Distinct functions of nuclear and cytoplasmic calcium in the control of gene expression

Calcium entry into neuronal cells through voltage or ligand-gated ion channels triggers neuronal activity-dependent gene expression critical for adaptive changes in the nervous system. Cytoplasmic calcium transients are often accompanied by an increase in the concentration of nuclear calcium, but the functional significance of such spatially distinct calcium signals is unknown. Here we show that gene expression is differentially controlled by nuclear and cytoplasmic calcium signals which enable a single second messenger to generate diverse transcriptional responses. We used nuclear microinjection of a non-diffusible calcium chelator to block increases in nuclear, but not cytoplasmic, calcium concentrations following activation of L-type voltage-gated calcium channels. We showed that increases in nuclear calcium concentration control calcium-activated gene expression mediated by the cyclic-AMP-response element (CRE), and demonstrated that the CRE-binding protein CREB can function as a nuclear calcium-responsive transcription factor. A second signalling pathway, activating transcription through the serum-response element (SRE), is triggered by a rise in cytoplasmic calcium and does not require an increase in nuclear calcium.

Synthesis of 3-arsonopyruvate and its interaction with phosphoenolpyruvate mutase

3-Arsonopyruvate was prepared in four steps from glycine. The arsenic-carbon bond was formed by a Meyer reaction between alkaline arsenite and 2-bromo-3-hydroxy-2-(hydroxymethyl)propionic acid; the 3-arsono-2-hydroxy-2-(hydroxymethyl) propionic acid formed was oxidized with periodate to give 3-arsonopyruvate. This proves to be an alternative substrate for phosphoenolpyruvate mutase, giving pyruvate, which was assayed using lactate dehydrogenase. The K(m) is 20 microM, similar to that observed for the natural substrate phosphonopyruvate (17 microM), whereas the kcat. of 0.01 s-1 was much lower than that for phosphonopyruvate (58 s-1). Arsonopyruvate competitively inhibited the action of the mutase on phosphonopyruvate.

A study on the nutritional status of adolescent girls

One hundred and twenty school girls in the age group of 13-15 years from four Government schools of Ludhiana city were selected for the study. On the basis of their family income they were divided into three experimental groups i.e. income group I (IgI), income group II (IgII) and income group III (IgIII). The results showed that the intake was low for all the foods. However, the consumption of fruits, milk and milk-products, sugar and jaggery, fats and oils by the subjects of IgII and IgIII was significantly higher (p < 0.05) than IgI. The mean daily intake of energy, protein, iron, calcium, vitamin A & vitamin C was inadequate while the intake of fibre was adequate by the subjects as compared to ICMR recommendations. There was no significant difference in energy, protein and iron intakes among the subjects of three groups. However, the fibre intake by the subjects of IgI was significantly higher (p < 0.05) than the subjects of IgIII, whereas the intake of calcium, vitamin A and ascorbic acid by the subjects of IgII & IgIII was significantly higher (p < 0.05) than those of IgI. The average body weights and heights of the subjects were normal. The haemoglobin (Hb) level of the subjects ranged from 8.5-12.5 g/dl with a mean value of 10.73 + 0.07 and reported that only 23 percent of the subjects had acceptable level.

Enolase and the arsonomethyl analogue of 2-phosphoglycerate

(RS)-3-Arsono-2-(hydroxymethyl)propionic acid was synthesized by the action of alkaline arsenite on 3-bromo-2-(bromomethyl)propionic acid. It is a substrate for yeast enolase (EC 4.2.1.11) with a Km of 6.5 mM (for 2-phospho-D-glycerate Km = 0.08 mM). The catalytic constant of the enzyme with the arsonomethyl analogue is 230 times lower than with 2-phosphoglycerate.

