Effective sunscreen ingredients and cutaneous irritation in patients with rosacea

Patients with rosacea are particularly susceptible to the irritation caused by sunscreen ingredients. The purpose of this bilateral comparison study was to examine the effects of different ingredients found in sunscreen on facial cutaneous irritancy in patients with rosacea. patients clinically diagnosed with rosacea were asked to test different preparations of common sunscreens on their faces. The results show that the presence or absence of appropriate protective ingredients, such as dimethicone and cyclomethicone in the vehicle, may prevent irritation from other sunscreen ingredients in patients with inflammatory conditions such as rosacea.

Relationship of gated SPECT ventricular function parameters to angiographic measurements

OBJECTIVES

Left ventricular volumes and ejection fractions constitute important information in the diagnosis of cardiac disease. This investigation examined the relations of functional parameters computed with a recently published scintigraphic gated tomographic method with those from angiography, analyzing discrepancies arising from differences involved in modeling the left ventricle.

BACKGROUND

While left ventricular ejection fractions obtained from myocardial perfusion gated single-photon emission computed tomography (SPECT) have demonstrated accurate comparisons with other imaging modalities, validations of volumes have not been examined as extensively, and some recent studies have reported a wide range of angiographic correlation. It is important to know how volumes obtained by a new class of methods compare with those from older, well-established techniques in order to interpret individual patients' results, particularly when scintigraphic images are severely hypoperfused.

METHODS AND RESULTS

Tc-99m sestamibi myocardial perfusion gated SPECT data were processed retrospectively for 58 patients studied by single-plane angiography. Endocardial borders were generated automatically on paired vertical and horizontal long-axis Tc-99m sestamibi gated tomograms for computing ventricular volume using a Simpson's rule summation of elliptical slices. Linear regression and paired t tests were used to compare SPECT with angiographic parameters for all patients and for groups identified on the basis of tomogram visual examination as hypoperfused, ischemic or nonischemic, with the latter category further subgrouped as to fixed defects or normal perfusion. Linear regression analysis demonstrated Pearson correlation coefficients of 0.87 for end-diastolic volumes, 0.91 for end-systolic volumes, and 0.86 for ejection fraction; paired t test analysis showed end-systolic volumes to be nearly identical (p > 0.99) to angiographic values. However, paired t tests also revealed gated SPECT end-diastolic volumes and ejection fractions were significantly lower (p < 10(-4)) than angiography. Correlations and trends were essentially the same for all subgroups except for the small sample (n = 10) of patients with normal perfusion.

CONCLUSIONS

Gated SPECT provides ventricular volumes and ejection fractions that correlate well with angiography, even in hypoperfused and ischemic populations. However, gated SPECT end-diastolic volumes and ejection fractions are significantly lower than angiographic measurements, partly because of inclusion of greater outflow tract amounts in standard angiographic models. Because myocyte concentration decreases rapidly at the ventricular base, it is likely that most gated SPECT methods will produce endocardial borders encompassing less of the outflow tract than do angiographic outlines.

Neurochemical characterization and distribution of enteric GABAergic neurons and nerve fibres in the human colon

GABA, somatostatin and enkephalin are neurotransmitters of enteric interneurons and comprise part of the intrinsic neural circuits regulating peristalsis. Within the relaxation phase of reflex peristalsis, nitric oxide (NO) is released by inhibitory motor neurons and perhaps enteric interneurons as well. Previously, we identified by GABA transaminase (GABA-T) immunohistochemistry, a subpopulation of GABAergic interneurons in the human colon which also contain NO synthase activity and hence produce NO. In this study, we have examined further the capacity for cotransmission within the GABAergic innervation in human colon. The expression of two important neuropeptides within GABAergic neurons was determined by combined double-labelled immunocytochemistry using antibodies for GABA-T, enkephalin and somatostatin, together with the demonstration of NO synthase-related NADPH diaphorase staining in cryosectioned colon. Both neuropeptides were found in GABAergic neurons of the colon. The evidence presented herein confirms the colocalization of NO synthase activity and GABA-T immunoreactivity in subpopulations of enteric neurons and further allows the neurochemical classification of GABAergic neurons of the human colon into three subsets: (i) neurons colocalizing somatostatin-like immunoreactivity representing about 40% of the GABAergic neurons, (ii) neurons colocalizing enkephalin-like immunoreactivity, about 9% of the GABAergic neurons and (iii) neurons colocalizing NO synthase activity, about 23% of the GABAergic neurons. This division of GABAergic interneurons into distinct subpopulations of neuropeptide or NO synthase containing cells is consistent with and provides an anatomical correlate for the pharmacology of these transmitters and the pattern of transmitter release during reflex peristalsis.

