Do quantitative changes in pain intensity correlate with pain relief and satisfaction?

OBJECTIVE

To correlate measured pain intensity (PI) changes with pain relief and satisfaction with pain management.

METHODS

A prospective single-group repeated-measures design study. A heterogeneous group of patients were asked to record their levels of PI at initial presentation and at ED release using a numerical descriptor scale (NDS) and a visual analog scale (VAS). At release, a 5-point pain relief scale and a pain management satisfaction survey were also completed.

RESULTS

A convenience sample of 81 patients were enrolled over the study period. The average reduction in PI for all patients was 33%. A 5%, 30%, and 57% reduction in PI correlated with "no," "some/partial," and "significant/complete" relief, respectively (p < 0.001). However, when patients were divided into 2 groups based on their initial PI scores, patients with moderate/severe pain (NDS > 5) required a reduction of 35% and 84% in PI to achieve "some/partial" and "significant/complete" relief, respectively. Patients in less pain (NDS < or = 5) needed 25% and 29% reductions in PI for the same categories (p=0.8). Patients were generally satisfied with their pain management. There was a positive association between pain relief and satisfaction with pain management.

CONCLUSION

There is a significant association between changes in PI and pain relief. Greater reductions in PI are required for patients presenting with more severe initial pain to achieve relief compared with those who have lesser initial PI. While there is a linear relationship between increasing pain relief and satisfaction, relief of pain appears to only partially contribute to overall satisfaction with pain management.

Effects of sulfinpyrazone on retinal damage induced by experimental diabetes mellitus in rabbits

The protective activity of the phenylbutazone derivative, sulfinpyrazone on retinal lesions has been assessed in rabbits with severe streptozotocin-induced diabetes. Sulfinpyrazone (8 mg kg-1 per day per os) was administered in diabetic animals in two different experimental procedures: for 135 days in a preventive approach (beginning on the day of initial hyperglicaemia); and for 30 days in a therapeutic approach (beginning on the day of appearance of severe retinal damage). The drug treatment made either with the preventive or the therapeutic approach reduced the incidence of serious retinal lesions and increased that of light lesions as assessed by a biomicroscopic method. Biochemical analyses showed that experimental diabetes was accompanied by sustained decrease in glucose and pyruvate and an increase of the lactate content in the retina. A decrease of alpha-ketoglutarate and citrate and an increase of succinate were also observed along with a decrease of ATP, ADP and an increase in AMP. Either the preventive or the therapeutic approach was followed by an increased pyruvate and ATP content and decreased lactate and AMP content in the retinal tissue. It is possible that this drug acts on the retinal tissue by inhibiting platelet aggregation and protecting vasal endothelium with the consequent suppression of the release of vasoactive substances that facilitate platelet adhesion.

Differential sensitivity to nickel and SK&F96365 of second messenger-operated and receptor-operated calcium channels in rat submandibular ductal cells

The intracellular concentration of calcium ([Ca2+]i) of rat submandibular ductal cells was measured with the intracellular fluorescent dye Fura-2. Carbachol (100 microM) and ATP (1 mM) both increased the [Ca2+]i. The late response to ATP was blocked by 0.5 mM Ni2+. This concentration of Ni2+ also blocked the increase of the [Ca2+]i and the uptake of manganese and calcium in response to 2'- and 3'-O-(4-benzoylbenzoyl) adenosine 5'-triphosphate (BzATP, 100 microM), a specific agonist of P2X receptors from salivary glands. The increase of the [Ca2+]i in response to 2-methylthioadenosine 5'-triphosphate (2-MeSATP, 100 microM) a specific P2Y agonist in salivary glands or to a muscarinic agonist (carbachol) was not affected by 0.5 mM Ni2+. Only higher concentrations of Ni2+ (in the millimolar range) inhibited the uptake of extracellular calcium in response to carbachol. SK&F96365, a blocker of store-operated calcium channels, inhibited the uptake of extracellular calcium in response to carbachol without affecting the response to BzATP. It is concluded that at low concentrations (below 0.5 mM), Ni2+ inhibits the non-specific cation channel coupled to P2X receptors. The uptake of extracellular calcium by store-operated calcium channels is inhibited by higher concentrations of Ni2+ and by SK&F96365.

