Selective and non-selective loss of immunoregulatory molecules (HLA-A,B,C antigens and LFA-3) in transitional cell carcinoma

The expression of the major histocompatibility complex (MHC) class I and II antigens and lymphocyte function-associated antigen-3 (LFA-3) was investigated using immunohistochemical staining of bladder tissue sections from 18 patients with transitional cell carcinoma (TCC) and two normal bladder specimens. The expressions of HLA-A,B,C antigens varied greatly between different tumours. Complete loss was observed in one of 18 cases. Moderate to strong expression of HLA-A,B,C antigens was observed in 10 of 18 cases with the remaining seven cases showing either weak expression or expression on only a proportion of the tumour cells. Selective loss of HLA-Bw6 was seen in one of 18 cases. In many cases heterogenous and often focal expression of HLA-D products was seen. In one case tumour cells not expressing HLA-DR antigens were adjacent to strongly HLA-DR expressing non-neoplastic bladder epithelium, indicating a lack of inducible HLA-DR in the tumour cells. LFA-3 was undetectable in two of 18 cases with the remaining 16 cases showing moderate to strong expression of the molecule. These findings indicate that a substantial proportion of bladder tumours have one or more of a wide range of different alterations in the expressions of immunoregulatory molecules that could contribute to escape from immune surveillance.

Histologic study of eyes with transsclerally sutured posterior chamber intraocular lenses

We studied the postmortem histologic characteristics of two eyes that had undergone penetrating keratoplasty and transscleral suturing of a posterior chamber intraocular lens for bullous keratopathy. The eyes were studied three days postoperatively in a 79-year-old man with pseudophakia and six months postoperatively in an 83-year-old man with aphakia. We also removed a posterior chamber intraocular lens in a 73-year-old woman who had an epithelial downgrowth three months postoperatively. In the first two cases, only one of four haptics was successfully positioned in the sulcus. Histologic study disclosed a thin fibrous capsule surrounding the haptics at their attachment site, no inflammation around the transscleral portion of the suture, and exposure of a suture tip externally. In the third case, the intraocular lens fell back into the vitreous cavity after the fixation sutures were cut externally at the time of surgical removal. Stability of the lens in all three cases was primarily a result of intact transcleral sutures and not fibrous encapsulation or ciliary sulcus placement of haptics.

The effects of phonosurgery on laryngeal vibration: Part I. Theoretic considerations

Surgical manipulation of the laryngeal framework (phonosurgery) is rapidly gaining interest and attention. To date, however, a comparative objective evaluation of the various phonosurgical techniques has not been reported. A theoretic model of the larynx, a four-mass model based on the work of Ishizaka (J Acoust Soc Am 1976;60:1193-8) and Koizumi et al. (J Acoust Soc Am 1987;82:1179-92), was developed and adapted to simulate laryngeal biomechanical behavior, as understood by current research. The model was then applied to a comparative evaluation of phonosurgical techniques. Input parameters that correlate laryngeal function and model simulation were developed. Surgical procedures were categorized according to their effect on these parameters. A model simulation of these techniques allowed comparison and prediction of the results of phonosurgery and a better understanding of the issues involved with surgical alteration of the voice.

Polyneuropathy, ophthalmoplegia, leukoencephalopathy, and intestinal pseudo-obstruction: POLIP syndrome

We describe 5 individuals (from three separate families) with a progressive neurological disorder characterized by sensorimotor peripheral polyneuropathy, cranial neuropathies (external ophthalmoplegia, deafness), and the syndrome of chronic intestinal pseudo-obstruction. Magnetic resonance imaging showed widespread abnormality of the cerebral and cerebellar white matter in the 2 patients studied. Autopsy examination in 3 revealed widespread endoneurial fibrosis and demyelination in the peripheral nervous system, possibly secondary to axonal atrophy, and poorly defined changes in cerebral white matter (leukoencephalopathy). The cranial nerves and spinal roots were less severely involved and the neurons in the brainstem and spinal cord were intact. The fatal gastrointestinal dysmotility was due to a severe visceral neuropathy. We suggest that these patients manifested a hereditary disorder with distinctive clinical, radiological, and neuropathological features, and propose the acronym POLIP to emphasize the distinctive tetrad of polyneuropathy, ophthalmoplegia, leukoencephalopathy, and intestinal pseudo-obstruction.