The EWS-WT1 translocation product induces PDGFA in desmoplastic small round-cell tumour

Chromosomal translocations resulting in chimaeric transcription factors underlie specific malignancies, but few authentic target genes regulated by these fusion proteins have been identified. Desmoplastic small round-cell tumour (DSRT) is a multiphenotypic primitive tumour characterized by massive reactive fibrosis surrounding nests of tumour cells. The t(11;22)(p13;q12) chromosomal translocation that defines DSRT produces a chimaeric protein containing the potential transactivation domain of the Ewing-sarcoma protein (EWS) fused to zinc fingers 2-4 of the Wilms tumour suppressor and transcriptional repressor WT1 (refs 2,3). By analogy with other EWS fusion products, the EWS-WT1 chimaera may encode a transcriptional activator whose target genes overlap with those repressed by WT1 (ref. 4). To characterize its functional properties, we generated osteosarcoma cell lines with tightly regulated inducible expression of EWS-WT1. Expression of EWS-WT1 induced the expression of endogenous platelet-derived growth factor-A (PDGFA), a potent secreted mitogen and chemoattractant whose promoter contains the many potential WT1-binding sites. Native PDGFA was not regulated by wild-type WT1, indicating a difference in target gene specificity between this tumour suppressor and its oncogenic derivative. PDGFA was expressed within tumour cells in primary DSRT specimens, but it was absent in Wilms tumours expressing WT1 and Ewing sarcomas with an EWS-Fli translocation. We conclude that the oncogenic fusion of EWS to WT1 in DSRT results in the induction of PDGFA, a potent fibroblast growth factor that contributes to the characteristic reactive fibrosis associated with this unique tumour.

Quality standards for immunization. Guidelines from the Infectious Diseases Society of America

This is the third in a series of guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. It is presented as a standard of care rather than a practice guideline because the case for following these recommendations is very strong and it should be followed with rare exceptions. The purpose of this guideline is to provide assistance to clinicians when making decisions on providing immunizations to healthy infants, children, and adults. The document is a summary of guidelines already developed by national organizations. The targeted providers are pediatricians, family practitioners, internists, and other physicians who provide immunizations. The IDSA provided the funding. Panel members represent experts in adult and pediatric infectious diseases. The guidelines are evidence-based. A standard ranking system is used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary and tables highlight the major recommendations. Indicators for measuring compliance with the standards are included.

Image enhancement of severely hypoperfused myocardia for computation of tomographic ejection fraction

Ejection fractions computed from 99mTc-sestamibi myocardial perfusion gated tomograms have demonstrated a high degree of accuracy and reproducibility. Although automated algorithms appear to provide reasonable endocardial outlines for patients over a broad spectrum of cardiac diseases, in cases of severe hypoperfusion, it is necessary to manually adjust contrast and brightness to judge whether borders are correct or must be altered.

METHODS

Midventricular horizontal and vertical long axis gated tomograms were generated for 116 studies chosen on the basis of extensive, severe myocardial perfusion defects. Automated software transformed cinematic tomograms into images demonstrating uniform appearance of the myocardium throughout the cardiac cycle. Transformed images were introduced to edge detection algorithms for subsequent calculation of ventricular volumes and ejection fractions.

RESULTS

Linear regression analysis demonstrated excellent intraobserver reproducibility for ejection fractions (r = 0.95) and volumes (r = 0.98). There was also good agreement of ejection fractions (r = 0.86) and volumes (r = 0.94) with values derived from an expert's manual drawings. In a subgroup of 22 patients, automated ejection fractions from transformed images demonstrated better agreement with independent first-pass values (r = 0.90) than did manual measurements derived from original data (r = 0.85).

CONCLUSION

Image enhancement algorithms succeeded in providing accurate, reproducible gated SPECT ejection fractions in the most difficult class of patients exhibiting severe hypoperfusion.

Diencephalic syndrome: clinical features and imaging findings

PURPOSE

To emphasize the importance of imaging in children with diencephalic syndrome due to hypothalamic/chiasmatic astrocytomas.

METHODS

Findings in nine patients (mean age, 26 months) with diencephalic syndrome and hypothalamic/chiasmatic astrocytomas were analyzed retrospectively, including reviewing clinical records, imaging examinations, and follow-up studies.

RESULTS

Symptoms and signs included failure to thrive (n = 9), nystagmus (n = 3), visual field defects (n = 1), optic pallor (n = 1), emesis (n = 2), and headache (n = 1). All patients had hypothalamic/chiasmatic masses. Five patients underwent biopsy, and, in all cases, specimens showed low-grade astrocytoma. Imaging studies were available in eight patients. All tumors were large (median maximum diameter, 3.5 cm), involved the chiasm and hypothalamus, and showed homogeneous enhancement. Three patients had hydrocephalus and two had metastases. At follow-up, five patients had recurrent disease and two had died.

CONCLUSION

Diencephalic syndrome is a rare cause of failure to thrive in childhood, and diagnosis of a hypothalamic/ chiasmatic astrocytoma might therefore be delayed. The astrocytomas associated with this syndrome are larger, occur at a younger age, and are often more aggressive than other astrocytomas arising in this region.

First-pass radionuclide angiocardiography with single-crystal gamma cameras

Both multicrystal and single-crystal detectors have been in use for more than 25 years for measurement of ejection fraction by analysis of images collected during the first-pass transit of radionuclides through the heart. Originally, multicrystal cameras were preferred, because they provided higher count rates than Anger cameras; however, over the years improvements in count rate capability and collimator design have enabled Anger cameras to perform equally well. This has become an important issue now that readily available 99mTc agents, such as sestamibi, enable evaluation of both myocardial function and perfusion from a single injection. The technical abilities of a particular camera determine which acquisition protocols are most likely to provide clinically useable images for the widest spectrum of patients. Electrocardiographic-gated list mode collection is highly desirable for first-pass imaging, providing the greatest flexibility of data review, rebinning, and analysis. Attention to quality control issues of data characterization and processing is important to ensure accuracy and precision of all measurements. Accurate determinations of ejection fraction of the left ventricle are possible routinely and, under favorable circumstances, of the right ventricle as well.