Determination of aryloxyphenoxypropionic acid herbicides in water using different solid-phase extraction procedures and liquid chromatography-diode array detection

For isolation and trace enrichment of aryloxyphenoxypropionic acid (ArPP) herbicides from drinking, spring, and ground water a sensitive, robust method is presented. A 1-2 1 volume of aqueous samples was passed through a disposable solid-phase extraction cartridge, packed with 500 mg of Carbograph-1 at a flow-rate of 100 ml/min. After washing, ArPPs are selectively eluted with 8 ml of dichloromethane-methanol (80:20, v/v) with 50 mmol/1 formic acid and evaporated to dryness. The mixture was reconstituted with 250 microliters of water-acetonitrile (75:25; v/v) acidified with 0.1% trifluoroacetic acid and 100 microliters was injected into the high-performance liquid chromatography system. The ArPPs were separated via a binary gradient of water and a mixture of methanol-acetonitrile. Detection and confirmation were performed by diode array detection. Recovery of the six acid herbicides ranged between 90% and 98%. The limits of detection of ArPPs were 7-20 ng/l for drinking water and 16-36 ng/l for spring water. In terms of recovery and selectivity the effectiveness of Carbograph-1 cartridges was compared with that of LiChrolut-EN cartridges and polystyrene-divinylbenzene Empore disks. Relevant parameters such as pH and flow-rate for solid-phase extraction with divinylbenzene resins were optimized.

Activation of the Na+-K+(NH4+)-2Cl(-)- cotransporter from rat submandibular glands in response to VIP

A cellular suspension from rat submandibular glands was prepared with collagenase. The intracellular pH (pHi) was estimated with 2',7'-bis-(2-carboxy-ethyl)-5(6)-carboxyfluorescein (BCECF). After exposure to NH4Cl, the pHi transiently increased (diffusion of NH3) and then dropped (influx of NH4+). Isoproterenol increased 2.5-fold the rate of NH4+ influx; bumetanide, an inhibitor of the Na+-K+-2Cl(-)-cotransporter blocked the response to isoproterenol, confirming that the beta-adrenergic agonist stimulated the cotransporter. Forskolin (1 micromol/L) mimicked the response to isoproterenol. VIP (1 nmol/L(-1) micromol/L) also increased the activity of the cotransporter. Cyclic AMP rather than calcium was the mediator of this activation since 1) carbachol which increased the [Ca2+]i fivefold increased the uptake of NH4+ by only 50%; 2) only high concentrations of VIP significantly increased the [Ca2+]i; 3) incubation in the presence of EGTA had no effect on the response to VIP; 4) low concentrations (nmol/L) of the neuropeptide increased the intracellular level of cAMP; and 5) the stimulation of the cotransporter by VIP, forskolin, and isoproterenol was inhibited by H8, an inhibitor of cAMP-dependent protein kinase. It is concluded that the Na+-K+-2Cl(-)-cotransporter of rat submandibular glands is activated by isoproterenol, forskolin, and neuropeptides of the VIP family by a mechanism involving cAMP-dependent processes. The activation of the cotransporter by VIP could partly explain the potentiating effect of VIP on the response to sialagogues like substance P or muscarinic agonists.

Use of a microquantity enzyme immunoassay in a large-scale study of measles, mumps and rubella immunity in Italy

The seroprevalence of antibodies to measles, mumps, and rubella viruses (MMR) was determined in 1498 subjects in Catania, Italy, ranging in age from 1 month to 25 years. The study population was divided into seven age groups and screened by enzyme immunoassay using microquantities (10 microl) of whole blood collected by fingerprick on filter paper discs. The results showed that seroconversion for measles (87.6%) and mumps (73.2%) occurred between 6 and 10 years of age. The seroprevalence of antibodies to rubella virus increased slowly through the age groups, reaching the highest rate (93.3%) between 16 and 20 years of age. Passively transmitted maternal antibodies to mumps and rubella were absent in babies between 5 and 8 months of age, and a few cases positive for measles antibodies were found among babies 6 and 7 months of age. The enzyme immunoassay was demonstrated to be suitable for low-cost large-scale screening for MMR immunity. The rate of vaccine failure was also evaluated and found to be 9.5% for the measles virus, 12.9% for the mumps virus and 0.0% for the rubella virus.

