Microvesicular-mediated gene transfer of prostate tumor markers

e16076

Background: Microvesicles have been a subject of research for many years. Recent work has focused on the potential for cancer vaccines via microvesicles. It has also been demonstrated that various cell-specific phenotypes can be transferred from one cell type to another through microvesicle transfer. Studies in our laboratory have demonstrated that co-culture of murine lung tissue with marrow cells across a cell impermeable membrane can induce elevations in lung-specific mRNA expression in human donor marrow stem cells. Our objective is to determine whether there is transfer of genetic or transcriptional factors via microvesicles from human prostate cancer cells to fresh human marrow cells. Methods: Fresh prostate tissue was harvested from surgical specimens following radical retropubic prostatectomy. Samples were histologically confirmed to contain prostatic adenocarcinoma. Co-cultures were established using a transwell system in which 0.05–0.100 grams of prostate tissue was minced and co-cultured with 1–3 million normal, human donor marrow cells for 2–7 days. Marrow not co-cultured with tumorserved as a control. Target cells were collected and total RNA was analyzed for prostate-specific gene expression byReal Time RT-PCR. Fold differences in expression of the genes were analyzed, using TaqMan®, gene assays (Applied Biosystems) and were expressed in relation to the marrow control. Results: We have observed significant increases in gene expression in marrow cells co-cultured with prostate tumor cells (Gleason grades 6–9). Variable increases in expression were seen in 3 patient samples, as high as 7-fold for ERG, greater than 10-fold for ACPP and greater than 100-fold for STEAP, PART, TMPRSS2, PSCA and ETV1. Conclusions: These studies demonstrate that prostate specific genes are present in fresh human marrow cells after co-culture with tumor tissue. This establishes a base to begin evaluating the significance of microvesicle-mediated genetic transfer, mechanisms of transfer and therapeutic options for blocking or manipulating such transfer to influence the disease process.

No significant financial relationships to disclose.

Islet transplantation for brittle type 1 diabetes: the UIC protocol

This prospective phase 1/2 trial investigated the safety and reproducibility of allogeneic islet transplantation (Tx) in type I diabetic (T1DM) patients and tested a strategy to achieve insulin-independence with lower islet mass. Ten C-peptide negative T1DM subjects with hypoglycemic unawareness received 1-3 intraportal allogeneic islet Tx and were followed for 15 months. Four subjects (Group 1) received the Edmonton immunosuppression regimen (daclizumab, sirolimus, tacrolimus). Six subjects (Group 2) received the University of Illinois protocol (etanercept, exenatide and the Edmonton regimen). All subjects became insulin- independent. Group 1 received a mean total number of islets (EIN) of 1460 080 +/- 418 330 in 2 (n = 2) or 3 (n = 2) Tx, whereas Group 2 became insulin- independent after 1 Tx (537 495 +/- 190 968 EIN, p = 0.028). All Group 1 subjects remained insulin free through the follow-up. Two Group 2 subjects resumed insulin: one after immunosuppression reduction during an infectious complication, the other with exenatide intolerance. HbA1c reached normal range in both groups (6.5 +/- 0.6 at baseline to 5.6 +/- 0.5 after 2-3 Tx in Group 1 vs. 7.8 +/- 1.1 to 5.8 +/- 0.3 after 1 Tx in Group 2). HYPO scores markedly decreased in both groups. Combined treatment of etanercept and exenatide improves islet graft function and facilitates achievement of insulin-independence with less islets.

Benchmarking comparison survey of regional neonatal units

There are currently eight regional neonatal units in Ireland; three in Dublin and one each in Cork, Limerick, Galway, Drogheda and Waterford. Previous studies have shown a significant variation in the provision of care and services between such units. In July 2005, a postal questionnaire was distributed to a focus group of staff in the eight regional units. The objective was to identify issues of significant concern in current neonatology practice in Ireland. Eighteen people were surveyed in this focus group and we had an overall response rate of almost 78%. All of the respondents felt that there was a difference between practises in the neonatal units and greater than 90% perceived these to be significant. We believe that this study has identified the desire for standardisation of neonatology practises in Ireland and that this may be achieved by the introduction of a Nationwide Newborn Network.

