[Arterial hypertension associated with hyperlipoproteinemia]

Hypertension and serum cholesterol levels are strongly interrelated as cardiovascular risk factors. The Framingham study showed that the risk of both ischaemic heart disease and brain infarction doubles in presence of mild hypertensive status and triplicates in presence of a definitive hypertension. The systolic pressure showed to be the best predictor of both ischaemic heart disease and cerebral infarction particularly in persons aged more than 65 years. In terms of physiopathology we point out several mechanisms by which hypertension could interact with hypercholesterolemia on the arterial wall causing endothelial lesion, enhancing the penetration of arterial wall by lipoproteins, calcium accumulation on smooth subendothelial muscle and suppression of the relaxation factor produced by endothelial cells. In relation to the dietetic treatment, we must restrict more rigorously the ingestion of salt, saturated fatty acids, and total calories. In terms of anti-hypertensive drugs, we should: Avoid thiazide diuretics in case of cholesterol levels of moderate to high risk. Avoid beta blockers in patients with high levels of triglycerides, low HDL and low ratio total cholesterol/HDL. Consider to choose a calcium antagonist, a converting enzyme or an alpha blocker.

Phenanthrylalkanoic acids, III: Syntheses and biological activities of 4-phenanthryl derivatives

Reformatsky reactions between 2,3-dihydro-4(1H)-phenanthrenone (5) and ethyl alpha-bromoacetate or propanoate yield several unsaturated esters which, upon aromatization followed by saponification, lead to the 4-phenanthrylacetic (1) and 2-(4-phenanthryl)propanoic (2) acids. The analgesic and anti-inflammatory properties of 1 and 2 were measured and compared with those of Fenbufen.

Radial bone mineral content in healthy Mexican women

Fifty healthy Mexican women from 21 to 70 years of age volunteered to undergo radial bone densitometry. The bone density in ten women per decade was assessed at two sites in the radius of the nondominant forearm; one site was the distal radius at 5 mm of separation from the ulna and the other at one-third of the distal radius. Calcium, inorganic phosphates and alkaline phosphatase were measured in serum samples and the calcium/creatinine ratio in fasting urine samples. Bone density at the distal radius was 360.6 +/- 36.2 mg/cm2, 369.8 +/- 47.9 mg/cm2 and 364.7 +/- 53.7 mg/cm2 in the 21-50 age group. There was no significant difference between these groups; the pooled value of all these samples was 365 +/- 46 mg/cm2. There was significant difference in the 51-60 age group, 290 +/- 48. mg/cm2 (p less than 0.01) and in the 61-70 age group. 277.9 +/- 49.9 mg/cm2 (p less than 0.01). Bone density at the one-third distal radius in the 21-20 age group was 696.3 +/- 60.9 mg/cm2; 31-40, 683.6 +/- 68.4 mg/cm2 and 41-50, 697.9 +/- 53.9 mg/cm2. There was no significant difference among these group; the pool of all these samples showed 692.6 +/- 59.6 mg/cm2. In the 51-60 age group it was 628.0 +/- 63.3 mg/cm2, a non significant difference. On the other hand, the density in the 61-70 group was 573.7 +/- 83.5 mg/cm2, significant (p less than 0.01) when compared to the 21-50 age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Longitudinal exposure to the seriously mentally ill: a halfway house affiliation

Psychiatric training takes place predominantly in institutional settings such as hospitals and outpatient clinics. There are significant benefits associated with training in community "field" sites. Conversely, training programs can be valuable resources for agencies providing residential and/or rehabilitative care for the mentally ill The authors discuss advantages to such affiliations and illustrate these with the affiliation of a halfway house with a psychiatry residency training program.

Deficient neurogenic innervation of the myenteric plexus with normal submucous plexus involving the entire small and large bowel

A newborn presented with a picture of intestinal obstruction. Multiple biopsies of the small and large bowel showed an unusual neurogenic innervation. The myenteric plexus of Auerbach was severely depleted of ganglion cells and nerve fibers, while the submucous plexus of Meissner was normally innervated. An ileostomy failed to function and extended trial with experimental smooth muscle stimulant (Cisapride) was equally ineffective. The patient was finally treated by a myectomy from the duodenum to the descending colon with a sigmoid colostomy. This procedure, coupled with a Nissen fundoplication, stopped the vomiting and allowed normal defecation through the colostomy. The patient is presently taking increasing increments of oral fluids with a concomitant decrease in the volume of parenteral nutrition. The myectomy initiated marked hypertrophy of the muscularis mucosa. Could this muscular hypertrophy account for the improvement in bowel function? Possible etiology will be discussed. We caution that rectal submucosal suction biopsy alone may be misleading if normal ganglion cells and nerve fibers are found, yet the patient's clinical symptoms fail to improve. A full thickness bowel wall biopsy is then recommended.

