Germline expression of H-Ras(G12V) causes neurological deficits associated to Costello syndrome

Costello syndrome (CS) is a rare congenital disorder caused by germline activation of H-Ras oncogenes. A mouse model of CS generated by introduction of an oncogenic Gly12Val mutation in the mouse H-Ras locus using homologous recombination in embryonic stem (ES) cells has been recently described. These mice phenocopied some of the abnormalities observed in patients with CS, including facial dysmorphia and cardiomyopathies. We investigated here their neurological and behavioral phenotype. The analysis of H-Ras(G12V) mice revealed phenotypes that resembled the hyperemotivity, hypersensibility and cognitive impairments observed in children with CS. Stronger neurological deficits were found in the analysis of mice homozygous for this mutation than in the analysis of heterozygous mice, suggesting the existence of a gene dose effect. These mice represent the first mouse model for CS, offering an experimental tool to study the molecular and physiological alterations underlying the neurological manifestations of CS and to test new therapies aimed at preventing or ameliorating the cognitive and emotional impairments associated to this condition.

Determinants of coronary artery calcification progression in renal transplant recipients

Coronary artery calcification (CAC) is associated with increased atherosclerotic burden and cardiovascular events. The objective of this study was to determine the natural history and risk factors associated with CAC progression in a cohort of incident asymptomatic renal transplant recipients with no history of coronary revascularization. Electron-beam computed tomography was performed in 82 subjects at time of transplantation and at least 1 year later. Mean (SD) and median CAC score increased for all subjects from 392.4 (747.9) and 75.8 at time of transplant to 475.3 (873.5), (p = 0.002[log]) and 98.9 (p < 0.001), respectively. Most subjects (89%) with no calcifications remained without calcification. Mean annualized rate (SD) of CAC score change was 52.5 (150) with a median of 0.5. Average yearly percent change was 67.3 (409.6) with a median of 1.4. In multivariate analysis, diastolic blood pressure at 3 months post-transplant, Caucasian race, glomerular filtration rate at 3.0, months post-transplant, body mass index and baseline CAC score were independent predictors of annualized rate of CAC change. There is significant progression of CAC post-renal transplantation in most subjects. Progression is most likely to occur in white patients and is associated with clinical factors such as blood pressure, body mass index, renal function and baseline CAC score.

Medical ethnobotany of the Teribes of Bocas del Toro, Panama

Ethnomedical uses of 108 medicinal plant species, belonging to 52 families, 89 genera, used by the Teribe Amerindians of Bocas del Toro Province in Panama, along with their socio-cultural practices are reported here. The methods of administration of the herbal remedies, the plant parts used, their families and local names are also documented. The recorded medicinal plants were used mainly for fever, various type of pain and inflammation. The potential value of 26 plants and their traditional uses was elucidated through literature search.

Decay of sperm obtained from epididymes of wild ruminants depending on postmortem time

We have carried out a study on the effect of postmortem time (PT) in some characteristics of epididymal sperm salvaged from hunted Iberian red deer and roe deer. Testis were collected, identified, refrigerated down to 5 degrees C, and sent to our laboratory by the wardens of the hunting reserves. This way, samples were delivered at different times postmortem. Sperm were extracted from the cauda epididymis by means of cuts. Analyzed parameters were: osmolality, pH, motility-both subjectively and with CASA, HOS test reactivity, acrosomal status and viability (assessed with propidium iodide). Osmolality and pH rose with prolonged postmortem time, possibly due to tissue decomposition. Most sperm quality parameters negatively correlated with PT. Besides, when comparing PT classes (groups of 24 h for red deer and 30 h for roe deer), we could appreciate that motility was more affected by PT than other quality variables. Progressive motility was especially impaired. We also classified the samples in high, medium and low quality for each PT group (considering progressive motility, intact acrosomes and reactivity to the HOS test), and it was clear that after 2 days the number of high quality samples was testimonial, and after several days, we almost found only low quality samples. In conclusion, epididymal sperm from Iberian red deer and roe deer undergo a decrease of quality with PT, but it could stay acceptable within many hours postmortem. There are implications for wildlife conservation programs, as epididymal sperm is a good source of germplasm. If valuable animals die and it is not possible to process their sperm immediately, it may still be possible to obtain viable spermatozoa many hours later.

Are dyspepsia management guidelines coherent with primary care practice?

BACKGROUND

Spontaneous physician behaviour can affect guideline applicability, implementation strategies and application costs, particularly in relation to widespread pathologies chiefly managed by general practitioners (GPs). Of the array of dyspepsia management guidelines, the closest to general practice, partly owing to proposing committee composition, are the European Society for Primary Care Gastroenterology (ESPCG) guidelines.

METHODS

To evaluate variability in dyspepsia management among GPs in Padua and divergence in spontaneous prescriptive behaviour from the ESPCG dyspepsia guideline, we prospectively studied the behaviour of 39 GPs over a 3-month period of outpatient activity, through questionnaires on each consultation. Test-group representativeness was preliminarily defined in terms of antisecretory drug expenditure.