Simultaneous determination of imidazolinone herbicides from soil and natural waters using soil column extraction and off-line solid-phase extraction followed by liquid chromatography with UV detection or liquid chromatography/electrospray mass spectroscopy

This paper describes the simultaneous quantification of the imidazolinone herbicides (IMIs) imazapyr, m-imazamethabenz, p-imazamethabenz, m,p-imazamethabenz-methyl, imazethapyr, and imazaquin in two types of samples. (a) Groundwater, lake water, and river water samples were enriched by off-line solid-phase extraction with a Carbograph-1 cartridge and analyzed by reversed-phase liquid chromatography using a UV detector (lambda = 240 nm). The overall recoveries of IMIs extracted from 1 L of groundwater (fortified with 500-100 ng/L), 0.5 L of lake water (fortified with 500-100 ng/L), and 0.5 L of river water (fortified with 1000-200 ng/L) samples were not lower than 89%. The mean relative standard deviation (RSD) was 5.1% (ranging from 4.1% to 6.8%) in natural water. The detection limits were 30-39 ng/L in groundwater, 43-51 ng/L in lake water, and 55-67 ng/L in river water. The method involves confirmatory analysis by LC/ES-MS in full-scan mode. The dependence of the ion signal intensities on proton concentration in the mobile phase was investigated with a view to optimizing the sensitivity of the ES-MS detector. When LC/ES-MS was used, the limit of detection, calculated from extracted-ion current profiles (EICPs), was 4-7 ng/L for ground-water and 9-13 ng/L for river water. (b) Soil sample analysis utilized combined soil column extraction (SCE) and off-line solid phase extraction (SPE) for sample preparation, analyzing with LC/ES-MS under selected ion monitoring (SIM). Several different extractants were evaluated for the purpose of SCE optimization. The system that best optimizes the extractability IMIs from the soil was found to be the mixture CH3OH/(NH4)2CO3 (0.1 M, 50:50 v/v). The effect of IMI concentration in the matrix on recovery was evaluated. The total recovery of each IMI from soil at each of the two levels investigated ranged from 87% to 95%. Under three ion SIM conditions, the limit of detection (S/N = 3) was 0.1-0.05 ng/g in soil samples.

Percept-genesis of the mother-child separation theme among panic and asthma patients

A stimulus portraying a mother figure who is leaving a baby alone on the floor (Separation Theme) was presented tachistoscopically at increasing exposure times, according to the method of the Defense Mechanism Test, to three sex-matched groups of 31 normal subjects, 31 patients with bronchial asthma, and 31 patients with Panic Disorder and Agoraphobia. The frequency of several codings was significantly higher in both clinical groups compared with normal controls. Asthma patients were characterized by reports of the child seen as a statue and of contact or fusion between mother and child. Agoraphobic patients employed different strategies, centered on the mother rather than on the child and mainly represented by the denial of mother's action, e.g., she is not leaving, she is entering. The findings support the hypothesis of a difference in defensive organization between neurotic and psychosomatic patients.

Characterization of specific corticosterone binding sites in adrenal cortex plasma membrane and their localization by autoradiographic studies

Specific corticosterone binding to calf adrenal cortex plasma membrane was measured using the biologically active radioligand [3H]corticosterone. Corticosterone binding was found to be time-dependent, saturable and reversible, and was reduced by more than 70% when membranes were pretreated with proteases. The population of corticosterone binding sites in calf adrenal cortex plasma membrane was homogeneous and displayed the following characteristics: equilibrium dissociation constant Kd = 77 +/- 8 nM and maximum specific binding capacity Bmax = 70,378 +/- 6,385 fmol/mg protein. The relative affinities of several structural analogues of steroids were deduced from competition assays. From these experiments we can conclude that the plasma membrane binding site characterized is selective for corticosterone and progesterone derivatives, and different from nuclear glucocorticoid, mineralocorticoid, estrogen and progestin receptors. Likewise, this corticosterone binding site is independent of mineralocorticoid and Na+, K(+)-ATPase digitalis receptors. From autoradiographic studies we suggest these corticosterone binding sites are located in the whole adrenal cortex.

