Lack of annexin 1 results in an increase in corticotroph number in male but not female mice

Annexin 1 (ANXA1) is a member of the annexin family of phospholipid- and calcium-binding proteins with a well demonstrated role in early delayed (30 min to 3 h) inhibitory feedback of glucocorticoids in the pituitary. We have examined corticotrophs in wild-type and ANXA1 knockout mice to determine the effects of lack of ANXA1 in male and female animals. Anterior pituitary tissue from ANXA1 wild-type, heterozygote and null mice was fixed and examined (i) by confocal immunocytochemistry to determine the number of corticotrophs and (ii) by electron microscopy to examine the size, secretory granule population and secretory machinery of corticotrophs. No differences in these parameters were detected in female mice. In male ANXA1 null mice, there were approximately four-fold more corticotrophs than in wild-type animals. However, the corticotrophs in ANXA1 null mice were smaller and had reduced numbers of secretory granules (the reduction in granules paralleled the reduction in cell size). No differences in the numerical density of folliculo-stellate, gonadotroph, lactotroph or somatotroph cells were detected in male ANXA1 null mice. Plasma corticosterone, adrenocorticotrophic hormone (ACTH) and pituitary pro-opiomelanocortin mRNA were unchanged but pituitary ACTH content was increased in male ANXA1 null mice. Interleukin (IL)-6 pituitary content was significantly elevated in male and reduced in female ANXA1 null mice compared to wild-type. In conclusion, these data indicate that ANXA1 deficiency is associated with gender-specific changes in corticotroph number and structure, via direct actions of ANXA1 and/or indirect changes in factors such as IL-6.

Directing ultrasound at the cemento-enamel junction (CEJ) of human teeth: I. Asymmetry of ultrasonic path lengths

The diagnosis of degenerative changes in human teeth is of general interest because early detections can avoid greater health problems and further weakening effects. Since the wear of teeth determines their stability and lifetime in relation to the physiological load, an ultrasonic survey of any dimensional changes of the enamel layer and especially of the dentin wall thickness may be very helpful. However, an ultrasonographic diagnosis requires first to determine the anisotropic human tooth properties at clinically relevant locations and to simulate wave propagation phenomena in inhomogeneous tooth models with proper dimensions. The first article of a series that provides modular data of mineralized tissues in human teeth at the cemento-enamel junction (CEJ) deals with an ultrasonic method for measuring the asymmetry of dimensional characteristics of extracted human teeth and their ultrasonic path lengths (UPL). Heavily attenuating tooth halves were investigated with respect to the symmetry of normal and inclined oppositely directed radial ultrasonic paths. The measured UPLs ranged from 1.2 mm to 4.4 mm. The relative difference in inclined UPLs between the left and the right tooth halves reaches almost 30%. This reveals a large asymmetry. The mean difference of angles that represent fastest path lengths was 2.2+/-8.1 degrees, which indicates large asymmetry and anisotropy. Several aspects, which are required for a proper integration of asymmetric data into models designed for medical element engineering and simulation (MEES), are discussed.

Patient Satisfaction for Carotid Endarterectomy Performed under Local Anaesthesia

OBJECTIVES

To develop, validate and use a procedure specific questionnaire to evaluate patient experience and satisfaction following carotid endarterectomy (CEA) under either general (GA) or local anaesthesia (LA).

METHODS

Twenty post-CEA patients were interviewed. Data were content analysed and recurrent themes used to generate the specific carotid endarterectomy experience questionnaire (CEA-EQ). The CEA-EQ consists of 15 pre-op and 13 postoperative questions. Validity was established by correlation with the FRS Patient Satisfaction with Surgical Services (SSSQ) and State form of the State Trait Anxiety Inventory (STAI-S) in 69 patients (35 LA, 34 GA). Subsequently 88 patients randomised to GA CEA and 88 to LA CEA received the CEA-EQ. A local anaesthetic intraoperative experience questionnaire (LA-EQ) was also developed and given to LA patients only.

