Life-span dendritic and spine changes in areas 10 and 18 of human cortex: a quantitative Golgi study

Dendritic neuropil is a sensitive indicator of the aging process and may exhibit regional cortical variations. The present study examined regional differences and age-related changes in the basilar dendrites/spines of supragranular pyramidal cells in human prefrontal (area 10) and secondary occipital (area 18) cortices. Tissue was obtained from the left hemisphere of 26 neurologically normal individuals ranging in age from 14 to 106 years (M(age) = 57 +/- 22 years; 13 males, 13 females). In tissue prepared by a modified rapid Golgi technique, ten neurons were sampled from each cortical region (N = 520) and were evaluated according to the following parameters: total dendritic length, mean segment length, dendritic segment count, dendritic spine number, and dendritic spine density. The effects of age and Brodmann areas were analyzed with a nested multiple analysis of variance design. Despite considerable interindividual variation, several clear findings emerged: 1) Dendritic systems were significantly larger in area 10 than in area 18 across the sampled life span, presumably because of the more integrative function of area 10 neurons. 2) There was a significant age effect, with a substantial decline in dendritic neuropil from the younger (< or =50 years) group to the older (>50 years) group, especially in spine measures, which decreased almost 50%. 3) Dendritic values were relatively stable after 40 years of age, suggesting that dendritic/spine degeneration in older, relatively healthy individuals may not be an inevitable consequence of the aging process. These findings underscore the importance of life-long commitment to a cognitively invigorating environment.

Sexual transmission of hepatitis B in Mwanza, Tanzania

BACKGROUND

Hepatitis B virus (HBV) is endemic and poses a grave public health problem in Africa where it is mainly transmitted from mother to baby or during childhood. Sexual transmission has also been suggested to play a role in East Africa, but this has never been properly demonstrated. Additional preventive strategies may be proposed if sexual transmission of HBV occurred in this region where HIV and other STDs are highly prevalent.

GOALS

To determine the prevalence of markers for hepatitis B virus (HBV)and other sexually transmitted diseases (STD) in routine blood samples taken from three populations in Mwanza, Tanzania, and to use the data collected to look at the association between hepatitis B and other STDs, including human immunodeficiency virus (HIV).

STUDY DESIGN

Routine blood samples were collected from 1,025 patients attending a clinic for STDs, 253 voluntary blood donors from secondary schools, and 952 blood donors who gave blood in a hospital specifically for a relative who needed a blood transfusion. All samples were tested for HIV by double enzyme-linked immunosorbent assay (ELISA), and for syphilis using the Treponema pallidum hemagglutination (TPHA) and rapid plasma reagin (RPR) tests. Two markers for HBV were examined by the double ELISA method, the presence of the anti-hepatitis B core antigen (anti-HBc) and the hepatitis B surface antigen (HBsAg).

RESULTS

There were high prevalences of HBV, syphilis, and HIV in relative donors and STD patients. Although HBV markers were more prevalent in men of increasing ages, syphilis and HIV markers were more prevalent in young women. Evidence of past infection with HBV (presence of anti-HBc) was associated with serologic markers of recent treponemal infection (both TPHA and RPR positive) in both sexes (men odds ratio [OR] = 1.91, P < 0.011; women OR = 2.34, P < 0.02) and with HIV in men (OR = 1.93, P < 0.003). Current infection with HBV (presence of HBsAg) was associated with recent syphilis in men (OR = 2.13, P < 0.006). In STD patients, current infection with HBV was associated with Trichomonas vaginalis in women (OR = 3.57, P < 0.002) and recent syphilis in men (OR = 3.46, P < 0.001). There was no further association between HBV markers and any other STD pathogen or any particular STD syndrome, nor was there any association between current HBV infection and HIV in both sexes. The population attributable fraction for sexual acquisition of hepatitis B is estimated at 7.2% in men and 3.0% in women, based on the association between hepatitis B and syphilis.

CONCLUSIONS

These findings suggest that sexual acquisition of hepatitis B occurs at low levels in Mwanza, and that HBV can be prevented through enhancement of the current HIV/STD control activities, in addition to improved vaccination strategies.

Acute isovolaemic haemodilution: the best option for autologous blood transfusion in Africa?

