Cockayne syndrome with tetralogy of Fallot: a case report

Cockayne syndrome (CS) is a rare autosomal recessive disorder characterized by growth retardation, senile-like appearance, loss of subcutaneous adipose tissue, photosensitive dermatitis, microcephaly, deafness, pigmentary degeneration of retina, disproportionately long limbs, skeletal malformations with knee contractures and neurologic abnormalities. This is a description of a three-year-old boy with typical features of Cockayne syndrome complicated with tetralogy of Fallot, pneumonia and hepato-splenomegaly. He had been suffering from frequent attacks of pneumonia and had been hospitalized for several times since birth. Tetralogy of Fallot was diagnosed under echocardiography study and he died suddenly in hospital during a mydriatic procedure in the Ophthalmologic Clinic.

Myocardial pharmacokinetics of thiopental in sheep after short-term administration: relationship to thiopental-induced reductions in myocardial contractility

The myocardial kinetics and dynamics of thiopental (750 mg over 2 min) were examined in chronically instrumented sheep (five studies in four sheep). The myocardial kinetics were studied by simultaneous rapid sampling of arterial and coronary sinus blood for 30 min. The myocardial kinetics for four of the five studies were best described by a single flow-limited compartment with apparent volumes of between 42 and 113 mL. These volumes equated to half-lives of equilibration between blood and myocardium of between 0.49 and 1.00 min when baseline blood flow was taken into account. The remaining study was better described by a model with a slight membrane limitation (permeability/flow ratio of approximately 2). Myocardial contractility was studied as a measure of myocardial pharmacodynamics and was reduced to 53% of baseline at approximately 2.5 min after the start of the dose. Effect compartment analysis showed that there was hysteresis between the time course of these contractility changes and the time course of the arterial concentrations, with effect compartment half-lives between 0.08 and 0.87 min. There was significantly less hysteresis for the coronary sinus concentrations. It is concluded that thiopental equilibrated rapidly with a component of the myocardium, and that consequently its effects on myocardial contractillity also rapidly equilibrated with both afferent and effluent myocardial blood.

Torticollis: a long-term follow-up study

To achieve better guidelines for the future management of torticollis, this study analyzed surgical and nonsurgical management of 253 torticollis patients who were treated in this hospital from 1971 to 1993. Of those, 37 cases received operation only, 78 cases were operated after failed physical therapy, and 138 cases were treated only at the Rehabilitation Department. If free neck movement was considered to be the primary goal of treatment, most parents were satisfied with the results. However, if facial and skull deformities were the serious sequelae of torticollis, then only less than half of the surgical and nonsurgical groups of patients were graded as normal. Further, 10.9% of physical therapy group and 7% of the surgical patients need further operation to release the fibrotic bundle which limited their neck movement. Therefore, it is suggested that torticollis treatment should include early interventions such as adjusting sleep position, careful planning of physical therapy and/or operation and a long term follow-up period as essential for better management of torticollis.

Adverse haemodynamic effects of the rapid intravenous injection of hypotonic solutions in sheep

The rapid intravenous administration of 10 ml of sterile water or hypotonic saline to five conscious sheep induced substantial adverse haemodynamic effects lasting 10 to 20 seconds. They included reductions in cardiac output (to 44 per cent of the baseline value measured in the 30 seconds before the injection), arterial blood pressure (67 per cent of baseline), left ventricular systolic pressure (60 per cent of baseline), myocardial contractility (60 per cent of baseline), and left coronary arterial blood flow (39 per cent of baseline), and increases in heart rate to 137 per cent of the baseline. The intensities of these effects were related directly to the rates of injection and inversely to the osmolalities of the solutions injected. Intravascular haemolysis was associated with the effects. These data are of potential importance to anyone administering drugs intravenously to sheep.