Automation of gated tomographic left ventricular ejection fraction

BACKGROUND

The feasibility of determining left ventricular (LV) ejection fraction (EF) from 99mTc-labeled sestamibi gated tomography (GSPECT) is well established. To improve precision of measurement, rules used by observers in processing tomograms were encoded for automation.

METHODS AND RESULTS

LV centers were estimated from activity centroids of time-difference images exceeding 50% of maximum counts. End diastole and end systole were defined by time-varying maximum count extremes. Endocardial borders were generated by fitting maximum locations with fifth-order two-dimensional harmonics, searching inward to predetermined thresholds, and reconciling endocardial with valve plane points. Regression analysis of GSPECT EF yielded r = 0.87 versus equilibrium gated blood pool in 75 patients and r = 0.87 versus gated first pass in 65 patients. GSPECT EF interobserver variability was r = 0.92 and intraobserver automatic versus manual linear correlation was r = 0.94. A subgroup of 25 studies was analyzed by six independent observers, for whom EF agreement with the core laboratory ranged from r = 0.93 to r = 0.96. Experienced observers judged it necessary to alter end-diastolic or end-systolic frames in 7% of patients, endocardial borders in 14%, and LV centers in 28%.

CONCLUSION

Results of automated GSPECT LV EF correlated well with those of manual GSPECT and gated first-pass and equilibrium blood pool values and were highly reproducible.

Stress experiences of occupational therapists in mental health practice arenas: a review of the literature

The experience of job stress and burnout in occupational therapy has received only scant attention in the literature, although occupational therapists (OTs) share a number of important characteristics with other health care professionals that leave them vulnerable to the experience of stress. In addition, this group has a number of unique personal and work-related characteristics that could serve to increase its risk profile. Little effort has been directed at delineating work-related stressors or experienced levels of stress within different practice arenas of occupational therapy, even though some specialisms (e.g. mental health, forensic psychiatry, learning disabilities or paediatrics) are likely to be more emotionally demanding than others. There are a number of indicators which confirm that job stress is an issue for OTs, although some of the empirical data suggests that, on average, this occupational group experience less burnout than other human service professionals.

Localization of GABAA receptor immunoreactivity in NO synthase positive myenteric neurones

GABAA receptors were localized within laminar preparations of the rat distal colon myenteric plexus using a monoclonal antibody (mAb 62-3G1) to the affinity purified GABAA receptor/benzodiazepine receptor/Cl- channel complex. The immunofluorescence procedure showed that approximately half of the myenteric ganglion cells displayed extensive GABAA receptor labelling of their soma. This population was further characterised by treating some GABAA-receptor-labelled laminar preparations for the histochemical demonstration of nitric oxide (NO) synthase-related NADPH-dependent diaphorase activity. A subpopulation of the GABAA-receptor-immunoreactive cells (35%) were also found to display intense NO-synthase-related activity. These findings extend our understanding of the GABAA-receptor-related innervation of the rat gut wall herein referred to as 'A-GABAergic' and provides an anatomical basis for the pharmacologically-identified GABA-nitrergic pathway in the mammalian gut.

Update on implantable cardioverter defibrillators: knowing the differences in devices and their impact on patient care

Sudden cardiac death, a common cause of cardiac mortality, can be treated with either pharmacologic therapy or implantation of an implantable cardioverter defibrillator. Tremendous technologic advances have changed implantable cardioverter defibrillator therapy from shock-only therapy to multiprogrammable, tiered-therapy devices with backup pacing. Methods of implantation have changed from open chest to non-thoracotomy procedures. To provide optimal patient care, the critical care nurse is challenged to be knowledgeable about the different devices. In this article, the authors examine the commonalities and differences in device function in the seven currently available implantable cardioverter defibrillators and their impact on patient care.

Immunopositive GABAergic neural sites display nitric oxide synthase-related NADPH diaphorase activity in the human colon

In the enteric nervous system, gamma-aminobutyric acid (GABA) is a transmitter of interneurons which are proposed to innervate excitatory and inhibitory motor neurons. Nitric oxide (NO) is a putative transmitter of enteric inhibitory motor nerves targeted by GABA. In addition, NO is synthesized by a variety of enteric nerves throughout the gut wall indicative of its potential to be a transmitter of other nerve types, including interneurons. We sought to determine if some populations of nitrergic neurons are interneurons in human infant colon. As enteric neural GABA is exclusive to interneurons, colocalization with NO synthase-related NADPH diaphorase was examined. GABA-transaminase (GABA-T) immunohistochemistry was used to identify GABAergic neurons and a histochemical protocol was used as a marker of neuronal NO synthase-related NADPH diaphorase activity in enteric layers. GABA-T immunoreactive neurons were seen in the ganglionated nerve networks of the myenteric and submucosal layers. GABA-T immunoreactive fibres were also present in the longitudinal and circular muscle layers. A subpopulation of GABA-T immunoreactive neurons within both the myenteric and submucosal ganglia express NO synthase-related activity. This colocalization extends further to a subpopulation of fibers within the muscle layers. These findings strongly suggest that in addition to its role in inhibitory motor neurons, NO may also be a transmitter of enteric interneurons.