Social support as a moderator of cardiovascular reactivity in women: a test of the direct effects and buffering hypotheses

This study examines the possibility that social support operates as a moderator of cardiovascular reactivity in women. Two models by which social support may operate were examined: the direct effects and buffering models. Twenty-six subjects were exposed to four conditions while playing a video game: two levels of stress (low, high) and two levels of social support (alone, together). Blood pressure and heart rate were monitored continuously. Ratings of stress were obtained for each condition. Results indicated that the support manipulation produced significant main effects for diastolic blood pressure and stress ratings, with lower diastolic blood pressure and ratings observed in the "together" condition, and that the interaction between support and stress produced lower reactivity for the cardiovascular measures in the high stress (but not the low stress) condition. No interaction was found for the stress ratings. We conclude that the results provide support for both the buffering and direct effects models. Implications concerning the (within-subjects) design of the study and the stress ratings are discussed.

Experience with intraluminal radiotherapy in advanced oesophageal cancer

Despite improvement in the diagnostic modalities, surgical technique, chemotherapy and radiotherapy, mortality and morbidity due to carcinoma esophagus continues to be dismal. Combination of external and intraluminal radio therapy (ILRT) has emerged as a powerful and promising palliative therapy in this disease. Thirty four patients with inoperable cancer esophagus treated with ILRT during June 1991 to December 1993 were evaluated to assess its palliative effects. Seventeen of these patients had received additional chemotherapy and external radiotherapy. Thirteen patients received only radiotherapy (both external radiotherapy + ILRT) and the remaining 4 received only ILRT. They were followed up for a mean period of 8.3 months (range 2 to 28 months) during which one patient was lost to follow up. Eight had a follow up of less than 6 months. Eight (33%) amongst the remaining 25 patients were considered disease free, 15 had recurrent and progressive disease, one developed metastasis and one patient died. In 21 (66%) dysphagia markedly improved. Nine (26%) patients survived beyond 1 year and the median survival for all patients was 8 months. Associated radiation morbidity was documented in 13 (38%) patients. We conclude that combination of external radiotherapy and ILRT is an effective and safe therapy for inoperable esophageal malignancies.

The Nd:YAG laser in caries removal

This paper shows how a laser can be used in the various stages of caries removal prior to the placement of a glass-ionomer restoration. In the future the laser may prove to be a valuable tool in enabling the dentist to perform surgical procedures with maximum comfort to the patient.

Predictors of perioperative morbidity and mortality in repeat valve replacement: a seven-year experience

Forty-nine consecutive repeat cardiac valve replacements in 46 patients were reviewed to define in-hospital morbidity, mortality, and determinants of risk. The overall operative mortality rate was 10.2%; it was 9% for the first reoperation and 25% for the second (four patients). The mortality rate was 12% at the mitral position (25 patients), 11% at the aortic position (18 patients), and 0% for repeat double valve replacement (four patients). Univariate and multivariate stepwise logistic regression models show that age over 70 years and the use of an intraaortic balloon pump preoperatively predict operative mortality, and age over 70, preoperative care in the coronary care unit, endocarditis, and the presence of an intraaortic balloon pump are determinants of perioperative morbidity in patients undergoing repeat valve replacement. Based on these data, close follow-up of patients with initial valve replacement is encouraged so that reoperation to correct prosthetic malfunction or periprosthetic leak can be done before hemodynamic collapse occurs. Furthermore, since age was the most significant factor affecting mortality (P < .01) and since most of the deaths (80%) in this study occurred in patients with torn bioprosthetic leaflets, the use of bioprostheses for initial valve replacement in patients under 70 years of age is discouraged.

Minor emergency clinic: key to the future of successful hospitals

This project set out to determine whether there is a relationship between the minor emergency facility an individual uses and their choice of a hospital for in-patient care. In studying this relationship, the factors that are important to persons choosing a clinic or hospital facility, as well as the influence of a physician, were also identified. A structured, undisguised telephone survey was used for interviewing a randomly selected sample population of 189 San Angelo residents. Analysis of the survey data indicated that dependency does exist between minor emergency clinic use and the hospital chosen for in-patient care. The results of this study also suggested that hospitals' marketing strategy should shift the emphasis of their advertising from the hospital itself to their physician association and clinics. In addition, a number of other interesting observations concerning the relative importance of various medical factors to the participants was also explored.