The purpose of this study was to identify the best method of autologous blood transfusion to be applied in an East African hospital. One hundred and nine consecutive patients for whom major blood loss was anticipated were enrolled. Seventeen patients donated 1 unit of blood 3 days preoperatively and 92 underwent acute isovolaemic haemodilution prior to induction of anaesthesia. For the haemodiluted patients a 2:1 ratio of sterile pryogen-free saline to collected blood was used. One of the 16 patients from whom 2 units were withdrawn by haemodilution experienced hypovolaemia which was rapidly restored by additional transfusion of colloid. Of the patients who donated blood preoperatively only 23.5% were autotransfused compared to 98.9% of the haemodiluted patients. Of the latter 23.9% (22) had an intraoperative blood loss exceeding 15% of their total blood volume and 7.6% (7) lost more than 25%. Only one received homologous blood in addition. For hospitals with limited blood bank facilities and regular cancellation of surgery, the use of acute isovolaemic haemodilution is recommended. A 3:1 ratio of saline to blood is now advised when 1 unit is withdrawn and a part replacement with crystalloid when 2 units are collected.

Evaluation of the circle of Willis with three-dimensional CT angiography in patients with suspected intracranial aneurysms

PURPOSE

To determine the usefulness of CT angiography in the setting of suspected acute subarachnoid hemorrhage or intracranial aneurysm.

METHODS

We prospectively studied 68 patients suspected of having subarachnoid hemorrhage or an intracranial aneurysm with noncontrast CT of the head followed immediately by contrast-enhanced helical CT of the circle of Willis with three-dimensional reconstruction. Twenty-seven patients with CT findings positive for subarachnoid hemorrhage or intracranial aneurysm were evaluated with digital subtraction angiography or MR angiography within 12 hours of CT angiography. Patients with negative CT/CT angiography findings were followed up with lumbar puncture.

RESULTS

CT angiography showed 23 of 24 aneurysms and 2 of 2 arteriovenous malformations (sensitivity, 96%; specificity, 100%). Aneurysm size ranged from 2 to 40 mm (mean, 7.9 mm). Interobserver variability was 10%. In the 23 cases of subarachnoid hemorrhage, cisternal blood did not limit the three-dimensional reconstruction. Two patients with aneurysms on CT angiography had normal noncontrast scans.

CONCLUSIONS

CT angiography of the circle of Willis is a useful technique for evaluation of suspected acute subarachnoid hemorrhage and intracranial aneurysm. It provides anatomic display of intracranial aneurysms, allowing for planning of conventional angiography and surgical approach. In selected cases, CT angiography may eliminate the need for preoperative conventional angiography.

Cuba's national AIDS program. The first decade

There is a high incidence of infection with the human immunodeficiency virus (HIV) in many Caribbean nations. But by 1993 Cuba, with a population of greater than 10 million people, had fewer than 1,000 seropositive persons and less than 200 cases of the acquired immunodeficiency syndrome (AIDS). To investigate Cuba's approach to the AIDS epidemic, we visited Cuba, reviewed published statistics, spoke with health care officials, interviewed HIV-positive patients, and toured medical facilities. Cuba established an extensive HIV surveillance program in 1983, and more than 15 million HIV antibody tests have been done. The sexual contacts of all infected persons are closely observed. A national education program is evolving. Since 1986, all known HIV-positive patients have been placed in sanitariums, which is the most controversial aspect of Cuba's program. We review available information on AIDS in Cuba and describe that nation's attempt to prevent the spread of disease. We discuss how the political system and Cuba's relative isolation have influenced this approach. Strategies have been developed that may be of limited efficacy and would not be acceptable in most Western nations.

The hazards of using a child as an interpreter

When a language barrier prevents communication with immigrant parents, there may be a temptation to use a bilingual child as an interpreter. We report a possible hazard.