Apoptosis is coordinately regulated with osteoblast formation during bone healing

The ultimate fate of the expanded pool of osteoblasts formed following a typical bone injury is unclear. Since necrosis has not been described in the latter stages of bone healing, there must be some other mechanism by which obsolete osteoblasts are cleared from an injury site. We therefore evaluated the possibility that their removal is pre-programmed, by investigating the occurrence of apoptosis in rats that received a standardized bone injury. Histological evidence identical to that found in tissues known to exhibit apoptosis was obtained, thereby showing that programmed cell death was a normal concomitant of fracture healing. The concentration of apoptotic bodies reached its maximum after the differentiative response had peaked, suggesting that the two processes were coordinated. The same result was found in a second group of rats that received the same bone injury plus a simultaneous standardized soft-tissue injury. The combined injuries resulted in more osteoblasts and more apoptotic bodies, but an identical temporal relationship between the peak responses in the two parameters. The results suggested that osteoblasts were removed from the injury site via apoptosis, and that the process was coordinately regulated with differentiation. Since the number of apoptotic bodies per osteoblast varied during healing, it is likely that apoptosis was associated with healing and not merely with osteoblast concentration.

Parvovirus B19 infection and rheumatic diseases

We reviewed the literature on relationships between human parvovirus B19 infection and rheumatic diseases. Parvovirus B19 causes erythema infectiosum in childhood, transient anemia in immunocompetent individuals, and potentially severe infections in fetuses; laboratory evidence that the virus is directly responsible for these disorders has been obtained. Acute arthropathy meeting American College of Rheumatology criteria for rheumatoid arthritis and disorders meeting some of the classification criteria for systemic lupus erythematosus are the most striking rheumatic manifestations of parvovirus B19 infection. Purpuric lesions have also been reported. Parvovirus B19 infection may be capable of inducing a number of manifestations that have not yet been described in the literature. Although the relationship between human parvovirus B19 infection and rheumatic diseases has been the focus of many studies, compelling evidence that the virus is directly involved in the pathogenesis of rheumatic diseases has not yet been obtained.

Study of nonspecific cation channel coupled to P2z purinergic receptors using an acid load technique

The intracellular pH (pHi) of rat submandibular cells was measured by 2',7'-bis(carboxyethyl)-5(6)-carboxyfluorescein (BCECF). The cells recovered from ammonium (30 mM) prepulse to their resting pHi within 10 min. Ethylisopropylamiloride (EIPA), an inhibitor of the Na+/H+ exchanger, slows the rate of pHi recovery. ATP (1 mM), in the presence of EIPA, increases the rate of recovery 3.7-fold in the absence or presence of ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid. The recovery was blocked by the addition of 5 mM Mg2+ or 10 microM Coomassie blue. The response was elicited by 2'- and 3'-O-(4-benzoylbenzoyl)-adenosine 5'-triphosphate but not by ADP, UTP, adenyl (beta-gamma-methylene)-diphosphonate, 2-methylthioadenosine 5'-triphosphate, or muscarinic or beta-adrenergic agonists. The purinergic response was also observed when the cells were acidified by sodium propionate and could not be mimicked by the depolarization of the plasma membrane. Aluminum fluoride did not reproduce the response to ATP, suggesting that the observed response does not involve a high-molecular-weight GTP-binding protein. It is concluded that the activation of P2z receptors, probably by the opening of nonspecific cation channels, increases the permeability to protons in rat submandibular glands.

Delayed gastric emptying: a novel gastrointestinal finding in Turner's syndrome

AIM

To evaluate gastric emptying in girls with Turner's syndrome to detect if gastrointestinal motor dysfunction was present.

SUBJECTS

Thirteen girls (mean age 8.1 years) with Turner's syndrome, seven girls with familial short stature (6.1 years), and eight control girls (7.6 years).

METHODS

Gastric emptying studies were performed by using 500 microCi of technetium 99m-sulphur colloid bound to a scrambled egg, and scintigraphic measurements were made for 60 to 90 minutes.

RESULTS

Mean (SD) percentage retention of gastric isotope was significantly greater in girls with Turner's syndrome than in children with short stature and in controls. Furthermore, in contrast with control subjects, in whom there was an inverse linear relationship between gastric emptying rate and body mass index, in children with Turner's syndrome the delay in gastric emptying was independent of the body mass.

CONCLUSIONS

The results of the study suggest that delayed gastric emptying is detectable in girls with Turner's syndrome independent of age, body mass index, karyotype, and growth promoting treatment.