Can HRCT be used as a marker of airway remodelling in children with difficult asthma?

Background

Whole airway wall thickening on high resolution computed tomography (HRCT) is reported to parallel thickening of the bronchial epithelial reticular basement membrane (RBM) in adult asthmatics. A similar relationship in children with difficult asthma (DA), in whom RBM thickening is a known feature, may allow the use of HRCT as a non-invasive marker of airway remodelling. We evaluated this relationship in children with DA.

Methods

27 children (median age 10.5 [range 4.1–16.7] years) with DA, underwent endobronchial biopsy from the right lower lobe and HRCT less than 4 months apart. HRCTs were assessed for bronchial wall thickening (BWT) of the right lower lobe using semi-quantitative and quantitative scoring techniques. The semi-quantitative score (grade 0–4) was an overall assessment of BWT of all clearly identifiable airways in HRCT scans. The quantitative score (BWT %; defined as [airway outer diameter – airway lumen diameter]/airway outer diameter ×100) was the average score of all airways visible and calculated using electronic endpoint callipers. RBM thickness in endobronchial biopsies was measured using image analysis. 23/27 subjects performed spirometry and the relationships between RBM thickness and BWT with airflow obstruction evaluated.

Results

Median RBM thickness in endobronchial biopsies was 6.7(range 4.6 – 10.0) μm. Median qualitative score for BWT of the right lower lobe was 1(range 0 – 1.5) and quantitative score was 54.3 (range 48.2 – 65.6)%. There was no relationship between RBM thickness and BWT in the right lower lobe using either scoring technique. No relationship was found between FEV₁ and BWT or RBM thickness.

Conclusion

Although a relationship between RBM thickness and BWT on HRCT has been found in adults with asthma, this relationship does not appear to hold true in children with DA.

Quantitative assessment of MRI T2 relaxation time of thigh muscles in juvenile dermatomyositis

OBJECTIVE

The aim of the study was to examine the validity and reliability of a quantifiable measure of inflammation using magnetic resonance imaging (MRI) in children with juvenile dermatomyositis (JDM).

METHODS

Children with active JDM, inactive JDM and healthy children received detailed assessments of recognized measures of muscle inflammation including muscle strength (manual muscle testing and myometry) and function (Childhood Myositis Assessment Scale, Childhood Health Assessment Questionnaire), the muscle enzymes lactate dehydrogenase (LDH) and creatine kinase (CK) and T2-weighted MRI scans of the thigh muscles, and these values were correlated with each other.

RESULTS

Ten children with active JDM, 10 with inactive JDM and 20 healthy children completed the study. There was no significant difference in ages between the three groups. The MRI T2 relaxation times were significantly increased in active JDM compared with inactive JDM and healthy children (P = 0.05), indicating a detectable increase in inflammation within the muscles. There were also good correlations between the MRI scores and the measures of muscle strength and function; however, there was no correlation between the MRI and muscle enzymes.

CONCLUSIONS

The MRI T2 relaxation time can be used as a quantitative measure of muscle inflammation and it has good correlations with other measures of disease activity.

Superficial siderosis of the central nervous system many years after neurosurgical procedures

Recurrent haemorrhage into the subarachnoid space causes superficial siderosis, which clinically manifests as cerebellar ataxia, sensorineural hearing loss, and myelopathy. Two patients developed clinical, radiological, and biochemical evidence of superficial siderosis many years after surgery. One had two posterior fossa operations, a left temporal craniectomy, and radiotherapy for a presumed brain tumour before developing clinical evidence of superficial sidersosis 37 years later. The other had small bilateral subdural collections from recurrent shunt revisions following posterior fossa surgery for a Chiari malformation, and then developed deafness and ataxia. The first patient currently has the longest recorded delay between presumed subarachnoid bleeding and clinical manifestations of superficial siderosis. Both patients provide further evidence that superficial siderosis of the central nervous system, a progressive neurodegenerative vascular condition, may be a delayed complication of neurosurgical procedures.

