[Torsion of the accessory spleen: an atypical etiology for acute abdomen]

The accessory spleen is often a incidental discovery. The accessory post-accidental spleen are unusual. The torsion of a movable spleen is possible and represent about 0.2 to 0.3% of splenectomy. But the torsion of an accessory spleen is exceptional. A case of acute torsion of an accessory spleen is reported. In a 26-year-old women was admitted with acute abdominal pain. The abdominal ultrasound and the abdominal X-Ray are no specific. In the face of the acute pain, a laparoscopy was necessary. At laparoscopy, the patient was found to have torsion and infarction of an accessory spleen in the pelvis. The treatment was a splenectomy and the evolution was favorable.

Observation of compressional Alfvén modes during neutral-beam heating on the national spherical torus experiment

Neutral-beam-driven compressional Alfvén eigenmodes at frequencies below the ion cyclotron frequency have been observed and identified for the first time in the National Spherical Torus Experiment. The modes are observed as a broad spectrum of nearly equally spaced peaks in the frequency range from approximately 0.2omega(ci) to approximately 1.2omega(ci). The frequency has a scaling with toroidal field and plasma density consistent with Alfvén waves. The modes have been observed with high bandwidth magnetic pickup coils and with a reflectometer.

[Assessing the quality of patients' medical records at the Claudius-Regaud Institute]

In 1999, the Claudius-Regaud Institute of Toulouse, France, specialized in oncology, set up a workshop in order to assess the quality of its patients medical records. A retrospective evaluation was performed on a 100-chart-sample drawn from all the charts in the institution. Results show that the medical records are subdivised into three parts: medical care, nursing care and imaging. Some of the explored charts show a lack of data, and a certain inconsistency in the charts' organization and in the structure of information was reported. Patient's record is a key to communication between the different care providers in oncology. To improve its quality, efforts will have to be done in restructuring the charts, creating guidelines and training the different caregivers.

The anxiolytic effects of intra-hippocampal midazolam are antagonized by intra-septal L-glutamate

According to Gray [The Neuropsychology of Anxiety: An Enquiry into the Functions of the Septo-hippocampal System, Oxford University Press, New York, 1982], the hippocampus and the septum act in concert to control anxiety. We found that micro-infusion of midazolam into the dorsal hippocampus increased rats' open-arm exploration in the elevated plus-maze. Co-infusion of L-glutamate into the septum suppressed this anxiolytic effect. However, intra-hippocampal midazolam failed to alter rats' burying behavior in the shock-probe test. These findings suggest that the hippocampus and septum work together to regulate rats' behaviors in some (plus-maze) but not all (burying) animal tests of anxiety.

Functions of GI-GPx: lessons from selenium-dependent expression and intracellular localization

Gastro intestinal glutathione peroxidase (GI-GPx) is one of the four distinct mammalian selenoperoxidases. It had been reported to be restricted to the gastrointestinal tract but has more recently been identified also in human liver and some tumor cell lines. GI-GPx ranks high in the hierarchy of selenoproteins. The GI-GPx mRNA rather increases than decreases in selenium deficiency. GI-GPx protein responds poorly to selenium deprivation and increases fast upon resupplementation. Putative biological roles of GI-GPx, e.g. protection against food-born hydroperoxides, redox-regulation of proliferation or apoptosis, and modulation of mucosal immunity, are discussed in the light of cellular and subcellular distribution, transcriptional regulation and observations with k.o. mice.

Influence of the delay of adjuvant postoperative radiation therapy on relapse and survival in oropharyngeal and hypopharyngeal cancers

PURPOSE

To determine whether the delay between surgery and the beginning of radiation therapy influences survival or the risk of local-regional relapse in oropharyngeal or hypopharyngeal squamous cell carcinomas.

METHODS AND MATERIALS

From 2052 patients referred to the Henri Becquerel Center for the radiation therapy of an oropharyngeal or hypopharyngeal cancer between January 1, 1981 and December 31, 1992, 420 were included in a retrospective study. Exclusion criteria were another cancer, metastasis, incomplete resection, lack of homolateral lymph node resection, or previous chemotherapy. Radiation therapy delivered 45 to 75 Gy on initial location and lymph node. Follow-up was performed until December 31, 1997. A Cox proportional hazard regression analysis was used to evaluate the prognostic factors.

