[Hourly serum cortisol assay over 24hr by immunoenzymology in depression]

Enzymoimmunoassays have been developed as alternatives to radioimmunoassays because they obviate the need for labelled compounds yet offering comparable specificity. The authors used an enzymoimmunoassay to investigate hourly serum cortisol levels over 24 hours in 6 patients (aged over 40 years) with endogenous depression (4 unipolar depressions, under antidepressor treatment and 2 bipolar depressions, without medication) and in 2 controls, aged 20 and 47 years. In agreement with literature data, a clear circadian rhythm was observed in controls and in the depressed patients, and hypercorticism was noted in one depressed patient. A trend towards phase advance in depression was seen in both the treated and untreated patients.

5-Methoxypsoralen as a specific stimulating agent of melatonin secretion in humans

The endocrine effects of the linear furocoumarin, 5-methoxypsoralen (Bergapten), were investigated in 11 normal adults according to a cross-over design with 2 conditions: a 1-week trial with 5-methoxypsoralen (5MOP) administered daily (40 mg/orally) at 0900 h, and after a 1-week period of washout, a similar 1-week trial with daily administrations of 5MOP at 2100 h. The subjects were living under normal nychtohemeral conditions. The plasma levels of melatonin, cortisol, TSH, PRL, and GH were evaluated by hourly blood samples over 24-h periods on the preceding day and on the last day of each condition. Our main finding is that 5MOP specifically stimulates melatonin secretion in humans, with a pronounced effect when administered during the dark phase of the day (at 2100 h). The other endocrine rhythms were unaffected by 5MOP administration. Melatonin has been shown to interact with the regulation of the human circadian system; this specific stimulation may, therefore, be of great interest in disorders associated with abnormalities of circadian rhythms.

Activation signals in human lymphocytes: interleukin 2 synthesis and expression of high affinity interleukin 2 receptors require differential signalling for the activation of protein kinase C

The mitogenic activation of resting T lymphocytes involves two distinct cellular events, the synthesis of the ultimate mitogen interleukin 2 and the synthesis and expression of receptors for it. In order to get more detailed information on the mechanisms associated with these activating steps (the effects of different stimuli, leading to activation of protein kinase C were investigated in human lymphocytes). The anti-T-cell receptor (TCR) and anti-CD3 monoclonal antibodies (BMA 031 and BMA 030, respectively), as well as the combination of the phorbol ester, TPA, with a calcium ionophore-induced interleukin 2 synthesis and subsequent proliferation in human peripheral blood lymphocytes. Incubation of cells with synthetic diacylglycerols and calcium ionophores proved to be effective in expression of high affinity interleukin receptors, no detectable amounts of interleukin 2 were, however, synthetized. When diacylglycerols were, however, added repetitively, interleukin 2 was also produced. Both anti-TCR/CD3 antibodies and TPA or DiC8 caused activation and translocation of protein kinase C from the cytosol to the plasma membrane. Significant differences, however, were observed between the time kinetics of the translocation of the enzyme. In plasma membranes of TPA-stimulated cells activation of protein kinase C was detectable up to 4 hr. In contrast, the highest specific activity of protein kinase C was measured in the plasma membranes after 15 min of DiC8 addition to cells. Anti-CD3 monoclonal antibodies activated protein kinase C in a biphasic manner. Shortly after binding of BMA 030 to the T cell antigen receptor/CD3 complex the activity of protein kinase C was increased in the plasma membrane, then it declined to control levels followed by a second long-lasting activation of the enzyme up to 4 hr. These results suggest different signal requirements for different activation steps. While for synthesis and expression of interleukin 2 receptors a short term activation of protein kinase C is sufficient, long-term activation of the enzyme is necessary for interleukin 2 synthesis in human lymphocytes.

Extended X-ray absorption fine structure (EXAFS) investigations of model compounds for zinc enzymes

A test of the ability of extended X-ray absorption fine structure (EXAFS) to determine structural information with specific reference to zinc sites in enzymes has been made. X-ray absorption spectra of 18 compounds of zinc have been measured and the nearest-neighbour scattering has been interpreted using a Fourier transform and an ab initio technique. Empirical Zn-N, Zn-O, Zn-S and Zn-Cl amplitude and phase functions have been extracted from Zn(C3H4N2)4(ClO4)2, ZnO, Zn(S2COC2H5)2 and [N(CH3)4]2[ZnCl4], respectively and tabulated as a function of the wavevector with respect to 9660.0 eV X-ray energy. These amplitude and phase functions were then tested with respect to the other 14 compounds. For a single species of atoms in the first coordination shell the interatomic distances can be established to +/- 0.5 pm (+/- 5 x 10(-3) A) whilst when mixed shells exist errors in distances are +/-4 pm (+/- 40 x 10(-3) A). Coordination numbers are given to +/- 16% for the single species case a and +/- 25% for the mixed coordination case. Using the theoretical amplitude and phase functions of McKale et al. [(1988) J. Am. Chem. Soc. 110, 3763-3768] the deduced distances are systematically too small by an average of 0.6 pm (6 x 10(-3) A). The errors in the coordination numbers are 18%.

