White sponge nevus presenting in the esophagus--case report and literature review

White sponge nevus (WSN) is a rare inherited disorder which usually presents as non-painful white plaques primarily involving the buccal mucosa, gingiva and palate. Extra-oral lesions most often occur in the esophagus or anogenital area but almost invariably follow the development of typical buccal lesions. We present a non-familial case in which the first manifestation of the disease was in the esophagus in the absence of oral lesions. This sequence of events has not previously been reported in the literature. The cytohistological and electron microscopical appearances which allow the recognition and differentiation of WSN from other conditions presenting as esophageal white lesions are discussed.

Imaging of sinonasal tumors

Imaging of the paranasal sinuses and the nasal cavity provides important anatomic information in the evaluation of suspected neoplasia. The primary modalities employed are conventional films, computed tomography (CT) and magnetic resonance imaging (MRI). Although plain sinus films remain the screening procedure of choice, CT is the preferred modality for more detailed assessment of the paranasal sinuses and the nasal cavity. When soft tissue discrimination is required, MRI is indicated. Imaging studies are used to define the limits of disease, not to diagnose malignancy.

Transcriptional activation of the cardiac myosin light chain 2 and atrial natriuretic factor genes by protein kinase C in neonatal rat ventricular myocytes

A cultured myocardial cell model was used to examine the role of protein kinase C-dependent pathways in the transcriptional activation of two cardiac muscle genes [myosin light chain 2 (MLC-2) and atrial natriuretic factor (ANF)] during alpha-adrenergic receptor-mediated hypertrophy. Phorbol ester (phorbol 12-myristate 13-acetate) and the alpha-adrenergic agonist phenylephrine both activate protein kinase C (PKC) and induce 4- to 5-fold increases in the expression of MLC-2 and ANF promoter/luciferase reporter genes with little effect on Rous sarcoma virus/luciferase or minimal prolactin promoter/luciferase genes. To further assess the role of PKC in cardiac gene regulation, PKC expression vectors encoding constitutively activated PKC-alpha or PKC-beta, or a catalytically inactive PKC, were transiently cotransfected with the cardiac promoter/luciferase constructs. Cotransfection of either activated PKC-alpha or PKC-beta cDNA induces the expression of MLC-2 and ANF promoter/luciferase genes and of a reporter gene responsive to the transcription factor AP-1. The Rous sarcoma virus/luciferase and minimal prolactin promoter/luciferase genes are not concomitantly induced by cotransfectin with the PKC genes, indicating specificity of the transcriptional effect. The finding that activated PKC increases cardiac gene transcription suggests that activation of this enzyme may be a proximal signal for coregulation of two cardiac genes, MLC-2 and ANF, during the course of myocardial cell hypertrophy.

The alpha-adrenergic stimulation of atrial natriuretic factor expression in cardiac myocytes requires calcium influx, protein kinase C, and calmodulin-regulated pathways

It has been shown recently that alpha-adrenergic agonists can stimulate atrial natriuretic factor (ANF) expression in ventricular cardiac myocytes; however, little is known about the intracellular signals mediating this activation. The present study focused on the potential roles of calcium-regulated kinases and calcium influx in the alpha-adrenergic stimulation of ANF gene expression in ventricular myocardial cell cultures. Myocardial cells maintained for 48 h in serum-free medium supplemented with phenylephrine (PE) possessed up to 15-fold higher levels of ANF peptide and ANF mRNA than control cells. The removal of PE, or the addition of nifedipine, resulted in a rapid decline in ANF expression, suggesting that the sustained elevation of some intracellular messenger (e.g. calcium and/or phospholipid hydrolysis products) was required for the adrenergic response. The calcium channel agonist BAY K 8644 was capable of increasing ANF expression in a nifedipine-sensitive manner; however, unlike PE, it did not stimulate phosphoinositide hydrolysis. The protein kinase C inhibitor, H7, caused an approximate 75% reduction in PE-stimulated ANF expression, but had no effect on BAY K-stimulated expression. W7, a calcium/calmodulin inhibitor, completely blocked the effects of both PE and BAY K 8644. The addition of either H7 or W7 24 h after the PE addition resulted in a decline of ANF expression. These results indicate that alpha-adrenergic agonists augment ANF gene expression through at least two pathways, one that is H7-sensitive, perhaps involving the sustained activation of protein kinase C, and the other that is W7-sensitive, perhaps involving the sustained activation of calmodulin-regulated kinases. Further, it appears that BAY K 8644-mediated increases in ANF expression are independent of protein kinase C activation and dependent on calmodulin-regulated events.