RESULTS

1790 forms on dyspepsia-related consultations were studied in a population of 51,193 registered patients; 1264 patients with a history of dyspeptic pathology consulted their GP (19% duodenal ulcer (DU), 9% gastric ulcer (GU), 54% gastro-oesophageal reflux disease (GERD), 32% non-ulcer dyspepsia (NUD), 1% cholelithiasis), while 526 patients presented with symptoms of dyspepsia with no previous gastroscopy (EGDS) (42% were aged <45 years), of whom 42% had twice consulted their GP. Empirical management by prescription of symptomatic drugs was the most common procedure in DU (33%), GU (73%) and NUD (74%) relapses. Helicobacter pylori eradication therapy was prescribed in only 2% of patients with a history of organic or functional dyspepsia. 145 patients with uninvestigated dyspepsia were referred for second-level endoscopy and 43 for H. pylori testing. Forty-four percent of endoscopies prescribed for uninvestigated patients did not comply with the ESPCG guideline; full compliance would have determined a 105% rise in endoscopies. Prescriptive variability between GPs was high (based on the Goodman-Kruskal (0.41, P < 0.001) and Cramer tests (V = 0.51, P < 0.005)) and agreement between observed and expected prescriptions according to ESPCG criteria was as low as V = 0.11. On the basis of the most frequently observed behaviours, we developed three options of the ESPCG guideline and compared them to spontaneous prescriptions.

CONCLUSIONS

Highest compliance emerged where the clinical approach for all patients with uninvestigated dyspepsia was symptomatic therapy at first presentation followed by a different attitude at second presentation, setting a higher cut-off age than in the guideline (which in our case proved, on mathematical calculation, to be 55 years).

Brown adipose tissue-specific insulin receptor knockout shows diabetic phenotype without insulin resistance

Although insulin regulates metabolism in both brown and white adipocytes, the role of these tissues in energy storage and utilization is quite different. Recombination technology using the Cre-loxP approach allows inactivation of the insulin receptor in a tissue-specific manner. Mice lacking insulin receptors in brown adipocytes show an age-dependent loss of interscapular brown fat but increased expression of uncoupling protein-1 and -2. In parallel, these mice develop an insulin-secretion defect resulting in a progressive glucose intolerance, without insulin resistance. This model provides direct evidence for not only a role for the insulin receptors in brown fat adipogenesis, the data also suggest a novel role of brown adipose tissue in the regulation of insulin secretion and glucose homeostasis.

A regulatory light chain of ciliary outer arm dynein in Tetrahymena thermophila

Ciliary beat frequency is primarily regulated by outer arm dyneins (22 S dynein). Chilcote and Johnson (Chilcote, T. J., and Johnson, K. A. (1990) J. Biol. Chem. 256, 17257-17266) previously studied isolated Tetrahymena 22 S dynein, identifying a protein p34, which showed cAMP-dependent phosphorylation. Here, we characterize the molecular biochemistry of p34 further, demonstrating that it is the functional ortholog of the 22 S dynein regulatory light chain, p29, in Paramecium. p34, thiophosphorylated in isolated axonemes in the presence of cAMP, co-purified with 22 S dynein and not with inner arm dynein (14 S dynein). Isolated 22 S dynein containing phosphorylated p34 showed approximately 70% increase in in vitro microtubule translocation velocity compared with its unphosphorylated counterpart. Extracted p34 rebound to isolated 22 S dynein from either Tetrahymena or Paramecium but not to 14 S dynein from either ciliate. Binding of radiolabeled p34 to 22 S dynein was competitive with p29. Phosphorylated p34 was not present in axonemes isolated from a mutant lacking outer arms. Two-dimensional gel electrophoresis followed by phosphorimaging revealed at least five phosphorylated p34-related spots, consistent with multiple phosphorylation sites in p34 or perhaps multiple isoforms of p34. These new features suggest that a class of outer arm dynein light chains including p34 regulates microtubule sliding velocity and consequently ciliary beat frequency through phosphorylation.

Effects of local bupivacaine instillation on pain after laparoscopy

STUDY OBJECTIVE

To evaluate the effect of preincisional and intraperitoneal bupivacaine administration on immediate and late pain after operative laparoscopy.

DESIGN

Randomized study (Canadian Task Force classification I).

SETTING

University teaching hospital.

PATIENTS

One hundred fifty women undergoing laparoscopy for various gynecologic indications.

INTERVENTION

A dose of 0.5% bupivacaine 10 ml (50 mg) was injected into cannula sites before incisions and another 10 ml diluted with 100 ml saline into the peritoneal cavity at completion of the procedure. Equal amount of physiologic saline was used in controls.

MEASUREMENTS AND MAIN RESULTS

Modified McGill pain intensity scores and amount of analgesic required in the recovery room and within 24 hours postoperatively were evaluated. Of 150 women, 142 completed the study (71 bupivacaine group, 71 controls). Groups did not differ significantly in body mass index, duration of surgery, return to consciousness, and analgesic requirement during 3-hour observation in the recovery room and 24 hours after discharge. Pain scores were highest 30 minutes after the procedure in both groups. At that time the pain score in the bupivacaine group was lower than that in the control group (1.8 +/- 0.2 vs 2.3 +/- 0.2, p <0.05). Beyond that time, the groups did not differ in pain scores and analgesic requirements.

CONCLUSION

Postoperative pain is the highest within 30 minutes after laparoscopy. Local instillation of bupivacaine before incision and intraperitoneally was effective in reducing pain immediately after operative laparoscopy, but the effect was not seen beyond 30 minutes.