Neural sites of the human colon colocalize nitric oxide synthase-related NADPH diaphorase activity and neuropeptide Y

BACKGROUND/AIMS

Nitric oxide and neuropeptide Y (NPY) exert similar biological actions in the mammalian intestine including modulation of food intake, blood flow, motility, and secretion. In addition, these substances coexist in submucosal secretomotor neurons of the rodent intestine. The aim of this study was to determine the relative disposition of elements displaying NPY immunoreactivity and NO synthase-related nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase activity in the nerve networks of the human infant colon.

METHODS

Transverse and longitudinal sections, treated for immunohistofluorescent detection of NPY and then processed for NO synthase-related NADPH diaphorase histochemistry, were examined.

RESULTS

Neural elements containing NPY immunoreactivity and NO synthase-related activity were identified in the external muscle layers, myenteric plexus, and all nerve layers of the submucosa, including Henle's plexus, the intermediate nerve layer, and Meissner's plexus. Perivascular NPY-immunoreactive nerve fibers did not contain NO synthase activity. There were no nitrergic perivascular nerve fibers. NPY-immunoreactive endocrine cells in the mucosa did not display NO synthase-related activity.

CONCLUSIONS

These findings provide anatomical data indicating that NPY immunoreactivity and NO synthase-related activity are extensively colocalized in all layers of the human infant gut wall.

First-pass ventricular ejection fraction using a single-crystal nuclear camera

The purpose of the study was to evaluate the reliability of ejection fractions obtained from first-pass radionuclide ventriculography with a large field-of-view tomographic single-crystal gamma camera.

METHODS

A SPECT camera had its electronics redesigned to improve counting efficiency and was equipped with an experimental ultra-high sensitivity collimator. Left ventricular ejection fraction (LVEF) was measured in 28 patients by 30 degrees RAO first-pass imaging and by "best septal view" LAO planar equilibrium radionuclide ventriculography on a conventional small field of view Anger camera. For 28 other patients, first-pass ejection fractions were compared to multicrystal gamma camera values. Visual analysis was performed to judge clinical acceptability of first-pass images for identification of wall-motion abnormalities.

RESULTS

Linear regression analysis of first-pass against equilibrium ejection fraction demonstrated good correlation (r = 0.92; slope = 0.90; intercept = 3.8; s.e.e. = 6.4%). First-pass ejection fraction values also correlated linearly with multicrystal camera values for the left ventricle (r = 0.94; slope = 1.05; intercept = 1.3; s.e.e. = 5.3%). For a subgroup of 19 patients, single-crystal camera right ventricle ejection fraction demonstrated good correlation with multicrystal camera values (r = 0.82; slope = 1.15; intercept = 1.3; s.e.e. = 6.1%). Interobserver variability correlated as r = 0.99 for LVEF ejection fraction and r = 0.92 for RVEF. Chi-square analysis of single-crystal first-pass image visual scores versus those from the gated equilibrium acquisitions showed close agreement (p < 10(-8)).

CONCLUSIONS

The evaluated camera/collimator system measured left and right ventricular ejection fraction accurately. Lung frame correction and dual regions were superior to paraventricular background correction and a fixed end-diastolic region.

Distribution of nitric oxide synthase activity in arterioles and venules of rat and human intestine

NO is produced within peripheral blood vessels through the action of the differentially distributed constitutive and inducible NO synthase isoforms in the vessel wall. As in other sites in the periphery, NO exerts local vasodilatory actions in the gastrointestinal microvasculature and is proposed to play a role in enteric vasomotor regulation. Using NO synthase histochemistry and endothelial cell immunohistochemistry, we provide the first anatomic evidence of NO synthesis in both endothelial and smooth muscle cells of submucosal blood vessels in the rat and human intestine. The findings of this study indicate that 1) as in the periphery, both the endothelial and vascular smooth muscle cells of the microvessels irrigating the rat and human intestinal wall possess NO synthesis potential, 2) NO synthase activity is predominantly localized to discrete subcellular patches, and 3) the source of NO within the vascular wall, either intimal or medial, should be a consideration in future studies in terms of the relative contribution of these sources of vasomotor tone in the rat and human gut wall.

Demonstration of benzodiazepine receptors in submucosal neurons of the gastrointestinal tract

Benzodiazepine (BZ) receptors were visualized in laminar preparations of the rat colon submucosa, using a fluorescent derivative of the benzodiazepine receptor ligand desdiethyl fluorazepam, Bodipy RO-1986 (50 nM). Collateral confirmation of the results obtained were sought through immunohistochemistry, using a monoclonal antibody (62-3GI) for benzodiazepine cell receptors. Both procedures showed that a large proportion of ganglia in the colon submucosa displayed cells with extensive labelling of their soma. Nerve fibres and processes, blood vessels and vascular nerve bundles were not labelled. Fluorescent ligand-labelling could be reduced, using the BZ receptor ligand diazepam (5 microM). These findings provide an anatomical basis for the previously described neuropharmacology of BZ in the gut.