A descriptive tool to characterize nonlinear kinetics, with applications to meperidine and lidocaine

We describe an explorative data analysis tool which can detect and describe the presence of nonlinearities in multiple dose kinetics studies. The method is nonparametric (i.e. not dependent on modeling assumptions), uses regression to estimate the functions representing the kinetics, and makes the detection of nonlinearity a part of the model selection process. Flexible functions (splines) are used to describe the kinetics corresponding to the lowest given dose, and to describe the (possible) departure of the kinetics corresponding to higher doses from the reference kinetics. The estimated kinetics and departures can be examined to offer possible insight into the nature of the nonlinearity. The methodology is applied to the analysis of meperidine and lidocaine kinetics through the lungs and the heart. We find that the lung kinetics of lidocaine and meperidine are linear. However their myocardial kinetics are complex and nonlinear.

Comparison of myocardial ischaemia in post-infarction patients with and without angina: assessment by dipyridamole 201T1 imaging

Ninety patients with old myocardial infarction were studied to evaluate the efficacy of intravenous dipyridamole 201Tl imaging for the detection of myocardial ischaemia in post-infarction patients, and to compare the prevalence of ischaemia in 63 patients with post-infarction angina (group I) and 27 patients without angina (group II). Thirty-four of the patients in group I and 15 of the patients in group II received coronary arteriography (CAG) for comparison; these were labelled groups IA and IIA, respectively. On 201Tl imaging, the incidence of scar with ischaemia in the infarct zone and scar with ischaemia at a distance were 72% and 42% in all patients, 89% and 52% in group I vs 33% and 19% in group II (P < 0.001 and P < 0.01, respectively). On CAG testing, the rates of infarct-related recanalization vessel and multi-vessel disease were 76% and 68% in group IA vs 40% and 40% in group IIA (P < 0.05 and P > 0.05, respectively). Thus, dipyridamole 201Tl imaging is a useful modality and post-infarction angina a proper indicator in the detection of myocardial ischaemia in post-infarction patients

Technetium-99m albumin scintigraphy in the diagnosis of protein-losing enteropathy: a case report

A 34-year-old female presenting with bilateral lower leg edema and distended abdomen was admitted to our hospital. The serum albumin was 1.42g/dl. Renal function and hepatic function were normal. Urinalysis did not show proteinuria. Tc-99m albumin scintigraphy was arranged for this patient to rule out protein-losing enteropathy. The results demonstrated loss of albumin into the intestines. We conclude that Tc-99m albumin scintigraphy of the abdomen is a valuable adjunct in the diagnosis of protein-losing enteropathy.

The pharmacokinetics of meperidine in the myocardium of conscious sheep

The pharmacokinetics of meperidine in blood and myocardium were studied in five conscious sheep. After an intravenous (i.v.) bolus of 100, 200, or 300 mg meperidine HCl, the maximum arterial blood concentrations (mean +/- SD) were 27.8 +/- 4.6, 66.8 +/- 13.3, and 114.5 +/- 23.1 micrograms/mL, respectively, and coronary sinus blood concentrations were 2.7 +/- 1.0, 7 +/- 1.5, and 13.7 +/- 2.5 micrograms/mL, respectively. These were linearly related to dose. Net uptake of meperidine into the myocardium occurred during the first minute and the maximum rates of uptake (influxes) were 5.1 +/- 2.6, 15.1 +/- 4.6, and 27.5 +/- 8.7 mg/min. Myocardial meperidine concentrations, calculated using mass balance principles for the 100-, 200-, and 300-mg doses, respectively, were 9.0 +/- 1.8, 20.5 +/- 8.6, and 34.1 +/- 7.4 micrograms/g at peak and had decreased to 57% +/- 11% of peak 5 min after injection. No pseudoequilibrium between blood and myocardial meperidine concentrations had been reached within the 15-min study period. Myocardial perfusion and blood-myocardial concentration gradients were both important determinants of meperidine myocardial pharmacokinetics. The fast uptake and brief sojourn of meperidine in the myocardium agreed with its rapid but transient negative inotropic effect reported previously.