Synergistic gene interactions control the induction of the mitochondrial uncoupling protein (Ucp1) gene in white fat tissue

Among a selected group of mouse strains susceptible to dietary obesity, those with an enhanced capacity for Ucp1 and brown adipocyte induction in white fat preferentially lost body weight following adrenergic stimulation. Based on the generality of this mechanism for reducing obesity, a genetic analysis was initiated to identify genes that control brown adipocyte induction in white fat depots in mice. Quantitative trait locus (QTL) analysis was performed using the variations of retroperitoneal fat Ucp1 mRNA expression in progeny of genetic crosses between the A/J and C57BL/6J parental strains and selected AXB recombinant inbred strains. Three A/J-derived loci on chromosomes 2, 3, and 8 and one C57BL/6J locus on chromosome 19 were linked to Ucp1 induction in retroperitoneal fat. Although A/J-derived alleles seemed to contribute to elevated Ucp1 expression, the C57BL/6J allele on chromosome 19 increased Ucp1 mRNA to levels higher than parental values. Thus, novel patterns of C57BL/6J and A/J recombinant genotypes among the four mapped loci resulted in a transgressive variation of Ucp1 phenotypes. Although the extent of the interchromosomal interactions have not been fully explored, strong synergistic interactions occur between a C57BL/6J allele on chromosome 19 and an A/J allele on chromosome 8. In addition to selective synergistic interactions between loci, variations in recessive and dominant effects also contribute to the final levels of Ucp1 expression.

Beliefs about breast cancer risk and use of postmenopausal hormone replacement therapy

BACKGROUND

Postmenopausal hormone replacement therapy (HRT) decreases the risks of coronary heart disease and osteoporosis, but increases the risk of breast cancer. Although only 20-30% of postmenopausal women in the United States take HRT, the relationship between breast cancer risk perception and use of HRT is not known.

OBJECTIVE

To assess the impact of belief that HRT increases breast cancer risk and high perceived risk of breast cancer on the use of HRT.

DESIGN

Cross-sectional mailed survey.

PARTICIPANTS

189 randomly selected postmenopausal women from a general internal medicine practice in the Philadelphia area.

MAIN RESULTS

Of the 268 women (67%) who returned surveys, 189 were postmenopausal; 70 (37%) were currently using HRT and 21 (11 %) had previously used HRT. Respondents' mean age was 59.6 years; 64% were Caucasian, and 33% had completed college. Fifty-nine women (33%) thought HRT increased the risk of breast cancer, 22 (12%) thought it did not, and 100 (55%) were unsure. Mean perceived lifetime risk of breast cancer was 31% (range 0%-100%). After multivariate adjustment, current use of HRT was inversely associated with age (OR 0.96 for each one-year increase, 95% CI 0.940.98), and positively associated with Caucasian race (OR 2.73, 95% CI 1.40-5.32). Use of HRT was not associated with belief that HRT increases the risk of breast cancer, breast cancer risk perception, or perceived severity of breast cancer.

CONCLUSIONS

Belief that HRT increases the risk of breast cancer and high perceptions of breast cancer risk may not be important barriers to use of HRT. Efforts to improve decision making about HRT should focus on previously established barriers, such as perceptions of menopause and lack of physician discussion, rather than misconceptions about breast cancer risk.

[Comparative study between sodium stibogluconate BP 88 and meglumine antimoniate in cutaneous leishmaniasis treatment. II. Biochemical and cardiac toxicity]

Toxicity of two antimonial pentavalents were evaluated in 111 patients with cutaneous leishmaniasis. Forty-seven patients received meglumine antimoniate (Group I) and 64 patients, sodium stibogluconate BP 88 (Group II), 20 mg Sbv/kg/day for 20 days. Evaluation of aminotransferases, alkaline phosphatase, amilase, creatinine, urea, urine analysis and electrocardiogram were performed at baseline, on the tenth and twentieth day of treatment. Greater frequency of aminotransferase abnormal levels were observed on the tenth and twentieth days in group II (p < 0.001) and a greater proportion of amilase abnormal levels at the tenth day in the same group (p < 0.001). There was a greater variation of aminotransferases, alkaline phosphatase and amilase in the first ten days of treatment in group II (p < 0.01). On the twentieth day there was a greater variation of aminotransferase levels in group II (p = 0.02 and p = 0.03, respectively). Forty-three percent of group I and 54% of group II showed electrocardiographic abnormalities (p = 0.30).

The midvastus surgical approach in total knee arthroplasty

We report a study of 2 surgical approaches to the knee in 42 consecutive patients undergoing a total arthroplasty. They were divided into 2 groups. In Group 1 (n=17) the knee was exposed through classic medial parapatellar arthrotomy and in Group 2 (n=25) the knee was approached through the fibers of the medial vastus. Preoperative assessment did not reveal any statistical differences between the groups, and blood loss, operation time, biochemistry values and radiographic evaluation were also similar. However, a higher number of lateral releases, a loss of knee extension and a reduced range of motion were significantly associated with classical parapatellar arthrotomy. As the number of operative or postoperative complications was not increased, we recommend the mid-vastus approach for total knee arthroplasty.