Attitudes and beliefs about blood donation among adults in Mwanza Region, Tanzania

A study was carried out to assess the attitudes and beliefs about blood donation among the population of Mwanza Region, Tanzania, in order to target better the voluntary blood donor recruitment and retention. A random sample of 1141 adults, 743 residents of Mwanza town and 398 from Mwanza rural areas were interviewed on aspects related to blood donation. A high proportion (26.4%) of interviewees had already given blood but only 3.8% had donated voluntarily within the last 10 years. Voluntary blood donation was correlated with secondary school attendance. We noted a positive attitude towards voluntary blood donation although the majority of people would do so only for an incentive in the form of remuneration. Respondents frequently thought that blood donation would infect them with HIV or damage their health. No correlation was found between fear to donate and self perceived risk for HIV infection. We found that a substantial number of men would accept pre-test counselling on HIV in order to "infect others" if found positive. Thus we recommend that HIV counselling should be done with extreme care and defer individuals with wrong intentions from blood donation. Donor recruitment campaigns should also focus on clearing wrong conceptions about blood donation through providing information on all aspects related to blood donation. Based on these findings, a scheme for blood donor recruitment and retention in Mwanza Region is proposed.

Developmental changes in brain metabolism in sedated rhesus macaques and vervet monkeys revealed by positron emission tomography

The present positron emission tomography study used 2-deoxy-2[18F]fluoro-D-glucose to examine age-related changes in local cerebral metabolic rates for glucose (LCMRglc) in sedated rhesus macaques and vervet monkeys. Nineteen vervet monkeys were scanned in a cross-sectional design, which consisted of three age groups (birth to 59 d, 60-179 d, 180 d to adult) that captured the developmental period of greatest synaptic density within the second group. Two rhesus and two vervet monkeys were also examined longitudinally. Subjects were sedated throughout the procedure with a combination of ketamine and midazolam. Longitudinal and cross-sectional analyses of 20 brain regions indicated lowest LCMRglc in rhesus and vervet monkeys < 2 months of age (about 60% of adult levels). These metabolic rates more than doubled to approximately 155% of adult levels after the second postnatal month, coincident with transient synaptic overproduction and increased sociobehavioral activity. LCMRglc remained high until 6 months postnatally, coincident with continued dendritic growth and the emerging sociobehavioral independence of the young monkey. After 6 months, LCMRglc decreased gradually to adult levels. Thus, the period between 2 and 6 months is a time of peak metabolic activity, which coincides with increased histologic and behavioral activity in the developing monkey.

Secondary school students: a safer blood donor population in an urban with high HIV prevalence in east Africa

We evaluated the enrollment of secondary school students as voluntary unremunerated blood donors in a city where the HIV-1 prevalence among the adult population is 11.8%. Between 1st July, 1992 and 1st December, 1993, consecutive blood donors were screened for anti-HIV-1, TPHA, HBsAg and anti-HBc. Test results were related to age, sex, voluntary or relative donor status. 525 (22.4%) of 2345 were voluntary donors aged 24 years or less and 529 (29.6%) of 1820 of the relative donors were of the same age group. Voluntary donors had statistically significant lower prevalence rates of anti-HIV-1, TPHA, and anti-HBc, 1.5%, 2.1% and 50.2% respectively, compared to relative donors of the same age group, 4.7%, 9.0% and 70.3% respectively. We conclude that secondary school students constituted a safer donor population. The student population offered the additional advantage of being easily accessible for donation and lesser blood units needed to be discarded. For a blood transfusion centre in an urban settlement, recruitment of secondary school students as voluntary unremunerated blood donors should be considered as a cost-effective strategy.

Metabolic recovery in caudate nucleus of children following cerebral hemispherectomy

In 3 children who had undergone cerebral hemispherectomy (hemidecortication) between the ages of 1 year 5 months and 4 years for the alleviation of intractable epilepsy, cerebral glucose utilization was studied serially with positron emission tomography. Three to 7 months after hemispherectomy, glucose utilization in the caudate nuclei on the side of hemispherectomy had decreased to below preoperative values, presumably due to total deprivation of ipsilateral cortical input. One to 2.5 years after surgery, complete restoration of glucose metabolic activity to preoperative levels was seen in 2 patients and partial recovery was seen in 1 patient. These alterations of cerebral glucose utilization are believed to reflect microscopic anatomical reorganizational changes (e.g., collateral sprouting) that have been documented following similar lesions in several animal models. Our findings suggest that positron emission tomography may provide a sensitive measure of developmental brain plasticity in vivo.