Activation signals in human lymphocytes. Incorporation of polyunsaturated fatty acids into plasma membrane phospholipids regulates IL-2 synthesis via sustained activation of protein kinase C

Human PBL activated with anti-TCR/CD3 mAb express high affinity receptors for IL-2, synthesize IL-2, and subsequently proliferate. In contrast, lymphocytes activated by dioctanoylglycerol (DiC8) and ionomycin express high affinity receptors; however, no IL-2 synthesis is detectable. Anti-TCR/CD3 antibodies, as well as DiC8 cause translocation of protein kinase C (PKC) from the cytosol to the plasma membrane. In DiC8-stimulated cells translocation of PKC is detectable after 15 min, then it declines to control levels. In lymphocytes activated by antiTCR/CD3 mAb translocation of PKC is detectable after 15 min, then it declines to control levels, followed by a second, long lasting activation of the enzyme up to 4 h. Addition of polyunsaturated fatty acids to DiC8 + ionomycin-treated cells leads to IL-2 synthesis and proliferation. Incorporation of poly-unsaturated fatty acids into plasma membrane phospholipids results in long term activation of PKC. The results suggest that elevated incorporation of polyunsaturated fatty acids and thus continuous activation and translocation of PKC represents a necessary early signal for IL-2 synthesis and proliferation in human lymphocytes.

Activation signals in human lymphocytes. Incorporation of polyunsaturated fatty acids into plasma membrane phospholipids regulates IL-2 synthesis via sustained activation of protein kinase C

Human PBL activated with anti-TCR/CD3 mAb express high affinity receptors for IL-2, synthesize IL-2, and subsequently proliferate. In contrast, lymphocytes activated by dioctanoylglycerol (DiC8) and ionomycin express high affinity receptors; however, no IL-2 synthesis is detectable. Anti-TCR/CD3 antibodies, as well as DiC8 cause translocation of protein kinase C (PKC) from the cytosol to the plasma membrane. In DiC8-stimulated cells translocation of PKC is detectable after 15 min, then it declines to control levels. In lymphocytes activated by antiTCR/CD3 mAb translocation of PKC is detectable after 15 min, then it declines to control levels, followed by a second, long lasting activation of the enzyme up to 4 h. Addition of polyunsaturated fatty acids to DiC8 + ionomycin-treated cells leads to IL-2 synthesis and proliferation. Incorporation of poly-unsaturated fatty acids into plasma membrane phospholipids results in long term activation of PKC. The results suggest that elevated incorporation of polyunsaturated fatty acids and thus continuous activation and translocation of PKC represents a necessary early signal for IL-2 synthesis and proliferation in human lymphocytes.

Abnormal melatonin response to 5-methoxypsoralen in dementia

The authors investigated the melatonin response to 5-methoxypsoralen in 39 healthy adult and elderly subjects and in 13 demented, 13 depressed, and 13 schizophrenic inpatients. Subjects' plasma melatonin levels were evaluated before they took single, oral 40-mg doses of 5-methoxypsoralen and 3 hours afterward. The preliminary results indicate that the melatonin response of the pineal gland to 5-methoxypsoralen is reduced in demented patients compared to that in healthy elderly subjects. Depressed and schizophrenic patients had a normal melatonin response to the drug. This finding suggests that the pineal gland may be functionally impaired in dementia but not in depression.