A prospective comparison of four techniques for measuring platelet-associated IgG

We describe a prospective study comparing four different assays for PAIgG. Platelets from patients with a variety of thrombocytopenic disorders were collected into ACD, washed, and the PAIgG then measured using three assays for surface PAIgG. These included: (a) a direct binding assay using 125I-monoclonal anti-IgG (MoAb); (b) a direct binding assay using 125I-staphylococcal protein A (SPA); and (c) a two-stage assay. PAIgG also was measured using an assay for 'total' PAIgG following platelet lysis. The mean +/- SD number of molecules of IgG per platelet on washed platelets from 29 healthy, non-thrombocytopenic controls was: 86 +/- 80 (125I-MoAb); 94 +/- 96 (125I-SPA); 3520 +/- 1890 (two-stage surface assay); and 10,850 +/- 3720 (total PAIgG). A total of 62 different patients with idiopathic thrombocytopenic purpura or thrombocytopenia complicating systematic lupus erythematosus, and 73 different patients with 'non-immune' thrombocytopenia, were tested using each of the four assays. These 'non-immune' thrombocytopenic patients included patients with carcinoma, septicaemia, pre-eclampsia, chronic leukaemia, thrombotic thrombocytopenic purpura, haemolytic uraemic syndrome, acute leukaemia and myelodysplasia. All four assays gave similar results for both the immune and non-immune thrombocytopenic patients. The sensitivity of the assays for the most severely thrombocytopenic patients with immune thrombocytopenia was: MoAb 60%; SPA 88%; two-stage 82%; and 'total' PAIgG 88%. The specificity of the four assays in the non-immune thrombocytopenic patients was 57% 'total' PAIgG; 63% two-stage surface; 25% SPA; 38% MoAb.(ABSTRACT TRUNCATED AT 250 WORDS)

Triiodothyronine nuclear binding capacity in rat tissues correlates with a 6.0 kilobase (kb) and not a 2.6 kb messenger ribonucleic acid hybridization signal generated by a human c-erbA probe

Recent studies have raised the possibility of multiple structurally distinctive tissue-specific nuclear T3 receptors, all exhibiting homology with the v-erbA oncogene and represented by mRNAs of various sizes. We have assayed the level of mRNAs recognized by a 32P-labeled cRNA derived from human plancetal c-erbA-A beta cDNA by solution hybridization and by Northern transfer in different rat tissues, as well as human liver and placenta. Two related mRNAs were demonstrated in the rat tissues analyzed, one measuring 6.0 and the other 2.6 kilobases (kb). In human liver and placenta a 6.0 kb mRNA was seen, but not a 2.6 kb mRNA. Only the 6.0 kb sequence correlated with the receptor concentration determined by 125I-T3 displacement analysis.

Differences in antibody recognition of the triiodothyronine nuclear receptor and c-erbA products

The in vitro translated products of several c-erbA cDNAs have recently been shown to bind thyroid hormones with high affinity and have been termed thyroid hormone receptors. We have used a panel of five erbA-related antibodies to probe the relationship between c-erbA translated products and thyroid hormone receptors, as conventionally measured by 125I-T3 labeling of nuclear extracts. All five antibodies immunoprecipitated the chick c-erbA translated products, but only one of them recognized chick liver and brain T3 receptor, as judged by acceleration of sedimentation through sucrose gradients. None of the antibodies reacted with rat liver and brain or human liver T3 receptors, although one antibody did immunoprecipitate a human c-erbA translated product. We conclude that the T3 receptor, as conventionally measured from these sources, is related but not identical to recently cloned c-erbA sequences.