Neuropathology of Rett syndrome: case report with neuronal and mitochondrial abnormalities in the brain

Neuronal changes in the brain of a Rett syndrome patient were examined in a frontal lobe biopsy performed at age 3 years and in the postmortem brain at age 15 years. In the brain biopsy, frontal cortex contained numerous scattered pyramidal neurons with cytoplasmic vacuolation and increased cytoplasmic density, with no neuronophagia or inflammation detected; electron microscopy showed these neurons to have large, lucent-appearing mitochondria, very abundant ribosomal content, and some lipofuscin granules. Postmortem brain 12 years later showed scattered neurons in frontal cortex, substantia nigra, and cerebellar folia, with increased electron density of the cytoplasm, stacks of ribosomal endoplasmic reticulum, and large amounts of disorganized membranous material, including autophagic-type organelles. Mitochondria of these neurons contained electron-dense, finely granular matrix inclusions; in the substantia nigra, some spherical mitochondrial inclusions completely filled the matrix space. Golgi preparations of (autopsy) frontal cortex and cerebellar folia showed truncation and thickening of dendrites and a degenerate appearance of cortical pyramidal neurons, similar to changes found in aged brain. Synaptophysin immunohistochemistry indicated that the density of synapses was not greatly altered compared to controls in frontal cortex and cerebellum. The patient also had a second genetic defect, severe combined immunodeficiency with thymic aplasia, which may be X-linked.

Quantitative dendritic and spine analyses of speech cortices: a case study

The present case study documents an unprecedented opportunity for correlative investigation of brain structure and function by quantitatively investigating the basilar dendritic systems of supragranular pyramidal cells in several cortical areas from a subject who had undergone electrical stimulation mapping 2 years prior to death. Electrical stimulation mapping results provided valuable functional information about the cortical areas removed for postmortem histological analysis. Morphometric analyses distinguished between proximal (first, second, and third order) and ontogenetically later developing distal (fourth order and above) basilar dendritic branches. In general, perisylvian language association stimulation sites (classical Wernicke's and Broca's areas) were characterized by different dendritic patterns than motor strip sites. In primary motor strip tissue blocks, proximal segments were longer than distal segments. In "higher order" elaborative cortical zones, distal segments were longer than proximal segments. Proximal segments outnumbered distal segments in primary motor zones, but the numerical difference between proximal and distal segments was reduced in the association areas. Finally, fourth order segments had significantly more dendritic spines than third order segments in all sites. These dendritic findings suggest a somewhat later ontogenetic development in classical Broca's and Wernicke's areas than in primary motor cortex.

A quantitative dendritic analysis of Wernicke's area in humans. II. Gender, hemispheric, and environmental factors

This quantitative Golgi study extends our investigation of relationships between cortical dendrite systems in humans and higher cognitive functions. Here we examine the relationship between the basilar dendrites of supragranular pyramidal cells in Wernicke's area and selected intrinsic (i.e., gender and hemisphere) and extrinsic (i.e., education and personal history) variables. Tissue was obtained from 20 neurologically normal right-handers: 10 males (Mage = 52.2) and 10 females (Mage = 47.8). Several independent variables were investigated: GENDER (male, female), HEMISPHERE (left, right), and EDUCATION (less than high school, high school, and university). These were evaluated according to Total Dendritic Length, Mean Dendritic Length, and Dendritic Segment Count. A distinction was made between proximal (1st, 2nd, and 3rd order) and ontogenetically later developing distal (4th order and above) branches. There was significant interindividual variation in dendritic measurements, which roughly reflected individuals' personal backgrounds. Females exhibited slightly greater dendritic values and variability than males across the age range examined. On the whole, the left hemisphere maintained a slight advantage over the right hemisphere for all dendritic measures when all subjects were pooled, but these differences were not in a consistent direction across individuals. Education had a consistent and substantial effect such that dendritic measures increased as educational levels increased. Dendritic differences between independent variable levels were most clearly illustrated in the total dendritic length of 3rd and 4th order branches. Distal dendritic branches appeared to exhibit greater epigenetic flexibility than proximal dendrites. The present findings concur with environmental enrichment research results in animals and suggest that dendritic systems in humans function as a sensitive indicator of an individual's (a)vocational activities.

