly than it binds trp t', while the wild type differential for these same RNAs is 10-20-fold. Curiously, rho201 displays increased secondary site RNA activation, with a Km for ribo(C)10 of 0.6 microM, compared to the wild type value of 3-4 microM. Although rho201 and the wild type protein hydrolyze ATP similarly with poly(C), or trp t' RNA, as cofactors, rho201 has a higher ATPase activity when activated by nonspecific RNA. Physically, rho201 displays an abnormal conformation detectable by mild trypsin digestion. Despite effective ATP hydrolysis, the rho201 mutant is a poor RNA:DNA helicase and terminates inefficiently on trp t'. The single F232C mutation thus appears to uncouple the protein's ATPase activity from its helicase function, so rho can no longer harness available energy for use in subsequent reactions.

Analysis of E. coli rho factor: mutations affecting secondary-site interactions

To define and differentiate primary and secondary RNA binding sites within the linear sequence of the rho protein, we investigated two mutant alleles, rho-115 and rhosuA1. They were first identified as defective in transcription termination in vivo, and later demonstrated to be defective in their interactions with RNA at the primary and secondary sites, respectively. Sequencing of rhosuA1 revealed a single lysine to glutamic acid residue change at position 352 (KE352), while rho-115 carries two mutations, glycine99 to valine (GV99) and a proline235 to histidine (PH235). Proteins carrying single mutations at each of these three positions were purified and their characteristics compared to the wild-type protein. We found both KE352 and GV99 to be defective in secondary-site RNA activation, with Km values for r(C)10 of 100 microM and approximately 650 microM, respectively, compared to the wild-type value of 4 microM. These observed secondary-site defects correlated with decreased helicase and ATPase activities, as well as a loss of transcription termination activity in vitro. By contrast, PH235 was very efficient at interacting with r(C)10 at the secondary site, with a measured Km of 0.5 microM, and displayed the characteristics of a hyperactive rho, as judged by its ATPase, helicase and termination capabilities. Our results show that mutations at three very different locations in the polypeptide can affect secondary-site activation by RNA, and that these interactions play a pivotal role in ATP hydrolysis, helicase activity and transcription termination.

Making sense of 'possession states': psychopathology and differential diagnosis

Possession is a common manifestation of distress in a multicultural setting. It is increasingly likely to be encountered by mental health professionals who may be unaware of the phenomenon. A review of the literature is presented with clinical guidelines for a culturally sensitive assessment and management.

A pre-operative mydriatic regime using a single application of tropicamide Novel Ophthalmic Delivery System and guttae phenylephrine 10%

Tropicamide Novel Ophthalmic Delivery System (NODS) and guttae (g.) phenylephrine 10% was applied once, 2 hours before cataract surgery, as an alternative to our standard pre-operative regime of g. cyclopentolate 1% and g. phenylephrine 10% used four times before surgery. The two treatment groups were compared using a randomised, prospective, observer-masked study design. The horizontal pupil diameter was significantly smaller using the new regime but the per-operative decrease in diameter was not significantly different, suggesting that surgical miosis was not influenced by reducing the number of mydriatic applications. There was no difference in the subjective grading of the pupil, suggesting that adequate mydriasis suitable for cataract surgery was obtained using the alternative regime. No major complications were documented in relation to the use of NODS. We discuss why less intensive mydriasis is likely to be as efficacious and describe its potential advantages.

Assessment of Yqh translocations

Two initially presumed Yqh translocations, one to Xp and another to 21p, were assessed by conventional banding procedures, 5-azacytidine treatment, electron microscopy, and fluorescence in situ hybridisation. While the Yqh nature of the heterochromatic block from Xp was confirmed, this was not the case with the 21ph+ variant. In conclusion, conventional banding techniques are insufficient to diagnose Y;G translocations.

