Subpopulations of GABAergic neurons in laminae I-III of rat spinal dorsal horn defined by coexistence with classical transmitters, peptides, nitric oxide synthase or parvalbumin

GABAergic neurons in laminae I-III of the spinal dorsal horn may contain one or more of the following compounds: glycine, acetylcholine, neuropeptide Y, enkephalin, nitric oxide synthase or parvalbumin. Although the pattern of co-localization of some of these compounds is understood, it is not known which types of GABAergic neurons contain parvalbumin, or whether nitric oxide synthase coexists with peptides, acetylcholine or parvalbumin in any of these neurons, and in this study we have used immunocytochemistry and enzyme histochemistry to resolve these issues. Parvalbumin-immunoreactivity was restricted to those GABA-immunoreactive neurons that also showed glycine-immunoreactivity and was not co-localized with neuropeptide Y-immunoreactivity or NADPH diaphorase activity. By combining NADPH diaphorase histochemistry with immunocytochemistry with an antiserum to nitric oxide synthase, we were able to show that NADPH diaphorase activity was a reliable marker for nitric oxide synthase in the spinal cord. Neurons that possess GABA- but not glycine-immunoreactivity may contain neuropeptide Y, enkephalin, acetylcholine or NADPH diaphorase, and all of the cholinergic neurons appear to contain NADPH diaphorase. By combining immunofluorescent detection of neuropeptide Y or enkephalin with NADPH diaphorase histochemistry, we showed that peptide-immunoreactivity did not coexist with NADPH diaphorase. This suggests that neither of these peptides coexists with nitric oxide synthase or with acetylcholine in neurons in the superficial dorsal horn. Several phenotypically distinct groups of GABA-immunoreactive neuron can therefore be identified in laminae I-III of the dorsal horn, and these may represent different functional types of inhibitory neuron.

Suppression of non-esterified fatty acids to treat type A insulin resistance syndrome

A patient with type A insulin-resistance syndrome resistance presented with severe hypertriglyceridaemia and diabetes. Fasting insulin and non-esterified fatty acids (NEFA) were very high (41 mU/L and 3.3 mmol/L). A low-fat diet failed to correct hyperlipidaemia and diabetes. Sustained suppression of NEFA with slow-release acipimox for 8 weeks resulted in substantial reduction of serum fasting NEFA (0.31 mmol/L). Glucose tolerance became normal and insulin sensitivity increased from 7% to 32%. The glucose fatty-acid cycle may operate in patients with severe insulin resistance and hyperlipidaemia: high serum NEFA aggravates insulin resistance and hyperglycaemia by inhibiting glucose uptake and utilisation.

Molecular scanning of the insulin receptor gene in syndromes of insulin resistance

Using the molecular scanning technique of single-stranded conformational polymorphism (SSCP), we have examined the exons encoding the insulin receptor gene in 26 patients with syndromes of insulin resistance. We found 27 variant sequences, 4 of which were mutations that altered an amino acid. One patient with the Rabson-Mendenhall syndrome was homozygous for a mutation in the extracellular alpha-subunit (Ser to Leu323), one type A insulin-resistant patient was heterozygous for Pro to Leu1178, and another type A insulin-resistant patient was heterozygous for a mutation in the COOH-terminus of the receptor (Arg to Gln1351). The previously reported, and probably functionally insignificant, variant Val to Met985 was detected in one patient. No missense or nonsense insulin receptor mutations were found in any patients whose insulin resistance was associated with gross obesity, lipoatrophy, or acromegaloid features. No missense or nonsense mutations were found in subjects with polycystic ovary syndrome or Syndrome X. Putting these findings in the context of other work in this field, we conclude that subjects with leprechaunism or Rabson-Mendenhall syndrome have a high probability of having a missense or nonsense insulin receptor mutation. Nonobese, nondysmorphic, severely insulin-resistant females with hirsutism, acanthosis nigricans, and menstrual disturbance (type A phenotype) have an intermediate probability of having this type of insulin receptor mutation. Although insulin receptor mutations have been occasionally described in other phenotypes of insulin resistance, the frequency of point mutations in the exons of the insulin receptor gene in patients with those phenotypes appears to be low.