Cardio-vascular effects of vecuronium & pancuronium in patients undergoing elective closed mitral valvotomy

Vecuronium, a monoquaternary analogue of pancuronium, the neuromuscular blocker, was compared with pancuronium in 50 patients undergoing elective closed mitral valvotomy. The patients were randomly divided into two groups of 25 each, and the muscle relaxants were administered in a dose of 0.1 mg/kg body weight. Both the agents produced identical intubating conditions at 3 min. Vecuronium showed a significantly shorter onset of action, as compared to pancuronium. The latter significantly increased the heart rate throughout the period of study whereas vecuronium significantly decreased the heart rate, 25 min after administration. There was significant increase in the mean arterial pressure (MAP) at tracheal intubation in both the groups, which persisted throughout the period of study in pancuronium group. There was a significant fall in MAP at 30 min after relaxant in vecuronium group. The incidence of arrythmias was similar and significant in both the groups. Vecuronium, thus showed a quicker onset of action with minimal haemodynamic effects, as compared to pancuronium in patients undergoing closed mitral valvotomy.

ERCP in the evaluation of choledochal cyst due to anomalous pancreatobiliary junction

With the application of endoscopic retrograde cholangio pancreatography (ERCP), the association of anomalous pancreatobiliary junction and choledochal cyst is being increasingly recognized. We describe here the ERCP findings in three patients who had this anomaly in association with fusiform (Type I) choledochal cyst. Two of our patients also had evidence of pancreatitis. The importance of ERCP in the preoperative assessment of such patients is highlighted.

Small cell osteosarcoma. A clinicopathologic study of 27 cases

We report a study of 27 patients with small cell osteosarcoma (SCO), 17 from the M. D. Anderson Cancer Center (MDAH) and ten from the Pediatric Oncology Group (POG). There were 12 male patients and 15 female patients; 19 were white, five were black, and three were Hispanic. They ranged from 6 to 28 years of age with a median of 14 years. Histologically there were three patterns: Ewing's-like, lymphoma-like, and spindle cell. All cases showed osteoid formation and a few had chondroid areas. There was cytoplasmic glycogen in ten cases. Initial treatment for MDAH patients included intraarterial infusion of cisplatin in ten, amputation in four, partial mandibulectomies in two, and biopsy with local radiotherapy and systemic chemotherapy in one. All POG patients had resection or amputation followed by adjuvant chemotherapy. Twelve patients are alive, of whom nine have had significant follow-ups for 25 to 90 months. Fourteen patients are dead of lung, spine, and brain metastases from 1 to 23 months after initial diagnosis. One patient is alive with lung relapse at 4 months. In summary, SCO is a high-grade variant of osteosarcoma, with an incidence of up to 4% of all osteosarcomas, that affects patients of the same age group and has the same anatomic location as conventional osteosarcoma. Currently, SCO appears to have a prognosis that is the same as or slightly worse than that of conventional osteosarcoma. Furthermore, although intraarterial infusion is effective for the primary tumors in the bone, distant metastases are difficult to control.