The hemodynamic effects of intravenous bolus doses of meperidine in conscious sheep

The hemodynamic effects of 100, 200, and 300 mg of meperidine injected intravenously were studied in five chronically instrumented adult ewes. The maximum rate of increase of left ventricular pressure was decreased, respectively, by 27.4% +/- 3.9%, 37.5% +/- 5.6%, and 31.9% +/- 13.0%, and recovery occurred by 5, 8, and 0.5 min, respectively. Mild central nervous system stimulatory effects (agitation) were observed in three of five sheep at 200 mg and moderate effects (rigor and jumping movements) were observed in four of five sheep at 300 mg. These doses also produced increases in heart rate (43%-64%) and mean arterial blood pressure (17%-27%). At these doses, cardiac output was increased for 0.5 min by approximately 25% without changes in stroke volume and left ventricular stroke work. Coronary blood flow was increased by 44%-81% for 0.5 min. We conclude that, in unpremedicated sheep, meperidine has a brief direct negative inotropic effect on the myocardium, but that at larger doses this is overridden by stimulatory central nervous system (CNS) and indirect hemodynamic effects.

An estimate of the rate of direct drug diffusion from the surface of heart and kidney--implications for their representation as compartments

In many regional pharmacokinetic experiments and models, the anatomical boundaries of the heart and kidney are intrinsically assumed to be barriers for drug diffusion such that these organs can be represented as one or more compartments. To test this, an experimental preparation was developed in which the heart and kidney of anaesthetized sheep were surrounded with 0.9% saline. The rate of drug diffusion from the surface of the organs into the saline was examined during constant-rate i.v. drug infusions. It was found that the maximum clearances of lidocaine and procainamide into the pericardial saline were 10.3-11.6 and 0.6-2.1 ml min-1 respectively, and the values for the kidney were 0.3-0.6, 0.1-1.0 and 0.4-1.3 ml min-1, for lidocaine, procainamide, and meperidine respectively. These corresponded to calculated times of 4-481 min to reach the steady-state saline concentration depending on the drug and the organ. The steady-state ratio of the saline concentrations over the arterial blood drug concentrations usually ranged from 0.5-1.0. It is concluded that drugs can rapidly enter regions of low or no perfusion surrounding these organs, and that the concept of treating the heart and kidney as compartments may not be valid in certain 'worst-case' situations.

Growth factor modulation of insulin-like growth factor-binding proteins in rat osteoblast-like cells

Insulin-like growth factors (IGFs) stimulate growth and differentiation of osteoblasts in culture, and these biological functions can be modulated by their binding proteins (IGFBPs). Previous studies have shown that IGFBP-2 is the major IGFBP synthesized by fetal rat osteoblast-like (ROB) cells, which also secret a minor 24-kilodalton IGFBP, presumably IGFBP-4. In this study we examined the modulation of the abundance of IGFBPs by various growth factors. By immunoprecipitation and ligand blotting, we have proved that the 24 kilodalton protein, which appeared at 25 kilodalton in the present study, is IGFBP-4, whose level was strongly enhanced by basic fibroblast growth factor (bFGF) and platelet-derived growth factor BB homodimer. Induction of IGFBP-4 by these factors was detected at 1 nM (10- to 30-fold) and increased to 50- to 70-fold of control at 10 nM. The abundance of IGFBP-4 was also increased but to a lesser degree by transforming growth factor-alpha (TGF-alpha) and epidermal growth factor (EGF). As opposed to the actions of other growth factors, TGF-beta 1 substantially lowered the levels of IGFBP-2 and IGFBP-4. PTH and PTH-related peptide did not induce IGFBPs in ROB cells. This is in contrast to the findings from a malignant rat osteoblast-like cell line, UMR 106-01. Since the level of IGFBP-4 after bFGF treatment remained elevated in the presence of hydroxyurea, the induction was likely to be independent of the stimulatory effects of these factors on mitogenesis. To further examine the mechanisms by which IGFBPs were regulated, cultures were treated with actinomycin D and cycloheximide with and without bFGF. Although the synthesis of IGFBP-2 and IGFBP-4 were both inhibited by cycloheximide, actinomycin D blocked the synthesis of basal and bFGF-induced IGFBP-4 but not IGFBP-2. Total RNA extracted from ROB cells and hybridized with specific rat complementary DNAs for IGFBP-2 and IGFBP-4 showed single transcripts of 1.3 and 2.2 kilobases, respectively. Regardless of the changes at the protein level, the abundance of IGFBP-4 transcripts was not different from the vehicle-treated controls at 2, 8, and 24 h after bFGF treatment. Similarly, the levels of messenger RNA for IGFBP-2 and IGFBP-4 did not change during the same time course in the TGF-beta 1 treatment. These data demonstrate that in ROB cells, the abundance of IGFBPs is differentially regulated by various growth factors.(ABSTRACT TRUNCATED AT 400 WORDS)