A Sec7-related protein in Paramecium

We have cloned and sequenced a SEC7-related gene in Paramecium tetraurelia that contains an open reading frame for 1135 amino acids encoding a 133 kDa protein, PSec7. Sec7, first identified in vesicular trafficking mutants in yeast, and its phylogenetic homologues function as guanine-nucleotide exchange factors for small G-proteins such as ARF (ADP-ribosylation factor). The deduced amino acid sequence in PSec7 for the motifs that form the ARF binding site are more than 70% identical to yeast Sec7 and similarly identical to ARNO, the human ARF exchange factor, with correct positioning of the critical glutamic acid residue within the motif region. Overall, the identity of PSec7 to yeast Sec7 is 32%. The deduced amino acid sequence also has five sequences that resemble IQ motifs, EF hand binding domains found in all myosins, and two pleckstrin homology domains. Similar sequences are present in yeast Sec7 and other Sec7-related molecules. A protein kinase A phosphorylation site may also be present. Southern blots suggest that a single gene encodes PSec7. Northern blots show that the message encoding PSec7 is induced on deciliation, followed by ciliogenesis, which suggests a role for PSec7 in cilia such as transport or targeting of ciliary membrane components.

[A lymphoepithelioma-like type of spinous-cell carcinoma of the cervix uteri]

Lymphoepithelioma-like carcinomas of the cervix uteri are very rare. They are poorly differentiated squamous cell carcinomas with intense stromal lymphocytic infiltration. These histologic features are similar to nasopharyngeal lymphoepithelioma and may have a better prognosis than other tumors of the cervix. A lymphoepithelioma-like lesion of the cervix uteri is described in a 33-year-old Caucasian woman who had an episode of vaginal bleeding. A review of the literature about these types of tumor is also presented.

Abnormal nonshivering thermogenesis in mice with inherited defects of fatty acid oxidation

When placed in the cold (4 degreesC), BALB/cByJ mice of both genders rapidly lose body temperature as compared with the control strain, C57BL/6J. This sensitivity to cold resembles that previously described for mice with a defect in nonshivering thermogenesis due to the targeted inactivation of the brown adipocyte-specific mitochondrial uncoupling protein gene, Ucp1. Genetic mapping of the trait placed the gene on chromosome 5 near Acads, a gene encoding the short chain acyl CoA dehydrogenase, which is mutated in BALB/cByJ mice. The analysis of candidate genes in the region indicated a defect only in the expression of Acads. Confirmation of the importance of fatty acid oxidation to thermogenesis came from our finding that mice carrying the targeted inactivation of the long chain acyl CoA dehydrogenase gene (Acadl) are also sensitive to the cold. Both of these mutations attenuate the induction of genes normally responsive to adrenergic signaling in brown adipocytes. These results suggest that the action of fatty acids as regulators of gene expression has been perturbed in the mutant mice. From a clinical perspective, it is important to determine whether defects in thermogenesis may be a phenotype in human neonates with inherited deficiencies in fatty acid beta-oxidation.

Emergence of brown adipocytes in white fat in mice is under genetic control. Effects on body weight and adiposity

The mRNA levels for the mitochondrial uncoupling protein (UCP1) in fat tissues of A/J and C57BL/6J inbred strains of mice varied in a regional-specific manner after stimulation of adrenergic signaling by cold exposure or treatment with a beta3-adrenergic agonist. While the differences between strains were minimal in interscapular brown fat, large differences occurred in white fat tissues, particularly in retroperitoneal fat. Among the AXB recombinant inbred strains, the Ucp1 mRNA levels varied up to 130-fold. This large induction at the mRNA level was accompanied by a corresponding increase in brown adipocytes as revealed by immunohistology with anti-UCP1 antibodies. A high capacity to induce brown fat in areas of traditional white fat had no impact on the ability to gain weight in response to high fat and sucrose diets, but did correlate with the loss of weight in response to treatment with a beta3-adrenergic agonist (CL 316,243). This genetic variation in mice provides an experimental approach to identify genes controlling the induction of brown adipocytes in white fat tissues.

Regional and temporal differences in real-time dopamine efflux in the nucleus accumbens during free-choice novelty

To assess dopamine efflux during novelty-seeking behavior in rats, fast-scan cyclic voltammetry in the nucleus accumbens was combined with free-choice entry into a novel environment. Cyclic voltammograms, confirmed by in vitro testing, revealed that entry into novel, but not familiar, surroundings increased dopamine efflux in a regionally and temporally distinct pattern. Whereas dopamine failed to change in the core region of the accumbens and overlying neostriatum, an abrupt increase occurred in accumbal shell, a limbic-related area implicated in goal-directed behavior. Although the dopamine response was confined to the brief period of entry into novelty (approximately 8 s duration), a less rapid and more persistent dopamine change (> 20 s duration) occurred in the shell-core transition zone, the so-called shore. These results suggest that novelty mimics other positively reinforcing stimuli in enhancing dopamine transmission in the nucleus accumbens, but the regional and temporal heterogeneity of this effect may represent different aspects of accumbal dopamine function.

