Distinct hemodynamic and gastric effects of human CGRP I and II in man

The human calcitonin gene-related peptides I and II (or alpha and beta) (CGRP I and II) are encoded by two different genes, but they have 34 of the 37 amino acid residues in common. Human CGRP I more potently stimulated blood flow through the skin and carotid artery (p less than 0.01), and the heart rate (p less than 0.05), and plasma renin activity and aldosterone secretion than human CGRP II (p less than 0.02). Inhibition of pentagastrin-stimulated gastric acid output, on the other hand, was only obtained with CGRP II. The separate effects of human CGRP I and II on the cardiovascular and gastric systems are presumably mediated by different receptors or receptor pathways recognized by the two closely related neuropeptides.

[Assessment of the leg veins using duplex ultrasonography]

Duplex scanning, first used for the investigation of arterial diseases, is characterized by the combination of B-Mode ultrasound and spectral analysis or color imaging of PW-Doppler signals. This provides information on both the morphology of the vessel and the corresponding hemodynamics. Compared to the conventional noninvasive techniques in phlebology such as plethysmography and CW-Doppler its major advantage is the additional morphologic information. Until now this anatomical information was only available by invasive phlebography. This technique, however, gives only limited informations on hemodynamics. Using an appropriate technique of duplex scanning, the deep veins from the calf to V. cava as well as the superficial veins and the perforators can be examined. In the hand of a skilled investigator deep vein thrombosis can be diagnosed with accuracy. Compared to the gold standard phlebography sensitivity and specificity are high: 96% and 99% resp. The duplex technique is also very reliable in differentiating the diagnosis of deep vein thrombosis: Baker's cysts, hematomas and tumors usually are easily detected by B-scan. Investigation of chronic venous insufficiency is also possible by duplex-scanning. Imaging of the veins and pulsed Doppler analysis allows to determine whether the reflux is in the deep or superficial system. On a more scientific field duplex allows the precise noninvasive determination of hemodynamic parameters. Thus it is possible to measure physiologic venous hemodynamics and to quantify drug effectiveness. Duplex sonography holds a key position in the phlebological diagnostic procedure. This new technique causes no harm to the patient and important information is obtained at relative low costs.

[The concept of integrated internal medicine-psychosomatic patient management--experiences and results with its application in a general hospital]

Psychosomatic therapy has been realized by integration into general ward's therapeutic program in a general hospital. Within 3 1/2 years of development the medical staff has been qualified to perform basic elements of psychosomatic therapy, whilst the structure of the medical department has been changed in different aspects. During a period of 28 days the real extend of psychosomatic therapy now has been evaluated by questionnaire: 438 psychosomatic and psychosocial interventions were documented in this time, concerning 149 patients (= 53% of all patients treated in the department). Causes, trigger mechanic, settings, frequency, median duration, and different kinds of all these interventions are described. According to the clientèle of our medical department, with a lot of elderly and multi-handicapped persons, the main topics of interventions concerned--besides of specific psychosomatic treatment--addiction and problems of alcoholism, coping strategies and compliance, as well as further support of handicapped singles after discharge.

[New therapeutic approach in the celiac trunk compression syndrome]

Etiology and treatment of the coeliac compression syndrome remains controversial. The external compression, near the origin of the truncus coeliacus and the poststenotic dilatation is well demonstrated by angiography on a lateral projection. The development of collaterals like the pancreaticoduodenal and gastroduodenal artery can be assessed on a frontal view. The grading of the stenosis as well as the direction of the flow in these artery can be measured with the duplex sonography. These investigations show a steal syndrome: blood coming from the mesenteric artery irrigate the common hepatic artery through the collaterals. The flow in the common hepatic artery is therefore retrograde. We used an original technique to correct this flow pattern in the case of a 52-year-old patient: after dividing the arcuate ligament, we reduced the vascular territory of the truncus coeliacus with the proximal ligation of the splenic artery. The duplex sonography shows postoperatively the suppression of the steal syndrome with a normal flow pattern in the hepatic artery despite minimal change in the stenosis of the truncus coeliacus. The patient remained asymptomatic since the operation. We concluded that an angioplasty or reimplantation of the truncus coeliacus is unnecessary to correct the steal syndrome. A normal flow can be provided by a stenotic truncus coeliacus once the splenic artery has been ligated.