Primary pulmonary lymphangiectasis in a premature infant: resolution following intensive care

Primary pulmonary lymphangiectasis is a rare disease, often described as fatal within the neonatal period. We report on an infant who developed severe bilateral chylous pleural effusions with computed tomography (CT) features of pulmonary lymphangiectasis. She recovered spontaneously with supportive treatment only. We discuss aspects of her intensive care which might have contributed to the good outcome, and conclude that modern intensive care may allow spontaneous recovery in conditions described in the literature as having a very poor outcome.

Applications of combined EXAFS and powder diffraction analysis in solid state chemistry

Recent applications of combined EXAFS/powder neutron and X-diffraction analysis are reviewed and provisional results for three additional compounds are presented. Criteria for successful refinements are suggested. The new results relate to the materials: CoAl2O4, La(6.4)Ca(1.6)Cu6Ni2O20 and Pr(0.5)Sr(0.5)FeO(2.75).

The treatment of Wilms' tumour: results of the United Kingdom Children's cancer study group (UKCCSG) second Wilms' tumour study

The aims of the UKW2 study were: (1) to further refine treatment for stage I and II favourable histology (FH) patients; (2) to consolidate the UKW1 results for stage III FH patients; (3) to improve the outlook for patients with inoperable primary tumours and those patients with stage IV and unfavourable histology disease. Treatment consisted of primary nephrectomy, wherever possible, followed by chemotherapy and radiotherapy, as dictated by stage and histology. Treatment was refined successfully for stage I and II FH patients. The 4-year event-free survival for these two groups was 94% and 91%, respectively. Stage III FH patients had a 4-year event free survival of 84%. The outlook for patients with clear cell sarcoma of the kidney is as good as for patients with favourable histology, whilst that for patients with anaplastic or rhabdoid variants remains poor. The outlook for the majority of children with Wilms' tumour is now excellent.

Endotracheal cardiac output monitor

BACKGROUND

The endotracheal cardiac output monitor (ECOM) is a new device that uses an endotracheal tube with multiple electrodes to measure cardiac output (CO). It measures the changes in electrical impedance caused by pulsatile blood flow in the aorta. The system was tested for safety and efficacy in 10 swine.

METHODS

Swine (60-80 kg) were chronically instrumented with a transit time flow probe on the ascending aorta and vascular occluders on the vena cava and pulmonary artery. After a minimum recovery of 4 days, the animals were anesthetized and intubated with an ECOM endotracheal tube. CO measurements from the ECOM system were compared to transit time flow probe measurements using linear regression and Bland-Altman analysis. Three different inotropic states were studied: (1) baseline; (2) increased (dobutamine); and (3) decreased (esmolol). CO was changed at each inotropic state by impeding left ventricular filling with the vena cava or pulmonary artery occluders. CO values between 0 and 15 l/min were studied. Pigs were studied for 24 h consecutively.

RESULTS

There was no deterioration of the impedance signal with time and no tracheal injury from the ECOM electrodes. There is a linear relationship between the ECOM and transit time flow probe CO between 0 and 15 l/min (slope = 0.94; intercept = 0.15 l/min; R2= 0.77). The mean difference between the two measures (bias) is 0.15 l/min and the SD is 1.34 l/min. The limits of agreement are -2.53 to 2.82 l/min.

CONCLUSION

Endotracheal CO monitor is a promising technology that needs further evaluation in clinical trials.

Emergency cranial computed tomography in the management of acute febrile encephalopathy in children

OBJECTIVE

Evaluation of the influence of emergency cranial computed tomography on the management of acute febrile encephalopathy in children.

METHODS

A retrospective study in children with acute febrile encephalopathy who underwent emergency cranial computed tomography within 12 hours of admission to the paediatric intensive care unit. All scans were evaluated by two independent radiologists.

RESULTS

Thirty nine children were included. Fourteen scans were abnormal and two had clinically insignificant incidental findings. Four children with focal neurological signs had scans demonstrating extra-axial collections. None required neurosurgical intervention. Clinically, raised intracranial pressure was present in 10 patients. Only five had cerebral oedema on computed tomography; these five children died. Emergency cranial computed tomography influenced subsequent management in no child without focal neurological signs and in only one child with focal neurology.