An extra band within the human 9qh+ region that behaves like the surrounding constitutive heterochromatin

An extra variant G band in a human 9qh+ region was analysed in normally condensed and 5-azacytidine undercondensed chromosomes. Fluorescence in situ hybridisation showed that specific, classical, alphoid and beta satellite DNA was not present. Nevertheless, this extra band behaves like the surrounding heterochromatin because (1) its chromatin fibres showed condensation inhibition after 5-azacytidine treatment, as confirmed by electron microscopy, and (2) it was not affected by in situ digestion with the restriction endonucleases AluI and Sau3A. These results suggest that this variant band may correspond to euchromatin that has become inactivated by a position effect.

[The risk of diabetes mellitus in relatives of diabetics treated with insulin]

The objective of this study was to compare the risk of diabetes mellitus in the relatives of type 1 (defined as cases diagnosed before 40 years and beginning insulin less than two years later) and in those of type 2 diabetics, treated with insulin. A random sample of 303 patients was obtained from responders to a postal survey sent to all 2800 diabetics living in the Oporto self county and identified as users of insulin the injection pen. After selecting those who completed the questions for sex, age, dates of diabetes diagnosis and of first insulin prescription, we were left with 192 index cases. They provided data concerning sex; age, and presence of diabetes for 1370 relatives (parents, siblings, offspring and spouses). The risk of diabetes (unspecified type) in family members was significantly lower in relatives of type 1 diabetics (OR = 0.31, CI 95%:0.19-0.48, p < 0.0005). This family risk was lower when the index case was a male (OR = 0.24, CI 95%:0.12-0.47 vs OR = 0.39, CI 95%:0.21-0.74) or for female relatives (OR = 0.22, CI 95%:0.11-0.42 vs OR = 0.43, CI 95%:0.22.-0.82). After adjustment for confounders applying logistic regression to each family stratum, the risk remained significantly lower for parents (OR = 0.35, CI 95%:0.17-0.71) and siblings of type 1 diabetics compared to similar relatives of type 2 cases (OR = 0.84, CI 95%:0.06-10.6) but was not significantly different for the offspring (OR = 0.68, CI 95%:0.11-4.17) or the spouses (OR = 0.84, CI 95%:0.06-10.6).(ABSTRACT TRUNCATED AT 250 WORDS)

Frequency of sister chromatid exchanges in humans at 14-16 week foetal stage and at birth

In order to identify transplacental induced mutagenicity in humans the baseline frequency of sister chromatid exchanges (SCEs) in amniotic fluid cells (8.56 +/- 0.28 per cell) from 14 to 16-week-old foetuses as well as in peripheral blood lymphocytes (7.96 +/- 0.26 per cell) from newborns was determined. A group of twelve patients who were analysed both at 14-16 weeks gestation and at birth showed no SCE variations. These results suggest that foetal amniocytes and T lymphocytes from newborns present a similar sensitivity to the mutagenic activity of the thymidine analogue 5-bromodeoxyuridine employed in the sister chromatid differentiation.

Endoscopy: throat spray or sedation?

Anxious patients tolerate endoscopy poorly. It was proposed that such patients might derive most benefit from sedation, while most non-anxious patients would prefer endoscopy with lignocaine throat spray alone. In a prospective study, 200 outpatients underwent diagnostic endoscopy after receiving one of two detailed information sheets which offered them either the choice between spray or sedation (n = 100) or the same choice but encouraged those who were anxious about endoscopy to choose sedation (n = 100). When given an informed choice, most non-anxious patients prefer not to be sedated most non-anxious patients prefer not to be sedated during diagnostic endoscopy. If patients who are anxious about the procedure are advised to choose sedation, those who nevertheless opt for topical throat spray alone find the endoscopy just as comfortable. If the endoscopy were to be repeated, 73% of the spray group and 77% of the sedation group would make the same choice again. Of 33 patients who chose spray but had been given only sedation for a previous endoscopy, 26 (79%) would choose spray again for a future endoscopy. The choice of spray or sedation should reflect the patient's view as well as that of the endoscopist.

