Giant fibrovascular polyp of the esophagus

An adult patient with a giant fibrovascular esophageal polyp, measuring 17 cm in length, is described in this report. The patient presented with dysphagia and intermittent partial regurgitation of a fleshy mass in the mouth, only after the polyp had attained giant proportions. The polyp appeared as a large polypoid filling defect on a barium swallow and the findings were confirmed at endoscopy. The stalk was attached just below the cricopharyngeus muscle, and the club-shaped polyp extended almost up to the gastroesophageal junction. Because of the vascularity of this large structure and the proximity of respiratory passages to the site of attachment of the stalk, surgical resection of the polyp was undertaken.

Phorbol esters inhibit agonist-induced [3H] inositol-1-phosphate accumulation in rat hippocampal slices

In rat hippocampal slices, carbachol and norepinephrine induce an accumulation of [3H]-inositol-1-phosphate which is markedly amplified in the presence of lithium. The tumor-promoting agents phorbol 12,13-dibutyrate (PDB) and 4 beta phorbol, 12 beta-myristate, 13 alpha-acetate (PMA) have no effect on [3H] inositol-1-phosphate accumulation alone, but when preincubated with hippocampal slices significantly inhibit the accumulation of [3H]-inositol-1-phosphate induced by carbachol and norepinephrine. The IC50 values for PDB and PMA are 0.2 microM and 25 microM respectively. In contrast, the weak tumor promoting agents 4-O-methylphorbol 12 myristate 13 acetate (MPMA) and phorbol 13,20-diacetate (P 13,20 DA) only slightly attenuate the agonist-induced response at concentrations less than or equal to 100 microM, whereas 4 alpha-phorbol (4 alpha-PHR), a biologically inactive phorbol, has no effect. These data suggest that phorbol ester receptor-mediated events may be negatively coupled to agonist-induced phosphatidylinositol hydrolysis.

Adenosine uptake sites in dog heart and brain; interaction with calcium antagonists

[3H] Nitrobenzylthioinosine (NBI) binding is characterized in dog heart and brain. Evidence is presented suggesting that [3H]NBI is binding to the adenosine uptake site in both tissues. Physiologic studies in open-chested dogs clearly demonstrate that NBI acts as a coronary vasodilator, consistent with an action at the adenosine uptake site. The binding is reversible, saturable and of high affinity (KD = 0.78 +/- .06 nM for heart and 0.52 +/- .05 nM for brain). Both dipyridamole and hexobendine are high potency inhibitors of [3H]NBI binding in heart and brain while other antihypertensives and vasodilators such as propranolol and nitroglycerin have no effect. The inhibition of [3H]NBI binding observed with dipyridamole was competitive indicating that both agents are acting at the same site. The dihydropyridine calcium antagonists also inhibited binding with a lower potency than the adenosine uptake blockers. Non-dihydropyridine calcium antagonists were much less potent in this regard. The inhibition of [3H]NBI binding observed with the dihydropyridine calcium antagonists was non-competitive suggesting that the calcium channel and adenosine uptake site may be coupled to each other.

Increased phosphorylation of a membrane protein consequent to amygdaloid kindling

The phosphorylation of both particulate and soluble proteins in the amygdala was examined in electrically kindled rats. In animals receiving electrical stimulation in the left amygdala for 5-6 days that displayed electrical after-discharges but no motor seizures, no changes were observed in the phosphorylation of either particulate or soluble proteins. In animals stimulated for 20-21 days where major motor seizures were produced, the phosphorylation of a protein having a molecular weight of 45,000 ( 45K ) was markedly increased. The phosphorylation of this protein was increased in both the right (unstimulated) and left (stimulated) amygdala. Major motor seizures induced by electroconvulsive shocks, however, did not alter phosphorylation of this protein. Phosphorylation of the 45K protein was stimulated by calcium and calmodulin. The 45K protein is a major phosphoprotein of amygdala, representing 3.2% of the total particulate phosphoproteins in control animals and 7.4% in the kindled animals. In the presence of calcium-calmodulin, 16.2% of net protein phosphorylation was accounted for by the 45K protein.