Circadian rhythms in depression and recovery: evidence for blunted amplitude as the main chronobiological abnormality

Circadian rhythms of body temperature, plasma cortisol, norepinephrine (NE), thyroid stimulating hormone (TSH), and melatonin were compared in 16 endogenously depressed, 15 recovered (after 3 weeks of anti-depressant treatment), and 16 normal subjects. The depressed patients showed clear circadian rhythm abnormalities, consisting mainly in amplitude reduction. This amplitude reduction was significantly correlated with the patients' Hamilton depression scores. Normal circadian profiles were restored after recovery when amplitude, in particular, was increased. Features of the circadian rhythms observed in remission may be associated with antidepressant drug effects, whereas those observed in depression resemble the circadian rhythms observed in normal subjects living under conditions of temporal isolation and those of blind subjects. Our findings suggest that depression may be related both to a weakening of the coupling processes between internal pacemakers and to an abnormal sensitivity to environmental information.

pH-controlled continuous cultivation of mycoplasmas

The continuous cultivation of mycoplasmas in a pH-controlled metabolistat was investigated with the fermentative strain Mycoplasma mobile 163K and the nonfermentative strain Mycoplasma arthritidis ISR1. The addition of medium and the removal of culture suspension were regulated by acid production from glucose by M. mobile 163K and by ammonium production from arginine by M. arthritidis ISR1, respectively. For both strains the optimal pH for continuous growth was 7.0. The steady state could be maintained for at least 21 days. With CFU of 8.4 X 10(9) ml-1 (M. mobile 163K) and 3.2 X 10(9) ml-1 (M. arthritidis ISR1), the cell concentrations were slightly higher than those obtained in batch cultures. The dependence on the adjusted pH values was measured for several parameters, such as flow rate, CFU, glucose fermentation or production of ammonia, and gliding velocity. Since the long lag phases of batch cultures can be avoided, pH-controlled continuous cultures provide an appropriate system for the production of mycoplasma cells.

5-Methoxypsoralen increases evening sleepiness in humans: possible involvement of the melatonin secretion

The acute and short-term effect of 5-methoxypsoralen (5-MOP) on daytime sleepiness was investigated in 12 healthy subjects according to a double-blind cross-over design. 5-MOP (40 mg/day) or placebo was orally administered (one week each) at 16.00 h. 5-MOP significantly increases daytime sleepiness 4 to 5 h after administration without affecting the subsequent sleep efficiency and duration. We found a positive correlation between sleepiness and melatonin levels. Our findings suggest that the melatonin secretion may play a role in the effect of 5-MOP on sleepiness in humans.

Arthroscopy and synovial hemangioma or giant cell tumour of the knee

A synovial hemangioma was localized in two knees and a xanthomatous giant cell tumour in one knee by arthroscopy. It is concluded, that synovial hemangiomas will be discovered earlier and more frequently by arthroscopy. Intraarticular hemangiomas may be operated at once, but in case of hemangiomas of intermediate type an angiography is recommended.

Twenty-four-hour profiles of body temperature and plasma TSH in bipolar patients during depression and during remission and in normal control subjects

The 24-hour patterns of body temperature and plasma thyrotropin (TSH) were measured in eight bipolar patients in both depressed and recovered (after 3 weeks of treatment) states and in eight normal control subjects. Clear circadian patterns were detected for both temperature and TSH. Nocturnal body temperature was increased and the nocturnal surge of TSH was blunted during depression; these abnormalities were corrected after recovery. The inverse relationship between changes in body temperature and TSH levels at night suggests that changes in thermoregulation may be responsible for the neuroendocrine disturbance and may play a role in the pathophysiology of depression.

5-Methoxypsoralen increases the plasma melatonin levels in humans

The aim of this study was to evaluate the acute effects of 5-methoxypsoralen (5-MOP) on the melatonin secretion in humans. Eleven normal volunteers were investigated before (drug-free) and after 6-day periods of treatment with oral 5-MOP, first administered daily at 9 A.M. and after a 1-week free interval administered daily at 9 P.M. Under nyctohemeral conditions, the plasma melatonin levels were evaluated over a 24-h period in each session by hourly blood samples and radioimmunoassay. The sensitivity of the retina to light was also evaluated by means of electroretinography performed at 11 A.M. before and after a morning administration of 5-MOP. Plasma levels of melatonin were significantly increased from the second hour after 5-MOP administration. The hourly mean levels were significantly higher after 5-MOP administration compared to baseline values. This increased secretion was more pronounced after evening than after morning administration. Also, 5-MOP increases the sensitivity of the retina to light under photopic conditions and in the early stages of the dark adaptation period, as observed under scotopic conditions.

The quadriceps function in patellofemoral disorders. A radiographic and electromyographic study

The influence of quadriceps contraction on patellar alignment was investigated in tangential views of 31 patients with patellofemoral complaints and compared with 25 controls. The congruence angle decreased significantly following quadriceps contraction in patients with patellar subluxation in contrast to those with chondromalacia and normals. Electromyography (EMG) of the vastus lateralis (VL) and vastus medialis obliquus (VMO) during maximal quadriceps contraction was obtained prior to and after 3 months of isometric quadriceps exercises in 15 knees with patellar subluxation and in 11 with idiopathic chondromalacia of the patella. The EMG after 3 months revealed an increase in the activity of both VL and VMO only in patients with patellar subluxation, but the muscular balance of the patella remained unchanged. Only seven patients were improved after 3 months. A more selective training of the VMO is proposed.