Cholinesterase solubilizing factor from Cytophaga sp. is a phosphatidylinositol-specific phospholipase C

In the culture supernatant of Cytophaga sp. we detected an enzyme that converted glycosylphosphatidyl-inositol-anchored acetylcholinesterase to the hydrophilic form. This enzyme had a cleavage specificity of a phospholipase C. It hydrolyzed phosphatidylinositol but did not act on phosphatidylcholine. On gel filtration the enzyme migrated with an apparent molecular mass of about 17 kDa. It displayed maximal activity between pH 6-6.5 and did not require cofactors for the expression of catalytic activity. Mercurials and zinc ions inhibited the enzyme and its activity also decreased with increasing ionic strength in the assay. With acetylcholinesterase as substrate optimal activity was obtained in pure micelles of Triton X-100, whereas in mixed micelles containing Triton X-100 and phosphatidylcholine the activity was reduced. The enzyme from Cytophaga sp. showed little activity towards acetylcholinesterase embedded in intact membranes where more than 1000-times higher concentrations of phosphatidylinositol-specific phospholipase C was necessary to solubilize acetylcholinesterase as compared to acetylcholinesterase in detergent micelles.

[Rational approach to peripheral arterial occlusive diseases]

A growing proportion of over 65-year-old persons in the population will increasingly confront physicians with peripheral arterial occlusive disease. Intermittent claudication is the characteristic symptom of stage II disease at which most patients consult their physician. Known risk factors like cigarette smoking, diabetes, hypertension and hyperlipidemia have to be assessed. Manifestations of atherosclerosis in other vascular beds such as carotids and coronaries should be sought. Clinical angiologic evaluation with inspection, palpation of pulses, auscultation of vessels at rest and after exercise as well as measurement of the walking distance permits assessment of peripheral perfusion quite well. Oscillography and Doppler-sonography are increasingly used. Duplex-scanning can replace angiography in many cases. Conventional and digital subtraction-angiography have their specific uses. Diagnostic and therapeutic measures recommended for peripheral arterial occlusive disease are summarized.

Calcitonin gene-related peptide (CGRP) causes redistribution of blood flow in humans

In normal human subjects (n = 6), blood flow in the common carotid artery, assessed with an ultrasonic duplex-scanning unit, was increased up to 152% of basal levels by 60-min infusions of human calcitonin gene-related peptide I (alpha CGRP) 80 pmol.kg-1.h-1, but it was not affected by 20 pmol.kg-1.h-1 CGRP or 88 pmol.kg-1.h-1 human calcitonin. In the superior mesenteric artery, on the other hand, blood flow was reduced by 80 pmol.kg-1.h-1 CGRP to 58% of the basal level, but not by 20 pmol.kg-1.h-1 CGRP or with 88 pmol.kg-1.h-1 calcitonin. Blood flow in the abdominal aorta remained largely unchanged under the same conditions. Skin blood flow, assessed by a laser Doppler unit, was increased up to 682% of the basal level by 80 pmol.kg-1.h-1 CGRP, but not by 20 pmol.kg-1.h-1 CGRP or calcitonin. Thus CGRP increased regional blood flow to the brain and the skin at the expense of the gastrointestinal tract.

Production and characterization of antibodies against the cross-reacting determinant of glycosyl-phosphatidylinositol-anchored acetylcholinesterase