[3H]GABA uptake and GABA localization in mucosal endocrine cells of the rat stomach and colon

The aim of this study was to characterize the distribution of GABAergic cells in the rat gut mucosa. Thin and/or thick serial sections of segments of rat antrum and distal colon were treated for autoradiographic localization of sites of [3H]GABA (50 nM) high-affinity uptake, or GABA immunoreactivity. Dense accumulations of silver grains were localized to a discrete population of granulated mucosal cells. These appeared to be D-type endocrine cells. These gut regions also displayed strongly GABA-immunoreactive mucosal cells. These results confirm the presence of GABAergic cells in the rat antral mucosa, and reveal that [3H]GABA is accumulated by mucosal endocrine cells in the rat colon.

Nitric oxide synthase distribution in the rat intestine: a histochemical analysis

BACKGROUND

Nitric oxide is an inhibitory transmitter of nonadrenergic, noncholinergic neurons and is purported to be an endothelium-derived relaxant-type factor in the mammalian gut. This study aimed to provide a complete report on the distribution of NO synthase in the rat small and large intestine.

METHODS

NO synthase was visualized histochemically through this enzyme's reduced nicotinamide adenine dinucleotide phosphate diaphorase activity and the distribution of staining within the gut wall.

RESULTS

The presence of NO synthase activity in myenteric neurons and their efferents to the circular muscle was confirmed. The largest proportion of stained cells per ganglion was found in the ileum, and the smallest proportion was in the colon. Stained neural elements were also found within the submucosa throughout the intestine. Stained cells within the myenteric and submucous nerve plexi displayed both type I and type II morphologies, with the latter being more numerous. In addition to neural staining, submucosal arterioles showed a regular pattern of small patches of staining unrelated to any perivascular innervation.

CONCLUSIONS

These findings indicate an extensive neural and vascular localization of NO generation potential throughout the wall of the rat intestine, thus providing a structural basis for the functional diversity of NO.

Left ventricular ejection fraction assessed from gated technetium-99m-sestamibi SPECT

By means of ECG gating of tomographic (SPECT) 99mTc-sestamibi (MIBI) images, myocardial perfusion and wall thickening have been evaluated after a single tracer injection. To determine if left ventricular ejection fraction (LVEF) can also be measured from gated MIBI SPECT, 30 patients 1 wk to 6 mo after myocardial infarction (MI) received 22-30 mCi 99mTc-MIBI during treadmill exercise. Eight frame per cardiac cycle gated MIBI 180 degrees SPECT was performed 60 min thereafter. Using 6.4-mm thick mid-ventricular vertical and horizontal long-axis slices from R-wave triggered end-diastolic and end-systolic frames, two independent observers manually drew endocardial borders at a count level of 34% of the maximum. LVEF was computed by the Simpson's rule method, corrected for the average point spread function of the SPECT camera. Results were correlated with LVEF determined from planar gated 99mTc-blood-pool studies performed within 4 days. LVEFs calculated from gated MIBI SPECT ranged from 0.21 to 0.73 and correlated linearly with gated blood-pool values (correlation coefficients ranged from 0.79 to 0.88; interobserver variability r = 0.75; intraobserver reproducibility r = 0.75). We conclude that in patients with MI resting LVEF can be determined from gated MIBI SPECT, thereby considerably augmenting the technique's diagnostic and prognostic value.

Histochemical localization of nitric oxide-synthesizing neurons and vascular sites in the guinea-pig intestine

Laminar preparations of fixed segments of the guinea-pig intestine were examined for nitric oxide synthase activity using reduced nicotinamide adenine dinucleotide phosphate and nitroblue tetrazolium salt as substrates. Under conditions specific for detecting nitric oxide synthase-related diaphorase activity, a subpopulation of neural elements in the myenteric plexus, deep muscular plexus and submucosa were intensely stained. Intensely stained nerve fibres were distributed throughout the meshworks of the myenteric plexus and its innervation of the circular muscle, and in the submucosa within Henle's plexus. Intensely stained nerve cells and their processes were evident in most myenteric ganglia but were rare in ganglia of Henle's plexus. Stained ganglion cells comprised types I, II and VI of the morphologically defined enteric nerve cells. Stained neural elements were increasingly prevalent within successively more caudal segments of the intestine. In addition to neuronal staining, arterioles of the submucosal vascular network displayed distinct, punctate patches of staining distributed over their surface. Perivascular nerve fibre staining was absent. These results show nitric oxide synthase activity to be present within neurons and fibres of the major enteric nerve layers and within submucosal blood vessels throughout the guinea-pig small and large intestine.