A prospective evaluation of a triple-drug regimen containing cisplatin, vinblastine, and dacarbazine (CVD) for metastatic melanoma

Based on the independent activity of cisplatin, vinblastine, and dimethyl-triazeno-imidazole-carboxamide (DTIC) (CVD), a combination of these agents was used in the treatment of patients with advanced melanoma. Vinblastine was used in a dose of 1.6 mg/m2/d for 5 days, DTIC was used in a dose of 800 mg/m2 intravenously (IV) on day 1, and cisplatin was used in a dose of 20 mg/m2/d for 4 days starting on day 2 of chemotherapy. The courses of chemotherapy were repeated at 3-week intervals. All patients were premedicated with antiemetics, and IV hydration was used before cisplatin. Fifty-two consecutive patients were registered and 50 were evaluable for response. Two patients achieved a complete response (CR) and 18 patients had a partial response (PR) for an overall response rate of 40% (95% confidence interval, 27% to 55%). The median duration of response was 9 months and the median survival time of the responders was 12 months. The overall median survival time of patients treated on this protocol was 9 months. The treatment was associated with significant toxicity consisting of nausea, vomiting, diarrhea, and partial hair loss. Additionally, neutropenia with a median nadir granulocyte count of 500/microliters was observed, and significant anemia required blood transfusions in a majority of the patients after three to four courses of chemotherapy. The dose-limiting toxicity was peripheral neuropathy which required discontinuation of cisplatin after six to eight courses of chemotherapy. We believe that this triple-drug regimen has significant activity that appears to be superior to the single-agent activity of these drugs, both in terms of increased response rate and duration of response.

Cholangiographically guided aspiration cytology in the management of malignant biliary obstruction

Fifteen patients with malignant biliary obstruction were subjected to fine needle aspiration cytology (FNAC) under fluoroscopic guidance. Fourteen (93%) of them were correctly diagnosed to have a malignancy at FNAC. Simultaneous with FNAC or at a later date, all the patients underwent percutaneous biliary drainage with a drop in serum bilirubin from a mean of 23.2 mg/dl to 8.5 mg/dl. Ten patients were subjected to exploratory laparotomy and biopsy at which the diagnosis of FNAC was confirmed in nine of them. The tenth patient with a negative yield at FNAC had a 1.0 cm cholangiocarcinoma. The usefulness of FNAC combined with biliary drainage as an alternative to surgery is highlighted.

Massive necrosis of fat and skin as complication of obesity

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The clinical spectrum of anomalous pancreatobiliary junction

Anomalous junction of pancreatobiliary ducts (AJPB) is known to be associated with choledochal cyst and gallbladder cancer. This report describes our experience with eight patients with AJPB, six of whom were diagnosed at endoscopic retrograde cholangiography and two at transhepatic cholangiography. Four of the patients with AJPB had an associated congenital choledochal cyst, two had a normal biliary tree and one each had inspissated bile syndrome and cholangiocarcinoma. The last two associations have not been previously described. It is felt that the clinical spectrum of AJPB may unfold further with the widespread use of the cholangiographic techniques.

Double blind study on the efficacy and safety of tetrabamate and chlordiazepoxide in the treatment of the acute alcohol withdrawal syndrome

1. Efficacy and safety of tetrabamate and chlordiazepoxide in the treatment of the acute or Primary Alcohol Withdrawal Syndrome (PAWS) were assessed during a randomized double blind clinical trial, carried out on sixty male alcoholic in-patients. 2. The two drugs were administered four times a day in double dummy conditions, according to a fixed-flexible decreasing dosage schedule (six days basic regimen). 3. Drug efficacy was measured daily throughout the study period using a battery of standard instruments for collecting quantitative clinical, behavioral, psychopathological and laboratory data. Side effects were daily recorded. 4. Tetrabamate was found to be as efficient as chlordiazepoxide in reducing the intensity of the PAWS, improving sleep and vital signs rapidly and alleviating anxiety progressively. 5. Tetrabamate was found particularly beneficial for severe tremor. Psychomotor and mood scores consistently favored tetrabamate, suggesting psychoanaleptic properties of this compound (increased diurnal vigilance). 6. Side effects were minimal with tetrabamate and generally of weak intensity with chlordiazepoxide. 7. The results of this study indicate that tetrabamate may represent a new alternative drug of choice for the therapy of the acute alcohol withdrawal syndrome.