IV bolus administration of subconvulsive doses of lignocaine to conscious sheep: relationships between myocardial pharmacokinetics and pharmacodynamics

We have studied relationships between the time-courses of lignocaine concentrations in arterial and coronary sinus blood and myocardial tissue, and negative inotropic effects on the myocardium, after i.v. bolus administration of 50-, 75- or 100-mg doses of lignocaine to conscious, chronically instrumented sheep. Peak arterial and coronary sinus blood lignocaine concentrations occurred 26-38 s before and 29-78 s after the maximum decreases in myocardial contractility, respectively. Peak myocardial concentrations occurred simultaneously with the maximum decreases in myocardial contractility, except for the 100-mg doses. Anti-clockwise hysteresis occurred only between arterial blood lignocaine concentrations and the negative inotropic effect. It was concluded that, after short-term i.v. administration, only the myocardial concentrations of lignocaine were in pseudoequilibrium with the negative inotropic effects of the lignocaine on the myocardium.

IV bolus administration of subconvulsive doses of lignocaine to conscious sheep: myocardial pharmacokinetics

Mass balance principles were used to study the myocardial pharmacokinetics of lignocaine in conscious sheep. After i.v. bolus doses of lignocaine 50, 75 or 100 mg, arterial lignocaine concentrations reached a peak in approximately 16 s and these increased linearly with dose. Coronary sinus concentrations reached a peak between 83 and 129 s and the values showed poor relationships with dose. Net myocardial lignocaine uptake lasted for approximately 60 s--this was much shorter than the reported initial distribution half-life of lignocaine. The maximum rate of uptake was proportional to both the dose and the peak arterial lignocaine concentrations. At 15 min, the myocardial lignocaine concentrations were 46 (SD 22)% of their peak values. Pseudo-equilibrium between blood and myocardial lignocaine concentrations was not observed. It is concluded that, despite the myocardium being very well perfused, lignocaine myocardial concentrations were not well represented by blood lignocaine concentrations for at least 15 min. A greater understanding of the determinants of myocardial drug concentrations is required.

Influence of cardiac output, injection time and injection volume on the initial mixing of drugs with venous blood after i.v. bolus administration to sheep

The aim of this study was to quantitate factors affecting the initial "peak" of the pulmonary artery (PA) drug concentrations after i.v. bolus drug administration, which is a determinant of the subsequent drug uptake into both the lungs and other well-perfused organs. Indocyanine green (ICG) was used as a marker drug in anaesthetized (1.5% halothane) sheep prepared with an inferior vena cava injection catheter and a large-gauge pulmonary artery blood sampling catheter. For three ranges of cardiac output, 2.5-mg doses of ICG were injected in the following combinations: 10 ml injected over 1, 5 or 10 s; 5 or 25 ml injected over 1 s. On-line PA ICG concentrations were recorded for approximately 60 s using a densitometer. The mean maximum PA ICG concentrations (2-8 mg litre-1), the mean times at which they occurred (7-18 s after injection) and the time lags before ICG was detected in the PA (4-9 s), were inversely related to cardiac output, but linearly related to the time over which the injection was made. The area under the curve of the peak was related inversely to cardiac output only, while the aspect ratio of the peak was related inversely to the time over which the injection was made only. The injectate volume had no effect on any of the measured values. We conclude that, in some circumstances, the rate of injection of drugs with narrow margins of safety should be tailored to the cardiac output of an individual.