Pulsatile ACTH and cortisol in goats: effects of insulin-induced hypoglycemia and dexamethasone

Insulin-induced hypoglycemia is a metabolic stress that stimulates secretion of adrenocorticotropic hormone (ACTH) and cortisol in a number of animal species. Dexamethasone is a potent synthetic glucocorticoid that suppresses the secretion of ACTH and cortisol. Both ACTH and cortisol exhibit complex secretory patterns demonstrating ultradian and circadian rhythms. This work investigated the pattern of ACTH and cortisol response to hypoglycemia in goats and the effect of dexamethasone on this response. Five goats were pretreated with dexamethasone (0.1 mg/kg) and 5 with saline. Blood samples were taken every 2 min for 60 min before and 60 min after administration of insulin (2.5 IU/kg, i.v.). Immunoreactive ACTH and cortisol were measured in all samples and glucose in selected samples. Data sets were analyzed for significant pulses with the Cluster Analysis program. Complete data sets were compared as well as those for each 30-min interval. Plasma glucose was lower than preinsulin levels at 10 min, declined rapidly between 10 and 30 min, and remained low 30-60 min after insulin injection in both treatment groups. Controls showed a rapid rise in ACTH and cortisol beginning 30 +/- 10 min postinsulin. The increase in mean plasma hormone levels during hypoglycemia was predominantly due to an increase in amplitude of secretory pulses for ACTH and cortisol compared with the 30 min before insulin. Dexamethasone significantly lowered mean ACTH and cortisol levels and prevented alteration in plasma ACTH and cortisol secretion during hypoglycemia but did not totally ablate pulsatile activity of either hormone. The amplitude of ACTH and cortisol pulses was significantly decreased by dexamethasone treatment. The frequency of cortisol but not ACTH pulses was also significantly decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

The solubility of calcium and phosphorus in neonatal total parenteral nutrition solutions

Precipitation of calcium phosphate in neonatal total parenteral nutrition (TPN) solutions remains a significant problem. Whereas numerous studies have attempted to establish guidelines for maximum concentrations of various combinations that can be mixed, differences in study design and reliance upon subjective visual assessment severely limit their applicability. The purpose of this study was to quantitatively determine calcium and phosphate compatibility in commonly used neonatal TPN solutions containing a final concentration of either 1 or 2% amino acids. The final dextrose concentration was 10%. Electrolytes, heparin, and pediatric vitamins and trace minerals were also added. Calcium gluconate (10%) and potassium phosphate (mono and dibasic) were added by calibrated micropipetors. Calcium concentrations ranged from 5 to 60 mEq/L and phosphate from 5 to 40 mM/L with a minimum of 84 combinations tested for each amino acid concentration. Calcium concentrations were measured in duplicate for each tested combination. Control solutions containing calcium but no phosphate were included to validate the assay methodology. All samples were stored at room temperature for 23.5 hours and then placed in a water bath at 37 degrees C for 30 minutes to simulate incubator conditions encountered during TPN infusion. Calcium determinations were then repeated and precipitation was judged to have occurred whenever calcium concentrations fell below 90% of the initial measured values. These data allowed plotting a calcium and phosphorus reference curve for TPN solutions containing 1 and 2% amino acids based on quantitative assessment. These reference curves should allow pharmacists to avoid compounding TPN solutions that will precipitate, thus saving considerable cost to the pharmacy and preventing complications.

Development and prospective application of quantitative 2-day stress-rest Tc-99m methoxy isobutyl isonitrile SPECT for the diagnosis of coronary artery disease

The clinical diagnostic accuracy of 2-day stress/rest quantitative Technetium-99m (Tc-99m) methoxy-isobutyl-isonitrile (Tc-sestamibi) single photon emission computerized tomography (SPECT) was assessed in a validation population of 61 patients from two different sites using two different camera/computer systems. The study population was made up of 53 catheterized patients, 29 from Cedars-Sinai Medical Center (CSMC) and 24 from the University of Texas Southwestern Medical Center (UTSMC), and eight UTSMC patients with a less than 5% pre-test likelihood of coronary artery disease. Interpretation employed gender-specific normal limits developed in an additional 15 men and 8 women at CSMC with less than a 5% likelihood of significant coronary artery disease. The results from CSMC compared with those from UTSMC were not different from each other. The overall sensitivity for detection of patients with coronary artery disease (greater than or equal to 50% stenosis) was 94% (CSMC: 92%, UTSMC: 95%). Overall specificity in the five patients with normal coronary arteriograms was 80% (CSMC: 67%, UTSMC: 100%). The normalcy rate in patients with a low likelihood of coronary artery disease was 88%. Vessel sensitivity was 85% (CSMC: 84%, UTSMC: 85%), while vessel specificity was 71% (CSMC: 72%, UTSMC: 69%). There was also no significant difference in the sensitivities and specificities between male and female populations. In addition, the agreement with coronary angiography for assessment of disease extent (normal coronary arteriogram, single or multivessel disease) was 75% (kappa = 0.6 +/- 0.1). This study demonstrated that Tc-sestamibi SPECT by quantitative analysis is accurate for the detection and localization of coronary artery disease. Furthermore, the CSMC quantitative method was shown to provide similar diagnostic accuracy when applied to data acquired at a different site using a different camera/computer system.