Immunohistochemical distribution of the 52-kDa protein in mammary tumors: a marker associated with cell proliferation rather than with hormone responsiveness

We have previously described a secreted glycoprotein of mol. wt 52,000 (52-kDa protein) which is induced by estrogen in some human breast cancer cell lines. This protein has been identified as the proenzyme of a lysosomal cathepsin-D-like protease which is secreted in large proportions in breast cancer cells. To determine which information may be generated by this marker when detected in mammary tumors, in comparison with hormone receptors, we used monoclonal antibodies interacting specifically with the 52-kDa protein and its related cellular processed products (mols. wts 48 and 34 kDa). A high concentration of this protein has been shown in proliferative ductal mastopathies and cysts, suggesting its value in detecting high-risk mastopathies. We now present the immunoperoxidase distribution of this protein in breast carcinoma compared to the cytosolic hormone receptors assayed in parallel. In 232 breast cancers, no correlation was found between the cellular 52-kDa protein content and cytosolic estrogen or progesterone receptor concentrations. This absence of correlation was also shown by the constitutive production of this protein by estrogen-receptor-negative breast cancer cell lines and confirmed by double immunostaining of breast cancer cell aspirates showing a dissociation between the cytoplasmic staining of this 52-kDa lysosomal protease and the nuclear staining of the estrogen receptor. These clinical results, associated with the in vitro mitogenic and proteolytic activities of this protein, strongly suggest that the 52-kDa protein staining in tissue is associated with tumor proliferation and/or invasion, rather than with hormone responsiveness.

Ovarian function during aflatoxin B1-induced hepatocarcinogenesis in the rat

Study of the endocrine status, which is often disturbed during hepatocarcinogenesis, is particularly valuable because gonadal function and hormone production regulate hepatic metabolism of the carcinogen. Sex steroids can even promote carcinogenesis. After aflatoxin B1 induction of liver carcinogenesis in adult female Sprague Dawley rats, livers were examined by histology, fluorescence microscopy of the carcinogen and its metabolites, and alphafetoprotein (AFP) assays. Ovarian activity was assessed, and both progesterone and estradiol levels were determined. Administration of a diet containing 10.32% total protein plus 2 ppm aflatoxin B1 was observed to prevent development of liver tumors during the 300 day study period. This finding is especially interesting for the study of populations suffering from malnutrition and exposed to dietary carcinogens. Under study conditions, aflatoxin B1 did not cause elevation of AFP levels, as occurs with other hepatotoxic substances. This absence of a rise in AFP despite liver alterations explains the surprising lack of ovarian modifications. In other experiments, AFP has been shown to cause genital function blockade which leads to reduced levels of hormonal promoters, for example during N2 fluorenylacetamide carcinogenesis. The endocrine reaction implicated in the development of tumors during carcinogenesis thus appears closely related to the nature of the carcinogen, AFP production, and the composition of the diet.

Patellofemoral incongruence in chondromalacia and instability of the patella

We measured the patellofemoral congruence in tangential radiographic projections according to Merchant in 64 patients with unilateral patellar pain. The congruence angle was usually within normal limits. However, compared with the asymptomatic side, the angle was increased in chondromalacia and instability of the patella. A comparison of congruence angles of the two knees seems more valuable than a comparison with normal values.

Scintimetry of hip joint tamponade in dogs

A unilateral, continuous hip joint pressure of 50 mm Hg was established for 6 h in five puppies under general anesthesia. 99mTc-DPD scintimetry 2 and 4 weeks after tamponade showed the mean ratio between the investigated and control hip to be 1.00 and 1.01, respectively, in the epiphyses. After killing and removal of the upper femora, the same ratio was 0.94 for epiphyses and 1.02 for metaphyses. Our study did not show signs of persistent bone ischemia after tamponade below the arterial pressure.

Patellar height and patellofemoral congruence

The patellar tendon/patella ratio and the patellofemoral congruence was estimated in 118 knees. There was a statistically significant positive correlation between the two measurements, high-riding patella occurring with patellofemoral incongruence.