RESULTS

Validity was confirmed through significant correlations with the STAI-S (r=0.67, p<0.001) and the SSSQ (r=0.44, p<0.001). In the randomised prospective study response rates were greater than 90%. Overall experience and satisfaction with CEA was high. There was no statistically significant difference in anxiety, satisfaction or overall experience between anaesthetic techniques. LA CEA was associated with a significantly better perception of recovery. The majority of LA patients found the procedure acceptable.

CONCLUSIONS

The CEA-EQ is a valid tool to assess qualitative aspects of CEA patient care. Overall satisfaction and experience with CEA is good and not related to anaesthetic technique. LA CEA is not associated with any increased anxiety, is tolerated by the majority of patients and is associated with a better perception of recovery.

Sigma ligands inhibit the growth of small cell lung cancer cells

The effects of sigma ligands on small cell lung cancer (SCLC) cells were investigated. 125I-N-(2-(piperidino)ethyl)-2-iodobenazmide (2-IBP) bound with high affinity to SCLC cell line NCI-H209 and NCI-N417. Specific 125I-2-IBP binding was inhibited with high affinity by ifendipine, haloperidol, (2-piperidinyl-aminoethyl)-4-iodobenzamide (IPAB) and 1,3-ditolylguanidine (DTG) with IC50 values of 3, 10, 15 and 90 nM respectively. In vitro, 10 microM 2-IBP, haloperidol or IPAB inhibited NCI-N417 proliferation using a MTT or clonogenic assay. In vivo, 4 mg/kg IPAB or 2-IBP inhibited NCI-N417 xenograft proliferation. 125I-2-IBP localized to the SCLC tumors after subcutaneous injection. These results suggest that sigma ligands may be utilized to localize and inhibit the proliferation of SCLC tumors.

A case of Perlman syndrome: fetal gigantism, renal dysplasia, and severe neurological deficits

We report on a neonate presenting with polyhydramnios; macrosomia; macrocephaly; visceromegaly including bilateral nephromegaly, hepatomegaly, cardiomegaly; thymus hyperplasia; cryptorchidism; generalized muscle hypotonia; and a distinctive facial appearance. The clinical course was marked by severe neurodevelopmental deficits combined with progressive respiratory decompensation leading to death at the age 6 months. Magnetic resonance imaging (MRI) disclosed a generalized cerebral atrophy with a marked deficit of the white matter. Renal ultrasound and MRI showed markedly enlarged kidneys with multiple small cystic lesions, a pattern indistinguishable from polycystic kidney disease. The postmortem kidney biopsy revealed dysplastic changes, microcysts, and a focal nephrogenic rest, characteristic features of the Perlman syndrome. In children with fetal gigantism, renal abnormalities, and neurological deficits, Perlman syndrome should be considered and may be confirmed by kidney biopsy.

Aminothiol multidentate chelators against Chagas disease

Three compounds of an aminothiol family of iron chelators were examined for activity against trypomastigote (human) and epimastigote (vector) forms of Trypanosoma cruzi: tetraethyl and tetramethyl derivatives of ethane-1,2-bis (N-1-amino-3-ethyl butyl-3-thiol) (BAT-TE and BAT-TM) and N',N',N'-tris-(2-methyl-2-mercaptopriopyl)- 1,4,7-triazacyclonane (TAT). BAT-TE at 270 microM completely arrested the growth of trypomastigote forms in mouse blood stored at 4 degrees C for 24 h (IC(50) 67.7+/-7 microM), while BAT-TM arrested growth at 630 microM (IC(50) 158+/-17 microM) and TAT at concentrations >800 microM (IC(50) 415+/-55 microM). In T. cruzi-infected mice, BAT-TE and BAT-TM had no anti-trypanosomal activity in doses up to 200 mg/kg, whether the route of administration was intraperitoneal or oral, and TAT was not tested due to insufficient quantity. TAT had an IC(50) of 52+/-7 microM against the epimastigote forms while BAT-TM and BAT-TE were inhibitory only at concentrations >250 microM. The trypanocidal activity of BAT derivatives in blood stored at 4 degrees C makes these compounds potential candidates for the purpose of clearing donated blood of trypomastigotes.

