Novel 1,2,3,4-tetrahydroisoquinolines with high affinity and selectivity for the dopamine D3 receptor

Using clearance and brain penetration studies as a screen, tetrahydroisoquinoline 3 was identified as a lead having low clearance in rats (CLb 20 ml/min/kg). Introduction of a 7-CF3SO2O- substituent into the tetrahydroisoquinoline, followed by replacement of the biphenylamido group of 3 by a 3-indolylpropenamido group gave 31, having high D3 receptor affinity (pKi 8.4) and 150 fold selectivity over the D2 receptor.

Relaxation effects in a system of a spin-1/2 nucleus coupled to a quadrupolar spin subjected to RF irradiation: evaluation of broadband decoupling schemes

We have investigated the suitability and performance of various decoupling methods on systems in which an observed spin-1/2 nucleus I (13C or 15N) is scalar-coupled to a quadrupolar spin S (2H). Simulations and experiments have been conducted by varying the strength of the irradiating radiofrequency (RF) field, RF offset, relaxation times, and decoupling schemes applied in the vicinity of the S-spin resonance. The T1 relaxation of the quadrupolar spin has previously been shown to influence the efficiency of continuous wave (CW) decoupling applied on resonance in such spin systems. Similarly, the performance of broadband decoupling sequences should also be affected by relaxation. However, virtually all of the more commonly used broadband decoupling schemes have been developed without consideration of relaxation effects. As a consequence, it is not obvious how one selects a suitable sequence for decoupling quadrupolar nuclei with exotic relaxation behavior. Herein we demonstrate that, despite its simplicity, WALTZ-16 decoupling is relatively robust under a wide range of conditions. In these systems it performs as well as the more recently developed decoupling schemes for wide bandwidth applications such as GARP-1 and CHIRP-95. It is suggested that in macromolecular motional regimes, broadband deuterium decoupling can be achieved with relatively low RF amplitudes (500-700 Hz) using WALTZ-16 multiple pulse decoupling.

Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography

A previously undescribed cause of abnormal uterine bleeding is presented. Nine of 310 women evaluated by sonohysterography for abnormal bleeding demonstrated an 8 to 17 mm gap in the anterior lower uterine segment myometrium at the site of prior cesarean deliveries. All women were premenopausal and had a history of 2 to 12 days of postmenstrual spotting. Presumably a lack of coordinated muscular contractions occurs around the cesarean scar, allowing the defect to collect menstrual debris. Subsequently, the debris leaches out through the cervix for several days after the majority of menstrual flow has ceased.

Bilateral Horner's syndrome: detection and occurrence

OBJECTIVE

To develop a method for the detection of bilateral Horner's syndrome in patients with bilateral interruption of the cervical sympathetic pathway or widespread autonomic neuropathy.

METHODS

Darkness pupil diameters and redilatation times during light reflexes have been recorded with infrared TV pupillometry in 65 healthy subjects, 47 patients with unilateral Horner's syndrome, and 20 patients with bilateral Horner's syndrome. The aetiologies of the last group were diabetic autonomic neuropathy (three cases), amyloidosis (four), pure autonomic failure (PAF) (four), dopamine-beta-hydroxylase deficiency (two), and one case each of hereditary sensory and autonomic neuropathy (HSAN) type III, carcinomatous sympathetic neuropathy, familial dysautonomia, multiple system atrophy, Anderson-Fabry disease, and anterior spinal artery thrombosis at C5,6 and one had had bilateral cervical sympathectomies.

RESULTS

Darkness diameters on the affected side were below normal in 12 patients with unilateral Horner's syndrome, the measurement yielding only 26% sensitivity for detection of the condition. By contrast, the time taken to reach three quarter recovery in the light reflex (T3/4) was abnormally prolonged (redilatation lag) in 33 of the same eyes. The measurement yielded 70% sensitivity and 95% specificity for detection of the condition. In 20 cases, diagnosed on clinical grounds as having bilateral Horner's syndrome of various aetiologies, pupil diameters were abnormally small on both sides in five and on one side in three patients. Fourteen of these patients had significant redilatation lag in both eyes, five patients in one eye, and one patient had it in neither eye. Measurement of redilatation lag was therefore a more sensitive diagnostic test than pupil diameter in both unilateral and bilateral Horner's syndrome.