Ontogeny of calcium antagonist binding sites in chick brain and heart

The ontogeny of chick brain and heart ventricle calcium antagonist binding sites was determined, using [3H]nitrendipine ([3H]NDP), as the ligand. The binding of [3H]NDP to adult heart and brain was kinetically very similar, with the former displaying a KD of 0.28 +/- 0.02 nM and a Bmax of 138 +/- 17 fmol/mg protein, and the latter a KD of 0.30 +/- 0.02 nM and a Bmax of 160 +/- 12 fmol/mg protein. The binding site in both brain and heart was highly specific for dihydropyridine calcium antagonists, such as nifedipine, nimodipine, and nisoldipine, since these drugs were several orders of magnitude more potent as inhibitors of [3H]NDP binding than verapamil, methoxyverapamil, or diltiazem. The developmental appearance of [3H]NDP binding sites in brain was rather gradual, with adult levels being attained just prior to birth. This was in contrast to the profile in heart ventricle which showed essentially adult levels at seven days gestation. The acquisition of [3H]NDP binding sites in chick brain roughly paralleled the onset of neuronal maturation and functional activity. In both chick brain and heart, verapamil and methoxyverapamil were weak inhibitors of [3H]NDP binding. However, the inhibition of binding in both tissues was markedly biphasic, with only 50% of the binding sites being susceptible to inhibition by each agent, suggesting that multiple calcium antagonist binding sites may exist in both tissues.

Tamoxifen (Nolvadex) versus adrenalectomy in metastatic breast cancer

The relative efficacy of adrenalectomy and tamoxifen (Nolvadex) was evaluated in a randomized study of 51 patients with metastatic breast cancer. In 25 patients undergoing adrenalectomy, there were 13 responders. There were 9 responders of 26 patients receiving tamoxifen. There was no statistically significant difference. In the crossover phase, 15 patients received tamoxifen following adrenalectomy and 3 responded, one of the 6 previous adrenalectomy responders and 2 of the 9 adrenalectomy nonresponders. Nine patients underwent adrenalectomy following tamoxifen, and there were five responders, one of two tamoxifen responders and four of seven tamoxifen nonresponders. Both tamoxifen and adrenalectomy were effective modalities, and appear to retain effectiveness in crossover trials. The frequency of remission was similar in both groups treated by both modalities in different sequences. Response rates to adrenalectomy, considered as both primary and secondary therapy, were significantly higher, since 18 of 34 patients (53%) responded to this therapy, whereas 12 of 41 (29%) responded to tamoxifen as either primary or secondary therapy.

Effects of chronic caffeine on brain adenosine receptors: regional and ontogenetic studies

The effect of chronic caffeine treatment on three different binding sites in five brain areas of mice is characterized. The sites studied were the adenosine receptor, using [3H] diethylphenylxanthine, the benzodiazepine receptor, using [3H] diazepam and the adenosine uptake site, using [3H] nitrobenzylthioinosine. Significant increases were only observed in adenosine receptors with the greatest degree of change seen in the cerebellum and brain stem at both 16 and 23 days of caffeine treatment. The lack of significant effects of chronic caffeine on benzodiazepine receptors and adenosine uptake sites indicates that the caffeine effect is specific. The effect of chronic caffeine treatment on the ontogeny of adenosine receptors was also studied with the result showing a significantly accelerated development of the receptor in the caffeine treated animals. The adult adenosine receptor levels were 20-30% higher than those observed in control animals. The observed alterations in adenosine receptor number which occur as a consequence of caffeine consumption may underlie some of the behavioral effects of this cortical stimulant as well as provide insights concerning the mechanisms of tolerance to and dependence on caffeine.