CONCLUSION

Emergency cranial computed tomography in acute febrile encephalopathy in children without focal neurological signs has little influence on subsequent management. Where cranial computed tomography is thought to be necessary, it should be carried out when the child's clinical condition has been stabilised.

The perinephric space and renal fascia: review of normal anatomy, pathology, and pathways of disease spread

The perinephric space is a cone-shaped retroperitoneal compartment containing the kidney, adrenal gland, perinephric fat, fibrous bridging septa, and a rich network of perirenal vessel and lymphatics. Perinephric space pathology may originate from within or outside the confines of the perirenal fascia. Most intrinsic perinephric space disease arises from the kidney or adrenal gland, and secondarily involves the perinephric space. Disease originating outside the cone of renal fascia may spread to the perinephric space via lymphatics (i.e., metastatic spread) or by directly transgressing perirenal fascial planes (e.g., invasive tumor or infections). Additionally, infiltrating soft tissue or rapidly accumulating retroperitoneal fluid may travel into or out of the perinephric space via perinephric bridging septa and renal fascia. In this article, we review the normal anatomy of the perinephric space and renal fascia, emphasizing the significance of retroperitoneal interfascial planes and perinephric bridging septa as a potential conduit for retroperitoneal disease spread. This review of normal anatomy and pathways of disease spread serves as background for a discussion of a variety of specific pathologic conditions that may involve the perinephric space and retroperitoneal fascia, including pancreatitis, retroperitoneal hematoma, urinoma, metastatic disease, and perirenal varices.

Histological response to stent graft therapy

BACKGROUND

The purpose of the present study was to examine the histological consequences of the endoluminal exclusion of blood flow effected with stent graft technology.

METHODS AND RESULTS

In 25-kg mongrel dogs, patulous vein patch infrarenal aortoplasty with iliac vein produces a fusiform abdominal aortic dilation (AAD). All aortic tributaries were preserved. Endoluminal exclusion via transfemoral placement of a thin-wall Dacron graft occurred 4 +/- 2 months later (n = 23). Balloon-expandable stents anchored the ends of the graft to the aorta. Hematoxylin and eosin, elastin van Gieson's, and Masson's trichrome staining was performed 6 and 12 months later at death. In control nongrafted AADs, the arterial portion of the AAD was lined by elastin -and collagen-rich intimal hyperplasia, and the venous portion developed medial hyperplasia containing collagen but little elastin. After stent graft placement, the stent struts and the graft were completely incorporated into an elastin-poor, collagen-rich neointima. Fibrosis of the vein patch was observed at 1 year. laminated thrombus did not form in the AAD until immediately after stent graft placement; flow arrest occurred in the space between the graft and the AAD intima despite the patent tributaries. At 6 and 12 months, microscopic recanalization was seen in this thrombus, although macroscopic flow was not discernible by duplex imaging or angiography. No AAD growth was measured.

CONCLUSIONS

Aortic dilation was not observed at 1 year after stent graft placement within AADs with patent side branches despite microscopic evidence of thrombus recanalization. A collagen-rich and elastin-poor neointima incorporated the entire stent graft.

Results of endoluminal grafting in an experimental aortic aneurysm model

We studied the impact of an endoluminally placed stented aortic graft on the geometry of a surgically created abdominal aortic dilation (AAD) in nonatherosclerotic mongrel dogs. Patulous iliac vein patch infrarenal aortoplasty produced a fusiform AAD, doubling the aorta diameter. Lumbar and mesenteric aortic tributaries were preserved and no mural thrombus formed. AADs created in 23 dogs were endoluminally excluded through transfemoral placement of a thin-wall Dacron graft 4 +/- 2 months later. Balloon-expandable stents were used to anchor each end of the graft to the aorta. The graft was crimped radially in its body and longitudinally at its ends to provide longitudinal and radial expandability in these respective zones. Serial color duplex, angiography, and direct caliper measurements were made. Before graft placement, a 19% +/- 11% diameter growth was observed. At graft placement, flow arrest immediately occurred in the space between the graft and the AAD intima in all cases. Although microscopic recanalization of the thrombus in this space was seen at sacrifice 6 and 12 months later, no macroscopic duplex flow was imaged. A 10% +/- 11% reduction in AAD diameter was measured at 6 months (p < 0.001), with no further reduction at 12 months. Graft dimensions remained stable. No anastomotic leaks developed. AAD growth stopped during the first year after effective endoluminal exclusion in normotensive dogs despite patent side branches (< 1.5 mm internal diameter) and no mural thrombus at the time of graft placement. Whether microscopic recanalization of the thrombus that forms outside the graft has an impact after 1 year remains to be seen.