Differences in testosterone metabolism by beard and scalp hair follicle dermal papilla cells

OBJECTIVE

Androgens have paradoxically different effects on hair follicles depending on body site, stimulating beard growth while inducing regression in some areas of the scalp. The mesenchyme derived dermal papilla at the base of the hair follicle regulates many aspects of the growth of follicular epithelium, and is probably the site of androgen action. Since 5 alpha-dihydrotestosterone is considered to be the active intracellular androgen in many target tissues and is required for some androgen-mediated hair growth, such androgen-sensitive cells should contain 5 alpha-reductase. This study was designed to investigate whether cultured human dermal papilla cells contain 5 alpha-reductase and whether the metabolic capacity varies with the body site of the follicle in line with the clinical picture.

DESIGN

Testosterone metabolism in cultured dermal papilla cells from androgen sensitive beard follicles was compared with less androgen dependent non-balding scalp follicles. Primary cell cultures were established from follicles of 11 patients with normal hair growth. The cells were grown to confluence in 10-cm Petri dishes and incubated with 5 nM 3H-testosterone in serum-free medium for 2 hours. The cells and the culture medium were collected separately for individual analysis.

MEASUREMENTS

Unlabelled carrier and 14C-marker steroids were added to both the cell and medium extracts before separation by thin-layer chromatography. The individual steroid identities were confirmed by recrystallizing up to five times to a constant 3H/14C ratio.

RESULTS

Testosterone was taken up by both cell types; significant amounts of 5 alpha-dihydrotestosterone were recovered inside beard cells, but not in scalp cells, whereas androstenedione was identified in both. An unidentified compound was present intracellularly in both cell types, but was not present in the culture medium. 5 alpha-Dihydrotestosterone was present only in the culture medium of beard cells but androstenedione was present in a similar amount in the medium from both cell types. The presence of other steroids could not be confirmed in either the cell extracts or the culture medium.

CONCLUSIONS

The production of 5 alpha-dihydrotestosterone by beard cells concurs with the poor beard growth in men with 5 alpha-reductase deficiency, supporting our hypothesis that androgens mediate their effects on the hair follicle via the mesenchyme-derived dermal papilla.

Oral teratoma (epignathus) with intracranial extension: a report of two cases

Epignathi are unusual congenital tumours presenting as oropharyngeal masses, often resulting in rapid asphyxia following birth. Occasionally, intracranial extension of the tumour is present, and two such cases are described. The presence of this complication, diagnosable by ultrasound examination, indicates that aggressive surgical treatment is inappropriate.

Non-enzymatic glycation of apolipoprotein B in the sera of diabetic and non-diabetic subjects

Utilising a combination of m-aminophenyl-borate affinity chromatography and an immunoradiometric assay for apolipoprotein B (apo B), we have developed a specific and highly sensitive (6 ng/ml) procedure for the assay of glycated apo B. We studied 52 diabetic patients, 50 non-diabetic control subjects and 12 patients heterozygous for familial hypercholesterolaemia (FH). Both insulin-dependent and non-insulin dependent diabetics were included in our study. Total apo B in the diabetics (108 +/- 5 mg/dl; mean +/- S.E.M) was increased (controls: 95 +/- 4 mg/dl; P less than 0.05). In the FH group the serum apo B concentration (216 +/- 24 mg/dl) was significantly higher (P less than 0.001) than both the other groups studied. Both the serum glycated apo B concentration (9.3 +/- 0.8 mg/dl versus 4.8 +/- 0.7 mg/dl) and the percentage glycated apo B (7.9 +/- 0.4% compared to 3.9 +/- 0.2%) were significantly higher in the diabetics than in non-diabetic controls (P less than 0.001). A positive correlation was found between the percentage of glycated apo B and glycated haemoglobin (r = 0.65; P less than 0.001) and fasting glucose concentration (r = 0.52; P less than 0.001) in diabetics. The percentage of glycated apo B in FH patients was not significantly different from controls, but the serum concentration of glycated apo B, because of the greatly increased total level of apo B was raised (8.2 +/- 1.4 mg/dl) to a similar extent to that of the diabetics.