Prediction of adult height from height and bone age in childhood. A new system of equations (TW Mark II) based on a sample including very tall and very short children

A new series of equations is presented for predicting the adult height of a child given present height and bone age. These equations (TW height prediction, Mark II) which replace the ones given in 1975 (TW height prediction, Mark I) are based on larger numbers of normal children, and more importantly on a sample that includes, for the first time, numbers of very tall, very short, and very growth-delayed children. In addition, equations are given for use when the increment of height or bone age, or both, over the previous year is known. These variates improve the prediction at most ages over 8 years in girls and 11 years in boys. The previously given parental allowance has been dropped. Typically 95% of the predictions lie within +/- 8 cm of the real value for boys aged 10 years, falling to +/- 6 cm for boys aged 15 years, or +/- 4 cm if their previous height increment is known. For premenarcheal girls the predictions lie within about +/- 6 cm at age 8 years; a figure which diminishes little till 13 years unless height and bone age increments are known, when it reaches +/- 4 cm at 13 years. For postmenarcheal girls the predictions are substantially more accurate.

Evaluation of latex-Rickettsia rickettsii test for Rocky Mountain spotted fever in 11 laboratories

A latex-Rickettsia rickettsii test for detection of antibodies to Rocky Mountain spotted fever (RMSF) was evaluated during the 1980 RMSF season in 11 laboratories in nine states where the disease is endemic. In a double-blind study, all sera submitted to each laboratory for RMSF testing were also examined by the latex-R. rickettsii test. A portion of each specimen was then sent to the New York State laboratory for testing by latex-R. rickettsii and by the reference microimmunofluorescence test. Results were exchanged at the end of the examination period. At the usual ratio of reactive to nonreactive sera encountered in a diagnostic laboratory on a day-to-day basis, the efficiency of the latex-R. rickettsii test relative to microimmunofluorescence was 96.79% for New York and 93.30% for the collaborating laboratories. Both the latex and microimmunofluorescence tests detected antibodies to RMSF within 7 to 9 days of onset. With the latex-R. rickettsii test--but not necessarily with microimmunofluorescence--a high titer (greater than or equal to 128) on a single serum was diagnostic of active RMSF. Changes in serum titer for patients with multiple sera were similar for both tests. The test detects rickettsial antibodies in patients with active infection, but in most cases it does not detect antibody in patients with past infection. Test reactivity could not be uniquely linked to a particular immunoglobulin class.

Cranial computed tomography and real-time sonography in full-term neonates and infants

The results of cranial ultrasonography (US) and computed tomography (CT) were compared in 52 full-term neonates and young infants. The chief indications for examination included: increasing head size, dysmorphic features, myelomeningocele, inflammatory disease, and asphyxia. Disorders detected included hydrocephalus, parenchymal abnormalities, intracranial hemorrhage, extraparenchymal fluid collections, and vascular and other developmental malformations. Hydrocephalus and subdural collections were seen in patients referred for all clinical indications, whereas diffuse parenchymal abnormalities, subarachnoid hemorrhage, and intraventricular hemorrhage occurred primarily in patients with hypoxia. CT and US essentially were equivalent in detecting hydrocephalus, moderate to large intraventricular hemorrhages or subdural collections, and large focal parenchymal lesions, although CT was somewhat better in determining the level and cause of obstruction in patients with hydrocephalus and characterizing parenchymal abnormalities. CT was more sensitive than ultrasound in detecting subarachnoid hemorrhage (100% vs. 0%), diffuse parenchymal abnormality (100% vs. 33%), and small intraventricular hemorrhages (100% vs. 0%) but these lesions often were not clinically significant. The results suggest that US should be used as the primary neuroradiological examination in term infants; CT probably should be reserved for further investigation after US in those patients with a history of hypoxia and progressive clinical deterioration.