CONCLUSIONS

Provided that the pupils are not tonic, bilateral Horner's syndrome can be diagnosed on the basis of redilatation lag. It occurs clinically in some generalised autonomic neuropathies and with interruption of the local sympathetic nerve supplies to the two eyes.

Management of nasal aspergillosis in a dog with a single, noninvasive intranasal infusion of clotrimazole

An 11-year-old, spayed female keeshond was presented for unilateral epistaxis and serous nasal discharge of four weeks duration. Initial nasal radiographs, rhinoscopy, and histopathology suggested severe, destructive lymphoplasmacytic rhinitis. The patient deteriorated while receiving an anti-inflammatory dose of prednisone. A computed tomographic scan of the nose demonstrated a soft-tissue density in both the right nasal cavity and frontal sinus. Samples for histopathology obtained at surgery were diagnostic for nasal aspergillosis. All clinical signs resolved with a single, noninvasive infusion of intranasal clotrimazole and a four-week course of oral itraconazole.

Effect of percutaneous endoscopic gastrostomy on gastric emptying in clinically normal cats

OBJECTIVE

To assess the effect of percutaneous endoscopic gastrostomy (PEG) tube placement on gastric emptying in clinically normal cats.

ANIMALS

8 healthy adult 3- to 5-year-old cats.

PROCEDURE

Cats were accommodated to the diet for 2 weeks prior to scintigraphy. Caloric needs were divided into 3 feedings/d. Food was withheld for 24 hours after tube placement, then was fed as a third of the caloric needs on day 1, two-thirds on day 2, and full caloric requirements thereafter. Gastric emptying was measured via nuclear scintigraphy. Labeled meals contained 111 MBq (3 mCi) of 99mTc-labeled disofenin. Sixty-second ventral scintigraphic images were acquired immediately, every 20 minutes for the first hour, then every 30 minutes for 4 hours after feeding. Each cat was evaluated 3 times prior to PEG tube placement. Cats were anesthetized, and 16-F mushroom-tipped Pezzar gastrostomy tubes were placed, using a video endoscope. Scintigraphy was repeated on days 1, 4, 7, 11, 14, and 21 after PEG tube placement.

RESULTS

Gastric emptying was faster with a PEG tube in place. Percentage of retained gastric activity was significantly lower after PEG for 150, 180, 210, and 240 minutes versus time before PEG tube placement.

CONCLUSION

Placement of a PEG tube does not delay gastric emptying in clinically normal cats.

CLINICAL RELEVANCE

Gastric retention of food, vomiting, and aspiration pneumonia after PEG tube placement may not be related to delayed gastric emptying.

Photoreceptor fine structure in Oreochromis niloticus L. (Cichlidae; Teleostei) in light- and dark-adaptation

The structure and arrangement of both light- and dark-adapted retinal photoreceptors of Oreochromis niloticus L. were studied. Eyes of four light-adapted and four dark-adapted O. niloticus were fixed routinely for light and transmission electron microscopy. Rods, single cones, and double (twin) cones were present in a ratio of 30:1:2, respectively. Light-adapted rods were tall, extending into the retinal epithelial layer. Rod inner segments showed a distal ellipsoid of mitochondria that narrowed dramatically in the myoid region. Dark-adapted rod inner segments were much shorter with a thicker myoid region, indicating photomechanical movement. Rod synaptic spherules were small, with both superficial synapses and invaginated sites. Single cones were similar to individual members of a double cone. Cone outer segments consisted of uniform discs with a single incisure. All cones displayed a short, tapering outer segment, a large ellipsoid of mitochondria, and a myoid region rich in organelles. Both members of double cones had extensive subsurface cisternae along their contiguous surfaces. Cone inner segments changed little throughout the circadian cycle, suggesting an absence of significant retinomotor movements. Large, vesicular cone nuclei were located adjacent to or through the external limiting membrane. The cones' synaptic pedicles had larger synapses than rod spherules, with more of both invaginated (ribbon) and conventional (superficial) synaptic sites. Cone photoreceptors were arranged in a repeating square mosaic pattern with a single cone surrounded by four double (twin) cones. The photoreceptors of the Nile tilapia presented basic piscine characteristics, and also some more species-specific features.