RESULTS

The delay between surgery and radiation therapy was not found to be a significant prognostic factor for survival or risk of local-regional relapse. The only parameters found to influence local-regional and survival control were margins' pathologic state (respectively p < 0.0001 and p = 0.015) and T (p < 0.0001) and N (respectively p < 0.0001 and p = 0.0004) stages. In terms of local-regional relapse only, age was a prognostic factor (p = 0.048), and a trend was noted for tumor emboli in vessels or nerves (p = 0.061).

CONCLUSION

In patients with oropharyngeal or hypopharyngeal squamous cell carcinoma, the delay between surgical procedure and radiation therapy does not influence survival or risk of local-regional relapse. Radiation therapy might be subjected to complete healing in these patients.

Intra-septal infusions of excitatory amino acid receptor antagonists have differential effects in two animal models of anxiety

Ablation or pharmacological inhibition of the septum produces anxiolytic-like effects in two animal models of anxiety: the elevated plus-maze and the shock-probe burying tests. Overall, these results suggest that the septum normally plays an excitatory role in the control of anxiety-related behaviors. The purpose of the present study was to examine this hypothesis in more detail, by testing the effects of intra-septal infusions of excitatory amino acid (EAA) receptor antagonists on rats' behavior in the shock-probe and plus-maze tests. We found that intra-septal infusions of the non-NMDA (N-methyl-D-aspartic acid) receptor antagonist CNQX (5 microg) suppressed open-arm avoidance in the plus-maze test, and reduced burying behavior in the shock-probe test, without affecting rats' normal avoidance of the shock-probe. In contrast, intra-septal infusions of the NMDA receptor antagonist AP-5 (5 microg) inhibited both shock-probe avoidance and burying behavior, without affecting rats' open-arm avoidance. These dissociations suggest that different EAA receptor types within the septum exert complex but distinct control of different anxiety-related behaviors.

Effect of angiotensin-converting enzyme inhibition on plasma, urine, and tissue concentrations of hemoregulatory peptide acetyl-Ser-Asp-Lys-Pro in rats

The hemoregulatory peptide Acetyl-Ser-Asp-Lys-Pro (AcSDKP) has been reported to accumulate in plasma and urine after the oral administration of angiotensin-converting enzyme (ACE) inhibitors in humans. It is unknown whether such an accumulation also occurs in tissues. We administered captopril (3, 10, or 30 mg/kg) orally for 2 weeks to Wistar rats. In a second experiment, captopril (10 mg/kg) was administered for 9 days and was followed by a 1-h i.v. infusion of either AcSDKP (0.1 or 2 mg/kg) or saline on day 9. Captopril alone dose-dependently increased plasma AcSDKP by a factor of 3 to 5 and urine AcSDKP by a factor of 3. It slightly increased renal and pulmonary AcSDKP concentrations but did not affect AcSDKP concentrations in bone marrow and spleen. The combination of AcSDKP (2 mg/kg) and captopril gave very high AcSDKP concentrations in plasma and urine and increases in AcSDKP concentration by factors of 27 in kidney, 5.5 in lung, and 6.9 in the extracellular fraction of bone marrow. In contrast, no change was observed in the AcSDKP concentration in spleen and in the intracellular fraction of bone marrow. In conclusion, during chronic ACE inhibition in rats, AcSDKP levels slightly increased in organs with high ACE contents. No such increase occurred in hematopoietic organs. AcSDKP had to be combined with captopril to significantly increase its concentration in tissues other than the spleen. The possibility of pharmacologically increasing AcSDKP levels in the extracellular fraction of bone marrow may be of value for protecting hematopoietic cells from the toxicity of cancer chemotherapy.