A quantitative dendritic analysis of Wernicke's area in humans. I. Lifespan changes

Age-related increases and decreases have been described in cortical dendritic neuropil. Here, we examine age-related changes in the basilar dendrites of supragranular pyramidal cells in human superior temporal gyrus (i.e., Wernicke's area) of left and right hemispheres. Tissue was obtained from 20 neurologically normal right-handers from 18-79 years: 10 males (Mage = 52.2 years; SDage = 17.4) and 10 females (Mage = 47.8; SDage = 20.5). In tissue prepared by a modified rapid Golgi technique, ten pyramidal cells were sampled from each hemisphere and evaluated according to the following parameters: total dendritic length, mean dendritic length, and dendritic segment count. Despite considerable interindividual variation, the data exhibited significant dendritic degeneration with aging. There was an age-related decrease in total dendritic length (r[20] = -0.44; P < 0.05) and especially in mean dendritic length (r[20] = -0.69; P < 0.001) with increasing age. Age-mean dendritic length correlations were negative for all segment orders and revealed a progressive decrease in segment length in more distal branches. The number of dendritic segments remained relatively stable across the age span sampled. The data also indicated that interhemispheric dendritic asymmetries decreased with age. Individuals under 50 years of age had significantly greater total dendritic length values in the left hemisphere. Interhemispheric dendritic differences were not significant in individuals over 50.

Alcoholism-induced bone necrosis

A total of 164 patients with alcoholism-induced osteonecrosis were seen over a 22-year period, from 1962 to 1984. Twenty-three percent of patients were female and 30.5% were black. The average duration of alcohol abuse was 9.5 years, ranging from 8 to 20 years. The presence of femoral head necrosis was diagnosed in patients aged 21-67 years; 28% of patients were under 40 years of age and 76% were under 50 years. Bilateral hip necrosis was present in 44.5% of patients and, within three years of the diagnosis of FHN, the presence of multifocal necrosis became evident in 23 cases at sites away from the hip (shoulders and knees). Hyperlipidemia was found in 38.4% of cases, involving both cholesterol and triglycerides. Serum amylase was elevated in 33 patients; liver dysfunction was present in 50; hepatomegaly was found in 32; and biopsy-confirmed cirrhosis was present in 22 cases. Hyperuricemia was found in 22 patients, some of whom had received steroids. Disabling hip pain was the first manifestation of disability related to alcohol abuse in 158 patients, most of whom required total hip joint replacement. This study supports the hypothesis that alcoholism-induced bone necrosis is caused by fat embolism linked to co-existent hyperlipidemia. The treatment of hyperlipidemia by dietary means or lipotropic medication and the cessation of alcohol abuse is advised. Multi-center studies employing such treatment should provide evidence of its effect on the evolution of necrosis as well as the incidence of bilateral hip femoral head necrosis and multifocal lesions.

Coexistence of cervical and lumbar disc disease

A retrospective analysis of 200 patients requiring cervical disc surgery was performed to determine the frequency of coexistent lumbar disc or spine abnormalities. The duration of follow-up ranged from 5 to 25 years, averaging 14 years. Sixty percent were women and 40% were men, their ages ranging from 25-73 years. Antecedent motor vehicle injury had occurred in 49 cases and work injury to the spine in 23. Sixty-four percent had no history of prior back injury. It was found that over 31% had undergone lumbar disc surgery, and a high number of patients demonstrated abnormal lumbar radiographs or myelograms, including 78 with bulging discs, 100 with major root defects, 78 with minor root defects, 8 with spinal stenosis, and 7 with spondylolisthesis. Myelograms were normal in 22 cases. The sites of lumbar abnormalities included L4-5 (110), L5-S1 (90), and multilevel (8). There was a higher incidence of lumbar disc abnormalities associated with multilevel cervical spondylosis. There also was a relationship between residual symptoms and myelographic abnormalities. Two studies in the authors' institution suggest an autoimmune basis for the frequent coexistence of cervical and lumbar disc disease, namely the demonstration of antigenic properties in the nucleus pulposus and high serum immunoglobulins.

Cervical angina

Cervical angina, resembling true angina pectoris, but resulting from cervical spondylosis and nerve root compression, is also known as pseudoangina. This report describes 164 patients treated over a 22-year period. Patients included 103 men and 61 women, with ages ranging from 45 to 68 years and averaging 54 years of age. The duration of symptoms prior to definitive diagnosis averaged ten months and ranged from ten to 18 months. Most patients had consulted at least two cardiologists prior to diagnosis. The results of stress testing were abnormal in ten patients, but none underwent angiography. Symptoms common to all patients, in varying severity, included neck pain and stiffness, occipital headache, arm pain with sensory symptoms. Neurologic deficit was found in only three instances. The majority of patients responded satisfactorily to a standard nonsurgical regimen, employed for at least three months, involving the use of a hard collar, intermittent traction, isometric exercise, and a combination of anti-inflammatory and muscle relaxant medications. In cases where disability persisted, myelography was usually employed and when confirming nerve root compression, anterior disc excision and spine fusion were performed. Such treatment was required in only 38 cases and resulted in complete relief of complaints in all but five instances in which fusion failure required re-operation with ultimate success. Fusion usually was completed in three months, during which time the patient was required to wear a hard collar.