Fine structure of the retinal pigment epithelium of Oreochromis niloticus L. (Cichlidae; Teleostei) in light- and-dark adaptation

The fine structure of the retinal pigment epithelium (RPE) of the cichlid Oreochromis niloticus was investigated in both light- and dark-adaptation. The eyes of four light-adapted and from four dark-adapted O. niloticus were fixed routinely for light and transmission electron microscopy. The RPE consisted of a single layer of columnar cells showing minimal basal infolding but plentiful apical processes that in light-adaptation interdigitated with the photoreceptor outer segments. The epithelial cells were joined by a series of basally-located tight junctions. These cells showed a large vesicular nucleus, plentiful smooth endoplasmic reticulum and polysomes, but only small amounts of rough endoplasmic reticulum. Phagosomes, lysosome-like bodies, lipid droplets, and myeloid bodies were observed. The choriocapillaris was a single layer of large-caliber capillaries, and Bruch's membrane (complexus basalis) was a trilaminate structure typical of teleosts. The RPE melanosomes moved basally (sclerally) in dark-adaptation and apically (vitreally) during light-adaptation. Other morphological features which changed at least to some degree during retinomotor responses were: the location of the RPE nucleus; the location and electron density of the mitochondria; and the location, number, and size of the myeloid bodies. A number of unique morphological changes take place within the RPE cells of this species during the circadian cycle in addition to the movement of melanosomes characterized in other vertebrates.

Resolution of a pancreatic pseudocyst in a dog following percutaneous ultrasonographic-guided drainage

A six-year-old, spayed female Shetland sheepdog was presented with acute onset of anorexia and vomiting. An inflammatory leukogram and elevated serum amylase, lipase, alkaline phosphatase, alanine transferase, and triglycerides supported a diagnosis of severe acute pancreatitis. An enlarged, hypoechoic pancreas was visualized on abdominal ultrasonography. The patient clinically responded to medical therapy consisting of nothing per os, total parenteral nutrition, and supportive care. She presented again three weeks later with anorexia and vomiting. A large, anechoic mass was seen in the left limb of the pancreas on ultrasonographic examination of the abdomen. Differentials for this mass included abscess, focal peritonitis, and pancreatic pseudocyst. Clinical signs resolved with supportive care. The mass failed to resolve. Sterile fluid (35 ml) was removed via ultrasonographic-guided centesis 42 days after initial presentation. Ultrasonographic appearance, biochemical analyses, and fluid examination with negative cultures suggested pancreatic pseudocyst. The pseudocyst gradually resolved over the next seven months postcentesis.

Fused aminotetralins: novel antagonists with high selectivity for the dopamine D3 receptor

Starting from a series of 2-aminotetralins 1, a novel series of N-[4-(4-phenylbenzoylamino)butyl]-octahydrobenzoquinolines and hexahydrobenzoindoles with high potency and selectivity for the dopamine D3 receptor has been designed. The effect of ligand chirality on binding affinity has been established. Selected derivatives (e.g. 2o, 2p) show high functional selectivity and enhanced in vivo properties compared to 1.