An in vitro comparison of two modern apex locators

Two apex locators were compared regarding their ability to accurately locate the apical constriction in the presence of various canal fluids at different meter readings. Forty-one root canals were filled with 1% NaOCl, 3% H2O2, and 0.9% NaCl, respectively. Electronic working length (EWL) measurements were recorded with the apex locators Root ZX (meter readings: "Apex", "0.5", and "1") and Apit (meter readings: "Apex" and "3"). The deviation of the EWL from the apical constriction was determined. The proportion of measurements within +/- 0.5 mm of the apical constriction ranged between 0.76 and 0.85 for Root ZX at the meter readings "Apex" and "0.5," regardless of the canal contents. Apit consistently displayed shorter measurement values than Root ZX and reached the highest proportions at the meter reading "Apex": 0.59 (1% NaOCl), 0.61 (3% H2O2), and 0.68 (0.9% NaCl). In the presence of NaOCl, Root ZX provides the more accurate EWL measurements at the meter reading "0.5" and "Apex."

Chelation of iron within the erythrocytic Plasmodium falciparum parasite by iron chelators

To examine the site of action of antimalarial iron chelators, iron ligands were added to control erythrocytes and to erythrocytes parasitized with Plasmodium falciparum, and the concentration of intracellular labile iron was monitored with the fluorescent probe, calcein. The fluorescence of calcein quenches upon binding iron and increases upon releasing iron. The chelators included desferrioxamine B, 2',2'-bipyridyl, and aminophenol II, a compound that is being newly reported as having anti-plasmodial properties. Calcein-loaded parasitized cells displayed fluorescence predominantly within the cytosol of both rings and trophozoites. The addition of chelators to both control and parasitized erythrocytes led to significant increases of fluorescence (P < 0.001). Fluorescence was observed to increase within the parasite itself after addition of iron chelators, indicating that these agents bound labile iron within the plasmodium. The relative increases of fluorescence after addition of chelators were greater in control than parasitized erythrocytes (P < 0.05) as were the estimated labile iron concentrations (P < or = 0.001). These results suggest that (i) the anti-malarial action of iron chelators might result from the ability to reach the infected cell's parasite compartment and bind iron within the parasite cytosol, and (ii) the labile iron pool of the host red cell may be either utilized or stored during plasmodial growth.

Plasmodium falciparum and Plasmodium yoelii: effect of the iron chelation prodrug dexrazoxane on in vitro cultures

To determine if an iron-chelating prodrug that must undergo intracellular hydrolysis to bind iron has antimalarial activity, we examined the action of dexrazoxane on Plasmodium falciparum cultured in human erythrocytes and P. yoelii cultured in mouse hepatocytes. Dexrazoxane was recently approved to protect humans from doxorubucin-induced cardiotoxicity. Using the fluorescent marker calcein, we confirmed that the iron-chelating properties of dexrazoxane are directly related to its ability to undergo hydrolysis. As a single agent, dexrazoxane inhibited synchronized cultures of P. falciparum in human erythrocytes only at suprapharmacologic concentrations (> 200 microM). In combination with desferrioxamine B, dexrazoxane in pharmacologic concentrations (100-200 microM) moderately potentiated inhibition by approximately 20%. In contrast, pharmacologic concentrations of dexrazoxane (50-200 microM) as a single agent inhibited the progression of P. yoelli from sporozoites to schizonts in cultured mouse hepatocytes by 45 to 69% (P < 0.001). These results are consistent with the presence of a dexrazoxane-hydrolyzing enzyme in hepatocytes but not in erythrocytes or malaria parasites. Furthermore, these findings suggest that dexrazoxane must be hydrolyzed to an iron-chelating intermediate before it can inhibit the malaria parasite, and they raise the possibility that the iron chelator prodrug concept might be exploited to synthesize new antimalarial agents.