Myocardial perfusion imaging with technetium-99m sestamibi SPECT in the evaluation of coronary artery disease

Technetium-99m (Tc-99m) sestamibi is a new myocardial perfusion imaging agent that offers significant advantages over thallium-201 (Tl-201) for myocardial perfusion imaging. The results of the current clinical trials using acquisition and processing parameters similar to those for Tl-201 and a separate (2-day) injection protocol suggest that Tc-99m sestamibi and Tl-201 single photon emission computed tomography (SPECT) provide similar information with respect to detection of myocardial perfusion defects, assessment of the pattern of defect reversibility, overall detection of coronary artery disease (CAD) and detection of disease in individual coronary arteries. Tc-99m sestamibi SPECT appears to be superior to Tc-99m sestamibi planar imaging because the former provides a higher defect contrast and is more accurate for detection of disease in individual coronary arteries. Research is currently under way addressing optimization of acquisition and processing of Tc-99m sestamibi studies and development of quantitative algorithms for detection and localization of CAD and sizing of transmural and nontransmural myocardial perfusion defects. It is expected that with the implementation of the final results of these new developments, further significant improvement in image quality will be attained, which in turn will further increase the confidence in image interpretation. Development of algorithms for analysis of end-diastolic myocardial images may allow better evaluation of small and nontransmural myocardial defects. Furthermore, gated studies may provide valuable information with respect to regional myocardial wall motion and wall thickening. With the implementation of algorithms for attenuation and scatter correction, the overall specificity of Tc-99m sestamibi SPECT should improve significantly because of a substantial decrease in the occurrence of attenuation-related image artifacts.(ABSTRACT TRUNCATED AT 250 WORDS)

Non-interventional background corrections for scintigrams

A method is presented for the interpolation of optimally 'smooth' background correction matrices within arbitrarily shaped boundaries. Practical means of implementing this technique are discussed, along with series expansions for the special cases of square and round boundaries. This class of interpolation methods has the advantages over previous techniques of providing a unique mathematical solution, connecting exactly to count rates on the boundary, and containing no singularities. Clinical scintigraphic images and mathematically generated surfaces are used to test the different cases of the method, and it is shown that confining the boundary to a circle produces the most rapid convergence with the minimum deviation from ideal surfaces. Under common clinical conditions, these techniques lend themselves well to automated, non-interventional computer processing.

Hematogenous pyogenic vertebral osteomyelitis: diagnostic value of radionuclide bone imaging

Hematogenous pyogenic vertebral osteomyelitis (HPVO) continues to be a diagnostic problem for clinicians due to nonspecific presentation of the disease (1,2). We reviewed our experience of the last 10 years to determine the diagnostic usefulness of radionuclide bone studies in this disease. We found 15 patients whose primary diagnosis was HPVO. Of the 15 patients, 12 had [99mTc]MDP bone scans which were all positive. Five of the 12 patients had positive [67Ga]citrate scans and one patient with chronic active HPVO had negative 67Ga and [111In]WBC bone images. At the same time, three patients' spine x-rays and one patient's CT scan of the vertebra were normal. Additionally, in three patients spine x-rays were interpreted as consistent with degenerative joint disease that contributed to the delay of the diagnosis. We conclude that when HPVO is suspected an abnormal [99mTc]MDP bone image increases the probability of the disease, even if the x-rays and CT scans of the spine are normal. An abnormal 67Ga image following an abnormal 99mTc bone image increases the specificity of the diagnosis. Normal [99mTc]MDP and [67Ga]citrate bone images of the vertebra virtually exclude the diagnosis of HPVO.

Relationship between HLA-DR expression by normal myeloid progenitor cells and inhibition of colony growth by prostaglandin E. Implications for prostaglandin E resistance in chronic myeloid leukemia

The expression of HLA-DR antigens by normal myeloid progenitor cells (CFU-GM) has been linked to inhibition of colony growth by prostaglandin E (PGE), while resistance to the inhibitory effects of PGE in chronic myeloid leukemia (CML) has been attributed to a lower fraction of HLA-DR+ CFU-GM in this disease. However, we have previously shown that virtually all CFU-GM in normal bone marrow (NBM) as well as CML peripheral blood express HLA-DR antigens, which raises the possibility that these surface molecules may not be the sole determinants of a progenitor cell's sensitivity to PGE. In order to evaluate the relationship between HLA-DR expression and prostaglandin inhibition, we partially purified NBM progenitor cells using fluorescence-activated cell sorting to prepare cell fractions with high and low HLA-DR antigen density. Normal progenitor cells with high DR density tended to form monocyte colonies in agar culture, whereas the low DR density fraction was enriched for granulocyte colony-forming cells. Inhibition by PGE was greatest in the high DR+ fraction and was largely restricted to monocyte progenitor cells. Inhibition of CFU-GM by PGE was less in CML than in NBM, but this decreased inhibition correlated with a significantly lower number of monocyte-CFU in CML. These data suggest that high HLA-DR antigen density may select for normal progenitor cells that are committed to monocyte differentiation and are, therefore, more likely to be inhibited by PGE. The relative deficit of monocyte progenitor cells in CML may partially explain the phenomenon of PGE resistance in this disease.