Creatine supplementation and age influence muscle metabolism during exercise

Young [n = 5, 30 +/- 5 (SD) yr] and middle-aged (n = 4, 58 +/- 4 yr) men and women performed single-leg knee-extension exercise inside a whole body magnetic resonance system. Two trials were performed 7 days apart and consisted of two 2-min bouts and a third bout continued to exhaustion, all separated by 3 min of recovery. 31P spectra were used to determine pH and relative concentrations of Pi, phosphocreatine (PCr), and beta-ATP every 10 s. The subjects consumed 0.3 g . kg-1 . day-1 of a placebo (trial 1) or creatine (trial 2) for 5 days before each trial. During the placebo trial, the middle-aged group had a lower resting PCr compared with the young group (35.0 +/- 5.2 vs. 39.5 +/- 5.1 mmol/kg, P < 0.05) and a lower mean initial PCr resynthesis rate (18.1 +/- 3.5 vs. 23.2 +/- 6.0 mmol . kg-1 . min-1, P < 0.05). After creatine supplementation, resting PCr increased 15% (P < 0.05) in the young group and 30% (P < 0.05) in the middle-aged group to 45.7 +/- 7.5 vs. 45.7 +/- 5.5 mmol/kg, respectively. Mean initial PCr resynthesis rate also increased in the middle-aged group (P < 0.05) to a level not different from the young group (24.3 +/- 3.8 vs. 24.2 +/- 3.2 mmol . kg-1 . min-1). Time to exhaustion was increased in both groups combined after creatine supplementation (118 +/- 34 vs. 154 +/- 70 s, P < 0.05). In conclusion, creatine supplementation has a greater effect on PCr availability and resynthesis rate in middle-aged compared with younger persons.

Unilateral enucleation of adult rats does not effect the synapse-to-neuron ratio within the stratum griseum superficiale of the superior colliculi

Ninety-day-old hooded male rats were anaesthetised with an intraperitoneal injection of a mixture of xylazine and ketamine and had their right eyes removed. Groups of non-enucleated control and enucleated rats were killed at either 150 or 390 days of age by intracardiac perfusion with fixatives. Stereological methods were used to estimate the synapse-to-neuron ratios within the stratum griseum superficiale (SGS) layers of both the ipsi- and contra-lateral superior colliculi. The enucleation had no significant effects on this ratio irrespective of the side or age of the brains examined. This experiment shows that a constant synapse-to-neuron ratio may be maintained within the SGS layer of the rat superior colliculus despite the inevitable loss of synaptic contacts due to the anterograde transneuronal degeneration initiated by the enucleation.

Favorable prognostic significance of high-level retinoic acid receptor beta expression in neuroblastoma mediated by effects on cell cycle regulation

We have previously shown that ectopic overexpression of retinoic acid receptor (RAR) subtypes alpha, beta and gamma in human neuroblastoma cells had different effects on growth and retinoid sensitivity. Only overexpressed RAR beta induced profound growth inhibition in the absence of additional retinoid, and increased retinoid sensitivity. In this study, we measured mRNA expression levels of RAR alpha, beta, and gamma in 50 primary neuroblastoma tumor samples, and found a strong correlation between favorable patient prognosis and high-level RAR beta expression. Human neuroblastoma cells transfected with a vector expressing RAR beta demonstrated irreversible growth arrest following a 1 week exposure to all-transretinoic acid, whereas control cells continued to proliferate. In the absence of additional retinoid, RAR beta transfectants demonstrated a higher proportion of cells in the G0/G1 phase of the cell cycle, increased p21WAF1/CIP1 expression and specific binding to a retinoic acid response element. These were changes which we also observed in control neuroblastoma cells following retinoid treatment. Our data indicate that RAR beta is an important factor mediating the growth inhibitory effects of retinoids in neuroblastoma cells. The favorable effect of high-level RAR beta expression on prognosis in primary tumor tissue may occur through RAR beta effects on p21 expression and consequent G0/G1 cell cycle arrest.