Cryotherapy for retinopathy of prematurity in a regional neonatal intensive care unit

Ninety-six low birth-weight premature infants at risk of retinopathy of prematurity (ROP) were screened over a 25-month period, yielding 30 eyes of 15 infants with 'treatable' disease. The response and complications of cryotherapy were prospectively evaluated in these infants over a 3-24-month period. Six eyes of three infants progressed to cicatricial disease despite treatment. One infant developed angle closure glaucoma but neither eye showed cicatricial disease. In 24 eyes of 12 infants regression of active ROP was observed after treatment. The local and systemic complications associated with cryotherapy are discussed.

Lipoprotein secretion by the human hepatoma cell line Hep G2: differential rates of accumulation of apolipoprotein B and lipoprotein lipids in tissue culture media in response to albumin, glucose and oleate

Serum low-density lipoprotein (LDL) concentration is a major determinant of susceptibility to the development of atherosclerosis. A major component of the protein moiety of LDL and its precursor very-low-density lipoprotein is apolipoprotein B (apo B). The human hepatoma cell line, Hep G2, was used as a model for the investigation of mechanisms which control hepatic secretion of the apo B and lipid components of lipoproteins. Using a sensitive immunoradiometric assay for apo B developed in this laboratory, we showed that bovine serum albumin inhibited and glucose, and fatty acids enhanced the rate of accumulation of apo B in the culture medium of Hep G2 cells. However, these substances did not necessarily affect LDL lipids in the same way as apo B. This finding appeared to be due to Hep G2 cells expressing lipase activities which led to triacylglycerol and phospholipid hydrolysis and lipid reuptake. Reuptake of apo B also occurred, but its rate of accumulation in the culture medium suggested it was a closer reflection of its true secretory rate.

Disturbance in sodium regulating hormones in chronic obstructive uropathy

Serum atrial natriuretic peptide (ANP), plasma renin activity (PRA), angiotensin II (AII) and aldosterone levels have been studied in patients with chronic bilateral ureteric obstruction resulting from high pressure chronic retention of urine (HPCR), both in the obstructed state and during the post-obstructed period. Increased ANP levels observed during chronic obstruction fell rapidly following urinary tract decompression by urethral catheterisation. Serum ANP resurged briefly within 24 h but stabilised thereafter at a lower level. PRA was initially suppressed but rose after catheterisation, the increase lagging behind the changes seen for ANP. Rising levels of AII and aldosterone followed this trend but, unlike PRA, levels were not completely suppressed in the obstructed state. The observed hormonal changes probably reflect homeostatic mechanisms directed to the maintenance of sodium and water balance during obstruction and to limitation of the diuresis following its relief.

Glucagon in women with polycystic ovary syndrome (PCO): relationship to abnormalities of insulin and androgens

To investigate the glucagon status of women with polycystic ovary syndrome (PCO) and to relate this to serum concentrations of insulin, androgens and SHBG, 44 women with PCO and 23 control subjects underwent a 75-g oral glucose tolerance test. Although obese (body mass index greater than 30 kg/m2) women with PCO had higher concentrations of glucose and insulin than overweight (BMI 25-30 kg/m2) and non-obese (BMI less than 25 kg/m2) women with PCO and control subjects, fasting and summed values of glucagon in response to oral glucose were similar in all groups. The fasting and summed concentrations of glucagon were inversely related to those of testosterone and androstenedione in obese women with PCO, but no other relationships were demonstrated between hormone values and those of glucagon in the other groups. We conclude that glucagon is not implicated in peripheral insulin resistance in women with PCO.