Mice lacking mitochondrial uncoupling protein are cold-sensitive but not obese

The mitochondrial uncoupling protein (UCP) in the mitochondrial inner membrane of mammalian brown adipose tissue generates heat by uncoupling oxidative phosphorylation. This process protects against cold and regulates energy balance. Manipulation of thermogenesis could be an effective strategy against obesity. Here we determine the role of UCP in the regulation of body mass by targeted inactivation of the gene encoding it. We find that UCP-deficient mice consume less oxygen after treatment with a beta3-adrenergic-receptor agonist and that they are sensitive to cold, indicating that their thermoregulation is defective. However, this deficiency caused neither hyperphagia nor obesity in mice fed on either a standard or a high-fat diet. We propose that the loss of UCP may be compensated by UCP2, a newly discovered homologue of UCP; this gene is ubiquitously expressed and is induced in the brown fat of UCP-deficient mice.

Metals of the bottom muds in Belize City Harbor, Belize

Seven bottom samples extending from the ocean up through Belize Harbor and City were acid leached (EPA method 200.7) and analyzed using inductively coupled plasma spectrometry to measure the bioavailability of Cd, Cr, Cu, Pb and Zn. Soil and environmental chemists would compare data to world averages of unpolluted soils, these samples were higher than this average by a factor of 10 for Cd, 4 for Cu, 2.7 for Zn and 2.6 for Pb. Geochemists argue that it's hard to find unpolluted soil so their comparison is with world average of ancient (pre-man) shales and the Belize samples were higher than this shale average by a factor of 30 for Cd, 3.7 for Pb, 2.2 for Cu and 1.7 for Zn. Ecologists would argue that the metal effect on the biota is the correct way to analyze the data by using the biological effects toxicity method, and this way the samples were above the lower limit by a factor of 5.1 for Cd, 2.9 for Cu and 1.6 for Pb. By all three lines of reasoning, it can be concluded that Cd, Cu, Pb and Zn, in that order, pose environmental problems. Since this site is located in the middle of Belize Barrier Reef, a highly sensitive environmental area that is also economically important to Belize, it poses a critical problem that needs to be addressed further.

Transjugular intrahepatic portosystemic shunt versus sclerotherapy in the elective treatment of variceal hemorrhage

BACKGROUND & AIMS

Uncontrolled studies suggest that placement of a transjugular intrahepatic portosystemic shunt (TIPS) could be useful in the treatment of variceal bleeding. The aim of this study was to evaluate the efficacy and safety of TIPS in the elective treatment of hemorrhage from esophageal varices in a randomized controlled study that compared the effects of TIPS with those of endoscopic sclerotherapy (ES).

METHODS

Sixty-three consecutive cirrhotic patients with hemorrhage from esophageal varices were included. Thirty-two patients were randomly allocated to ES and 31 to TIPS groups.

RESULTS

One patient in each group died before the therapeutic procedure could be performed. During a mean follow-up period of 15 months, variceal rebleeding occurred in 51.6% of the patients in the ES group and 23% of those in the TIPS group. Uncontrolled rebleeding occurred in 10 of 31 patients in the ES group, whereas rebleeding did not occur in any patient of the TIPS group. Hepatic encephalopathy was more frequent in TIPS patients (33.3%) than in those treated by ES (13%). However, mortality was similar in both treatment groups.

CONCLUSIONS

These preliminary results suggest that TIPS is more effective than ES in the prevention of variceal rebleeding in cirrhotic patients, even though no difference in survival was observed.

Sternoclavicular septic arthritis in a patient with end-stage liver disease

Sternoclavicular septic arthritis is an uncommon clinical entity that is often misdiagnosed on initial presentation. It has generally been described in IV heroin users and immunocompromised hosts. We report the case of a 43-year-old woman with endstage liver disease who presented with a fever, a painful sternoclavicular joint, and gastrointestinal bleeding. The clinical presentation, diagnosis, and treatment of sternoclavicular septic arthritis are reviewed.

Triiodothyronine induces the transcription of the uncoupling protein gene and stabilizes its mRNA in fetal rat brown adipocyte primary cultures

Confluent fetal rat brown adipocytes in primary culture showed an almost undetectable level of uncoupling protein (UCP) mRNA and a low mitochondrial content of functional UCP. Treatment of confluent cells with 10 nM triiodothyronine in a serum-free medium, in the absence of noradrenergic stimulation, increased the amount of UCP mRNA in a time-dependent manner. This effect was due to an increased UCP gene transcription rate and UCP mRNA stabilization, resulting in a higher content of immunoreactive mitochondrial UCP and functional UCP (detected by its ability to bind GDP). Thus, triiodothyronine might play a significant physiological role in the UCP expression throughout fetal development, when brown adipose tissue starts to differentiate and UCP is primarily expressed.

Homologous conditioned medium enhances expression of TRH in hypothalamic neurons in primary culture

Primary cultures of hypothalamic cells maintained in the presence of serum were either kept with homologous conditioned medium (CM) (i.e. only half of the medium was removed at each medium change) or without (total medium change). In cultures with homologous CM, TRH levels were increased. The effects of CMs from various intervals of the primary culture were tested. The strongest increases of TRH levels were obtained with CM from cultures enriched with hypothalamic glia.

Telephone follow-up of gynecology day surgery patients. On line for quality and continuity of care

Traditionally, patients who received minor gynecology surgery remained in the hospital for a few days, during which time post-operative care was given by nurses. However, since patients are now often discharged the same day, the responsibility for this care has been transferred to the patients and their families. Because the nursing staff of the Gynecology Day Surgery Unit at the Royal Victoria Hospital believes there is a need for patient-monitoring after discharge and CLSCs do not offer services for this generally healthy clientele, they developed, with the head nurse and the assistant head nurse, a post-operative telephone follow-up program. This idea stemmed from the general need to adapt care as a result of the increase in day surgery. In addition to extending care beyond the hospital walls and improving its quality, this program has increased the job satisfaction of the nurses involved.