Purification of a cortisol binding protein from hepatic plasma membrane

A cortisol binding protein from rat liver plasma membranes has been solubilized in active form by using the zwitterionic detergent CHAPS. Two types of binding sites have been characterised in both native and solubilized membranes. The first is of high affinity and low binding capacity (12 nM; 946 fmol/mg) and the other one is of low affinity and high capacity of binding (344 nM; 12677 fmol/mg) for solubilized membranes. The purified material retained a binding activity comparable to that displayed by the original membrane. The specific binding activity was enriched about 12700-fold, with an 8% yield. Analysis of the purified preparation on sodium dodecyl sulphate-polyacrylamide gel electrophoresis showed two protein subunits with molecular mass of 52000 and 57000 Da. The new cortisol-specific binding membrane protein could be related to the nongenomic effects previously described for this hormone.

Low affinity purinergic receptor modulates the response of rat submandibular glands to carbachol and substance P

The effect of extracellular ATP on the intracellular calcium concentration ([Ca2+]i) in rat submandibular glands was tested. The dose-response curve for ATP was biphasic with a first increase in the 1-30 microM concentration range and a further increase at concentrations higher than 100 microM. Among ATP analogs, only benzoyl-ATP stimulated the low affinity component. ATP tau S blocked this response. All the other analogs tested reproduced the high-affinity low capacity response. Magnesium and Coomassie blue selectively blocked the low affinity component. High concentrations of ATP blocked the increase of the intracellular calcium concentration [Ca2+]i in response to 100 microM carbachol. By itself, substance P (100 pM-1 microM) increased the [Ca2+]i. One mM ATP potentiated the response to concentrations of substance P higher than 10 nM. This potentiation was reversed by extracellular magnesium. Carbachol 100 microM and substance P (100 pM-1 microM) increased the release of inositol trisphosphate (IP3) from polyphosphoinositides (polyPI). Activation of the low affinity ATP receptors did not activate the polyPI-specific phospholipase C but inhibited its activation by 100 microM carbachol (-50%) and by 100 nM substance P (-60% at 1 nM substance P and -40% at 100 nM substance P). Substance P induced a strong homologous desensitization: a preincubation with 1 nM substance P nearly completely abolished the response to 1 microM substance P. When the cells were exposed to ATP before the second addition of substance P, the purinergic agonist partially restored the response to the tachykinin without totally reversing the desensitization. It is concluded that two types of purinergic receptors coexist in rat submandibular glands; a high-affinity, low capacity receptor which remains pharmacologically and functionally undefined and a low affinity site, high capacity receptor of the P2z type coupled to a non-selective cation channel. The occupancy of these low affinity sites blocks the increase of the [Ca2+]i in response to a muscarinic agonist and the activation of polyPI-specific phospholipase C by carbachol and substance P. It potentiates the effect of high concentrations of substance P on the [Ca2+]i.

Thrombin-stimulated phospholipase C activity is inhibited without visible delay by a rapid increase in the cyclic GMP levels induced by sodium nitroprusside

Different drugs that elevate the cGMP levels inhibit the agonist-induced platelet activation. The mechanisms of action of cGMP probably include inhibition of both phospholipase C and the increase in intracellular Ca2+ concentration, and these effects seem to be mediated by cGMP-dependent protein kinases. However, in most studies, cells were preincubated with nitrovasodilators before stimulation. The effect of the preincubation with sodium nitroprusside before stimulation or the simultaneous addition of sodium nitroprusside and thrombin has been compared. The simultaneous addition of sodium nitroprusside and thrombin was able to inhibit without any significant delay the platelet aggregation. This rapid effect was correlated with an inhibition of both the maximum increase in intracellular Ca2+ concentration and the phospholipase C activity. Also, the simultaneous addition of sodium nitroprusside and thrombin clearly accelerated the decline in the Ca2+ signal, which was not observed in platelets preincubated with sodium nitroprusside. The rapid inhibition induced by sodium nitroprusside was correlated with a rapid and significant increase in the cGMP levels and reversed when platelets were pretreated with methylene blue. The inhibitor of cAMP-dependent protein kinase Rp-8-(4-chlorophenylthio)-adenosine-3',5'-cyclic monophosphorothioate was able to abolish nearly completely the inhibitory effect induced by sodium nitroprusside independent of the protocol used. Thus, the rapid inhibition induced by sodium nitroprusside seems to be induced by a rapid phosphorylation-dependent mechanism. In addition, both cGMP- and cAMP-dependent protein kinase seem to be involved; however, the cAMP-dependent protein kinase seems to be more important.