Imaging patients with Wilms tumor

Imaging plays a significant role in the management of Wilms tumor. Appropriate imaging continually must undergo refinement related to improvements in therapy and imaging modalities. We must recognize the need to demonstrate effectiveness in all phases of patient management and address the contentious issue of maximizing yield and minimizing cost.

Hepatic ultrasound findings in the glycogen storage diseases

Hepatic ultrasonography was performed on 70 patients with the hepatic glycogen storage diseases (GSDs) to assess parenchymal echogenicity. 27 patients had GSD-I, 24 had GSD-III and 19 had GSDs-VI/IX; ages varied from 0.6 to 35.7 years (median 11.7). 31 (44%) had normal or mild parenchymal changes, and 41% (11/27) of those with GSD-I, 25% (6/24) with GSD-III and 11% (2/19) with GSDs-VI/IX had marked changes. No relationships were found between the ultrasonographic appearances and other indices of metabolic control, including plasma triglycerides, total cholesterol or height standard deviation score. Seven adult patients (21-29 years) were found to have hepatic tumours: six with GSD-I and one with GSD-III. Those with GSD-I and tumours tended to have the more severe hepatic parenchymal changes. We conclude that ultrasonography may be useful in identifying patients with GSD-I at risk of hepatic tumour formation.

Neurogenic hyperalgesia: central neural correlates in responses of spinothalamic tract neurons

1. The contribution of activity in spinothalamic tract (STT) neurons to the pain and neurogenic hyperalgesia produced by an intradermal injection of 100 micrograms of capsaicin was investigated. Electrophysiological responses of identified STT neurons recorded in anesthetized monkeys were compared with psychophysical measurements of pain and hyperalgesia obtained in humans using identical stimuli. 2. Magnitude estimates of pain in humans were obtained after an injection of capsaicin or the vehicle. Capsaicin produced immediate burning pain that was most intense within 15 s after injection and then declined over the next 10-30 min. The vehicle produced no pain. 3. Cutaneous hyperalgesia to gentle stroking (allodynia) and also hyperalgesia to punctate stimulation developed in a wide area surrounding the capsaicin injection. Within this area, magnitude estimates of pain produced by a punctate stimulus (von Frey type with force of 225 mN) increased over preinjection values by an average of sixfold at test sites, 1, 2, and 3 cm away from the injection site. At the capsaicin injection site, magnitude estimates of pain in response to punctate simulation typically remained the same or were decreased. 4. After capsaicin, but not vehicle, the mean heat pain thresholds were lowered from approximately 45 degrees C before injection to 34 degrees C after, but only in the immediate vicinity of the injection site. At a site located 2 cm away, the thresholds were not significantly altered. Similarly, magnitude estimates of pain produced by suprathreshold heat stimuli were increased after capsaicin only at the injection site. 5. STT neurons were classified as high-threshold (HT) or wide-dynamic-range (WDR) cells according to responses evoked by graded cutaneous mechanical stimulation. An intradermal injection of capsaicin excited 4 of 7 HT cells and 10 of 12 WDR cells. The discharge rates of STT neurons correlated in time course with the magnitude estimates of pain in humans. The correlation was considerably better for WDR than for HT neurons, suggesting a predominant contribution of WDR neurons to the pain from capsaicin. 6. Capsaicin significantly increased the responses of HT neurons (9-fold) and the responses of WDR neurons (2-fold) to stroking the skin within the receptive field. Similar increases in responses to a standard punctate stimulus were observed at test sites, 1, 2, and 3 cm away from the injection site. After injection of vehicle, the responses to punctate stimulation increased by a mean of only 1.2- and 1.4-fold for HT and WDR neurons, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