IV bolus administration of subconvulsive doses of lignocaine to conscious sheep: effects on circulatory function

We have studied the effects of subconvulsive doses of lignocaine on circulatory function in five conscious, chronically instrumented sheep. In the absence of overt signs of central nervous system toxicity, 50-, 75- or 100-mg i.v. bolus doses of lignocaine induced reductions in myocardial contractility, as assessed by the maximum rate of increase in left ventricular pressure (LV dP/dtmax), of 17 (SD 4)%, 25 (4)% and 33 (4)%, respectively. The durations of these reductions in myocardial contractility were 2-3.5 min. There were no significant changes in cardiac output, coronary artery blood flow, mean arterial pressure, heart rate or left ventricular systolic and diastolic pressures. It is concluded that the initial toxic effects of lignocaine are on the heart rather than the central nervous system, as is generally believed. This negative inotropic effect of lignocaine in vivo may be more deleterious to myocardial function when the heart is compromised by pre-existing disease, or the co-administration of other myocardial depressive drugs.

An assessment of methods for sampling blood to characterize rapidly changing blood drug concentrations

The accuracy of different blood sampling methods used to characterize rapidly changing blood drug concentrations was examined both in vitro and in vivo. It was shown in vitro that blood sampling methods based on the fraction collection principle failed to characterize a "square wave" change in drug concentration, and there was a 9-16-s delay before achieving 95% of the expected drug concentration. Varying the catheter size and length did not improve the response. This observation is consistent with laminar and/or turbulent flow producing dispersion and mixing of blood of different drug concentrations in the catheter. A sampling method (flush and withdrawal) was developed to minimize these effects. In vivo studies showed that peak blood drug concentrations obtained using this method after an iv bolus of a drug were approximately 25-28% higher than those simultaneously obtained by methods based on fraction collection principles. It is concluded that blood sampling methods based on fraction collection principles can produce significant errors in measured blood drug concentrations. The error is greater the greater the rate of change of the blood drug concentrations.

Infantile digital fibromatosis: ultrastructural human papillomavirus and herpes simplex virus DNA observation

We studied a case of infantile digital fibromatosis (IDF) by transmission electron microscopy. We could not detect either human papillomavirus (HPV) DNA types 6, 11, 16, and 18, or herpes simplex virus (HSV) DNA types 1 and 2 in IDF. Our results suggest that IDF is not associated with HPV and HSV infection.

Insight into interstitial drug disposition: lymph concentrations of lidocaine, procainamide and meperidine in the hindquarters of unanesthetized and anesthetized sheep

Drug concentrations in the lymph of the hindquarters of sheep were used to gain insight into drug disposition within the interstitial space. Lidocaine, procainamide and meperidine were each infused into the right atrium of adult merino ewes for 220 min. The time courses of drug concentrations in arterial and inferior vena caval (IVC, draining the hindquarters) blood and hindquarter lymph were determined. It was found that in unanesthetized sheep the mean (+/- S.D., n = 3) lidocaine, procainamide and meperidine concentrations in the hindquarter lymph, were 74 +/- 11, 107 +/- 25 and 94 +/- 17%, respectively, of the arterial and 92 +/- 15, 113 +/- 27 and 134 +/- 28%, respectively, of the IVC blood drug concentrations. Drug binding in lymph, determined by equilibrium dialysis, was not significantly higher than that in blood, except for lidocaine at an initial buffer concentration of 5 micrograms/ml. When the studies were repeated with different animals under halothane anesthesia, the lymph/arterial and lymph/IVC blood drug concentration ratios of the three drugs decreased to 66 +/- 9, 73 +/- 13 and 71 +/- 13% and 77 +/- 8, 88 +/- 19 and 85 +/- 10%, respectively. These values were all significantly lower than those in unanesthetized animals. The results suggest that drug protein binding in interstitial fluid and the status of the microcirculation are important determinants of drug distribution in the interstitial and intracellular spaces. The data also confirm the assumption made in pharmacokinetic studies based upon mass balance principles that the rate of drug removal from organs by lymph is negligible.