Unexpected second foreign bodies in pediatric esophageal coin ingestions

OBJECTIVE

To determine the frequency of unexpected second foreign bodies in children who present to the pediatric emergency department with esophageal coin impaction.

DESIGN/METHODS

A retrospective chart review pediatric patients with esophageal coin impaction who underwent esophagoscopy/laryngoscopy for coin removal in a 16-year period at a tertiary referral center. Data analysis consists of descriptive statistics.

RESULTS

Eighty three of 85 (95%) eligible charts were reviewed. Three children (3.6%) had unsuspected second foreign bodies: an adherent penny, a second penny low in the esophagus, and pieces of paper and lint. No significant esophageal injury occurred.

CONCLUSIONS

Unexpected second foreign bodies in pediatric esophageal coin ingestions with adequate radiographic studies are rare and generally do not cause significant esophageal injury.

Intact PTH study: shipping frozen vs. unfrozen samples

DCI Laboratory, Nashville TN compared INCSTAR N-tact PTH SP Kit (INCSTAR Corp., Stillwater, MN, USA) results from renal dialysis patients analyzed on frozen versus unfrozen samples; unfrozen samples were analyzed at 24, 48, and 72 hours post-collection. There was no statistical or clinical difference in the results of the frozen samples and unfrozen samples analyzed at 24 hours. Clinics may now ship unfrozen samples if they arrive within 24 hours.

Benzo[a]pyrene-induced hypocellularity of the pronephros in tilapia (Oreochromis niloticus) is accompanied by alterations in stromal and parenchymal cells and by enhanced immune cell apoptosis

Numerous reports indicate that carcinogenic polycyclic aromatic hydrocarbons (PAH) are mammalian immunotoxicants. These environmental contaminants are widely distributed in both freshwater and costal marine ecosystems where they have been found to bioaccumulate in aquatic species, yet limited information exists regarding potential adverse effects of specific PAH on fish immune function. In the present report, Oreochromis niloticus fish (tilapia) were exposed by intraperitoneal injection to 5, 25, or 50 mg/kg of the PAH, benzo[a]pyrene (B[a]P). Histopathologic evaluation of the primary hematopoietic compartment of fish, the pronephros, demonstrated increased vacuolation of both stromal and parenchymal cells, reduction of lymphoid elements, and immune cell apoptosis. Total pronephros cell counts were diminished in a dose-dependent manner by the chemical exposure. The oxidative metabolic burst in phorbol myristate acetate (PMA)-simulated macrophages isolated from the pronephros was significantly inhibited by B[a]P, but only at the highest dose level employed. The phagocytic capacity of pronephros macrophages was not altered by the chemical treatment.

Effector systems involved in the insulin secretory responses to efaroxan and RX871024 in rat islets of Langerhans

One component of the mechanism by which imidazoline compounds promote insulin secretion involves closure of ATP-sensitive K+ channels in the beta-cell plasma membrane. Recently, however, it has also been proposed that these compounds may exert important effects on more distal effector systems. In the present work, we have investigated the contribution played by protein kinases A and C to the insulin secretory responses of isolated rat islets of Langerhans treated with efaroxan and RX871024 (1-phenyl-2-(imidazolin-2-yl) benzimidazole). Removal of extracellular Ca2+ or blockade of voltage-sensitive Ca2+ channels prevented stimulation of insulin secretion by efaroxan, confirming a critical role for increased Ca2+ influx in the secretory response. By contrast, inhibition of protein kinases A or C failed to alter efaroxan-induced insulin secretion. RX871024 dose-dependently increased insulin secretion from cultured islets incubated with 20 mM glucose. This effect was unaffected by modulation of protein kinase C, but was significantly attenuated by a selective inhibitor of protein kinase A (Rp-cAMPs). Measurements of cAMP revealed that RX871024 increased the islet cAMP content by more than 3-fold; reaching values similar in magnitude to those elicited by 50 microM 3-isobutyl-1-methyl xanthine. The results reveal that neither protein kinase A nor protein kinase C is obligatory for stimulation of insulin secretion by imidazolines. However, they suggest that a rise in cAMP may contribute to the amplified secretory response observed when cultured islets are incubated with RX871024 in the presence of a stimulatory glucose concentration.