The intracranial topography of the P3 event-related potential elicited during auditory oddball

In order to isolate the anatomical locus of neural activity primarily responsible for generating the scalp-recorded P3 (or P300), the topography of event-related potentials (ERPs) elicited during an auditory oddball task was compared between medial-to-lateral aspects of the frontal, parietal, and temporal lobes in 10 epileptic patients undergoing stereoelectroencephalography for seizure localization. Evidence of local ERP generation was obtained from each of these areas. Small amplitude P3-type potentials were sometimes observed to invert polarity across recording contacts in the frontal lobe. Large amplitude positive polarity P3-type components were observed in the lateral neocortex of the inferior parietal lobule (IPL), that rapidly attenuated in amplitude at more anterior, posterior, superior, inferior, and medial recording contacts. Large amplitude polarity inverting P3-type components were also observed to be highly localized to hippocampal contacts of temporal lobe electrodes. These data are discussed in the context of other recent studies of lesion effects, scalp topography, and intracranial recordings, and it is concluded that activity generated in the IPL is likely to make the major contribution to the scalp-recorded P3, with smaller contributions from these other sources. Finally, salient topographical differences between the intracranial distribution of the P3 and those of the N2 (or N200) and slow wave (SW) suggest that the generators of these components are not identical.

Opioid receptors in skeletal muscle of normal and dystrophic mice

Autoradiography was used to investigate the presence of opioid receptors in soleus, extensor digitorum longus (EDL) and diaphragm muscles in two strains (C57BL/6J and C57BL/10) of mice which can inherit muscular dystrophy. Binding sites for two radiolabelled opioid ligands [125I]beta-endorphin and [3H]naloxone, were seen in a few muscle fibres in the normal mice. However, a significantly greater number of fibres exhibited the binding sites in the dystrophic individuals of both strains. The binding sites were not restricted to the endplate regions but were present over the entire surface in these fibres.

Neuronal activity in the human medial temporal lobe during recognition memory

Human medial temporal lobe neuronal activity and event-related potentials were recorded during the following behaviours: contextual recognition of words and faces, semantic discrimination of nonwords from words, and discrimination of stimulus classes based on perceptual attributes. Three distinct classes of behavioural correlates of unit activity were demonstrated by visual inspection of peristimulus histograms and by nonparametric statistics: (1) neuronal excitation during a keypress related to the subject's choice; (2) specific and nonspecific excitation to words; (3) excitation or inhibition to rare stimuli in a sensory discrimination task. Responses specifically to familiar (as opposed to unfamiliar) words or faces, or to tasks requiring recent memory per se were never seen. Keypress excitation was relatively common (32/76 units) and occurred regardless of whether the keypress target was a repeated or nonrepeated word, or the task required recent or remote semantic memory. In a more complex recognition task utilizing two responses and an imperative cue for the patient's response, units with prior keypress excitation failed to generate the response. This suggests that keypress excitation is not strictly tied either to response choice or to generation. The onset latencies and temporal relationship to event-related potentials of the nonspecific and specific excitation to words and the excitation to rare stimuli suggest that they represent contextual encoding of stimuli. Similar evidence suggests that the inhibition to rare stimuli represents inhibitory processes terminating contextual encoding. Thus human medial temporal lobe neurons seem to contribute information during successive stages of a cognitive stimulus-response task: contextual encoding, closure and response-selection.

Disintegration of mercury disc cells in simulated gastric juice: implications for management of disc cell ingestion

The disintegration of charged alkaline mercury button cells in simulated gastric fluid over a 24 h period has been studied. The integrity of the cells and the amount of mercury that can leak out of them were assessed. The cells raised the pH of the incubating solutions. Disruption was seen in five out of 18 cells tested in 0.1 mol/L hydrochloric acid and one out of nine in 0.9% saline. Five of the six disrupted cells were made by the same manufacturer. Major leakage of mercury only occurred after complete disintegration of the cells. The implications of these findings for the management of patients who have ingested mercury-containing button cells are discussed.