Girdlestone arthroplasty for loosening of the total hip prosthesis: evaluation and results

A total of 72 patients (73 hips) who had been submitted to Girdlestone arthroplasty to treat aseptic (63%) and septic (37%) loosening of total hip replacement, and who had been followed-up after an average of 6.8 years, were reviewed. Good pain control was obtained in nearly 60% of the patients. Functional results were poor, but 52% of the patients said that they were satisfied. Mean score based on the Harris Hip Score was 54. Infection was dominated in 92.6% of the cases. The best results were obtained in younger patients, while we did not observe any differences based on the cause of loosening (aseptic or septic). Despite the limits of the method, Girdlestone arthroplasty continues to constitute an effective indication for the treatment of loosening in total hip replacement, when the choice of reimplantation exposes the patient to a high risk of further failure.

Colorectal carcinomas: diagnosis and preoperative staging by hydrocolonic sonography

BACKGROUND

The aim of this study was to determine the sensitivity, specificity, and predictive value of hydrocolonic sonography (HS) in the detection and preoperative staging of colonic carcinomas.

METHODS

One hundred four patients referred to our department for colorectal disease were examined in a prospective study with conventional transabdominal sonography followed by HS and other well-established means for detection of colorectal cancer. In all diagnosed colorectal carcinomas, surgical resection and histologic examination were carried out, and the histologically confirmed tumor stage was then compared with the stage predicted by HS.

RESULTS

HS staged and made a correct diagnosis of carcinoma in 39 of 40 patients, with a sensitivity of 97.5% and a specificity of 98%. Positive predictability was 97.5% and negative predictability 98%. In the evaluation of cancer depth invasion, HS staging was correct in all but one case, in which a T3 tumor was incorrectly judged to be T2. In the assessment of the presence or absence of peritumor metastatic lymph nodes, HS had a sensitivity of 50% and a specificity of 100%.

CONCLUSIONS

HS allows the diagnosis and preoperative staging of colorectal carcinomas with high sensitivity, specificity, and predictive value. We highly recommend its preoperative use because of its definitive influence on surgical approach.

Human T-lymphotropic virus type I and type II infections and correlation with risk factors in blood donors from São Paulo, Brazil

BACKGROUND

Little is known about the prevalence of and risk factors for human T-lymphotropic virus type I and type II (HTLV-I, HTLV-II) infections in Brazil.

STUDY DESIGN AND METHODS

Sera from 17,063 healthy Brazilian donors were screened by enzyme-linked immunosorbent assay for antibody to HTLV-I/II between August 1991 and July 1993. Repeatedly reactive samples were confirmed by Western blot, and discrimination between HTLV-I and HTLV-II was made by polymerase chain reaction or synthetic peptide enzyme-linked immunosorbent assay. A univariate analysis was performed on demographic and serologic data.

RESULTS

HTLV-I infection was demonstrated in 83 percent of the 30 donors with reactive serologic tests (0.15% of the total tested [17,063]; 95% CI, 0.09-0.20) and HTLV-II infection in 17 percent (0.03% of the total tested [17,063]; 95% CI, 0.01-0.05). HTLV-I-positive donors were more likely than reference groups to be of Asian ethnicity (odds ratio [OR] 15.1; reference group: whites), more than 50 years old (OR 4.2; reference group: 20-29 years old), and positive for antibody to hepatitis C virus (anti-HCV) (OR 21.8) or to hepatitis B core (antigen) (anti-HBc) (OR 5.7). HTLV-II showed a significant association with anti-HCV (OR 75.2) and anti-HBc (OR 21.8). Eleven of the 25 HTLV-I-positive donors were counseled. Family origin in endemic areas of Japan (n = 4), prior blood transfusion (n = 3), or sexual contact with prostitutes (n = 1) were the risk factors reported by 8 donors. In 3 white men, no risk factors could be identified.

CONCLUSION

Both HTLV-I and HTLV-II occur among Brazilian blood donors. HTLV-I is associated with Asian ethnicity, greater age, and the presence of anti-HCV and anti-HBc. Three HTLV-I-positive donors had a history of blood transfusion, which emphasizes the need for HTLV-I/II screening in Brazil.

IGF-I induces the uncoupling protein gene expression in fetal rat brown adipocyte primary cultures: role of C/EBP transcription factors

Fetal rat brown adipocytes proliferate and reach confluence when cultured in the presence of serum, almost losing their expression of the tissue-specific gene uncoupling protein (UCP). Confluent cells in a serum-free medium induced the expression of UCP in response to 1.4 nM IGF-I at 72 h, in a time-dependent manner. This effect was not produced by 1 nM insulin. However, insulin but not IGF-I induced the expression of the lipogenic marker malic enzyme, suggesting that IGF-I but not insulin is involved in the thermogenic differentiation process of fetal brown adipocytes. Furthermore, the expression of C/EBP transcription factors was present in fetal brown adipocytes prior culture, decreasing during cell proliferation throughout culture. After confluence, insulin induced the expression of C/EBP alpha and delta, whereas the expression of C/EBP beta remained essentially unmodified. IGF-I induced C/EBP alpha but decreased C/EBP delta, this might indicate that both transcription factors play a reciprocal role in the expression of the tissue specific UCP gene.