Regulation of c-fos and c-jun protooncogene expression by the Ca(2+)-ATPase inhibitor thapsigargin

Thapsigargin, a non-phorbol-ester-type tumor promoter, discharges intracellular Ca2+ stores by specific inhibition of the endoplasmic reticulum Ca(2+)-ATPase. We used this drug to analyze the involvement of Ca2+ and Ca(2+)-ATPases in the control of growth- and transformation-related genes. Here we show that treatment of mouse NIH 3T3 fibroblasts with thapsigargin induced rapid expression of the c-fos and c-jun protooncogenes. Inhibition or depletion of protein kinase C partially diminished the c-fos but not the c-jun response. Furthermore, thapsigargin could synergize with the tumor promoter phorbol 12-myristate 13-acetate to induce c-fos but not c-jun. However, thapsigargin had no effect on basal or phorbol ester-induced protein kinase C activity. Our results indicate that Ca2+ is a potent second messenger that controls expression of growth- and transformation-related genes. Since inhibition of the endoplasmic reticulum Ca(2+)-ATPase results in a strong induction of these genes, our data suggest that this Ca2+ pump may act as a negative regulator of cell growth.

Outcome of pregnancy following renal transplantation

Successful renal transplantation improves fertility with 1 in 50 women of childbearing age becoming pregnant. Pregnancy following renal transplantation is associated with increased maternal and fetal complications. In Belfast 118 women of childbearing age (15-45 yrs) have received a renal allograft and of these 14 (12%) have become pregnant. Twenty-seven pregnancies have resulted in 23 live births (including one set of identical twins), 1 still birth and 4 first trimester abortions. The most frequent complications were hypertension and prematurity. In this group of patients, whose sole immunosuppressive therapy was azathioprine and prednisolone, pregnancy post transplantation was associated with frequent successful outcome and a low incidence of maternal and fetal complications.

Electroconvulsive therapy in the treatment of depression: the impact on length of stay

It has been reported that one advantage to administering electroconvulsive therapy (ECT) for the treatment of depression is that it results in shorter hospitalizations than alternative treatments. The generality of this finding was assessed in the present study, which comprised a retrospective review of 192 admissions for depression. It was found that the prompt initial decision to administer ECT did not reduce the overall length of hospital stays. In fact, patients who were discharged after an initial medication trial actually had shorter admissions than patients treated promptly with ECT. Nevertheless, one subgroup of patients--those who were started on medications, but who were later switched to ECT--had very long admissions. Whether the prompt initiation of ECT will reduce the average length of stay at any individual institution may depend on the numbers of patients who fall into this latter category. This number, in turn, appears to vary widely across institutions.

Crystallization of HLA-DR antigens

The class II major histocompatibility antigens HLA-DR1, DR2, DR3, DR4, DR7 and DR8 were purified by immunoaffinity chromatography from homozygous human B lymphoblastoid cell lines. The purified, detergent-soluble molecules were cleaved with the protease papain to remove the hydrophobic transmembrane regions and cytoplasmic tails. Crystals were obtained for each of the papain-solubilized fragments. DR1 crystallized under a variety of different conditions, resulting in two different orthorhombic crystal forms, one of which diffracts as far as 3.5A. Crystals of DR2, DR3, DR4 and DR8 have the same unit cell dimensions as the DR1 crystals, and crystals of DR3 and DR4 have the same diffracting power as the DR1 crystals. The best DR7 crystals obtained thus far are hexagonal and diffract to only about 8A. Crystals of similar hexagonal form have also been observed for most of the other DR subsets.

Dissociation of protein kinase C redistribution from the phosphorylation of its substrates

Increases in cytoplasmic [Ca2+] caused by receptor activation are thought to stimulate the redistribution of loosely associated protein kinase C (PKC) to a tightly membrane-bound form that is activated by diacylglycerol. The precise role of Ca2(+)-dependent redistribution of PKC in the activation of this enzyme has not been critically assessed. We examined the relationship between PKC redistribution and substrate phosphorylation by comparing the kinetics and the Ca2+ dependence of the two events. Using immunoblotting with specific PKC antibodies, we find that 1321N1 cells express the alpha form of PKC, approximately 10-20% of which is membrane-associated in unstimulated cells. This fraction is increased to 60% in response to muscarinic receptor stimulation. Agonist-induced redistribution of PKC is rapid and transient, peaking at 30 s and returning to control levels by 2-5 min. Stimulation of muscarinic receptors also rapidly increases phosphorylation of both an endogenous 80-kDa protein and the peptide substrate, VRKRTLRRL. However, unlike the time course of PKC redistribution, PKC-mediated phosphorylation of these substrates is sustained for up to 30 min. To compare the Ca2+ dependence of PKC redistribution and substrate phosphorylation, we buffered muscarinic receptor-induced increases in cytoplasmic [Ca2+] with the divalent cation chelator 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid. Under these conditions, redistribution of PKC and phosphorylation of the exogenous peptide substrate are inhibited by about 80%. In contrast, muscarinic receptor-stimulated phosphorylation of the 80-kDa protein occurs even when increases in cytoplasmic [Ca2+] are prevented. Taken together, these data demonstrate that the redistribution of PKC does not correlate in extent or duration with phosphorylation of PKC substrates.