Erythropoietin blood level is increased in sudden infant death

Erythropoietin (EPO) is the main red cell growth factor and its release into the blood stream is stimulated by anemia and also by various kinds of hypoxia. We studied the blood EPO concentration in a population of 96 infants who died suddenly and compared their mean EPO levels to control infants. The normal values were low at birth and progressively increased during the first 2 years. In the sudden infant death (SID) group the EPO level was significantly higher (p = 0.001) for the entire population and particularly in the youngest group (0-2 months): 14.7 +/- 2.4 IU/l (mean +/- SEM) in SID group vs. 3.6 +/- 0.4 IU/l in control group (p < 0.001). Although we could not analyze the blood hemoglobin concentration after death, the anemia hypothesis was refuted by an assay of the percentage of fetal hemoglobin which was normal for age in the control and SID groups. Moreover, there was no significant difference in EPO levels between explained and unexplained deaths. We also observed an increase in the stress hormones, cortisol and beta-endorphin, in the entire SID group. These SID results suggest a profound and long-lasting hypoxia at least during terminal agony.

[Combined blockade of the renin-angiotensin system]

In view of the internal counter-regulation mechanisms of the renin-angiotensin system (RAS), complete blockade would not seem to be possible if only one of its components is targeted. Instead of increasing the dosage of an angiotensin converting enzyme (ACE) inhibitor or that of an angiotensin II antagonist (AA), blockade of the system at two different levels by neutralising the internal counter-regulation mechanism could provide more effective blockade and, therefore, more pronounced biological effects. For this reason, the authors undertook two studies in a model of mild salt depletion of a normotensive subject, which showed additive effects on the lowering of the blood pressure and renin secretion during combined administration of captopril and losartan, then enalapril and losartan. There was no additive effect on plasma aldosterone levels. The administration of the ACE inhibitor neutralised the expected increases in plasma Angiotensin II values due to the losartan. All combinations of ACE inhibitor and AA were tested in spontaneous hypertensive rats using a dosage scale from 1 to 30, the results of which showed the beneficial effects of combined blockade on left ventricular mass and the deleterious effects on renal function when blockade of the RAS is too complete. Based on the results obtained in normotensive subjects and homogeneous groups of hypertensive animals, the authors conclude that low doses of an AA and of an ACE inhibitor is more effective in lowering the blood pressure than higher doses of each drug administered separately. How can these results be applied clinically in hypertension and cardiac failure? The choice between increasing the dose of each of the two drugs or the association of low doses of both drugs will depend more on the tolerance of each therapeutic strategy than on the efficacy. The choice between the two strategies will also depend on the demonstration of consequences specific to each modality of inhibition of the system, especially with respect to the effects of accumulation of bradykinin and to stimulation of type 2 receptors. The additive effects of a combined treatment should be validated by repeated administration in hypertensive patients.

In vivo assessment of captopril selectivity of angiotensin I-converting enzyme inhibition: differential inhibition of acetyl-ser-asp-lys-pro and angiotensin I hydrolysis

Angiotensin I-converting enzyme (ACE) is a zinc metallopeptidase that plays a major role in blood pressure regulation. The demonstration that the hemoregulatory peptide acetyl-Ser-Asp-Lys-Pro (AcSDKP) is a natural and specific substrate of the N-active site of ACE suggests that this enzyme may have a new physiological role such as the modulation of hematopoietic stem cells. In vitro studies have shown that ACE inhibitors displayed various potencies in inhibiting the degradation of different natural or synthetic substrates of ACE, among which captopril inhibits AcSDKP hydrolysis more potently than angiotensin I hydrolysis. To look for this selectivity in vivo, we investigated the pharmacodynamic effect of increasing doses of captopril (0.01-10 mg/kg) during the 90 min after i.v. administration to spontaneously hypertensive rats. Plasma and urinary AcSDKP levels were measured. The renin-angiotensin system was evaluated by measurements of ACE activity in plasma samples, using the synthetic substrate Hip-His-Leu, by determinations of plasma renin concentrations and measurements of arterial blood pressure. The results showed that captopril (0.01-0.3 mg/kg) selectively inhibited AcSDKP hydrolysis, with limited effects on the renin-angiotensin system. AcSDKP levels in plasma and urine rose to a plateau 4 times the basal level for doses more than 0.3 mg/kg. All of the parameters reflecting the renin-angiotensin system were significantly affected at doses of 1 and 10 mg/kg. The present study therefore confirms that captopril can be used to protect hematopoietic stem cells during antitumor chemotherapy while having only a limited effect on cardiovascular homeostasis.