Aberrant oncogene expression in uncultured human sarcoma and melanoma

Protooncogenes have the ability to induce and/or maintain the transformed state when they are overly expressed or altered by mutation or gene rearrangement. To study the possible involvement of these cellular oncogenes in the neoplastic transformation, we have analyzed their expression in 44 fresh samples obtained from primary, recurrent, or metastatic tumors from patients with a variety of sarcomas and a melanoma. Our analysis was carried out by the northern blot technique using poly (A)+ RNA hybridized with human cellular DNA probes. A normal 2.3-kb c-myc transcript was observed almost universally at various levels. A normal c-k-ras transcript of 5.2-kb was detected at a low level in most of the samples. In three samples we detected aberrant c-k-ras transcripts of 7.0 and 8.5-kb, while in two other samples we found an aberrant lower-molecular-weight transcript of 1.4-kb. N-myc was expressed in only three samples, and in all instances, the transcripts were aberrant (more than 10-kb). A normal 3.7-kb c-sis transcript was expressed at a low level in most of the sarcomas and the melanoma but was uniquely overexpressed in giant cell tumors of bone. C-fos (2.2-kb) was expressed at a low level in almost half of the samples; c-myb was never expressed. We conclude that c-k-ras, n-myc, c-sis, and c-myc are aberrantly or overexpressed in sarcoma/melanoma, and their activation may play a role in the transforming events leading to development and/or progression of these tumors.

Capgras syndrome: a case report from Zimbabwe

A case of Capgras syndrome in a black Zimbabwean patient is described. The syndrome occurs in the setting of a schizophrenic illness, but psychodynamic factors are readily identified despite the patient's different cultural background.

On the pathogenesis and therapy of dementia of the Alzheimer type: some neuropathological, biochemical, genetic and pharmacotherapeutic considerations

The extensive literature on dementia of Alzheimer type (DAT) testifies to the enormous progress achieved in the clinical and biochemical delineation of this disease. Newly developed laboratory and imaging techniques are also being applied to the diagnosis of DAT. Nevertheless, unequivoval diagnosis still relies primarily on morphological data from biopsy or autopsy. An overview is presented of major morphological changes occurring at different levels of organization in the central nervous system (CNS) in DAT. Currently formulated etiopathogenic hypotheses of DAT are reviewed and discussed in the context of morphological alterations. Some of the recombinant DNA methods, that are currently available for gene analysis, are described. Some approaches for studying Alzheimer specific genes using the above methods have been suggested. Finally, a critical overview of the current pharmacotherapeutic armamentarium used in DAT and senile dementia is presented. The efficacy, side effects, and the main mechanisms of action of the two categories of drug therapy -supposed etiopathogenic and symptomatic- are presented.

Ethanol metabolizing system in Drosophila. Aldehyde dehydrogenase: functional aspects in adult and during development

Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) activities were determined in adult flies from several Drosophila species endowed with widely different tolerance to ethanol (ETOH). Plotting ALDH against ADH activities resulted in a high correlation coefficient (r = 0.966). This finding was confirmed in developmental studies. From early larval stage up to late adult life, DH and ALDH activities demonstrated almost parallel profiles. In the highly ETOH tolerant species D. melanogaster (D.m.), ADH and ALDH profiles were U-shaped: high activities in larvae, low activities in pupae and high activities in adults. In D. simulans (D.s.), a species less tolerant to ETOH, the profiles were L-shaped: high activities in larvae but low activities in both pupae and adults. Interestingly, similar activities (ADH and ALDH) were observed in the larvae of both species. Subcellular distribution studies of larval ALDH in both species revealed that the total ALDH activity is largely contributed by a mitochondrial high affinity enzyme. ALDH activity, clearly distinguishable from aldehyde oxidase (ALDOX), was visualized through analytical isoelectric focusing of the subcellular fractions. The estimated pIs for D.m. and D.s. were 4.9 and 5.2 respectively, thus different from those of ADH. The key biological role initially attributed to Drosophila ALDH is further supported by the present data. In addition the Drosophila developmental model opens new avenues for research on the study of genetic regulation of ADH and ALDH expression.