Influence of danazol and goserelin on insulin and glucagon in non-obese women with endometriosis

To investigate the effects of medical treatment of endometriosis on concentrations of insulin and glucagon in comparison with those of androgens, 12 non-obese women with minimal endometriosis were randomly allocated to receive treatment with either danazol or the gonadotropin-releasing hormone analogue, goserelin. In subjects treated with danazol, mean (SD) summed serum insulin (1.08 (0.22) nmol/l pretreatment; 3.00 (1.50) nmol/l after treatment, p less than 0.05) and summed plasma glucagon (94 (21) pmol/l pretreatment; 238 (113) pmol/l after treatment, p less than 0.05) responses to oral glucose administration increased significantly, but remained unchanged in subjects treated with goserelin. In the danazol-treated group, the mean free testosterone index increased from 3.3 (1.6) to 13.3 (4.2) (p less than 0.01), but there was no correlation between either glucagon or insulin and free testosterone index. In the goserelin-treated subjects, however, there was no change in mean free testosterone indices (pretreatment 3.6 (1.0), post-treatment 3.9 (1.8). Thus, the increase in free testosterone index induced by danazol treatment is not responsible for the concomitant development of hyperinsulinaemia and hyperglucagonaemia.

Measurements of glutathione S-transferase B1 in plasma after birth asphyxia: an early indication of hepatocellular damage

Concentrations of glutathione S-transferase (glutathione transferase; EC 2.5.1.18) B1 and B2 subunits (B1 and B2) and activity of alanine aminotransferase (ALT; EC 2.6.1.2) were measured in sequential plasma samples taken from 14 infants with birth asphyxia. Within 6 h of asphyxia, abnormal concentrations of B1 were found in 11 infants, whereas only seven infants showed abnormal ALT activities at this time. In plasma sampled 24 h after birth, values for ALT were abnormal in 10, whereas values for B1 were abnormal in six. Abnormal concentrations of B2 were found in relatively few of these infants, apparently because this monomer is poorly expressed in liver samples obtained up to 41 weeks after conception. We conclude that measurement of B1 may provide a useful index of hepatic impairment in birth-asphyxiated infants.

Clinical and biochemical assessments of damage due to perinatal asphyxia: a double blind trial of a quantitative method

Using conventional criteria, a series of 26 infants was selected for intrapartum asphyxia from about 4000 deliveries over one year at a single hospital to assess the efficacy of a new biochemical method. Tissue damage was estimated from urinary excretion of hypoxanthine, an important and central intermediate in purine metabolism. The overall pattern showed agreement between the grading (by previously accepted methods) of asphyxia in the perinatal period and our new biochemical approach. The association with handicap at one year of age following asphyxia was complex. This biochemical technique could be used to exclude postasphyxial damage as a cause of clinical disturbances and to select a small group (0.1% of all births) who require further investigation for rarer disorders which may also cause long term handicap.

Long-term treatment of Nelson's syndrome with sodium valproate

Eleven patients with Nelson's syndrome were given sodium valproate (Epilim, Sanofi). Plasma ACTH and cortisol levels were measured under carefully controlled conditions which were designed to eliminate spontaneous fluctuations in ACTH. At 6 weeks all 11 patients were reassessed while taking sodium valproate 600 mg/day; there was then a small but significant (P less than 0.05) reduction in plasma ACTH concentration. Six patients continued to take sodium valproate, and were reassessed at 1 year when five were taking 1200 mg/day and one patient was taking 600 mg/day. At 1 year for these six patients there had been an increase in mean plasma ACTH which was then not significantly different from basal values. The five patients who discontinued sodium valproate were also reassessed at 1 year, when there were no significant differences compared to basal or 6-week values. During therapy with sodium valproate, there were no significant changes in the half-life of plasma cortisol, plasma sodium and potassium concentrations, or serum liver enzymes. Weight gain on sodium valproate was the main reason for patients asking to discontinue therapy. Sodium valproate is not an effective long-term therapy for reducing plasma ACTH for patients with Nelson's syndrome.