5-azacytidine produces differential undercondensation of alpha, beta and classical human satellite DNAs

Fluorescence in situ hybridization employing human alphoid, beta and classical satellite DNA probes was performed on 5-azacytidine treated and untreated chromosomes obtained from human lymphocytes. The individual used in this study presented a polymorphism of constitutive heterochromatin of chromosomes 1 and 9 as revealed by in situ digestion with the restriction endonuclease Alul. Neither the alphoid nor the beta satellite DNA domains were susceptible to condensation-inhibition by 5-azacytidine. Only the classical satellite localized on chromosome 9 was affected. The constitutive heterochromatin size polymorphism was shown to depend mainly on variations of the classical satellite DNA domain. Therefore, condensation-inhibition, as a phenomenon which may modify the natural folding of the chromatin fibre, regionally affects human constitutive heterochromatin and seems to be dependent on the heterochromatic family.

Detection of a Cytosolic Glutamine Synthetase in Leaves of Nicotiana tabacum L. by Immunocytochemical Methods

Two glutamine synthetase (GS) polypeptides (44 and 39 kD) were immunodetected on western blots of leaf extracts from tobacco (Nicotiana tabacum L.), a plant that has been reported to contain only chloroplast GS in the leaves. By immunocytochemical methods, we confirmed the localization of GS in the cytosol of cells in the vascular tissue and in the chloroplasts of mesophyll cells.

[Echocardiography-guided temporary implantation of electrode catheters: an alternative with reliable results even during prolonged use]

OBJECTIVE

Two-dimensional echocardiography (2D-ECO) evaluation as an alternative guidance technique during temporary pacing wire placement.

DESIGN

Prospective evaluation of implantation and pacing parameters.

SETTING

Admission from the Emergency Room and patients studied in the Cardiology Department of the Hospital Distrital in Faro.

PATIENTS

Twenty patients with indication for temporary cardiac pacing during, at least, twelve hours (H). Fluoroscopy equipment shouldn't be readily available for implantation.

INTERVENTIONS

The mean ages of the 20 pts. (14 men and 6 women) were 71.90 +/- 2.12 years. All pts. had a temporary pacing lead implantation under 2D-ECO guidance. Indications for cardiac pacing were: second or complete atrioventricular block (17 pts.), new onset bifascicular bundle branch block during anterior acute myocardial infarction (1 patient) and sick sinus syndrome (2 pts.). The transvenous route of approach has been the right internal jugular in all the cases and venipuncture time accounts for the calculation of total implantation time.

MEASUREMENTS AND RESULTS

Ventricular capture was achieved in all pts., with stable stimulation thresholds. The mean implantation time was +/- 9.21 minutes and the mean acute stimulation threshold 0.33 +/- 0.20 V and 0.65 +/- 0.35 mA. The mean voltage of the intracavitary QRS was 11.15 +/- 2.95 mV and the mean lead resistance was 851.33 +/- 194.04 Ohms. The mean utilization time of the pacing leads was 95.15 +/- 87.49 H and the mean stimulation threshold during lead explanation was 0.85 +/- 0.47 mA. The only complication appearing during our study has been one lead dislodgment (5%), 72 h after implantation, placed again with the guidance of 2D-ECO and used during 216 H without further complications. Subcostal 2D-ECO window alone was used in 85% of the pts. but in the remaining (15%), it was insufficient and an apical window was needed too.

CONCLUSIONS

The 2D-ECO was an efficient alternative technique of guidance during temporary lead placement, ensuring satisfactory longterm pacing and sensing. Our results indicate that 2D-ECO may be the best alternative control for urgent lead implantation whenever fluoroscopic facilities are remote or logistically not convenient.

Ascites adenosine deaminase activity is decreased in tuberculous ascites with low protein content

The value of adenosine deaminase activity (ADA) in ascitic fluid was examined in 12 patients with confirmed peritoneal tuberculosis and compared with that of 96 patients with ascites of other different etiologies as an age-matched control group, to determine the diagnostic value of the ADA activity in tuberculous ascites. The mean adenosine deaminase activity (ADA) value in ascitic fluid of the tuberculous peritonitis group was 47.9 +/- 21.9 IU/L and in the control group 9.6 +/- 5 U/L (mean +/- SD); p less than 0.01. A different method than that usually reported in tuberculous peritonitis was used for ascites ADA estimation. The best sensitivity and specificity was obtained when greater than 32 U/L was used as a cutoff point. The ascites ADA activity correlated with the ascites total protein concentration in the tuberculosis group (r = 0.842). Our findings confirm other results and support the ADA activity determination in ascitic fluid as a useful noninvasive screening test in the diagnosis of peritoneal tuberculosis in endemic areas or in high risk patients. However, false-negative results may occur in those patients in which ascites total protein concentration is low.