Can echocardiography identify mildly hypertensive patients at high risk, left untreated based on current guidelines?

OBJECTIVE

To determine whether the decision to treat uncomplicated mild hypertension with drugs, in accordance with the World Health Organization - International Society of Hypertension (WHO/ISH) guidelines based on a series of blood pressure (BP) measurements over 6 months, resulted in the treatment of patients at high risk on the basis of echocardiography.

METHODS

One hundred and eighteen patients with mild hypertension (diastolic blood pressure 90-105 mm Hg and/or systolic blood pressure 140-180 mm Hg) were examined by echocardiography at inclusion and followed up for 6 months by a single physician unaware of the echographic results.

RESULTS

Drug treatment was given to 48 patients, and 70 remained untreated. Treated patients had higher echographic indices than untreated patients (all P<0.05): left ventricular (LV) mass/body surface area (83.0+/-15.6 versus 75.3+/-14.8 g/m2), inter-ventricular septal thickness (9.7+/-1.7 versus 8.5+/-1.3 mm), LV posterior wall thickness (8.4+/-1.1 versus 7.8+/-1.1 mm), relative wall thickness (0.37+/-0.06 versus 0.34+/-0.06). LV geometry was normal in 98 patients, and 20 had LV concentric remodelling. The 10-year coronary disease risk (Framingham equation) was higher in the 20 patients with concentric remodelling than in those with normal LV geometry (10.4 versus 4.2%; P<0.005). Nine of these 20 patients were still untreated at the end of the 6-month follow-up period.

CONCLUSION

Rigorous application of the WHO/ISH clinical guidelines in a group of mild hypertensive patients led to the treatment of patients with slightly higher LV mass and more concentric LV geometry than were found in those not treated. However, a high-risk subgroup, with concentric remodelling, was not identified and left untreated.

Effects of centrally administered anxiolytic compounds in animal models of anxiety

The effect of intra-cerebrally infused compounds in animal models of anxiety were reviewed. A large body of evidence suggested that benzodiazepine agonists in different brain regions--including areas of the raphe, hypothalamus, periaqueductal gray, septum, hippocampus, and amygdala--produce reasonably consistent anxiolytic effects in a variety of animal models. However, evidence regarding the effects on anxiety of 5-HT1A agonists, 5-HT2 compounds, and 5-HT3 antagonists was somewhat less extensive, both anatomically and behaviourally, and more complex. For example, establishing receptor specificity for 5-HT ligand effects was often complicated by the lack of 'silent' and/or selective antagonists. Neuropeptides had significant effects on anxiety, but these were shown in a smaller number of animal models and in a limited number of brain regions. Regardless of the compounds tested, however, there seemed to be a surprising number of double dissociations (brain site by behavioural test). In fact in some instances, different fear reactions appeared to be controlled by distinct receptor subpopulations within particular parts of the limbic system. These results suggest that the neural control of anxiety might be analogous in organization to sensorimotor systems, i.e., anxiety is controlled by complex systems of multiple, distributed, parallel pathways.

Renal changes on hyperglycemia and angiotensin-converting enzyme in type 1 diabetes