An immunochemiluminometric assay for serum free thyroxine

An immunochemiluminometric assay has been developed for the measurement of free T4 concentrations in serum. The assay uses chemiluminescent acridinium ester labelled monoclonal antibodies which react with free T4 in the sample. A T4-rabbit immunoglobulin G conjugate competes for antibody binding sites, immune-complexes containing this being isolated using an anti-immunoglobulin G antibody coupled to paramagnetic particles. Associated chemiluminescence intensity is thus dependent on the free T4 concentration. The assay distinguishes patients with primary thyroid disease from euthyroid subjects and is unaffected by abnormal binding proteins which compromise the diagnostic accuracy of radiolabelled analogue immunoassays. the test yields results which accurately reflect the clinical thyroid status of euthyroid patients with a variety of acute and chronic non-thyroid illnesses. This is again in marked contrast to the aberrant results seen using certain radiolabelled analogue procedures.

Chemiluminescent labeled-antibody assay for thyroxin in serum, with magnetic separation of the solid-phase

A chemiluminescent labeled-antibody immunoassay has been developed for measurement of total thyroxin (T4) in serum. Monoclonal antibodies to T4 labeled with a chemiluminescent acridinium ester are used. Serum samples are incubated with the labeled antibodies and a thyroxin-rabbit immunoglobulin conjugate, then reacted with magnetizable particles containing sheep anti-rabbit immunoglobulin. The total reaction time is 40 min. The chemiluminescence intensity of the solid-phase immune complexes is inversely proportional to the concentration of T4 in the sample. The sensitivity of the assay is 1 nmol/L, and the working range of 20-190 nmol/L is characterized by CVs less than or equal to 10%.

Group treatment of general practice anxiety problems

This study examined the effects on anxiety levels and primary care team workload of group psychological treatment for anxiety compared with individual treatment. Patients making high demands on primary care services were selected for group treatment, following which demands for services were considerably reduced. Two types of group treatment were used: the anxiety support group required less staff time to run than the anxiety management group but neither treatment had a clinically significant impact on anxiety symptoms. Individual psychological treatment was more effective in reducing levels of anxiety but required slightly more staff time per patient. These findings show that there is no close correspondence between reduction of anxiety and reduction of service costs and underline the importance of evaluating treatment effects with reference to the specific objectives of treatment.

Chemiluminescent labeled-antibody assay for thyroxin in serum, with magnetic separation of the solid-phase

A chemiluminescent labeled-antibody immunoassay has been developed for measurement of total thyroxin (T4) in serum. Monoclonal antibodies to T4 labeled with a chemiluminescent acridinium ester are used. Serum samples are incubated with the labeled antibodies and a thyroxin-rabbit immunoglobulin conjugate, then reacted with magnetizable particles containing sheep anti-rabbit immunoglobulin. The total reaction time is 40 min. The chemiluminescence intensity of the solid-phase immune complexes is inversely proportional to the concentration of T4 in the sample. The sensitivity of the assay is 1 nmol/L, and the working range of 20-190 nmol/L is characterized by CVs less than or equal to 10%.

Isolated adrenocorticotrophin deficiency and empty sella associated with hypothyroidism

A case of isolated ACTH deficiency is described. The patient had an empty sella and longstanding radio-iodine induced hypothyroidism. The association between isolated ACTH deficiency, empty sella and hypothyroidism is reviewed. It has not previously been recognized that the commonest endocrine association of isolated ACTH deficiency is primary thyroid failure. ACTH secretion does not recover following thyroxine replacement treatment.