Cisapride in neurologically impaired children with chronic constipation

The efficacy of cisapride as a treatment for chronic constipation in children with severe brain damage was studied in 20 children. Each subject was randomly assigned to double-blind treatment with either cisapride (N = 10) or placebo (N = 10) for 12 weeks. Stool habits, total gastrointestinal transit time, colonic segmental transit times, and anorectal motility were evaluated in all children before and at the end of the treatment period. Although cisapride significantly (P < 0.05) increased stool frequency from baseline to week 12 and no significant change was documented in the placebo group, the mean change in stool frequency per week from baseline to 12 week was not significantly different between the two treatment groups. The use of laxatives or suppositories was significantly (P < 0.05) decreased by cisapride, but remained unchanged in the placebo group. Furthermore, cisapride significantly (P < 0.05) reduced rectal compliance but had no effect on total gastrointestinal transit time and colonic segmental transit times. In summary, in neurologically impaired children with chronic constipation, cisapride increased bowel frequency but did not alter the delay in total and segmental gastrointestinal transit times.

Can surgical gloves be made thinner without increasing their liability to puncture?

A new process has been used to develop Biogel Super-Sensitive gloves which are thinner but theoretically as strong as standard Biogel gloves. The two types of glove were compared for their effects on manual sensitivity and dexterity in a randomised controlled trial. The Super-Sensitive gloves impaired sensitivity significantly less than standard gloves but made no difference to the ability to tie knots. No statistically significant difference was shown in the resistance to perforation between the two types of gloves. Surgeons who prefer more sensitive but relatively strong gloves should find the new gloves useful.

ENZEDUC 1.0: a user-friendly software package for computation of hyperbolic enzyme kinetic data in biochemical education

ENZEDUC 1.0 is a software package developed in Microsoft QuickBASIC v7.1 for computation of hyperbolic enzyme kinetics. The educational focus of the package is laboratory practical teaching. The program can manage a maximum of 18 substrate concentration values and 72 reaction rate values for each substrate concentration (1296 pairs of values). Samples can also be of unequal sizes. More than one reaction rate value for each substrate concentration can be handled. Real-time screen plots are obtained for the Michaelis-Menten function and the most popular linear transformations. Printer outputs are available. Hardware requirements are minimum 640 Kb RAM, EGA graphics card and 80286 processor.

[Hemorrhage caused by rupture into the duodenum of aneurysm of a branch of the pancreaticoduodenal artery (posterior superior or retroduodenal pancreaticoduodenal artery)]

A case of serious haemorragic shock caused by the rupture into the duodenum of a septic aneurysm of the pancreatic-duodenal artery is reported. The diagnostic difficulties and the need to carry on "blind" laparotomies, in these cases, are underlined.

Detection of immunoglobulin G to a Sindbis-related virus by a membrane antigen enzyme immunoassay

We determined the seroprevalence of a Sindbis-related virus isolated for the first time in 1975 from ticks in south-east Sicily and typed by Gresikova et al. in 1978. An indirect enzyme immunoassay based on viral membrane antigen for coating microtiter strips was used for the detection of immunoglobulin G to the Sindbis-related virus. The method appeared more sensitive than a similar enzyme immunoassay based on crude lysate antigen. Comparison of the results obtained from sera tested both by membrane antigen enzyme immunoassay and microneutralization test showed 92% agreement, while the agreement between microneutralization test and crude antigen enzyme immunoassay was 76%. An overall elevated seroprevalence (63.66%) was found in a population group living in and around the area of first isolation and seroprevalence in different age groups was also studied.

Determination of serum total lipid and free N-acetylneuraminic acid in genitourinary malignancies by fluorimetric high performance liquid chromatography. Relevance of free N-acetylneuraminic acid as tumour marker