Heparin-induced thrombocytopenia: laboratory studies

This report describes studies into the pathophysiology of heparin-induced thrombocytopenia. The IgG fraction from each of nine patients with heparin-induced thrombocytopenia caused heparin-dependent platelet release of radiolabeled serotonin. Both the Fc and the Fab portions of the IgG molecule were required for the platelet reactivity. The platelet release reaction could be inhibited by the Fc portion of normal human or goat IgG, and patient F(ab')2, but not F(ab')2 from healthy controls. These results suggested that the Fab portion of IgG binds to heparin forming an immune complex and the immune complexes initiate the platelet release reaction by binding to the platelet Fc receptors. To directly challenge this hypothesis, we preincubated the serotonin-labeled platelets with the monoclonal antibody against the platelet Fc receptor (IV.3). This monoclonal antibody completely inhibited the release reaction caused by heparin and patient sera, as well as heat aggregated IgG, but did not block collagen or thrombin-induced platelet release. Heparin-dependent platelet release also could be inhibited in vitro by the addition of monocytes and neutrophils, but not by red cells, presumably because the Fc receptors on the phagocytic cells have a higher binding affinity for IgG complexes than do platelets. Platelets from patients with congenital deficiencies of specific glycoproteins Ib and IX (Bernard-Soulier syndrome) and IIb and IIIa (Glanzmann's thrombasthenia) displayed normal heparin-dependent release indicating that the release reaction did not require the participation of these glycoproteins. These studies indicate that heparin-induced thrombocytopenia is an IgG-heparin immune complex disorder involving both the Fab and Fc portion of the IgG molecule.

Colocalization of calcitonin gene-related peptide and somatostatin in pancreatic islet cells and inhibition of insulin secretion by calcitonin gene-related peptide in the rat

Calcitonin gene-related peptide (CGRP)- and somatostatin (SRIF)-containing cells were identified by immunocytochemical techniques in pancreatic islet cells of the rat. CGRP-containing cells were found primarily in the peripheral portion of the pancreatic islets. In addition, CGRP-containing cells also contained somatostatin, which identifies the islet CGRP-containing cells as D cells. In the present study, we also tested the effect of CGRP on gastrin-releasing peptide (GRP; 10(-9) M)- or cholecystokinin (CCK-8, 10(-9) M)-stimulated release of insulin from isolated rat islets in vitro. At concentrations of 10(-8)-10(-11) M, CGRP inhibited GRP- and CCK-8-stimulated release of insulin significantly when compared with GRP or CCK-8 alone. At the lowest concentration of CGRP (10(-11) M), the inhibitory effect of CGRP on CCK-8-stimulated release of insulin was statistically significant (p less than 0.05) and exceptionally potent (65-90% inhibition). We have also found that CGRP does not stimulate the release of SRIF from isolated islet cells. These findings suggest that CGRP may play a regulatory role in the release of insulin.

Labile proteins are necessary for T3 induction of growth hormone mRNA in normal rat pituitary and rat pituitary tumor cells

Previous studies from our laboratory have shown that ongoing protein synthesis is required for L-tri-iodothyronine (T3) regulation of rat hepatic genes. In this report we have examined the role of ongoing protein synthesis in T3 regulation of the growth hormone gene (GH) in rat pituitary and GC cells. T3 (200 micrograms/100 g body weight injected intraperitoneally or 10(-8) M added to the media) induced a 3-fold rise of GH mRNA concentration after 8 h in rat pituitary (from 5.9 +/- 1% to 17.8 +/- 1.4% of an internal standard (IS), p less than 0.01) and a 5-fold rise in GC cells after 6 h (from 0.1 +/- 0.01% to 0.54 +/- 0.03% of IS, p less than 0.01). Cycloheximide (1 mg/100 g body weight intraperitoneally or 25 microM added to the media) completely blocked the increase in GH mRNA when given before the hormone in rat pituitary (7.5 +/- 0.5% of IS after 8 h) and GC cells (0.095 +/- 0.01% of IS after 6 h). Similar results were observed when emetine and puromycin were used to block protein synthesis. GH transcription rate in pituitaries from hypothyroid animals was 20 +/- 8 ppm and increased to a value of 295 +/- 85 parts per million 2 h after the injection of T3, and a similar 8-fold increase was observed in GC cells after 2 h. However, when cycloheximide was given before the hormone, the T3-induced increase in transcription was completely blocked. We also demonstrate here that the differences observed in GH transcription rate between hypo- and euthyroid rat pituitaries fully account for the differences observed in mRNA concentration. We conclude that short-lived proteins are involved in T3 regulation of the GH gene in rat pituitary and GC cells.