Interferon-beta impairs induction of HLA-DR antigen expression in cultured adult human astrocytes

We studied the effect of interferons on the expression of class II histocompatibility (HLA-DR) antigens by cultured adult human astrocytes. Cultures were derived from brain tissue resected for surgical treatment of intractable epilepsy. Cultured astrocytes did not spontaneously display HLA-DR antigen as determined by immunocytochemistry and flow cytometry with antibody to HLA-DR. Astrocytes cultured for 72 h with recombinant or natural interferon-gamma (IFN gamma) demonstrated a dose-dependent increase in HLA-DR expression with optimal stimulation by 100 U/ml IFN gamma. HLA-DR expression was not detectable in astrocytes cultured with IFN gamma for less then 48 h, and peak HLA-DR expression (over 80% of cells) was seen at 120 h of culture. Optimal HLA-DR expression required continuous presence of IFN gamma. Exposure of astrocytes to recombinant or natural interferon-beta (IFN beta) did not induce HLA-DR and pretreatment of astrocytes with IFN beta or interferon-alpha (IFN alpha) significantly inhibited subsequent induction of HLA-DR expression by IFN gamma. These observations suggest that interferons may function in regulating human astrocyte HLA-DR expression within the central nervous system.

Burns after spinal cord injury

The problem of burns after spinal cord injury is described. Chart review was performed on thirty-five known cases. All burns occurred below the level of the lesion (p less than .001). Causes included bathing and showering, food and beverage, and therapeutic and environmental heating devices. We conclude that spinal cord injured patients should be educated about the risk of burn injury and the situations in which burns can occur.

Post-transfusion purpura: initiation by leukocyte-poor red cells in a polytransfused woman

An elderly, multiparous, multiply transfused woman developed post-transfusion purpura (PTP) after the transfusion of 2 units of leukocyte-poor red cells and was successfully treated by plasmapheresis and corticosteroids. Her pre-PTP transfusion history was characterized by frequent, multiple transfusions of platelet antigen-containing blood products 12 to 5.5 years prior to the onset of disease and, apart from the initiating transfusion, only frozen red cells in the 5.5 years immediately preceding the onset of thrombocytopenia. Leukocyte-poor red cells thus appear capable of initiating PTP. Use of a few units of frozen red cells may result in a shorter than normal refractory period, after which time PTP may occur upon exposure to sufficient platelet antigen.

Trends in hepatitis B surface antigen (HBsAg) prevalence in volunteer blood donors in Connecticut, 1973-1983

A total of 1,573,769 blood donations from volunteer blood donors from Connecticut were tested for Hepatitis B Surface Antigen (HBsAg) from 1973 to 1983. The prevalence of HBsAg decreased over this 10 year period among first time as well as repeat donors. This decrease was much more pronounced in the first three years of the study (1973 to 1975) in repeat donors. Thereafter, prevalence was stable. In first-time donors, the largest decrease also occurred in the first three years. In contrast to repeat donors, however, marked fluctuations in the prevalence were noted in first time donors. As has been the case in previous studies, HBsAg prevalence in first-time donors was significantly higher than that observed in repeat donors. Our study encompasses the longest period of observation in comparison to previous reports on HBsAg prevalence among blood donors. While it has been previously established that a decrease in prevalence over time does occur among repeat donors, stabilization of prevalence after an initial reduction found in our study has not been previously documented. This may indicate an irreducible minimum prevalence rate in the repeat donor population. In addition, our study for the first time convincingly demonstrates a reduction in prevalence in first-time donors which may reflect better communications at the donor recruitment and nursing level.