How recent medical school graduates evaluate the clinical relevancy of their behavioral science curriculum

Recent graduates of the University of South Carolina School of Medicine (n=108) evaluated the clinical relevancy of their behavioral science curriculum. The results indicate that a body of behavioral science data are clinically relevant to physicians regardless of their specialty. Additional behavioral science content areas are clinically relevant for practitioners in particular medical specialties. Suggestions are made for the role of behavioral science material in continuing medical education.

Localisation of acetylcholinesterase in rat myotubes in the presence of beta-endorphin and beta-endorphin-(1-27)

In rat embryo skeletal myotubes, acetylcholinesterase is present, as multiple forms, and can be detected in deposits at the cell surface. Myotubes cultured in the presence of beta-endorphin, exhibit an increased predominance of the globular (precursor) forms of the enzyme, which are largely restricted to intracellular sites associated with nuclei. In the presence of beta-endorphin-(1-27), the relative proportions of the different forms of acetylcholinesterase is similar to that seen in the controls, but the enzyme is intracellular and has a characteristic focal localisation in the myotube.

The organization, delivery, utilization and financing of rehabilitation care for the elderly

In order to meet the needs of a large elderly disabled population in the 1990s, the inevitable close linkage between the hospital and post-acute care providers will place increased demands and responsibilities upon the hospital management team and their hospital practicing physicians for patient care decisions along the continuum of care for the elderly.

Sequence of tissue responses in the early stages of experimental allergic encephalomyelitis (EAE): immunohistochemical, light microscopic, and ultrastructural observations in the spinal cord

Experimental allergic encephalomyelitis (EAE) was induced in adult Lewis rats with purified guinea pig CNS myelin and Freund's adjuvant. As soon as the very earliest clinical signs appeared the animals were perfused with fixatives and the spinal cord analyzed by electron microscopy, silver methods, and immunocytochemistry. Our findings suggest that in the early stages of EAE a sequence of events can be traced, although these events frequently overlap. The earliest morphological change appears to be astrocytic edema in both the cell body and processes. Increased amounts of glycogen particles and dispersion of glial filaments are prominent. These changes seem to occur just prior to the time when inflammatory cells begin to penetrate the capillary walls. Invasion of the neuropil mainly by macrophages and lymphocytes closely follows. Both macrophages and microglia seem to participate in phagocytosis of oligodendrocytes and myelin. Demyelination, however, is not a prominent feature at this early stage.

Intracellular and extracellular levels of cyclic AMP during the cell cycle of Saccharomyces cerevisiae

Using the technique of centrifugal elutriation it was demonstrated that during the cell division cycle of the budding yeast Saccharomyces cerevisiae there are stage-specific fluctuations in the intracellular concentration of adenosine 3',5'-cyclic monophosphate (cAMP). Results shown here indicate that the intracellular concentration of cAMP is at its highest during the division cycle, and at its lowest immediately prior to and just after cell separation. Results also show the extrusion of extracellular cAMP into the medium by Saccharomyces cerevisiae, extracellular cAMP levels being ten to one hundred times higher than intracellular levels. During the cell cycle of Saccharomyces cerevisiae the extracellular level of cAMP does not fluctuate.

Repetition priming of words and pseudowords in divided attention and in amnesia

Repetition priming of novel stimuli (pseudowords) and stimuli with preexisting representations (words) was compared in two experiments. In one, 19 normal male subjects performed a lexical decision task with either focused or divided attention. In another, lexical decision performance was compared between 8 male Korsakoff patients and 8 alcoholic control subjects. In control conditions, repetition speeded responses to both stimulus types. Experimental conditions that minimized the contribution of episodic memory to task performance eliminated reaction time priming for pseudowords but not for words. However, in these same conditions, repetition increased the likelihood that pseudowords would be incorrectly classified. These results indicate that preserved repetition priming effects in amnesia do not solely reflect activation of representations in semantic memory.