Cycloheximide inhibits S-14 gene transcription and abolishes DNase I hypersensitive S-14 sites in the livers of euthyroid but not hypothyroid rats

Earlier studies from our laboratory have demonstrated that cycloheximide administration to hypothyroid rats inhibited the induction of the hepatic mRNA-S14 by T3. These results suggested a role of short-lived proteins in the hormonal regulation of this gene. To define the possible mechanism of the cycloheximide effect, we examined the influence of cycloheximide on the in vitro transcription rate of the gene and its chromatin structure. Forty-five minutes after injection of cycloheximide to euthyroid rats, the in vitro transcriptional rate fell by 60% and this effect persisted for 4 h. In the same euthyroid rats, cycloheximide caused the disappearance of all four DNase I-hypersensitive sites situated in the 5'-flanking region of the gene. However, cycloheximide given to hypothyroid rats affected neither the basal transcription rate nor the chromatin structure. When cycloheximide was administered 30 min after an acute injection of T3 (200 micrograms/100 g BW) to hypothyroid animals, it completely blocked the hormone induction of the transcriptional rate. These results suggest that one or more labile proteins are required for maintenance of S14 chromatin structure in a configuration which permits hormonal regulation of gene expression. The ability of cycloheximide to block mRNA-S14 induction by T3 appears to be mediated at least in part by an inhibition of T3-stimulated transcription.

Triiodothyronine regulation of multiple rat hepatic genes: requirement for ongoing protein synthesis

We have examined the role of rapidly turning over proteins in the T3 regulation of multiple rat hepatic genes. T3 induction of the rapidly responsive mRNA-S14 was markedly inhibited by cycloheximide (1 mg/100 g BW) or emetine (3 mg/100 g) injected ip 30 min before T3 (mRNA-S14 concentration was only 35% of that in T3-treated controls 8.5 h after administration of either protein synthesis inhibitor, P less than 0.01). Cycloheximide exhibited a similar effect on each of five other more slowly responsive T3 regulated genes. When cycloheximide was given 10 h after T3, the expected T3-induced rise of mRNA-S7 activity was completely prevented, and for mRNA-S4 activity the anticipated rise was blunted to 40% of T3-treated control (P less than 0.05). Cycloheximide caused sharp declines in the activity of two other mRNAs, S6 and S8, which because of shorter lag times of response to T3, had already risen when the drug was given. Values for both these mRNAs returned to the baseline hypothyroid level within 6 h of injection of the drug and remained low for a further 8 h (P less than 0.05). The expected deinduction of mRNA-S10 by T3 was also markedly modified. T3 lowered this mRNA to 11% of the hypothyroid control after 8 h, whereas cycloheximide given 30 min before the hormone blunted this fall to only 72% of control (P less than 0.01). Thus there appeared to be a 70% reduction in the rate of T3 induced fall of mRNA-S10. We did not find that cycloheximide caused a generalized decrease in poly (A)+ RNA mass.(ABSTRACT TRUNCATED AT 250 WORDS)

Insulin and glucagon production in experimental cirrhosis

The release of insulin and glucagon in cirrhotic rats was examined. Rats were made cirrhotic by a combination treatment of carbon tetrachloride (CCl4) and phenobarbitone. Liver cirrhosis was verified by histologic findings. Both basal and stimulated release of insulin from isolated pancreatic islets, in vitro, were decreased significantly in cirrhotic rats, as compared with control rats. Basal, but not stimulated, levels of glucagon, in vitro, were reduced significantly in cirrhotic rats. Circulating levels of plasma insulin, glucagon, glucose, bilirubin, and amylase levels were unaffected in cirrhotic rats when compared with control rats. There were no signs of pancreatitis. The results indicated that the release of insulin and glucagon is depressed in cirrhotic rats and in rats treated with phenobarbitone and CCl4. Clearance of circulating insulin and glucagon by the liver was apparently reduced, since circulating levels of insulin and glucagon were unaltered in all treated rats.

Repair of atrioventricular septal defects in infancy

Fifteen infants less than 12 months of age with complete atrioventricular septal defects underwent repair of the defect between January, 1981, and December, 1984. The average age at operation was 8 1/2 months and the average weight was 5.7 kg. Eight of 15 (53%) infants had preoperative mild to moderate mitral insufficiency. Pulmonary artery hypertension was present in all infants and 13 of 15 infants had a pulmonary arterial resistance greater than 4 units (mean 8.8 units). Operative indication was based on pulmonary artery hypertension, congestive heart failure, and failure to thrive. Ventricular distention was utilized during operative repair to assess location of valve incision, level of attachment of valves to the patch, and cleft approximation. It was also used to check the competency of the mitral repair once complete. The average circulatory arrest time was 55.7 minutes. There were no operative deaths. There were two late deaths. We conclude that ventricular distention is the key to the operation, and operative repair is safe in infants with atrioventricular septal defects.