Aldehyde dehydrogenase in Drosophila: developmental and functional aspects

Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) activities were determined in adult flies from several Drosophila species endowed with widely different tolerance to ethanol (ETOH). Plotting ALDH against ADH activities resulted in a high correlation coefficient (r = 0.966). This finding was confirmed in developmental studies. From early larval stage up to late adult life, ADH and ALDH activities demonstrated almost parallel profiles. In the highly ETOH tolerant species D. melanogaster (D.m.), ADH and ALDH profiles were U-shaped: high activities in larvae, low activities in pupae and high activities in adults. In D. simulans (D.s.), a species less tolerant to ETOH, the profiles were L-shaped: high activities in larvae but low activities in both pupae and adults. Interestingly, similar activities (ADH and ALDH) were observed in the larvae of both species. Subcellular distribution studies of larval ALDH in both species revealed that the total ALDH activity is largely contributed by a mitochondrial high affinity enzyme. ALDH activity, clearly distinguishable from aldehyde oxidase (ALDOX), was visualized through analytical isoelectric focusing of the subcellular fractions. The estimated pIs for D.m. and D.s. were 4.9 and 5.2 respectively, thus different from those of ADH. The key biological role initially attributed to Drosophila ALDH is further supported by the present data. In addition the Drosophila developmental model opens new avenues for research on the study of genetic regulation of ADH and ALDH expression.

Osseous manifestations in congenital syphilis: a study of 55 cases

Radiology plays an important role in the early diagnosis of congenital syphilis. Osseous manifestations in 55 cases of congenital syphilis have been analysed and their radiological appearances described. In addition to the common findings of metaphysitis, periostitis and osteitis of the long bones, unusual involvement of the skull, mandible, nasal septum, scapulae and short bones of the hands and feet was observed.

Biochemical correlates of tolerance in rodents and in Drosophila. Possible role of alcohol dehydrogenase, aldehyde dehydrogenase and superoxide dismutase

In the rat, prolonged exposure to ethanol (ETOH) vapor induced an acquired increase in tolerance. After a single ETOH administration, the duration of recovery was decreased by 20% as compared to control animals and the rate of ETOH elimination from blood was increased by 27%. From the data obtained on liver enzymes--alcohol dehydrogenase (ADH), aldehyde dehydrogenase (ALDH) and superoxide dismutase (SOD)--it is suggested that the increased ALDH activity would be the consequence of an increased formation of the product of ETOH oxidation, the acetaldehyde. This over-production would not be accounted for by ADH. It is assumed that among others, the coupled reaction SOD-catalase would represent a possible alternate pathway. Data on Drosophila demonstrate that initial tolerance to ETOH is well correlated with ADH activity. It is suggested that ETOH metabolites (mainly acetaldehyde) would act also as determinant of this initial tolerance. The value of Drosophila as animal model for the study of behavioral and biochemical correlates of initial tolerance is discussed.

Congenital duodenal stenosis. The duodenal cervix sign

A case of congenital duodenal stenosis is reported complicated by recurrent pancreatitis. The diagnosis was not initially entertained because of the pancreatitis. The radiographic appearance on gastrointestinal series was unusual for pancreatitis. The finding of an anomalous celiac axis on arteriography suggested the possibility of other congenital anomalies. The diagnosis of congenital duodenal stenosis was confirmed at laparotomy. The obstruction was relieved with a duodenojejunostomy. Two year follow-up reveals the patient to be asymptomatic without recurrence of pancreatitis. This is the first endoscopic report of this lesion and the presence of the duodenal cervix sign should suggest the diagnosis of congenital duodenal stenosis.

New look at tennis elbow

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Abnormalities of urinary tract and skeleton associated with congenital absence of vagina

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