Triiodothyronine induces the expression of the uncoupling protein in long term fetal rat brown adipocyte primary cultures: role of nuclear thyroid hormone receptor expression

Fetal rat brown adipocytes at the beginning of culture showed a minimal T3 nuclear binding capacity and very low expression of the c-erbA genes, with low steady state levels of the mRNA forms beta-type and 5.5- and 2.6-kilobase (kb) alpha-types. The levels of these mRNA species increased after 7 days in culture in the presence of thyroid hormone-depleted serum; however, no significant increase in nuclear T3-binding capacity was observed. The addition of T3 incremented the abundance of the c-erbA beta-mRNA, induced the appearance of the 6.6-kb c-erbA alpha-mRNA and increased the nuclear T3-binding capacity by 30-fold. Parallel analysis of the uncoupling protein (UCP) mRNA, immunoreactive UCP, and functional UCP (detected by its ability to bind GDP) demonstrated that T3 induced the expression of the UCP gene in long term treated fetal brown adipocytes in culture. The presence of noradrenaline, a positive control for UCP expression, increased only the level of expression of the 5.5-kb c-erbA alpha-mRNA, but values for nuclear T3-binding capacity similar to those obtained in T3-treated cells were observed. Simultaneous addition of both hormones gave a pattern of expression of the c-erbA-mRNA forms similar to those obtained with these agents individually, and no further increment in their separate effects was observed on the nuclear T3-binding capacity and UCP expression.

[Dopaminergic system genes in Mexican schizophrenics]

This investigation reports an association study with alleles of the dopaminergic system genes (tyrosine hydroxylase (TH), D2 and D4 receptors) in schizophrenic patients and non-schizophrenic subjects. The genotypes were typed using a polymerase chain reactions PCR-based CA repeat polymorphisms. There were no significant associations between the studied alleles and schizophrenia. Also, a linkage analysis was performed using the same genes (TH, D2 and D4) in two multiple affected schizophrenic families. There was no linkage among any of three genes and schizophrenia. The maximum lod score (Z = 0.43, theta = 0.10 penetrance 100%) was for the tyrosine hydroxylase gene. Linkage analysis significantly excluded the D2 receptor gene (Z = 5.6, theta = 0.01), assuming an autosomal dominant pattern and complete penetrance, However, when the lod scores were calculated with other penetrance values, they lost significance.

[Digestive hemorrhage caused by aorto-duodenal fistula. Report of 5 cases]

The aortoduodeonal fistula is a rare condition and has high mortality. We report five retrospective cases of digestive hemorrhage due to an aortoduodenal fistula (4 secondary and 1 primary) between 1986 and 1990. Three of them died. Attention is called to the importance of clinical suspicion and the main diagnostic methods in early diagnosis such as oral endoscopy. We also enhance the importance of emergency surgery for survival.

Large-volume paracentesis and intravenous saline: effects on the renin-angiotensin system

Fourteen cirrhotic patients with tense ascites were treated with total paracentesis and intravenous isotonic saline infusion. Standard liver and kidney function tests, plasma renin activity and aldosterone concentration were measured before, at 48 hrs and at 7 days after total paracentesis. The volume of ascites removed was 7.7 +/- 5.6 l (mean +/- S.E.M.). None of the treated patients had clinical complications or significant alterations in liver or kidney function test results. Paracentesis and intravenous isotonic saline infusion were not associated with significant changes in mean plasma renin activity or plasma aldosterone concentration. These results suggest that this therapeutic procedure could be a safe and cost-effective alternative treatment of tense ascites in patients with cirrhosis.

Action of exogenous potassium and calcium ions on in vitro metacyclogenesis in Trypanosoma cruzi

The cations Ca2+ and K+ and the anions Cl-, HCO3-, and PO4- were studied for their contribution to metacyclic trypomastigote formation of Trypanosoma cruzi in starvation media consisting of phosphate-buffered saline (PBS) + 10 mM proline + 10 mM sodium acetate as well as one of the following salts: 0.035% NaHCO3 (PBSNPA), 0.035% K2CO3 (PBSKPA) or 0.035% K2HPO4 (PBSPPA). Isolates CL and DM28c were activated to transform with 5% CO2 and the percent metacyclogenesis determined after incubation for 96 h in PBS starvation media. Maximal metacyclogenesis was found with CaCl2 and KCl. In the presence of K+, the percent transformation was highest with the phosphate salt, followed by the carbonate and the chloride salts. Cells incubated in PBSNPA and the cationic ionophores A23187 (5 x 10(-6) M), lasalocid (5 x 10(-6) M), and valinomycin (10(-8) M) do not survive; addition of 2 mM CaCl2 or 17 mM KCl to DM28c cells, reversed the lethal action of the ionophores permitting differentiation into metacyclic forms. The addition of CaCl2 to CL cells incubated in ionophores abrogated the lethal effect of the ionophores but transformation was significantly different than in control preparations. Adding KCl to ionophore incubated cells resulted in normal levels of transformation except in the case of valinomycin. DM28c and CL cells incubated in PBSKPA show significantly greater metacyclogenesis in the presence of 5 mM EGTA. These results indicate that exogenous concentrations of several cations and anions significantly influence T. cruzi metacyclogenesis and that the degree of response by the parasite to free ion levels may be strain dependent.