Hyperglycemia causes capillary vasodilation and high glomerular capillary hydraulic pressure, which lead to glomerulosclerosis and hypertension in type 1 diabetic subjects. The insertion/deletion (I/D) polymorphism of the angiotensin I-converting enzyme (ACE) gene can modulate risk of nephropathy due to hyperglycemia, and the II genotype (producing low plasma ACE concentrations and probably reduced renal angiotensin II generation and kinin inactivation) may protect against diabetic nephropathy. We tested the possible interaction between ACE I/D polymorphism and uncontrolled type 1 diabetes by measuring glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) during normoglycemia ( approximately 5 mmol/L) and hyperglycemia ( approximately 15 mmol/L) in 9 normoalbuminuric, normotensive type 1 diabetic subjects with the II genotype and 18 matched controls with the ID or DD genotype. Baseline GFR (145+/-22 mL/min per 1.73 m2) and ERPF (636+/-69 mL/min per 1.73 m2) of II subjects declined by 8+/-10% and 10+/-9%, respectively, during hyperglycemia; whereas baseline GFR (138+/-16 mL/min per 1.73 m2) and ERPF (607+/-93 mL/min per 1.73 m2) increased by 4+/-7% and 6+/-11%, respectively, in ID and DD subjects (II versus ID or DD subjects: P=0.0007 and P=0.0005, for GFR and ERPF, respectively). The changes in renal hemodynamics of subjects carrying 1 or 2 D alleles were compatible, with a mainly preglomerular vasodilation induced by hyperglycemia, proportional to plasma ACE concentration (P=0.024); this was not observed in subjects with the II genotype. Thus, type 1 diabetic individuals with the II genotype are resistant to glomerular changes induced by hyperglycemia, providing a basis for their reduced risk of nephropathy.

Vascular and cardiac remodeling in world class professional cyclists

BACKGROUND

Numerous studies have demonstrated that left ventricular (LV) hypertrophy is often associated with conditioning.

METHODS AND RESULTS

The aim of the study was to evaluate cardiac and carotid artery changes induced by professional cycling. We collected M-mode left ventricle and B-mode right common carotid artery data from 149 male professional cyclists before the 1995 "Tour de France" race and 52 male control subjects. LV mass indexed to body surface area in cyclists was double that in control subjects, with no overlap of 95% confidence intervals (cyclists 100.9 to 187 g/m2 and control subjects 51.8 to 96.3 g/m2). Both mean arterial diameter and mean arterial diastolic intima-media thickness (IMT) were 13% higher in cyclists than in control subjects, with overlap of 95% confidence intervals (for arterial IMT 0.45 to 0.65 mm in cyclists and 0.38 to 0.60 mm in control subjects).

CONCLUSIONS

Our results suggest that intense cycling has an effect on the cardiovascular system, more pronounced on the left ventricle and less pronounced on large arteries. Nevertheless, athletic training should be considered as a potential determinant of carotid modification.

Does the bed nucleus of the stria terminalis mediate fear behaviors?

The bed nucleus of the stria terminalis (BNST) has been implicated in autonomic and hormonal reactions to fearful stimuli, but its role in behavioral reactions to these stressors is less clear. This is puzzling, because 2 closely related areas, the septum and the amygdala, have been repeatedly implicated in fear behaviors. To investigate further, the behavioral effects of BNST lesions were compared to those of septal and amygdaloid lesions in 2 models of rat anxiety: the plus-maze and shock-probe tests. Septal lesions inhibited rats' open-arm avoidance in the plus-maze and suppressed burying of the shock-probe, whereas amygdaloid lesions specifically inhibited shock-probe avoidance. However, BNST lesions produced none of these anti-fear effects; thus, its involvement in the behavioral expression of fear is questionable.

Is barakol anxiolytic?

A recent report suggested that barakol, a biologically active extract of the south-east Asian plant, Cassia siamea, has anxiolytic properties. The purpose of the present study was to replicate and extend these findings by examining the dose-response effects of barakol (0-20 mg/kg) in two pharmacologically validated tests of rat anxiety: the elevated plus-maze and the shock-probe burying tests. Although the purity of our sample of barakol was confirmed by chemical analysis, we found no evidence of its anxiolytic effects in either the plus-maze or shock-probe burying tests.

Does the bed nucleus of the stria terminalis mediate fear behaviors?

The bed nucleus of the stria terminalis (BNST) has been implicated in autonomic and hormonal reactions to fearful stimuli, but its role in behavioral reactions to these stressors is less clear. This is puzzling, because 2 closely related areas, the septum and the amygdala, have been repeatedly implicated in fear behaviors. To investigate further, the behavioral effects of BNST lesions were compared to those of septal and amygdaloid lesions in 2 models of rat anxiety: the plus-maze and shock-probe tests. Septal lesions inhibited rats' open-arm avoidance in the plus-maze and suppressed burying of the shock-probe, whereas amygdaloid lesions specifically inhibited shock-probe avoidance. However, BNST lesions produced none of these anti-fear effects; thus, its involvement in the behavioral expression of fear is questionable.