The reliability of total sialic acid (TSA), lipid sialic acid (LSA) and free sialic acid (FSA) as markers in genitourinary malignancies was evaluated in 20 normal subjects, 21 patients with prostatic cancer, 22 patients with urinary bladder cancer and 14 patients with renal cell carcinoma. We introduce the new concept of 'corrected' lipid sialic acid (CLSA), which expresses the actual concentration of sialic acid bound to glycolipds by subtracting the concentration of FSA determined by a novel ultrafiltration method. TSA did not show significant differences with respect to normal controls, except for renal cell carcinoma, whose mean value (879 +/- 145 micrograms/ml) showed a P value < 0.001. Instead, CLSA showed only significant differences (P = 0.001), with respect to normal controls in stage I and in all grades of renal cell carcinoma. While all data indicated significant increases (P = 0.001) in the FSA values, (means +/- S.D.) of 0.621 +/- 0.272 micrograms/ml were found in patients with prostatic cancer, 0.796 +/- 0.443 micrograms/ml in patients with urinary bladder cancer and 0.667 +/- 0.146 micrograms/ml in patients with renal cell carcinoma. Separate TSA and CLSA measurements appeared to be of limited value in the detection of genitourinary malignancies. However, results show that FSA was the most sensitive of the three markers tested for detecting malignancies.

Correlation of serum sialic acid fractions as markers for carcinoma of the uterine cervix

Serum total sialic acid (TSA) and lipid-bound sialic acid (LSA) levels have aroused considerable interest as markers of malignancy. FSA (Free Sialic Acid) has not been considered as a potential tumor marker due to a lack of sensitivity of the methods used in the studies performed up to now. The present investigation determined the TSA, CLSA (Corrected Lipid Sialic Acidi) and FSA values for 20 normal females, 10 patients with benign gynecological disease and 32 patients with various stages of carcinoma of the uterine cervix. Data analysis indicated significant (0.01 < P < 0.05) increases of TSA value only in the mean values (671 +/- 126 micrograms mL-1) in stage II A of carcinoma of the uterine cervix when compared to normal controls (mean 534 +/- 102 micrograms mL-1). It showed, instead, significant (0.01 < P < 0.1) increases of CLSA values only in the mean values (6.41 +/- 1.32 micrograms mL-1) found on stage I B of carcinoma of the uterine cervix when compared to normal controls (mean 5.33 +/- 1.50 micrograms mL-1). In the case of FSA significant differences were found with respect to normal controls (mean 0.316 +/- 0.081 micrograms mL-1) in all stages of carcinoma of the uterine cervix. The mean values found were 0.485 +/- 0.118 micrograms mL-1 (0.001 < P < 0.01) in patients with stage I A, 0.666 +/- 0.176 micrograms mL-1 (P < 0.001) in patients with stage I B and 0.572 +/- 0.164 +/- micrograms mL-1 (0.001 < P < 0.01) in patients with stage II A. TSA and CLSA separated measurements appeared to be of limited value in the detection of carcinoma of the uterine cervix. However, results show that FSA was the most sensitive of the three markers tested for detecting malignancies.

Biochemical changes induced by pyrphenoxone in the lens of rabbits and rats

The xanthomatine analogue, pyrphenoxone, which is known to diminish the incidence of cataract in animals and in man, was applied in two different in vivo models of cataract induced in rabbits by tryptophan-free dietary regimen and in rats by hypergalactosemic diet. The drug was also applied at different concentrations in an in vitro model of cataract. It was found that soluble proteins and sulphurated amino acids of the lens in all in vivo and in vitro models of cataract were higher after pyrphenoxone was applied. Furthermore, the drug treatment was followed by a dose-dependent increase in reduced glutathione content in the lens of rabbits and rats. The same was found in the in vitro model of cataract. These results suggest that pyrphenoxone may act by inducing various biochemical changes that lead to a protection of lens against oxidative processes.

Detection of immunoglobulin G to measles virus, rubella virus, and mumps virus in serum samples and in microquantities of whole blood dried on filter paper

Immunity to measles virus, rubella virus, and mumps virus was determined by EIA in serum samples and in dried whole blood specimens spotted on Whatman filter paper (5 mm in diameter). Both specimens were obtained from each patient by venepuncture and finger prick. Ten microliters of whole blood is enough to detect antibodies to these three different viruses. The comparison of the results obtained by EIA from 227 serum and whole blood samples have demonstrated close agreement: 98.6% for measles virus, 99.1% for rubella virus, and 96.0% for mumps virus. Moreover, 96 whole blood samples can be tested in a microtiter plate and can be stored at room temperature for 15 days or at +4 degrees C for several months. Therefore, whole blood dried on filter paper is a convenient alternative method for collecting and transporting specimens, it is easier and safer than venepuncture, and could be used for large-scale epidemiological studies, especially in newborns. This method could solve the problem of sampling, especially in young children, and could simplify studies of vaccine efficacy.