Impact of a diabetes electronic management system on the care of patients seen in a subspecialty diabetes clinic

OBJECTIVE

To compare the compliance with diabetes care performance indicators by diabetes specialists using a diabetes electronic management system (DEMS) and by those using the traditional paper medical record.

RESEARCH DESIGN AND METHODS

A DEMS has been gradually introduced into our subspecialty practice for diabetes care. To assess the value of this DEMS as a disease management tool, we completed a retrospective review of the medical records of 82 randomly selected patients attending a subspecialty diabetes clinic (DC) during the first quarter of 1996. Eligible patients were defined by the suggested criteria from the American Diabetes Association Provider Recognition Program. During the first quarter of 1996, approximately one half of the providers began using the DEMS for some but not all of their patient encounters. Neither abstractors nor providers were aware of the intent to examine performance in relationship to use of the DEMS.

RESULTS

Several measures were positively influenced when providers used the DEMS. The number of foot examinations, the number of blood pressure readings, and a weighted criterion score were greater (P < 0.01) for providers using the DEMS. There was evidence, although not statistically significant, for lower mean diastolic blood pressures (P = 0.043) in patients and for number of glycated hemoglobins documented (P = 0.018) by users of the DEMS.

CONCLUSIONS

Performance and documentation of the process of care for patients with diabetes in a subspecialty clinic are greater with the use of a DEMS than with the traditional paper record.

Hypohydration effects on skeletal muscle performance and metabolism: a 31P-MRS study

The purpose of this study was to determine whether hypohydration reduces skeletal muscle endurance and whether increased H+ and Pi might contribute to performance degradation. Ten physically active volunteers (age 21-40 yr) performed supine single-leg, knee-extension exercise to exhaustion in a 1.5-T whole body magnetic resonance spectroscopy (MRS) system when euhydrated and when hypohydrated (4% body wt). 31P spectra were collected at a rate of one per second at rest, exercise, and recovery, and were grouped and averaged to represent 10-s intervals. The desired hydration level was achieved by having the subjects perform 2-3 h of exercise in a warm room (40 degrees C dry bulb, 20% relative humidity) with or without fluid replacement 3-8 h before the experiment. Time to fatigue was reduced (P < 0.05) by 15% when the subjects were hypohydrated [213 +/- 12 vs. 251 +/- 15 (SE) s]. Muscle strength was generally not affected by hypohydration. Muscle pH and Pi/beta-ATP ratio were similar during exercise and at exhaustion, regardless of hydration state. The time constants for phosphocreatine recovery were also similar between trials. In summary, moderate hypohydration reduces muscle endurance, and neither H+ nor Pi concentration appears to be related to these reductions.

The contribution of classical (beta1/2-) and atypical beta-adrenoceptors to the stimulation of human white adipocyte lipolysis and right atrial appendage contraction by novel beta3-adrenoceptor agonists of differing selectivities

The role of beta3- and other putative atypical beta-adrenoceptors in human white adipocytes and right atrial appendage has been investigated using CGP 12177 and novel phenylethanolamine and aryloxypropanolamine beta3-adrenoceptor (beta3AR) agonists with varying intrinsic activities and selectivities for human cloned betaAR subtypes. The ability to demonstrate beta1/2AR antagonist-insensitive (beta3 or other atypical betaAR-mediated) responses to CGP 12177 was critically dependent on the albumin batch used to prepare and incubate the adipocytes. Four aryloxypropanolamine selective beta3AR agonists (SB-226552, SB-229432, SB-236923, SB-246982) consistently elicited beta1/2AR antagonist-insensitive lipolysis. However, a phenylethanolamine (SB-220646) that was a selective full beta3AR agonist elicited full lipolytic and inotropic responses that were sensitive to beta1/2AR antagonism, despite it having very low efficacies at cloned beta1- and beta2ARs. A component of the response to another phenylethanolamine selective beta3AR agonist (SB-215691) was insensitive to beta1/2AR antagonism in some experiments. Because no [corrected] novel aryloxypropanolamine had a beta1/2AR antagonist-insensitive inotropic effect, these results establish more firmly that beta3ARs mediate lipolysis in human white adipocytes, and suggest that putative 'beta4ARs' mediate inotropic responses to CGP 12177. The results also illustrate the difficulty of predicting from studies on cloned betaARs which betaARs will mediate responses to agonists in tissues that have a high number of beta1- and beta2ARs or a low number of beta3ARs.