c-fos and c-jun are induced by muscarinic receptor activation of protein kinase C but are differentially regulated by intracellular calcium

It has become increasingly clear that agents classically thought to act as neurotransmitters can also alter gene expression. To understand the early events by which neurotransmitters could effect genetic responses, we have studied the induction of two immediate early genes, c-fos and c-jun. These genes encode proteins that form a dimeric complex (AP-1) active as a transcriptional factor. Using the stable acetylcholine analog carbachol to activate muscarinic receptors (mAChR) in a glial cell line (1321N1), we show that c-fos and c-jun mRNA levels are transiently increased, reaching a maximum at 30 min after agonist addition. Experiments in which the actions of carbachol are blocked by adding atropine at various times demonstrate that only 1.5 min of agonist stimulation is needed to give maximal increases in c-fos or c-jun mRNA at 30 min. These results suggest that events previously shown to occur in the first minute of mAChR occupation (the mobilization of intracellular Ca2+, activation of protein kinase C) are sufficient for induction of these immediate early genes. In cells in which protein kinase C has been down-regulated, carbachol no longer stimulates c-fos or c-jun expression, indicating a critical role for protein kinase C in these responses. In cells loaded with bis-(o-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid (BAPTA) to buffer increases in cytosolic [Ca2+], mAChR-mediated induction of c-fos is markedly reduced; in contrast there is enhanced c-jun expression. The strong enhancement of c-jun induction by carbachol in BAPTA-treated cells is due at least in part to mRNA stabilization. Experiments using phorbol ester (phorbol 12-myristate 13-acetate) in combination with the Ca2+ ionophore ionomycin confirm that activation of protein kinase C induces c-fos and c-jun expression and that a concomitant increase in cytosolic [Ca2+] potentiates the induction of c-fos while repressing that of c-jun. The data suggest that the ability of neurotransmitters or growth factors to mobilize Ca2+ would modulate the effect of concomitant protein kinase C activation on AP-1 generation and consequent target gene expression.

Solvent abuse, toluene acidosis and diabetic ketoacidosis

Solvent abuse in adolescents and young adults has been reported to cause a metabolic acidosis with a normal or increased anion gap (Streicher et al., 1981; Voights & Kaufman, 1983, Anonymous, 1988). We report a particularly severe clinical problem produced by the combination of toluene intoxication and diabetic ketoacidosis.

Acyl chain and head group regulation of phospholipid catabolism in senescing carnation flowers

Microsomal membranes from the petals of senescing carnation (Dianthus caryophyllus L.) flowers contain phosphatidylcholine, phosphatidylethanolamine, phosphatidylglycerol, and phosphatidylinositol. These phospholipid classes decline essentially in parallel during natural senescence of the flower and when microsomal membranes isolated from young flowers are aged in vitro. However, measurements of changes in the endogenous molecular species composition of microsomal phospholipids during natural senescence of the flower petals and during in vitro aging of isolated membranes have indicated that the various molecular species of phospholipids have quite different susceptibilities to catabolism. Acyl chain composition and the nature of the head group are both determinants of their susceptibility to catabolism. As well, a comparison of the phospholipid catabolism data for naturally senesced membranes and for membranes aged in vitro suggests that the phospholipid composition of membranes is continuously altered during senescence by acyl chain desaturation and possibly retailoring so as to generate molecular species that are more prone to catabolism. The results collectively indicate that provision of particular molecular species of phospholipids with increased susceptibility to degradation contributes to enhanced phospholipid catabolism in the senescing carnation petal.

Rapid protein kinase C-dependent activation of phospholipase D leads to delayed 1,2-diglyceride accumulation