Prior anterior cruciate ligament reconstruction complicating intramedullary nailing of a tibia fracture

As the number of patients with anterior cruciate ligament reconstructions continues to grow, a subpopulation of patients with displaced tibia-fibula fractures will emerge who have had prior anterior cruciate ligament reconstructions. Previous cruciate ligament surgery can complicate the operative treatment of tibia-fibula fractures by intramedullary nailing. Technical complications arise because the tibial tunnel-graft-screw is in the path of insertion of the intramedullary implant. We present a case in which we traced the path of the patellar tendon autograft, adjusted our entry point for the tibial intramedullary canal, and removed the interference screw to facilitate the fracture surgery. This technical note provides an approach to planning intramedullary nailing of the tibia in patients with prior anterior cruciate ligament surgery.

Direct current cardioversion does not cause cardiac damage: evidence from cardiac troponin T estimation

AIM

To determine whether elective direct current (dc) cardioversion of atrial fibrillation/flutter causes myocardial damage.

METHODS AND RESULTS

Cardiac troponin T and creatine kinase were estimated 20-28 hours after dc cardioversion in 51 patients who received dc shocks for elective cardioversion of chronic atrial fibrillation/flutter. Although creatine kinase was raised in 44 patients, cardiac troponin T was undetectable in all patients.

CONCLUSION

Cardiac damage does not occur as a result of cardioversion.

Hydrophobicity of HIV protease inhibitors by immobilized artificial membrane chromatography: application and significance to drug transport

PURPOSE

The feasibility of using hydrophobicity measurements as screens for intracellular availability in T-cells or intestinal permeability in Caco-2 cells was examined.

METHODS

T-cell experiments: Cells were counted, collected, then incubated with drug solution at 37 degrees C. At selected time intervals, uptake was quenched by transferring a sample into oil, followed by rinsing, lysis of cells, protein precipitation and analysis by HPLC. Caco-2 cell experiments: Cells were grown on plastic dishes for 7-10 d, then rinsed and incubated with drug solution at 37 degrees C. Uptake was quenched, cells were lysed, protein precipitated and drug was analyzed by HPLC. IAM chromatography: Stock solutions were injected onto an IAM column for HPLC. Mobile phase consisted of varying amounts of acetonitrile in buffer (pH 7.4). The capacity factor, k'IAM, was calculated using citric acid to measure the void volume and was obtained by extrapolation to pure buffer.

RESULTS

Nine HIV protease inhibitors were studied for uptake by CEM T-cell suspensions or Caco-2 cell monolayers. Capacity factors (log) between IAM and C-18 columns were positively correlated for this series. Caco-2 uptake rates correlated well with T-cell uptake rates when normalized by protein mass. Single-variable regression using IAM or C-18 columns was acceptable for analysis of T-cell data. Correlation coefficients between T-cell uptake and log k'IAM or log k'C-18 were not improved with multivariable regression. Correlation between Caco-2 uptake and log k'IAM was enhanced when molecular weight and hydrogen-bonding potential were included in multivariable regression analysis (from r2 of 0.39 to 0.91). Correlations obtained using log k'IAM, log k'C-18 or log distribution coefficient (log D) were comparable when regressed against Caco-2 uptake using this approach. Calculated log partition coefficient (ClogP) provided the poorest correlation in the multivariable analysis (r2=0.57 for T-cell uptake and r2=0.71 for Caco-2 cell uptake).

CONCLUSIONS

Uptake of HIV protease inhibitors by T-cell suspensions or Caco-2 cell monolayers was positively correlated. Uptake by T-cell suspensions was adequately described by hydrophobicity alone. Description of uptake by Caco-2 cell monolayers required multivariable regression analysis in which molecular weight and hydrogen bonding were included. Experimental measures of hydrophobicity (log k'IAM, log k'C-18 and log D) were superior to ClogP in the correlation analysis.