Gas-producing infections after lower-limb amputation because of ischemia

During the period 1972-1982, 22 patients with gas-producing infections after lower-limb amputation because of ischemia were reviewed. In 16 cases bacteria of the genus Clostridium could be cultured. Treatment consisted of hyperbaric oxygen, surgical debridement, and antibiotics. The incubation period was 1-11 days after the primary amputation, and the duration of the infection 2-31 days, significantly lower among 14 patients with diabetes mellitus. There was no difference in the course of clostridial and nonclostridial infections. No deaths were attributable to gas-forming infection.

Dynamic knee brace in the treatment of patellofemoral disorders

The efficiency of a knee brace with a 0 degree-30 degrees range of motion was studied in 17 patients with anterior knee pain. Eighteen patients with identical symptoms served as controls. The brace was worn for 6 weeks. Follow-up was performed after 6 weeks and 3 and 12 months. After 6 weeks, 82% of the patients treated with the brace were classified as improved, compared with 44% without it, according to a strict evaluation system. However, after 12 months only 35% of the patients treated with the knee brace could be rated as improved. Despite this marked deterioration, the brace should be considered an alternative to immobilization, because it minimizes the load on the patellofemoral joint and prevents atrophy of the quadriceps muscle.

Isometric contractions in the patellofemoral pain syndrome. An electromyographic study

The role played by the vastus lateralis and vastus medialis obliquus in their alignment of the patella during maximal isometric quadriceps contractions was studied by electromyography in 28 patients with unilateral symptoms of the patellofemoral pain syndrome. Eleven knees were classified as subluxation of the patella and 17 as idiopathic chondromalacia patellae. The muscular activity pattern was the same in the two groups but decreased as compared with the contralateral nonsymptomatic knees. However, none of the groups revealed differences in the activity of vastus lateralis and vastus medialis obliquus suggesting muscular imbalance.

The circadian rhythm of plasma thyrotropin in depression and recovery

The 24-hr patterns of plasma thyrotropin have been observed in 12 endogenous depressed patients in both depressed and recovered states and in 13 normal subjects. A clear circadian rhythm was detected in controls with high values at night. In depression, the circadian rhythm was altered with amplitude reduction and blunted nocturnal secretion, abnormalities particularly relevant in bipolar patients. This flattened profile could be linked to the blunted response of TSH to TRH administration reported in depressed patients. Normal nyctohemeral patterns have been restored after recovery. These chronobiological abnormalities as well as their normalization under antidepressant drugs seem to be similar to those reported for various parameters (e.g. temperature, cortisol, etc) in depression which could support the chronobiological hypothesis for affective disorders.

Antibiotic prophylaxis in lower limb amputation

We have prospectively studied the effect of 1-day prophylactic antibiotic therapy in lower-limb amputation for ischaemia. Twenty-seven patients were treated with Meticillin 1 g X 4 intravenously on the day of operation; 23 control patients did not receive any antibiotics. Eight patients in the control group had postoperative wound infections compared to none in the Meticillin group. Seven patients were re-amputated because of infection. Preoperatively, Staphylococcus aureus was isolated in 5/8 of the patients in the Meticillin and 6/8 in the control group. In the postoperatively infected stumps, S. aureus occurred in 6/8 of the patients in the control group, and one patient developed gas gangrene.

Non-painful phantom limb phenomena in amputees: incidence, clinical characteristics and temporal course

58 patients undergoing limb amputation mainly because of peripheral vascular disease were interviewed by means of a standard questionnaire and examined 8 days, 6 months and 2 years after limb amputation regarding non-painful phantom limb phenomena. During the follow-up period, 41% of patients died. The incidence of phantom limb 8 days, 6 months and 2 years after limb loss was 84%, 90% and 71%, respectively. Phantom limb phenomena changed within the first half year after amputation from a mainly proximal and distal distribution to a mainly distal localized sensation. While approximately 3/4 of patients with phantom limb had kinaesthetic sensations in the limb (i.e. feeling of length, volume or other spatial sensation) during the first 6 months after amputation, less than 50% of patients had this later in the course; 30% of patients noticed a clear shortening of the phantom limb during the follow-up period. While the incidence of phantom limb did not decrease during the follow-up period, both the duration and frequency of phantom limb phenomena declined significantly. The distribution of non-painful and painful phantom limb did not differ significantly from each other. The present findings suggest that mechanisms both in periphery, spinal cord and brain participate in generating the phantom limb percept.

Simultaneous dorsal dislocation of both interphalangeal joints in a finger

Following simultaneous dorsal dislocation of both interphalangeal joints of a finger, attention must be paid to the risk of a long period of recovery because of the severity of the lesion. Approximately one year after such an accident to a footballer arthrodesis was performed on the proximal interphalangeal joint, as the patient was still suffering from constant pain in the finger.