Differential expression of HLA-DR antigens in subsets of human CFU-GM

Expression of HLA-DR surface antigens by granulocyte/monocyte colony-forming cells (CFU-GM) may be important in the regulation of proliferation of these cells. Using immunological techniques to enrich for progenitor cells, we investigated the expression of HLA-DR in subsets of CFU-GM. "Early" (day 14) CFU-GM express higher levels of HLA-DR than do "late" (day 7) CFU-GM. Among late CFU-GM, cells destined to form monocyte (alpha-naphthyl acetate esterase-positive) colonies express higher levels of HLA-DR than do CFU-GM destined to form granulocyte (chloroacetate esterase-positive) colonies. Because high-level expression of DR antigen was a marker for monocyte differentiation, we examined several lymphokines for their effects on both DR expression and in vitro commitment to monocyte differentiation by myeloid precursor cells. DR antigen density could be increased by more than twofold over 48 hours upon exposure to gamma-interferon (gamma-IFN), whereas colony-stimulating factors had no effect. This was associated with a dose-dependent inhibition of total CFU-GM number, and a relative, but not absolute, increase in the ratio of monocyte colonies to granulocyte colonies. Similarly, in day 7 suspension cultures of purified myeloid precursor cells, gamma-IFN inhibited cell proliferation and increased the ratio of monocytes to granulocytes. Thus, despite the induction of high levels of HLA-DR antigen on precursor cells (a marker of monocyte commitment), the dominant in vitro effect of gamma-IFN was inhibition of granulocyte differentiation.

Effect of narcotic premedication on scintigraphic evaluation of gallbladder perforation

A case of gallbladder perforation is presented in which a small bile leak was demonstrated by cholescintigraphy while the patient was receiving meperidine, but not after meperidine was discontinued. The scintigrams obtained during meperidine therapy also showed a pattern of bile-duct obstruction. It is suggested that increased biliary pressure secondary to meperidine administration permitted visualization of the leak. Use of narcotic drugs may be a useful pharmacologic intervention in cases of peritonitis due to small or obscure bile leaks.

A new scintigraphic method for determining left ventricular volumes

A new scintigraphic count-based method for measuring absolute left ventricular volumes is presented. It is a fast and simple technique that allows geometrical assumptions to be avoided and is free of radiation attenuation corrections. This method requires the acquisition of an image of the left ventricle in the right anterior oblique projection and the collection of gated blood pool images in the left anterior oblique projection. To assess the accuracy of the method scintigraphic stroke volumes were compared with those derived from thermodilution measurements during cardiac catheterization in 20 subjects, and to assess its precision the technique was applied to phantom data of known radionuclide volumes. Excellent correlations were found between the scintigraphic and both the thermodilution (r = .98) and phantom data (r = .99). The reproducibility (r = .97) of results was investigated by repeating data acquisition and analysis for 15 subjects on two different days, and the interobserver variability (r = .97) of the method was studied by having two computer operators calculate volumes for the same patient data for 20 randomly selected studies.

Extraocular muscle fibers: ultrastructural identification of iontophoretically labeled fibers contracting in response to succinylcholine

Cat extraocular muscle fibers (from the superior rectus or inferior oblique) were penetrated in vivo with Procion red-filled glass microelectrodes. When stable penetrations were obtained, succinylcholine (Sch), 8 to 20 microng, was injected into the femoral vein. In some fibers, a depolarization-repolarization response was obtained with the same time course (2 min.) as the total muscle contraction. The depolarizing fibers were labeled iontophoretically. The ultrastructural characteristics of five depolarizing fibers and three control (nondepolarizing) fibers were then studied. The fibers that did not depolarize to Sch had the characteristics of singly innervated cells, whereas those sensitive to Sch had morphological characteristics of multi-innervated fibers.

School phobia: its classification and relationship to dependency

We have studied 29 school phobic youngsters (14 boys and 15 girls), of mean age 12 years 10 months (S.D. = 14.7 months) shortly before admission to an adolescent psychiatric in-patient unit. The diagnosis was made when there was severe difficulty in attending school, severe emotional upset at the prospect of having to go to school, staying home during school hours with the parents' knowledge and absence of significant anti-social disorders. Information was gathered from the patient and one parent, usually mother. Most youngsters had completely refused to go to school (23) and the remainder went occasionally with great reluctance; this seemed to depend on the attitudes of parents, school and medical agencies. Psychoses, gross physical illness, truancy, and neurotic disturbances other than school phobia resulting in absence from school were excluded. The cases were classified, reliably, into 19 ‘acute’ (11 boys, 8 girk) and 10 ‘chronic’ (3 boys, 7 girls) school phobics. This was done on the criterion of previous severe reluctance to attend school: at least 3 years of trouble-free attendance led to a classification as ‘acute’, the remainder were ‘chronic’. The mean age of the acutes (13 years 1 month) was significantly higher (P<0.001) than that of the chronics (12 years 3 months). In the acutes, the school phobia had been present 5 months (S.D. =3.5 months) on average in the boys, and 1 year 5 months (S.D. = 16.5 months) on average in the girls; which was a significant difference (P<0.02). The mean time between onset of symptoms and complete refusal was 3.5 months [boys-2 months (S.D. = 2 months) girls-6 months (S.D. = 9 months)]. The following features did not show significant differences between the acutes and chronics; social class of the patient's father (the typical social class was 5a on the Hall and Jones Scale of Occupational Prestige for Males), the mean age of mother when the child was bom, the number of only or youngest children in the family, birth complications, the number of severe illnesses, accidents and operations added to separations from mother in the first decade, missing some school without the parents' knowledge, suicidal gestures, the occurrence of symptoms on transfer to secondary school, somatic symptoms, frank mental illness in parents and I.Q. (W.I.S.C. total score); 4 acute cases had symptoms coming on following a bereavement.