The relationship of microbial pathogens to acute infectious diarrhoea of childhood

Bacterial, viral and parasitic enteric pathogens were detected in 692 of 916 children below 36 months of age with acute diarrhoea and in 289 of 587 matched controls. The rates of identification of only four groups of pathogens, rotavirus, Shigellae, Salmonella typhimurium and enterotoxigenic E. coli, were significantly higher in the patients. The prevalence of a variety of other enteric pathogens was similar in controls of patients. Shigellosis had a characteristic clinical profile but none of the other agents could be suspected on clinical grounds. The high prevalence of pathogens in controls suggested that the population may be partially protected against a variety of enteric pathogens and that final common pathways leading to diarrhoea may be activated by changes in the microbial ecology of the gut lumen.

[Morphologic course of the left ventricle after renal transplantation. Echocardiographic study]

OBJECTIVE

To characterize and to quantitate the morphologic changes in left ventricle, in renal transplant patients (Pts) treated with cyclosporine, through sequential echocardiographic examinations.

DESIGN

A prospective study of renal transplant patients, between October/88 and May/89, who maintained good function of the renal graft during the follow-up.

SETTING

Cardiology and Nephrology departments of Santo António Hospital.

MATERIAL AND METHODS

20 patients, 13 men and 7 women, mean age of 33 +/- 10, ranging from 20 to 56, constitute the final group of the study. These patients have been receiving dialysis during 3.8 +/- 2.3 years (0.4-8). Seven patients were excluded, five by echocardiographic criteria and another two because of chronic renal graft disfunction (creatinine greater than 2.0 mg%). The echocardiographic examinations were performed during the first week, and 1, 2, 3, 6 and 12 months after renal transplantation. The following measurements were performed: left ventricular end-diastole diameter (LVED), interventricular septal thickness (IVST), posterior wall thickness (PWT) and left ventricular mass index (LVMI). The measurements were obtained in M-mode following the conventional recommendations. Average values of at least 3 cardiac cycles were used. Heart rate, blood pressure, creatinine, hematocrit, body surface area and fistula patency, were determined at the time of each echocardiogram.

MAIN RESULTS

The LVED decreased progressively until the third month, from 51.9 +/- 7 mm to 47.8 +/- 6 mm (p less than 0.001), remaining stable thereafter. The baseline value of IVST, 13.6 +/- 5 mm, was similar at the twelfth month, 13.8 +/- 2 mm (ns). The baseline value of PWT, 13.7 +/- 4 mm, decreased gradually since the second month, having reached 12.7 +/- 2 mm at the twelfth month (ns). The LVMI (g/m2) reduced progressively, from 243 +/- 82 to 190 +/- 38 at the end of the study (p less than 0.05. A high incidence of arterial hypertension was detected during the follow-up period; at the twelfth month, 18 patients (90%) were on antihypertensive drug therapy, 11 of which had blood pressure greater than or equal to 160/95 mmHg.

CONCLUSIONS

We verified, one year after the renal transplantation, a significant decrease of LVMI, that was mainly determined by the LVED reduction. Left ventricular walls thickness had no significant variation; we think that the high incidence of hypertension during the follow-up period, in part due to the pressure effect of cyclosporine, may have been responsible for this fact.

New Secale cereale (rye) DNA derivatives for the detection of rye chromosome segments in wheat

Subcloning of a clone of the 120-bp family of rye, pSc119, has produced two extremely useful probes. pSc119.1 assays rye-specific dispersed repetitive sequence families. It is present on all seven rye chromosomes and hybridizes to the entire length of each chromosome, with the exception of some telomeres and the nucleolar organiser region. pSc119.2, in contrast, hybridizes predominantly to the telomeric regions of rye chromosomes, with some interstitial sites. Unlike pSc119.1, it assays similar repetitive sequence families in both wheat and rye chromosomes.