The preparation and characterization of alkaline phosphatase-thyroxine conjugates and their use in the enzyme immunoassay of thyroxine

Alkaline phosphatase from calf intestine was conjugated to thyroxine using cyanuric chloride, glutaraldehyde and 1-cyclohexyl-3(-2 morphoinoethyl)-carbodiimide as coupling reagents. The conjugates produced were studied for incorporation of thyroxine, retention of enzyme activity and immunoreactivity in a thyroxine radioimmunoassay system against a range of thyroxine antisera. The use of these conjugates in thyroxine enzyme immunoassay was studied using second-antibody separation. Comparison of the results with radioimmunoassay data was satisfactory and indicates the potential of these conjugates for thyroxine immunoassay. The use of cyanuric chloride as a coupling reagent was unsatisfactory, but good results were obtained with glutaraldehyde. Although satisfactory immunoreactivity of carbodiimide conjugates was observed in a radioimmunoassay system, these results were not reflected in the enzyme immunoassay systems studied.

Hyperkalaemia in diabetes mellitus--potential hazards of coexisting hyporeninaemic hypoaldosteronism

Two patients with insulin-dependent diabetes mellitus (Type I), developed severe, life-threatening hyperkalaemia, the first following treatment with spironolactone, the second during treatment for staphylococcal septicaemia when glucose-induced hyperkalaemia occurred. Investigations demonstrated co-existing hyporeininaemic hypoaldosteronism. Prompt recognition of this combined hormone-deficiency syndrome led to appropriate treatment and recovery. The biochemical features and clinical importance of hyporeninaemic hypoaldosteronism are discussed.

High serum thyroxine-binding globulin--an important cause of hyperthyroxinaemia

Four patients are described who had a significant elevation of serum thyroxine-binding globulin (TBG). Review of these patients indicated that inappropriate therapy for thyrotoxicosis had been given in three cases. A study of our laboratory records revealed that significant TBG elevation was a relatively common phenomenon which occurred in approximately 0.45% of our hospital population. Patients with this abnormality have serum thyroxine levels which are comparable to those with clinical thyrotoxicosis. Tri-iodothyronine is frequently elevated though less so than in patients with clinical thyrotoxicosis. Measurement of TBG is indicated in all cases of hyperthyroxinaemia in which the clinical features of thyrotoxicosis are doubtful. The TRH test was found to be most useful in evaluating the thyroid status of these patients.

A ligand-binding assay for thyroxine-binding globulin based on polyethylene glycol separation

A simple ligand-binding assay for thyroxine-binding globulin (TBG) is described. The method depends on the partition of labelled thyroxine between bovine serum albumin and TBG. Differentiation between labelled thyroxine bound to TBG and bovine serum albumin is achieved by the addition of excess TBG antiserum and subsequent precipitation with polyethylene glycol. The results are compared with the Corning Immophase kit method for TBG.

Hypermineralocorticism without excessive aldosterone secretion: an adrenal carcinoma producing deoxycorticosterone

A 51-year-old female was thought to have Conn's syndrome because she had hypertension, hypokalaemia and low plasma renin activity. The cause was not aldosterone excess, but there was an adrenal cortical carcinoma producing 11-deoxycorticosterone (DOC) in extremely large quantities, with ineffective 11 beta-steroid hydroxylation. Plasma and urinary aldosterone levels were within the normal range. Blood levels of other steroids including those on the pathways of formation of glucocorticoids and sex steroids were unaffected. The tumor was cultured in vitro and shown by high performance liquid chromatography (HPLC) to produce predominantly DOC from tritiated pregnenolone, with no detectable aldosterone, in agreement with the in vivo results.

Atopy predisposing to acute bronchiolitis during an epidemic of respiratory syncytial virus

Thirty-one infants admitted to hospital with acute bronchiolitis during an epidemic of respiratory syncytial virus were compared with a control group of 32 infants to establish whether the two groups differed in atopic background. Past history of respiratory illness, eczema, and present reactions to skin testing differed significantly between the two groups. Thus, infants with acute bronchiolitis had a significantly higher atopic predisposition than the controls.