Assay of free and total tocainide by high performance liquid chromatography (HPLC) with ultraviolet (UV) detection

A rapid high performance liquid chromatographic (HPLC) method for the determination of tocainide, using N-(2,6-dimethylphenyl)-2-amino-butanimide as an internal standard, was developed. A methylene chloride extraction involving salting out at pH 9.0 was employed. An 85:15 mixture of 0.025M monobasic potassium phosphate at pH 3.0 and acetonitrile was used as the mobile phase. The separation and quantitative analysis of tocainide was performed on a mixed phase column with a 1.0-mL/min flow rate and detection at 210 nm. Separation of tocainide from some of its metabolites required the use of heptane sulfonic acid as an ion-pairing reagent. For the free-drug assay, the specimen was centrifuged through an Amicon Centrifree filter before being processed.

[Von Recklinghausen neurofibromatosis and malignant pheochromocytoma: presentation of 3 cases]

Neurofibromatosis may involve every organ. Manifestations vary greatly and different kind of neoplasia may be associated with excessive frequency; it's the case of pheochromocytoma that, as a benign tumor, coexists in 10%. Description of coexistency as a malignant tumor is a rarity; therefore, we think it's interesting to publish our experience. Nevertheless the association of Von Recklinghausen's disease with hypertension is not always dependent of that kind of association.

[Value of ascitic lipids and sero-ascitic gradient of albumin in the differential diagnosis of ascites]

In order to compare its diagnostic value in the differentiation between malignant and hepatic ascites, we analysed the ascitic fluid concentrations of cholesterol (Ct) and triglycerides (Tg) and the serum-ascites albumin gradient (S-A alb grad) in 58 patients--forty one with chronic liver disease (CLD) and 17 with malignancy. In CLD group the mean values +/- SD for Ct (27.1 +/- 20.1 mg/dl), Tg (34.2 +/- 33.8 mg/dl) and S-A alb grad (1.9 +/- 0.6 g/dl) were significantly different from those obtained in malignant ascites (Ct 103.1 +/- 45.1 mg/dl; Tg 62.1 +/- 43.0 mg/dl; S-A alb grad 0.5 +/- 0.4 g/dl) (p less than 0.001 for all parameters). Application of the cutoff concentrations given in the literature revealed the following results: Ct-Sensitivity (Se) 82.4%, Specificity (Sp) 85.4%, Efficiency (E) 84.5%; Tg-Se 29.4%, Sp 95.1%, E 75.9%; S-A alb grad- Se 88.2%, Sp 97.6%, E 94.8%. The exclusion of the 4 patients with massive hepatic metastasis from malignant group by ultrasound or computer tomography gave an efficiency of 87.0% for Ct, 88.9% for Tg and 98.1% for S-A alb grad. We conclude that: 1) S-A alb grad is the best analysed parameter in the discrimination between malignant and hepatic ascites, 2) the combination with non-invasive imaging methods increases its diagnostic value.

Esophageal strictures: balloon dilation

One hundred seventy transnasal balloon catheter dilation procedures were performed in 35 patients with esophageal strictures to assess the efficacy and safety of the procedure. On the average, five dilations were required per patient. Depending on the cause of the esophageal stricture, success rates for the technique ranged from 67% to 87%, with success defined as the resolution of dysphagia to both fluids and solids. Three complications, all perforations, were seen; one perforation required surgical repair. No procedure-related deaths were identified in this series. Balloon catheter dilation can be safely applied to esophageal strictures from a variety of causes, with a high degree of clinical success.

Nonrandom X chromosome inactivation in B cells from carriers of X chromosome-linked severe combined immunodeficiency

X chromosome-linked severe combined immunodeficiency (XSCID) is characterized by markedly reduced numbers of T cells, the absence of proliferative responses to mitogens, and hypogammaglobulinemia but normal or elevated numbers of B cells. To determine if the failure of the B cells to produce immunoglobulin might be due to expression of the XSCID gene defect in B-lineage cells as well as T cells, we analyzed patterns of X chromosome inactivation in B cells from nine obligate carriers of this disorder. A series of somatic cell hybrids that selectively retained the active X chromosome was produced from Epstein-Barr virus-stimulated B cells from each woman. To distinguish between the two X chromosomes, the hybrids from each woman were analyzed using an X-linked restriction fragment length polymorphism for which the woman in question was heterozygous. In all obligate carriers of XSCID, the B-cell hybrids demonstrated preferential use of a single X chromosome, the nonmutant X, as the active X. To determine if the small number of B-cell hybrids that contained the mutant X were derived from an immature subset of B cells, lymphocytes from three carriers were separated into surface IgM positive and surface IgM negative B cells prior to exposure to Epstein-Barr virus and production of B-cell hybrids. The results demonstrated normal random X chromosome inactivation in B-cell hybrids derived from the less mature surface IgM positive B cells. In contrast, the pattern of X chromosome inactivation in the surface IgM negative B cells, which had undergone further replication and differentiation, was significantly nonrandom in all three experiments [logarithm of odds (lod) score greater than 3.0]. These results suggest that the XSCID gene product has a direct effect on B cells as well as T cells and is required during B-cell maturation.