S-100-mediated inhibition of brain protein phosphorylation

The effects of the glial-specific, calcium-binding, S-100 protein on brain membrane and supernatant protein phosphorylation were assessed. S-100 concentrations as low as 5 micrograms/ml caused a marked inhibition of the phosphorylation of a soluble brain protein having a molecular weight of 73,000 daltons (73K). This protein was designated the S-100 protein-modulated phosphoprotein (SMP). Half-maximal inhibition of the phosphorylation of SMP by S-100 was obtained at concentrations of 12 micrograms/ml (0.57 microM). The inhibition of SMP phosphorylation by S-100 was calcium-dependent, with a calculated calcium Ka of 2.0 +/- 0.3 microM. SMP phosphorylation was also inhibited by calmodulin, but only partially and with a much lower potency. The inhibition of SMP phosphorylation by S-100 was not inhibited by fluphenazine, whereas the effect of calmodulin was. SMP was found in many brain areas, with the highest levels seen in the corpus callosum. Various peripheral tissues, such as kidney; liver; and pineal, pituitary, and adrenal glands, did not contain detectable SMP levels. At higher S-100 concentrations, greater than 10 micrograms/ml, the phosphorylation of several other soluble proteins was markedly inhibited. These proteins have molecular weights of 56K, 50K, and 47K. The phosphorylation of these proteins was enhanced by calmodulin. These data suggest that the S-100 protein may function to modulate the phosphorylation of brain proteins in a manner analogous to (although in a reciprocal fashion) that of calmodulin.

Specific and potent interactions of carbamazepine with brain adenosine receptors

Carbamazepine, a drug effective in pain, seizure, and affective disorders, was screened for its ability to interact with a variety of neurotransmitter and neuromodulator binding sites on brain membranes. The most potent effect was observed on adenosine antagonist ( [3H]DPX) binding to the adenosine receptor (KI = 3.5 +/- 0.4 microM) followed by adenosine agonist ( [3H]CHA) binding (KI = 24.5 +/- 3.6 microM). Lower potency effects were observed on benzodiazepine receptors, and no inhibition was seen in a variety of other systems. The inhibition of adenosine receptor binding by carbamazepine was competitive. No correlation was observed between the potency of a series of carbamazepine analogs as inhibitors of either ( [3H]DPX, [3H]CHA or [3H]diazepam binding and their ability to inhibit electroshock-induced convulsions, suggesting that the anticonvulsant properties of these agents are not mediated by the adenosine receptor, but raising the possibility that other clinical effects of carbamazepine may relate to its ability to act at the adenosine receptor.

Differential binding properties of adenosine receptor agonists and antagonists in brain

The binding properties of N6-cyclohexyl [3H]adenosine ( [3H]CHA) and 1,3-diethyl-8-[3H]phenylxanthine ( [3H]DPX) in rat forebrain membrane are compared. The kinetic parameters of binding for each ligand are quite distinct, with [3H]CHA displaying two populations of binding sites (KD = 0.4 +/- 0.05 nM and 4.2 +/- 0.3 nM; Bmax = 159 +/- 17 and 326 +/- 21 fmol/mg protein), whereas [3H]DPX yielded monophasic Scatchard plots (KD = 13.9 +/- 1.1 nM; Bmax = 634 +/- 27 fmol/mg protein). The metals copper, zinc, and cadmium are potent inhibitors of [3H]CHA binding, with respective IC50 concentrations of 36 microM, 250 microM, and 70 microM. Copper is a much less potent inhibitor of [3H]DPX binding (IC50 = 350 microM). The inhibitory effect of copper on both [3H]CHA and [3H]DPX binding is apparently irreversible, as membranes pretreated with copper cannot be washed free of its inhibitory effect. The inhibitory effect of both copper and zinc on [3H]CHA binding was reversed by the guanine nucleotide Gpp(NH)p. [3H]DPX binding is only partially inhibited by zinc and cadmium (60% of specific binding remains unaffected), suggesting that this adenosine receptor ligand binds to two separate sites. Guanine nucleotides had no effect on the inhibition of [3H]DPX binding by either copper or zinc. Differential thermal and proteolytic denaturation profiles are also observed for [3H]CHA and [3H]DPX binding, with the former ligand binding site being more labile in both cases. Stereospecificity is observed in the inhibition of both [3H]CHA and [3H]DPX binding, with L-N-phenylisopropyladenosine (PIA) being 50-fold more potent than D-PIA in both cases. Evidence is therefore provided that adenosine receptor agonists and antagonists have markedly different binding properties to brain adenosine receptors.