Pregnancies in women with hyperprolactinaemia: obstetric and endocrinological management of 50 pregnancies in 37 women

Fifty pregnancies occurred in 37 women with hyperprolactinaemia. Thirty women (81%) initially attended with infertility and 24 (65%) had secondary amenorrhoea. Twelve women (31%) had pituitary macroadenomas, of whom seven (19%) were treated with neurosurgery and/or external radiotherapy before conception. Forty-one conceptions (82%) followed treatment with bromocriptine. There were no unusual obstetric or endocrinological complications. Serum prolactin measured at least 6 months post partum when under basal conditions, without bromocriptine and not breast feeding, showed no significant trends compared with initial values. Tumour growth was not stimulated by the high oestrogen levels of pregnancy.

Rapid non-invasive diagnosis of herpes encephalitis

A sensitive and specific radioimmunosorbent assay for serum and cerebrospinal fluid (CSF) IgG antibodies against Herpesvirus simplex has been evaluated as an early diagnostic test for herpes encephalitis. When combined with the measurement of albumin in serum and CSF as accurate diagnostic index was obtained in twenty-four out of twenty-six patients. Out of ten patients tested before day 10 of neurological illness, five had positive diagnostic indices. Three patients with negative indices before day 10 had positive indices when re-tested later.

A correlative study of computed tomography and histology in human and experimental vasogenic cerebral edema

The computed tomography (CT) scans of nine patients with vasogenic cerebral edema and five monkeys with cryogenic lesions were correlated with histologic findings. The areas of diminished density on the CT scan corresponded to foci of histologically recognizable edema. The attenuation number of the edematous tissue in the human varied from 18.0 to 28.8 Hounsfield units (HU: 1,000 scale) and in the monkey from 27.0 to 34.7 HU. There was a rough correlation between the extent of decrease in the attenuation number and the degree of staining of edematous tissue by the periodic acid-Schiff method. The decreased attenuation number of edematous tissue signifies dilution by edema fluid only when it is above 20 HU or represents a change of less than 12 HU. Lower numbers imply an additional process, possibly transformation of complex into neutral lipids. It is our belief that cerebral edema in the human can be quantitatively studied with the presently available CT scanners.

Twenty-four hour profiles of serum prolactin during male puberty with and without gynaecomastia

Twenty-four hour profiles of circulating prolactin have been documented in eight boys with simple delayed puberty, eleven with gynaecomastia, three of whom were retested following its spontaneous resolution, and two normal adult men. Mean 24 h prolactin levels in four boys with delayed puberty and ten with gynaecomastia exceeded the mean levels for the two adult men. A sleep-associated rise in prolactin levels occurred at all stages of puberty irrespective of the presence or absence of gynaecomastia, and in some subjects peaks also occurred during the daytime. Boys with gynaecomastia had higher 24 h means levels of prolactin (P less than 0.05), higher daytime levels (P less than 0.05) and higher sleep-associated levels (P less than 0.05) than did control subjects. These were not related to the degree or duration of the gynaecomastia, but 24 h mean levels of prolactin and oestradiol were positively correlated. In one subject who had had transient galactorrhoea, high levels of circulating prolactin, oestrone and oestradiol fell following spontaneous resolution of the gynaecomastia. We believe that oestrogen: androgen imbalance during the daytime is the major cause of pubertal gynaecomastia, with hyperprolacinaemia (which may cause galactorrhoea) sometimes occurring as a response to relative hyperoestrogenaemia.

Failure of oral bromocriptine to affect hypergastrinemia in two patients with the Zollinger-Ellison syndrome

Bromocriptine was administered to 2 subjects with gastrin-secreting tumors of the pancreas. The absorption of the drug was confirmed by a rise in growth hormone levels but no change in the elevated serum gastrin levels were observed. Bromocriptine does not appear to affect gastrin hypersecretion in the way that it influences the hypersecretion of pituitary hormones.