In vitro effects of the extracellular protein of Renibacterium salmoninarum on phagocyte function in brook trout (Salvelinus fontinalis)

Renibacterium salmoninarum is a facultative intracellular pathogen often found in host phagocytes where it appears to successfully avoid the host fish's immunological defenses. The objective of this investigation was to determine if soluble extracellular protein (ECP) produced by R. salmoninarum may contribute to the immunomodulation in bacterial kidney disease (BKD) via inhibition of phagocyte respiratory burst and/or phagocytosis mechanisms. Splenic cells from adult brook trout (Salvelinus fontinalis) were incubated with two different concentrations of ECP (0.1 mg/ml and 1.0 mg/ml) and viable R. salmoninarum. Splenic cell cultures were evaluated for respiratory burst activity via flow cytometry with the dichlorofluorescin diacetate (DCF-DA) assay and for phagocytosis via light microscopic assessment of microsphere engulfment. Respiratory burst activity was significantly inhibited in all treatment groups as compared to untreated fish, while no differences were noted in phagocytic activity.

Amiodarone-Induced Hyperthyroidism and a Thyroid Nodule

OBJECTIVE

To report two cases of thyrotoxicosis associated with amiodarone therapy and to discuss how the presence of a thyroid nodule alters management.

METHODS

We describe two patients with amiodarone-induced hyperthyroidism, review the mechanisms of disease, and outline a strategy for decision making relative to treatment in the presence of a thyroid nodule.

RESULTS

Amiodarone-induced thyrotoxicosis occurs by two mechanisms: a direct toxic effect and iodine loading. This condition may be treated medically or surgically, but when discontinuation of amiodarone therapy is not possible and medical management is ineffective, surgical therapy is often necessary. The optimal presurgical management in the cases described required the use of thyroid scanning to determine whether the disease process was attributable to a hyperfunctioning nodule or generalized. The findings were helpful in planning the extent of surgical excision.

CONCLUSION

When surgical treatment is planned for patients with a solitary thyroid nodule and amiodarone-induced hyperthyroidism, preoperative thyroid scanning will direct the surgeon to perform either subtotal thyroidectomy for diffuse disease or lobectomy for a hyperfunctioning nodule.

Unilateral alpha reactivity: an electroencephalographic finding in albinism

Persons with various forms of albinism frequently have misrouting of their optic nerve fibers. Visual evoked potential (VEP) studies can confirm this because monocular stimulation tends to result in asymmetrical rather than symmetrical occipital response. This type of decussation abnormality is associated only with albinism. In the electroencephalogram (EEG) of normal subjects, unilateral eye opening or closing does not affect the frequency, reactivity, regulation, and symmetry of alpha rhythm. In contrast, in our study, 6 of 19 persons with oculocutaneous and ocular albinism responded to unilateral eye opening with contralateral disappearance or significant attenuation of their alpha rhythm. The most likely explanation of this phenomenon is that the visual pathway misrouting is complete or nearly complete in some children with albinism so that one rather than both occipital lobes receive visual information from each eye. This type of alpha behavior, like VEP studies, supports the diagnosis of albinism, and such testing can be easily performed during a routine EEG recording.