A total organic carbon analysis method for validating cleaning between products in biopharmaceutical manufacturing

The validation of cleaning procedures for biopharmaceutical products produced by recombinant DNA (rDNA) technology presents a diverse analytical challenge. This is because of the need for quantitation of a broad range of potential residual cellular components, including proteins, carbohydrates, and nucleic acids, as well as trace levels of detergents at various manufacturing stages. The validation of a Total Organic Carbon (TOC) analysis method for use in cleaning validation studies is presented. The method has a limit of detection of approximately 0.1 ppm, with a limit of quantitation of 0.5 ppm. TOC analysis has an accuracy of 50 to 70% or better in the 0.5- to 10-ppm range and demonstrates an overall variability of approximately 5%. The method is broadly applicable to a variety of impurities and contaminants that are likely to be encountered following the manufacture of rDNA products.

[Therapeutic effect of methyl 5-aminosalicylate on experimental ulcerative colitis in rabbits]

Using the improved Kirsner model of ulcerative colitis in rabbits, we found that the therapeutic effect of methyl 5-amino salicylate hydrochloride (M-5-AS) was similar to that of sulfasalazine (salicylazosulfapyridine, SZ). The length of pathological damage and the range of diffuse ulcers were decreased in comparison with the control group (P less than 0.01, 0.05). Microscopically, tissue repairing at the regions of ulcers and proliferation in serolemma were noted, and the edema in muscular mesenchyme was less evident in the treated rabbits. M-5-AS completely inhibited the spontaneous contraction of rat stomach fundus strips and colon. The IC50 of the resting tone of the 2 tissues were 1.30 +/- 0.39 and 0.72 +/- 0.25 mmol/L, respectively. In addition, M-5-AS antagonized the contraction induced by human fresh semen. The results suggest that the therapeutic mechanism is related to the antagonism of prostaglandins in the inflammatory regions.

[Study on molecular hybridization with biotin-labelled HPV 16 DNA probe in human cervical carcinoma]

Biotin-labelled human papillomavirus (HPV) 16 type DNA probe was prepared by the techniques of molecular biology. And dot hybridization technique was used to detect the HPV 16 homologous sequences in the tissues DNA of human cervical carcinoma. The results indicated that 16 cases out of 28 of the human cervical carcinoma tissues were positive. The positive rate was 57%. The other 4 cases of normal uterine cervix tissues were negative. Only 1 in 4 chronic cervicitis tissues showed positive. The HPV 16 plasmid DNA, as the positive control group, showed strong positive, while lambda-phage DNA was negative. The results have shown that the genome of the HPV actually exists in the tissue of the cervical carcinoma and that there is a close relationship between the cervical carcinoma and HPV infection. This experiment adopted the Biotin-labelled HPV 16 DNA probe. And it may provide us with a quick and sensitive method for investigation of the infection of HPV and its role in the carcinogenesis of cervical carcinoma.

[Automatic static quantitative perimetry of the central 30 degrees visual field in normal subjects]

131 normal volunteers (131 eyes) with visual acuities of 20/20 or better were tested by automatic static quantitative perimetry (Octopus-500E) for the central 30 degrees visual field. The results revealed that only 35 eyes (26.7%) had sensitivities at all points tested equal to or better than the age-corrected norms established for the device, and 96 eyes (73.3%) were 5 dB or more below the age adjusted norms at one point at least in areas not adjacent to the blind spot; the farther from the point of fixation, the sensitivity drop became more obvious and with higher frequency. When the central 30 degrees field was divided into five concentric circles, the greatest sensitivity drops appeared in the area between 25-30 degrees. The authors put forward more reasonable criteria for defects in the central 25 degrees visual field by Octopus-500 E Program 36.