An optimised radioimmunoassay for maternal serum alpha1-fetoprotein using polyethylene glycol

A radioimmunoassay for alpha1-fetoprotein in human maternal serum at 15-20 weeks' gestation using polyethylene glycol to separate bound and free antigen is described. A number of variables has been investigated to define optimal conditions for use at this gestation. The method gives results which agree with those from a double-antibody technique. It has good precision in the critical concentration range, and recoveries are satisfactory. The importance of including sufficient serum protein in the analytical system is stressed. There were systematic differences between three standard preparations of alpha1-fetoprotein, but three out of four antisera tested gave very similar results. The implications for screening for neural tube defects in early pregnancy are discussed.

A simplified radioimmunoassay procedure for serum progesterone

A simple, rapid radioimmunoassay for progesterone in unextracted serum is described. Cortisol is used to inhibit progesterone binding to corticosteroid binding globulin. The method has been optimised for the determination of progesterone in pregnancy sera or in the luteal phase of the menstrual cycle.

A study of peroxidase levels in human cervical mucus as an index of ovulation

Fourteen healthy women were screened for the following parameters throughout one complete menstrual cycle: levels of urinary oestrogens and pregnanediol; levels of plasma and urinary gonadotrophins; and pH, protein content and levels of peroxidase in the cervical mucus. It was found that concentrations of peroxidase in the cervical mucus were not a reliable index of ovulation.

Experimental study of relation of fever to cerebral edema

✓ The effect of hyperthermia on the development of the cerebral edema associated with cryogenic lesions was studied in monkeys. Exposure to a body temperature of near 104°F for a period of only 2 hours increased the edema by 40%. This effect was independent of the hypertensive action of hyperthermia but was intensified when the latter was present. It is suggested that, in human diseases known or thought to be associated with cerebral edema, fever should be vigorously treated.

Experimental acute lead encephalopathy in the juvenile rhesus monkey

Lead subacetate (0.5g) and 1000 units of vitamin D were given three times a week to four newly-weaned rhesus monkeys. In addition, two animals received only the vitamin D. The poisoned animals had an increase in the urinary excretion of delta-aminolevulinic acid, an elevated content of lead in the blood, and a fall in hemoglobin concentration. Between 6 and 18 weeks the animals suddenly developed ataxia, nystagmus, generalized weakness, and convulsions. At this time the animals were killed by perfusion of fixative and the brain prepared for light and electron microscopic studies. Definite morphological evidence of disease was confined to the central nervous system, except for one animal which showed the characteristic renal inclusions of lead poisoning. All animals showed PAS-positive globules associated with blood vessels and an exudative edema involving the white matter of the cerebral hemispheres and cerebellum. Ultra-structurally, this appeared as a granular precipitate within an expanded extracellular space. Alterations of nerve fibers were not seen in the white matter but axonal swelling was observed in the cerebral cortex. The perikaryon and neuropil appeared normal. The control animals showed no significant cerebral changes.

Electron microscopic and chemical studies of the vascular changes and edema of lead encephalopathy. A comparative study of the human and experimental disease

Lead encephalopathy was induced in suckling rats by administering lead to the mother. The brains were studied by light and electron microscopy, and the results were compared with observations in the human disease as well as in cases of cerebral ischemia in children. In their severe forms, both human and experimental lead encephalopathies are characterized by exudative extracellular edema and perivascular PAS-positive globules. The latter consist of osmiophilic non-membrane-limited cytoplasmic inclusions located, in the rat exclusively and in the human predominantly, in perivascular astrocytes. Intervascular strands are also found in both forms of the disease. In the rat these consist of basement membrane surrounding endothelial cytoplasm. Chemically, experimental lead encephalopathy with morphologically demonstrable edema is associated with an increase in brain water, sodium and serum albumin. Relative to the serum concentration, the increase in water is disproportionately greater than the sodium or albumin. There were no demonstrable changes in chloride or potassium.