Enhanced DNA synthesis of human glial cells exposed to human leukocyte products

DNA synthesis was studied in primary glial cell cultures derived from adult human non-neoplastic and neoplastic brain tissues. Enhanced DNA synthesis occurred in 5/5 non-neoplastic astrocyte, one oligodendroglioma, and 2/5 astrocytoma cultures after exposure to medium containing 1.25-12.5% supernatant fluid (SF) from insoluble concanavalin A (Con A) stimulated unseparated or T lymphocyte-enriched human mononuclear leukocytes (MNL). Analyses of SF indicated that the presence of platelet-derived growth factor (PDGF) could not account for glial cell stimulation, and exposure to semi-purified interleukin-2 (IL-2) in amounts comparable to those in SF from Con A-stimulated MNL had no effect on glial cells. These data indicate that non-neoplastic astrocytes and other human glial cells are stimulated by products of human MNL.

Intramuscular meptazinol and morphine in postoperative pain

Meptazinol is an agonist-antagonist opioid analgesic believed to be unique in its selectivity for mu1 (high affinity) receptors and its cholinergic activity. Our objectives were to determine the relative analgesic potency of intramuscular meptazinol and morphine and to compare mood and side effects in 102 patients with cancer who have postoperative pain. Meptazinol (50, 100, and 200 mg) and morphine (4, 8, and 16 mg) were given for moderate to severe pain in a double-blind, randomized but balanced, incomplete block design. Serial multiple assessments of pain, relief, mood, and side effects were made. The most precise estimates of relative analgesic potency indicate that meptazinol is equivalent to 10 mg morphine at 120 mg (95% confidence interval 80 to 170 mg) for peak effect and at 175 mg (95% confidence interval 125 to 270 mg) for total effect. Mean (+/- SE) times to peak effect and to remedication were 0.9 +/- 0.1 and 3.6 +/- 0.2 hours for meptazinol and 1.4 +/- 0.1 and 4.8 +/- 0.4 hours for morphine at equianalgesic peak effects. The percentages of subjects with one or more side effects were 18, 49, and 73 for graded meptazinol doses and 32, 49, and 65 for graded morphine doses. Mean numbers of side effects per subject were 0.3, 1.5, and 3.5 for meptazinol and 0.5, 0.7, and 1.7 for morphine. Profiles of side effects differed. Mood improvement and overall satisfaction were dose related and greater for morphine than for meptazinol. Side effects may limit the use of meptazinol in doses that relieve severe postoperative pain.

Femoral neck fractures complicating Gaucher disease in children

In normal children, fractures of the femoral neck are uncommon and accompany severe trauma and multiple injuries elsewhere in the skeleton [16, 17]. In children with Gaucher disease, a rare hereditary disorder of lipid metabolism, midcervical or basicervical fractures can occur with minor or no trauma and without other injury to the skeleton. Three children with Gaucher disease who developed pathologic fractures of the femoral neck are described. In all three, the fractures occurred between five and nine years of age, and the fracture lines passed through areas of abnormal bone characterized by poorly defined patches of increased and decreased density and cortical thinning along the medial femoral necks. In the affected hips, there was no evidence of avascular necrosis of the femoral heads at the time of injury. One child's fracture was preceded by multiple bone "crises" localized to the proximal femora.

Thrombocytosis: an acute-phase reactant, not an adverse reaction to the new beta-lactam antibiotics

Thrombocytosis has been described as an adverse drug reaction in up to 30% of patients treated with new beta-lactam antibiotics. We evaluated 350 patients with acute noninfectious conditions and infectious diseases treated with a variety of new and old agents. Results indicate that thrombocytosis is an acute-phase reactant and not an adverse reaction to any antimicrobial agent.

Sarcoidosis presenting as cervical radiculopathy: a case report and literature review

A unique case of sarcoidosis, presenting as a unilateral multilevel cervical radiculopathy without spinal cord compression, is discussed. The clinical presentation, along with the initial myelographic findings and emphasis on local compressive etiologies delayed the diagnosis. The aim of this report is to focus on this unique entity and to review its role in the differential diagnosis of patients with atypical cervical radiculopathy. A pleocytosis of cerebrospinal fluid, an increase in protein concentration, and hypoglycorrhachia support the diagnosis of spinal cord sarcoidosis. While the outlook for patients with spinal cord sarcoid is poor, improvement of neurologic deficits has been documented after steroid therapy. A review of the literature on sarcoid involvement of the spinal cord and roots is summarized.