The septum and the hippocampus differentially mediate anxiolytic effects of R(+)-8-OH-DPAT

Infusing the 5-HT1A receptor agonist R(+)-8-OH-DPAT into the septum or hippocampus reduced the fear responses of rats differentially in the elevated plus-maze and shock-probe burying tests, two rat models of anxiety. Intra-septal infusions of R(+)-8-OH-DPAT (5 and 10 microg) produced dramatic reductions in rat burying behavior in the shock-probe test, whereas it did not alter rat open-arm activity in the plus-maze test, across a wide range of doses (0.1, 0.25, 5 and 10 microg). Conversely, intra-hippocampal infusions of R(+)-8-OH-DPAT (0.1 and 5 microg/side) produced substantial increases in open-arm activity in the plus-maze test, but did not alter rat burying behavior in the shock-probe test. These dissociations suggest that 5-HT1A receptors in the septum and hippocampus exert parallel but distinct control over different fear reactions.

Short-term effects of withdrawing angiotensin converting enzyme inhibitor therapy on home self-measured blood pressure in hypertensive patients

The aim of this study was to compare blood pressure rise after interruption of two angiotensin converting enzyme (ACE) inhibitors in hypertensive patients. After a 2-week placebo run-in period, hypertensive patients were treated with either trandolapril 2 mg once daily or perindopril 4 mg once daily for 4 weeks in a double-blind design. A placebo was then administered for 1 week. Three periods of 1-week home self-measured blood pressure (SMBP) were programmed: end of placebo run-in period, end of treatment period, and final withdrawal placebo period. Every day, three consecutive measurements were requested both in the evening and in the morning. Individual reversion to baseline BP level was studied in the subgroup of patients responding to therapy (evening diastolic SMBP decrease > or =6 mm Hg). The ratio (R) of mean post-drug DBP lowering (residual effect) over evening on-drug DBP lowering (full effect) was used to study reversion to baseline. Patients exhibiting a lower value than the median of this ratio were called Reverters, whereas others were called Nonreverters. One hundred-nineteen patients entered the analysis. During the treatment period, mean SMBP decreased significantly, from 150 +/- 14/97 +/- 7 mm Hg to 139 +/- 15/91 +/- 9 mm Hg (all P < .001). The on-drug BP level was similar in the evening in the two treatment groups. However, both systolic and diastolic morning SMBP levels were significantly lower in the trandolapril group. After drug discontinuation, the mean BP level significantly rose to 144 +/- 14/94 +/- 9 mm Hg (all P = .01) but remained lower than the baseline BP values (P = .003 for SBP and P = .002 for DBP). The post-drug BP level was significantly lower in the trandolapril group than in the perindopril group. Seventy-four patients were responders to therapy. In this subgroup, the median of the R ratio used to analyze reversion to baseline after drug discontinuation was 44%. Nonreverters were characterized by a sustained on-drug BP decrease, compared to Reverters. We therefore conclude that ACE inhibitor treatment withdrawal is accompanied by a rapid rise in BP (within 48 h), followed by a 5-day BP plateau that is lower than the initial level. Reverters to baseline after drug discontinuation were more likely to be insufficiently controlled during therapy, particularly in the morning. The longer duration of action of trandolapril was associated with a lower BP level during both the morning during the active treatment phase and the 1-week posttreatment phase.

Dissociations among the anxiolytic effects of septal, hippocampal, and amygdaloid lesions

Fear reactions of rats given bilateral lesions to the septum, hippocampus, or amygdala were compared with those of rats given sham lesions, in 2 animal models of anxiety: the shock-probe burying test and the elevated plus-maze test. Septal lesions produced anxiolytic effects in both tests (i.e., an increase in open-arm activity and a decrease in burying), whereas hippocampal and amygdaloid lesions produced neither of these effects. On the other hand, hippocampal and amygdaloid lesions impaired rats' passive avoidance of the electrified shock-probe, whereas septal lesions did not. These dissociations suggest that limbic structures such as the septum, amygdala, and hippocampus exert parallel but distinct control over different fear reactions.