We have shown previously that the major source of diglyceride (DG) formed following muscarinic receptor (mAChR) stimulation of 1321N1 astrocytoma cells is phosphatidylcholine (PC) rather than the phosphoinositides (Martinson, E. A., Goldstein, D., and Brown, J. H. (1989) J. Biol. Chem. 264, 14748-14754). We have also noted that there is a delay of several minutes before significant DG accumulation is observed. In the present work, we examine the time course and mechanism of PC hydrolysis in response to mAChR stimulation. Treatment of 1321N1 cells with carbachol results in increases in radiolabeled choline, phosphatidic acid (PA) and phosphatidylethanol (PEt), metabolites that are products of phospholipase D (PLD) action on PC. These products are all formed within 15 s of mAChR stimulation and reach a plateau within 30-60 s. The time course of PEt formation suggests that PLD is no longer activated after several minutes of mAChR stimulation. Thus there is a discrepancy between the rapid and transient activation of PLD and the delayed accumulation of DG. It appears that most of the DG is formed through the action of PLD, since propranolol (which inhibits the conversion of PA to DG) and down-regulation of protein kinase C (which prevents activation of PLD by carbachol) both markedly inhibit DG production. Using a protocol in which cells are stimulated with carbachol for only one minute (a period during which PLD and PA formation are maximally activated), we show that DG mass continues to increase following removal of agonist. We suggest that the rapid and transient activation of PLD results in delayed accumulation of DG due to the relatively slow conversion of PA to DG by PA phosphatase.

Control of a Desert-Grassland Transition by a Keystone Rodent Guild

Twelve years after three species of kangaroo rats (Dipodomys spp.) were removed from plots of Chihuahuan Desert shrub habitat, density of tall perennial and annual grasses had increased approximately threefold and rodent species typical of arid grassland had colonized. These were just the most recent and drmatic in a series of changes in plants and animals caused by experimental exclusion of Dipodomys. In this ecosystem kangaroo rats are a keystone guild: through seed predation and soil disturbance they have major effects on biological diversity and biogeochemical processes.

Endothelin induction of inositol phospholipid hydrolysis, sarcomere assembly, and cardiac gene expression in ventricular myocytes. A paracrine mechanism for myocardial cell hypertrophy

The present study examined the effects of endothelin-1 on phosphoinositide hydrolysis, diacylglycerol formation, and the induction of myocardial cell hypertrophy utilizing a well characterized cultured neonatal rat myocardial cell model. In this system, a hypertrophic response can be assessed by increases in myocardial cell size, an increase in the assembly of an individual contractile protein (myosin light chain-2) into organized contractile units, accumulation of contractile proteins, the activation of a program of immediate early gene expression, and the induction of genes encoding contractile and embryonic proteins (Iwaki, K., Sukhatme, V., Shubeita, H.E., Chien, K.R., (1990) J. Biol. Chem. 265, 13809-13817). Utilizing these criteria, the present study documents that stimulation with endothelin-1 can produce myocardial cell hypertrophy, induce the expression and release of ANF in ventricular cells, and can activate the transcription of cardiac-specific genes. In addition, endothelin-1 stimulates phosphoinositide hydrolysis and the accumulation of diacylglycerol. It is proposed that endothelin-1 stimulation may represent an important paracrine mechanism for the in vivo regulation of cardiac growth and hypertrophy.

Pupillary effects of alfentanil and morphine

We have measured the onset and extent of the miotic effect of morphine and alfentanil in conscious patients. Forty unpremedicated ASA I and II patients were allocated randomly to four groups to receive either i.v. saline (control group), morphine 0.1 mg kg-1, alfentanil 4.0 micrograms kg-1 or a combination of these doses, and pupil diameters were measured for the next 30 min. There were no significant differences in the control diameters. In the opioid groups, a significant decrease in diameter (about 1 mm), occurred 4 min after administration of the drug and persisted throughout the study. The opioid groups behaved similarly for 25 min. After 10 min the mean diameter of the alfentanil group began to increase, but this did not reach statistical significance until after 25 min.

Phosphorylation of magainin-2 by protein kinase C and inhibition of protein kinase C isozymes by a synthetic analogue of magainin-2-amide

Magainins are a family of antimicrobial peptides present in the skin extracts of Xenopus laevis. Both magainin-1 and -2 do not have any significant effect on the activity of protein kinase C (PKC). Magainin-2 was found to be readily phosphorylated by PKC to 0.5 mol 32P/mol of peptide. Neither magainin-1, which has a sequence of S8AGK and not S8AKK as in the case of magainin-2, nor the magainin-2 analogue with substitution of Ala for Ser8 was phosphorylated by the kinase, suggesting that Ser8 is the phosphorylation site of magainin-2. One synthetic analogue of magainin, designated magainin B, which has a greater tendency for alpha-helix formation in non-aqueous environment than the parent peptide resulting from substitution of Ser8, Gly13, and Gly18 with Ala in magainin-2-amide, is a potent inhibitor of PKC. This peptide inhibits all three PKC isozymes with IC50 less than 20 microM. Magainin B also inhibits the binding of [3H]phorbol 12,13-dibutyrate to the kinase. These results suggest that magainin-2 may be modified by PKC through phosphorylation and that certain synthetic analogues of magainins may be used as inhibitors of PKC.