Dimeric acetylcholinesterase is anchored in the cell membrane by a glycosyl-phosphatidylinositol attached to the C-terminus of the protein. The complex glycan contains an antigenic epitope, the cross-reacting determinant (CRD), which is only revealed after removal of the diradylglycerol by phosphatidylinositol-specific phospholipase C (PI-PLC) but is cryptic in the amphiphilic form. Polyclonal antibodies were raised against the CRD of vertebrate acetylcholinesterase. The purified anti-CRD antibodies recognized only the PI-PLC treated hydrophilic forms of acetylcholinesterase from bovine erythrocytes and Torpedo, and of variant surface glycoprotein from trypanosomes but not the corresponding amphiphilic proteins. Competition experiments showed that inositol-1,2-cyclic phosphate and glucosamine inhibited the binding of the antibodies to the CRD. Furthermore, binding of the anti-CRD antibodies to acetylcholinesterase containing N-methylated glucosamine was markedly reduced. The amphiphilic N-methylated enzyme is less sensitive to digestion with PI-PLC than the non-methylated form. From our results we conclude that inositol-1,2-cyclic phosphate and glucosamine, especially the free amine group of this residue, contribute significantly to the epitope recognized by the anti-CRD antibodies.

Comparison of bone marrow histology in early chronic granulocytic leukemia and in leukemoid reaction

A retrospective study was performed on bone marrow biopsies of 50 untreated patients with leukemoid reactions (LR) and 50 untreated patients with early chronic granulocytic leukemia (CGL). A comparison was made between hematopoietic and adipose tissues, bone and its cells, as well as other stromal components in these two disorders. Histologic and histomorphometric analyses revealed significant differences in trabecular structure, in localization of fat cells, in numbers of sinusoids, capillaries and various stromal elements. No significant differences between LR and CGL were detected in the quantity of erythro- and granulocytopoiesis and of megakaryocytes, but these were smaller in CGL than in LR. This histologic and histomorphometric evaluation demonstrates that certain histologic features may serve as valuable aids in distinguishing LR from CGL.

[Angiography findings before and following transplantation of free myocutaneous flaps]

Prerequisite for successful split-skin flap transplants of myocutaneous flaps is the presence of adequate adjacent afferent and efferent vessels, thus making an arteriography of the receiving region mandatory during surgery preparation. In 20 or 29 patients in whom a split myocutaneous flap was transplanted to the lower leg, angiography revealed 22 pathological or other therapyrelevant findings. Besides the afferent vessels it is basically necessary to visualise the peripheral efferent pathways in order to prevent that vascular anastomosis to the split-skin flap obstructs the blood supply of the leg.

Cyanobacterial RNA polymerase genes rpoC1 and rpoC2 correspond to rpoC of Escherichia coli

The DNA-dependent RNA polymerase (ribonucleoside triphosphate:RNA nucleotidyltransferase, EC 2.7.7.6) of cyanobacteria contains a unique core component, gamma, which is absent from the RNA polymerases of other eubacteria (G. J. Schneider, N. E. Tumer, C. Richaud, G. Borbely, and R. Haselkorn, J. Biol. Chem. 262:14633-14639, 1987). We present the complete nucleotide sequence of rpoC1, the gene encoding the gamma subunit, from the heterocystous cyanobacterium Nostoc commune UTEX 584. The derived amino acid sequence of gamma (621 residues) corresponds with the amino-terminal portion of the beta' polypeptide of Escherichia coli RNA polymerase. A second gene in N. commune UTEX 584, rpoC2, encodes a protein which shows correspondence with the carboxy-terminal portion of the E. coli beta' subunit. The rpoBC1C2 genes of N. commune UTEX 584 are present in single copies and are arranged in the order rpoBC1C2, and the coding regions are separated by short AT-rich spacer regions which have the potential to form very stable secondary structures. Our data indicate the occurrence of divergent evolution of structure in the eubacterial DNA-dependent RNA polymerase.

[Diagnosis using ultrasound in peripheral arterial disorders: possibilities and limitations]

Ultrasound plays an increasingly important role in investigating peripheral vascular disease. Two major approaches, the Doppler technique and the (B-mode) imaging technique, are routinely used. Duplex scanning combines the two ultrasonic techniques taking advantage of both the hemodynamic and anatomic data that can be obtained. The simple conventional Doppler devices may be used to measure limb blood pressure at rest and after exercise and to assess velocity patterns. Recent advances in duplex technology allow non-invasive assessment of the vascular tree from the aorta to below the knee. Compared with arteriography duplex scanning has a sensitivity of 96% and a specificity of 81%. In selected cases duplex scanning can safely and reliably replace arteriography.