The effects of bergapten and sunlight on cutaneous pigmentation

The effects of bergapten-containing preparations in sunlight-induced skin pigmentation were evaluated. Oil and lotion vehicles with bergapten/UV-B sunscreen or sunscreen alone were applied to the backs of subjects twice weekly for 4 weeks and the subjects were exposed to gradually increasing doses of midday sunlight. The degree of skin darkening was assessed by clinical examination, reflectometry, and light microscopy of skin biopsy specimens. At 5 weeks, 1 week after the last sunlight exposure, the sites treated with either the bergapten/UV-B sunscreen lotion or the lotion vehicle were significantly darker than the sites treated with the sunscreen lotions without bergapten. Oil preparations produced less clearcut results, possibly because of a less potent sunscreen or because the bergapten did not leave the vehicle and absorb into the epidermis. In type I skin, the bergapten/sunscreen and the oil vehicle alone produced the same amount of tanning; both yielded more tanning than the sunscreen in oil by clinical examination. The findings were not confirmed by reflectometry or by light microscopy. Thus, we conclude that bergapten added to a UV-B sunscreen lotion preparation can increase skin pigmentation over the sunscreen alone when one is exposed to sunlight. The bergapten/UV-B sunscreen combination is a potentially useful product since one can develop a psoralen and UV-A-induced tan while being protected from UV-B-induced sunburn by the UV-B sunscreen incorporated into the formulation.

Preclinical Creutzfeldt-Jakob disease discovered at autopsy in a human growth hormone recipient

An adolescent girl with idiopathic hypothalamic dysfunction and hypopituitarism was treated with human growth hormone between 1969 and 1979, dying of parainfluenza pneumonia 2 months after her last hormone treatment. Although she had no signs of progressive neurologic disease, reexamination of autopsy material revealed a focus of spongiform change and astrogliosis in the corpus striatum. Thus, this growth hormone recipient, who died of intercurrent infection, was unexpectedly found to be in an early, preclinical phase of Creutzfeldt-Jakob disease.

Compression of the optic chiasm due to a lymphoreticular malignancy

A patient is described who presented with visual loss due to infiltration of the optic chiasm by chronic lymphocytic leukaemia. This case demonstrates intracranial infiltration as a primary presentation of chronic lymphocytic leukaemia without lymphoreticular involvement and, to our knowledge, is the first report of a chiasmal syndrome due to this lymphoproliferative disorder.

A collaborative study of the measurement of glycosylated haemoglobin by several methods in seven laboratories in the United Kingdom

A collaborative study compared methods for measuring glycosylated haemoglobin in seven laboratories in the United Kingdom. No satisfactory standard for general use was found. Satisfactory internal quality control systems were in use for each assay which allowed the maintenance of a normal range in each participating laboratory. No satisfactory quality control system suitable for general use could be identified. Costs and convenience of the assays are reported. The technical problems with each type of assay and precautions for their use were identified, such as the need for standardization in incubation times, the practicability of automation of colorimetric assays, and the precision of pH needed for buffers in column separation methods. The relevance of the technical problems to interpretation of measurements is also considered. It is concluded that laboratories measuring glycosylated haemoglobin should maintain a normal range, use 'in-house' quality controls to monitor assay performance and keep clinical colleagues informed of the findings and of any changes in methodology that might affect the interpretation of results.

Impact of home blood glucose monitoring on childhood diabetes

Ninety diabetic children each provided at least one 24-hour blood glucose profile at home using an impregnated filter paper strip. The mean 24-hour blood glucose level correlated significantly with urine control, height velocity, and Hb A1. The correlation coefficient for individual blood glucose values (r = 0.61) and for mean 24-hour blood glucose values (r = 0.73) repeated within 14 days showed an acceptable degree of reproducibility for the blood glucose profiles. Mean 24-hour blood glucose values fell significantly overall (11.4 to 9.8 mmol/l; 205 to 176 mg/100 ml) in 47 children who had repeated profiles more than 2 weeks apart. Unrecognised nocturnal hypoglycaemia (less than 3.0 mmol/l; 54 mg/100 ml) was found in 19% of children on twice-daily Semitard insulin. The study shows that children over age 7 years manage home blood glucose monitoring without difficulty. It shows that the results are reproducible and correlate with other indices of control, and that it provides a practical basis for the improvement of diabetic control.