Multicenter controlled study of Sinemet CR vs Sinemet (25/100) in advanced Parkinson's disease

Controlled-release carbidopa/levodopa 50/200 (Sinemet CR) and standard carbidopa/levodopa (Sinemet 25/100) were compared in a multicenter double-blind trial involving 202 patients with advanced Parkinson's disease and motor response fluctuations. Treatment with Sinemet CR significantly reduced daily "off" time. According to both physician and patient global ratings, patients showed significant improvements with Sinemet CR compared to treatment with standard Sinemet. Patients preferred Sinemet CR treatment by a ratio of approximately 2 to 1. Daily dosing frequency was 33% less with Sinemet CR, while daily intake of levodopa required was increased by 25%. The safety profiles of the 2 formulations were similar. We conclude that Sinemet CR is superior to standard Sinemet for many patients with advanced Parkinson's disease, although it does not solve the problem of fluctuating motor performance.

Pharmacokinetics and bioavailability of Sinemet CR: a summary of human studies

The pharmacokinetics of Sinemet CR, a controlled-release formulation containing carbidopa and levodopa, were investigated in healthy young and elderly volunteers and in patients with Parkinson's disease. Sinemet CR produced more sustained plasma levels of levodopa, carbidopa, and 3-O methyldopa than did conventional Sinemet. In elderly subjects, the corresponding steady-state plasma levels fluctuated in narrower ranges with Sinemet CR than those following the administration of Sinemet. Results indicate a levodopa bioavailability of 71% for Sinemet CR, in contrast to a bioavailability of 99% for Sinemet for these subjects. The carbidopa bioavailability of Sinemet CR was 58% relative to that of Sinemet. Systemic decarboxylase inhibition was comparable between the 2 regimens as indicated by the renal clearance of levodopa. The absorption of levodopa was slower and more protracted with Sinemet CR than with Sinemet. Food increased the levodopa bioavailability of Sinemet CR. This increase was attributed to an increased gastric retention time. No dose-dumping occurred with Sinemet CR in either the nonfasting or the fasting state. Levodopa bioavailability was lower in young volunteers than in elderly volunteers. This was attributed to an age-related decrease in gastric emptying and in 1st-pass metabolic decarboxylation in the gastrointestinal (GI) tract. In parkinsonian patients, as in healthy subjects, the Sinemet CR formulation produced more sustained levodopa plasma levels. These patients required a higher total daily dosage of Sinemet CR than of Sinemet for control of parkinsonian symptoms, but less frequent dosing was required during chronic therapy. Peak plasma levodopa levels increased proportionately with increasing Sinemet CR dosage. These observations were consistent with the pharmacokinetic characteristics of the formulation.

Frontal sinus osteoma

Osteoma is the most common benign tumor of the nose and paranasal sinuses, and the frontal sinus is its most frequent location. This tumor may be discovered incidentally on radiographs or may enlarge to produce symptoms and, rarely, complications referable to its location near the orbit and anterior cranial vault. A series of 22 cases of frontal sinus osteoma treated at the UCLA Center for the Health Sciences is reviewed. The presenting symptoms of this tumor, patient examination, radiographic evaluation, diagnosis, and indications for surgical and nonsurgical management are discussed. Various surgical approaches are reviewed, with emphasis on the advantages and disadvantages of each technique. Issues at surgery include the location of the surgical incision, technique of sinus entry, tumor removal, status of the posterior sinus table, patency of the nasofrontal duct, sinus obliteration, and avoidance of cosmetic deformity. Patient outcomes are assessed and recommendations given based on our findings and experience.

Proopiomelanocortin-derived peptides in mice with motoneurone disease

beta-Endorphin and alpha-melanotropin immunoreactivity was detected in motor nerves in histological sections of murine skeletal muscle, using the peroxidase-antiperoxidase technique. In mice of the wobbler strain, which can inherit motoneurone disease, a significantly higher proportion of the intramuscular nerves in soleus, extensor digitorum longus and diaphragm muscles of the diseased mice were immunoreactive than in the corresponding muscles of their healthy littermates.

Angiolymphoid hyperplasia with eosinophilia of the orbit associated with obstructive airway disease

Two patients with angiolymphoid hyperplasia with eosinophilia isolated to the orbit had eyelid swelling, a superior orbital mass, and histories of intermittent obstructive airway disease. One patient later developed a transient peripheral blood eosinophilia as high as 36%. One lesion recurred 38 months postoperatively and responded to systemic corticosteroid therapy.