Adenosine uptake inhibitors potentiate the sedative effects of adenosine

A major action of adenosine is the induction of profound behavioral inactivity. 6-(4-Nitrobenzyl)-thioinosine (NBI) and 6-(2-hydroxy-5-nitrobenzyl)-thioguanosine (NBG) have been shown to inhibit adenosine uptake. To investigate the possible synergism between exogenous ligand and reuptake inhibition, mice were treated with NBI or NBG + adenosine. NBI and NBG potentiated the effects of adenosine at doses which did not in themselves induce behavioral inactivity. These behavioral results support the proposed role of NBI and NBG as adenosine uptake site blockers which increase synaptic concentrations of adenosine and postsynaptic responses to adenosine in vivo.

Chronic caffeine consumption increases the number of brain adenosine receptors

Caffeine, a potent central stimulant, is known to competitively inhibit the specific binding of both adenosine and benzodiazepine receptor ligands to brain membranes in vitro. In mice receiving a diet containing non-toxic doses of caffeine (200 or 400 mg/kg diet) for periods up to 40 days, a dose-related increase in the number of binding sites for [3H]-CHA and [3H] DPX was observed in whole brain membranes without modifications of the receptors' affinity. Furthermore, a transitory increase in the number of [3H]-DZP binding sites was observed. These preliminary data seem to confirm the involvement of the adenosine receptors in the mode of action of caffeine and may be relevant to the development of both tolerance and dependence to some of the central effects of this compound.

Attenuation of alcohol drinking in tetrahydroisoquinoline-treated rats by morphine and naltrexone

In rats of either the Sprague-Dawley or Long-Evans strain, either tetrahydroisoquinoline (THP) was infused chronically ICV, or one of three protoberberine (PBN) compounds was administered subcutaneously at birth. When the animals were 120-180 days of age, a constant concentration of alcohol was offered simultaneously with water to those rats which demonstrated a clear-cut preference for alcohol. This concentration was selected on the basis of an alcohol preference screen. After alcohol intakes had stabilized, naltrexone was injected subcutaneously in a dose of either 1.0 or 5.0 mg/kg twice a day for three consecutive days. The higher dose (10.0 mg/kg total) of naltrexone suppressed the voluntary intake of alcohol by 26%, whereas the lower dose (2.0 mg/kg total) attenuated alcohol drinking by 14%. Both doses of naltrexone reduced food intake but did not appreciably affect water intake or body weight. When morphine was injected according to the same regimen in a dose of 10.0 or 2.5 mg/kg twice per day, a 49% reduction in alcohol intake was produced by the higher dose and a 32% decline followed the lower dose. Although morphine attenuated food intake, neither water intake nor body weight was affected. Saline control injections administered twice daily in the same way failed to alter any of the intake measures or body weight. These findings indicate that the long-lasting opiate antagonist naltrexone attenuates the voluntary consumption of alcohol in a manner similar to that produced by naloxone. The present results are discussed in terms of the evidence that an opiate agonist and antagonist may exert their actions by different mechanisms in the brain, possibly through separate subpopulations of opiate receptors.

Lateral disk herniation into the lumbar intervertebral foramen: differential diagnosis

Lateral disk herniation into the intervertebral foramen if not recognized may result in a negative surgical exploration. The condition is readily recognized by computed tomography (CT), which demonstrates a soft-tissue mass in the intervertebral foramen, focal protrusion of the posterolateral margin of the disk into the foramen, absence of dural sac deformity, and occasionally the presence of calcium or gas in the intervertebral foramen. The differential diagnosis includes metastatic neoplasm, primary neoplasm, and conjoined root sheath anomaly. Features that enable CT differentiation of these conditions from lateral disk herniation are described. Myelography is useful in the identification of a conjoined root sheath.

Brain atrophy in dementia judged by CT scan ranking

In order to further investigate the relationships of brain atrophy, age, and dementia, computed tomographic (CT) scans on two groups of subjects aged 65-80 years were rank-ordered according to ventricular and sulcal size. Each group contained subjects with mild senile dementia of the Alzheimer type (SDAT) and matched controls. In both experiments there was a strong correlation between these rank orders, ventricular size, and the clinical dementia rating. There was also a weaker but significant correlation between rank ordering and sulcal size. This suggests that brain atrophy in excess of that normal for age alone occurs in early SDAT.