Determination of therapeutic and toxic concentrations of doxepin and loxapine using gas-liquid chromatography with a nitrogen-sensitive detector, and gas chromatography-mass spectrometry of loxapine

A gas-liquid chromatographic procedure is presented for the determination of therapeutic and toxic serum levels of doxepin and loxapine, using a nitrogen-phosphorus-sensitive detector. Amitriptyline is used as the internal standard. The method is accurate, sensitive and specific with no derivatization required prior to analysis. An advantage of the procedure is the small serum sample size needed for analysis and the selectivity and sensitivity of the detector, with the limit of detection being 3 and 2 microgram/l for doxepin and loxapine, respectively. Nine cases of doxenin and loxapine misuse are presented. Serum doxepin concentrations ranged from 113 to 439 microgram/l, with a loxapine concentration of 192 microgram/l observed in one patient. The presence of the tricyclics was identified and confirmed by gas chromatography-mass spectrometry and the mass spectrum of loxapine is reported.

Disopyramide determination by gas chromatography, liquid chromatography, and gas chromatography--mass spectrometry

Disopyramide is determined in serum by gas chromatography with a nitrogen-selective detector, by liquid chromatography, and by gas chromatography--mass spectrometry. Comparable results are obtained with the three techniques, with a within-run and between-run precision of 5 to 10% (coefficient of variation). Least-squares analysis of data on patients' sera, analyzed first by gas chromatography (y) and then liquid chromatography (x), gave a slope of 1.12; y-intercept, -0.31; standard error of estimate, 0.46; and correlation coefficient, 0.94. Comparison of patients' sera by gas chromatography (y) and then by gas chromatography--mass spectrometry (x) gave a slope of 0.94; y-intercept, 0.42; standard error of estimate, 0.38; and correlation coefficient, 0.97. Interferences observed when using one technique--for example, gas chromatography--can be eliminated by analyzing the sample extract with one of the other techniques.

Disopyramide determination by gas chromatography, liquid chromatography, and gas chromatography--mass spectrometry

Disopyramide is determined in serum by gas chromatography with a nitrogen-selective detector, by liquid chromatography, and by gas chromatography--mass spectrometry. Comparable results are obtained with the three techniques, with a within-run and between-run precision of 5 to 10% (coefficient of variation). Least-squares analysis of data on patients' sera, analyzed first by gas chromatography (y) and then liquid chromatography (x), gave a slope of 1.12; y-intercept, -0.31; standard error of estimate, 0.46; and correlation coefficient, 0.94. Comparison of patients' sera by gas chromatography (y) and then by gas chromatography--mass spectrometry (x) gave a slope of 0.94; y-intercept, 0.42; standard error of estimate, 0.38; and correlation coefficient, 0.97. Interferences observed when using one technique--for example, gas chromatography--can be eliminated by analyzing the sample extract with one of the other techniques.

Interrelations between serum gastrin levels, gastric emptying and acid output before and after proximal gastric vagotomy and truncal vagotomy and antrectomy

In a prospective study of proximal gastric vagotomy and truncal vagotomy and antrectomy measurements were made, before and after operation, of acid output, gastrin output and gastric emptying of a solid and a liquid meat extract meal. No relationships were demonstrable between acid output and gastrin output. Truncal vagotomy and antrectomy (TVA) produced rapid early emptying of both meals combined with gross prolongation of the overall emptying of the solid meal. Truncal vagotomy and antrectomy reduced the intergrated gastrin output after either meal. Proximal gastric vagotomy (PGV) produced rapid early emptying of the liquid meal with no alteration in the early emptying of the solid meal; however, overall solid meal emptying was delayed. Proximal gastric vagotomy increased basal, peak and integrated gastrin output. In preoperative patients slow solid meal emptying was associated with higher gastrin output but after PGV the reverse was found, the slowest emptiers having the lowest gastrin output. These findings do not support the contention that a pyloroplasty should be added to PGV to reduce the hypergastrinaemia produced by the operation.