Dose due to man-made radionuclides in terrestrial wild foods near Sellafield

Radiological dose implications for consumers of wild foods around Sellafield have been assessed. Habits were surveyed from 72 households, mostly within a few kilometres of Sellafield. A few people were included who lived further away but collect wild foods close to Sellafield. Dose estimates were based on measured gamma emitters, as well as 239Pu, 241Am, 14C and 129I in selected samples. In all cases, doses were dominated by 137Cs. One infant was identified who consumed wild food, giving an estimated effective dose of 0.3 microSv a(-1). In the age group 2 to 10 years a mean dose of 0.51 microSv a(-1), and a maximum of 2.8 microSv a(-1), were estimated. Intakes by adults were higher and resulted in more radiologically significant doses. The extreme individual received a dose of 32 microSv a(-1) largely due to consumption of honey that included contributions from the Chernobyl accident, and hedgerow fruits. This is comparable to doses to the critical group for consumption of conventional agricultural produce close to the Sellafield site. The 97.5th percentile dose, for all age groups of consumers taken together, was 16.6 microSv a(-1), or 6.2 microSv a(-1) if the contributions from Chernobyl are excluded. Considering the contributions from different foods to the whole group of 181 wild food consumers, the rank order is honey, blackberries and venison.

(Arg15, Arg21) VIP: evaluation of biological activity and localization to breast cancer tumors

VIP analogs, which contain a single lysine amino acid, were synthesized and evaluated using breast cancer cells. (Arg15, Arg20) VIP, (Argl5, Arg21) VIP, and (Arg20, Arg21) VIP inhibited 125I-VIP binding to T47D cells with high affinity (IC50 values of 1.2, 1.0, and 0.8 nM, respectively). The VIP analogs elevated cAMP in T47D cells with ED50 values ranging from 0.1-1 nM. Because (Arg15, Arg21) VIP was the most potent at elevating cAMP, it was characterized further. (Arg15, Arg21) VIP transiently increased c-fos gene expression in breast cancer cells. N-Succinimidyl-4-18F (fluoromethly) benzoate was prepared in one chemical step from N-succinimidyl-4-(4-nitrobenzenesulfonyl)oxomethyl)benzoate by adding 18F in acetone at room temperature. This prosthetic group was then reacted with (Arg15, Arg21) VIP ((RR) VIP). (18F-RR) VIP bound with high affinity to T47D cells and was rapidly internalized. (18F-RR) VIP was injected intravenously into nude mice bearing breast cancer xenografts and after 4 h, the density of (18F-RR) VIP was elevated in the tumors relative to normal organs. These data suggest that VIP receptors may be used to localize breast cancer tumors.

[Computer tomographic diagnosis of acute cerebral ischemmia]

Computed tomography (CT) is the first step in the radiological diagnostics of brain emergencies. We intend to study which pathophysiological changes are detected by CT and how CT contributes to prognosis and patient management in acute cerebral ischemia. We review recent publications about the role of CT in acute cerebral ischemia. Ischemic brain edema is associated with a decreased X-ray attenuation. Computed tomography is thus highly sensitive in detecting irreversibly damaged ischemic brain tissue. Patients showing large volumes of ischemic edema, exceeding one third of the middle cerebral artery territory, do not benefit from thrombolysis and have an increased risk of brain hemorrhage. The brain territory at risk from ischemia can be detected by CT angiography. To combine CT with CT angiography is a pragmatic approach which enables carefully directed treatment in acute cerebral ischemia.

[New possibilities in therapy and rehabilitation of alcohol dependent patients. Catamnestic study of the efficacy of ambulatory withdrawal therapy exemplified by a model facility]

We report on catamnestic and clinical results of a 18-24 month follow-up study of 65 alcohol-dependent patients who in 1992-1994 took part in an 8-month outpatient treatment programme. The psychotherapeutic concept of this treatment facility is described. 51 of the 65 patients who had participated in the programme could be subsequently personally interviewed, 7 patients refused to take part, 6 could not be reached and 1 had died. 40 of the 51 patients had properly completed the outpatient treatment. Assuming that all patients who could not be interviewed or refused, were relapsers the abstinence rate was found to be 48% (n = 31). Although selective factors may contribute to this result, the clinical findings so far seem to indicate that outpatient treatment for alcoholics is a promising new therapeutic approach in the treatment of alcoholism. Further studies are needed to assess the possible benefits and the indications for this outpatient treatment in greater detail.