Gas-chromatographic determination of disopyramide in serum, with use of a nitrogen-selective detector

In this procedure for disopyramide in serum, the drug is extracted into n-heptane/isobutanol (96/4 by vol), then back-extracted into 1 mol/L H2SO4. The acidic solution is made basic with sodium hydroxide, extracted with diethyl ether, and the extract evaporated. The residue is redissolved in ethanol and analyzed by gas-chromatography, with use of a nitrogen-selective detector. p-Chlorodisopyramide is used as internal standard. Concentration and instrument response for serum extracts are linearly related from 1 to 5 mg/L, the slope being 0.61, the y-intercept -0.10, the standard error of estimate 0.01, and the correlation coefficient 0.99. Within-run precision was 6 and 4% for 3 and 5 mg/L concentrations, respectively, with a between-run precision of 7% at the 3 mg/L concentration. Diazepam interferes, but procainamide, chlordiazepoxide, quinidine, lidocaine, propranolol, sulfanilamide, and many other basic drugs do not.

Gas-chromatographic determination of disopyramide in serum, with use of a nitrogen-selective detector

In this procedure for disopyramide in serum, the drug is extracted into n-heptane/isobutanol (96/4 by vol), then back-extracted into 1 mol/L H2SO4. The acidic solution is made basic with sodium hydroxide, extracted with diethyl ether, and the extract evaporated. The residue is redissolved in ethanol and analyzed by gas-chromatography, with use of a nitrogen-selective detector. p-Chlorodisopyramide is used as internal standard. Concentration and instrument response for serum extracts are linearly related from 1 to 5 mg/L, the slope being 0.61, the y-intercept -0.10, the standard error of estimate 0.01, and the correlation coefficient 0.99. Within-run precision was 6 and 4% for 3 and 5 mg/L concentrations, respectively, with a between-run precision of 7% at the 3 mg/L concentration. Diazepam interferes, but procainamide, chlordiazepoxide, quinidine, lidocaine, propranolol, sulfanilamide, and many other basic drugs do not.

Gastrin and the ultrastructure of G cells in the fasting rat

The effect of fasting on serum and antral gastrin concentrations and G cell ultrastructure in the rat has been examined using a radioimmunoassay and quantitative electron microscopy. Serum gastrin levels in fasting animals were markedly reduced and there was also a significant decrease in antral gastrin concentrations after 48 hours and 72 hours of fasting. This was associated with a significant fall in the granule content and cytloplasmic volume of individual G cells, at its greatest by 48 hours. A relative absence of electron dense granules in the Golgi zones of cells from animals fasted for 72 hours suggested a paucity of newly formed granules, but fasting produced no detectable change in the electron density of the granule population taken as a whole. The results indicate that, during fasting, release and then synthesis of gastrin is inhibited, so that granule stores and cell size diminish. The correlation between the granule content of G cells and the antral content of gastrin suggests that hormone release occurs by exocytosis, rather than by any change in the content of individual granules.

A modified sensitive spectrofluorometric method for the determination of propranolol in serum

A modification of the spectrofluorometric propranolol procedure of Shand and associates and Ambler and colleagues is presented. A 3-ml volume of propranolol in serum is made basic with sodium hydroxide and extracted with 1.5% isoamyl alcohol in n-heptane. The drug is back-extracted into a mixture of 0.01 M citric acid in 50% ethylene glycol and measured spectrofluorometrically with the use of 299 nm for excitation and 352 nm for emission. Excellent linearity is observed in the 25--200 ng/ml range. The effects of sodium hydroxide, citric acid, and ethylene glycol concentration on the procedure were investigated. Ethylene glycol--citric acid in water is a better back-extracting mixture from the organic phase than hydrochloric acid. Using pentyl acetate as the extracting solvent instead of isoamyl alcohol in n-heptane did not change significantly the amount of the drug extracted. Other extracting solvents investigated did not increase sensitivity. At high citric acid concentrations a decrease in fluorescence intensity was observed at 350 nm. Interferences from other drugs using this procedure were investigated. Quinidine, methaqualone, and procainamide interfere at therapeutic levels.