[Efficiency of utilization of resources used at a polyvalent intensive care and resuscitation center]

Along the lunes of a survey by GIRTI of 2,710 patients hospitalized in the 14 costituing CRTI, a parallel research has been carried out 350 patients in a polyvalent CRTI in order to compare the results. Omega score has been calculated to evaluate the intensity of the supplied treatment and consequently to settle efficiency of the resources. The results show a greater number of treated patients compared to those only monitored for intensive examination and a majority of patients from medical and surgical departments, compared to those from traumatological dpts. This proves that the intensity of treatment depends significantly and progressively on the diagnosis, seriousness and, above all, duration of hospitalization, with the only difference that more resources were needed for those patients who died than for those survived. Despite the coincidence of the quality of the results, this survey diverges from that of GIRTI as far as the quantity of utilized resources, which were about a half of those reported in their survey. This is probably due to the lack of medical and particularly nursing personnel as well as instruments especially monitoring ones, which prevented CRTI from working at its maximum. Then it has been pointed out that some pathologies (extrahospital cardiac arrest and pulmonary embolism) which caused losses of the utilized resources, could improve by creating Emergency and Urgency Departments.(ABSTRACT TRUNCATED AT 250 WORDS)

Dexamethasone-dependent modulation of human lymphoblastoid B cell line through sphingosine production

The relationship between dexamethasone-dependent changes in intracellular sphingosine levels, energy and phospholipid metabolism have been investigated by 31P-NMR spectroscopy and high-performance liquid chromatography. The cellular functions have been evaluated by cellular growth and immunoglobulin M secretion (IgM). Significant increases in intracellular phosphorylcholine (PCho), extracellular choline (Cho), and endogenous sphingosine levels were observed only at 30 min incubation with dexamethasone. These results confirmed a sphingosine-dependent hydrolysis of choline-linked phospholipids (Miccheli, A., Ricciolini, R., Piccolella, E., Delfini, M. and Conti, F. (1991) Biochim. Biophys. Acta 1093, 29-35). Furthermore, no significant variations were evidenced at hours 1, 2, 6 and 18 of incubation. Dexamethasone causes an inhibition of cellular growth and IgM secretion as well as the sphingosine treatment. The results suggest that the effect of dexamethasone may be mediated by endogenous sphingosine production in Epstein-Barr virus transformed B lymphocytes.

Aniracetam improves behavioural responses and facilitates signal transduction in the rat brain

The effect of aniracetam (10, 50, 100 mg/kg i.p. daily for 15 days) on both behavioural and biochemical parameters was investigated in the adult rat. Animals given aniracetam (50 mg/kg 1 h before the trial) showed a significant increase in the percentage of conditioned active avoidance responses and a reduction of latency times. Aniracetam significantly counteracted the scopolamine-induced memory failure at the passive avoidance (step down) test, while it did not modify the locomotion of the animals. In purified frontocortical and hippocampal synaptic membranes of rats treated with aniracetam (50 mg/kg i.p. daily for 15 days) a potentiation of basal, carbamylcholine-, dopamine- and norepinephrine-stimulated adenylyl cyclase activity was observed, while forskolin-stimulated enzyme activity was not modified. With regard to inositol phosphate production measured in fronto-cortical synaptoneurosomes, aniracetam potentiated the stimulation by angiotensin II, while the stimulation by carbamylcholine, not affected by 10 and 50 mg/kg aniracetam, was notably, although not significantly, decreased by 100 mg/kg aniracetam. Furthermore, in synaptosomes derived from hippocampus, aniracetam (50 mg/kg i.p. daily for 15 days) caused an increase of both basal and K(+)-stimulated intrasynaptosomal Ca(2+) concentration. In conclusion, a correlation between the improvement of behavioural performance and the modulation of transducing systems by aniracetam seems to take place in brain areas, such as frontal cortex and hippocampus, known to play a major role in the control of cognitive functions.

A hydrolysis method using microwaves: determination of N-acetyl- and N-glycolylneuraminic acids in biological systems by fluorometric high-performance liquid chromatography

A simple, rapid, and extremely sensitive method for determining N-acetyl- and N-glycolylneuraminic acids in serum and in submandibular, sublingual, and parotid glands using high-performance liquid chromatography with a fluorometric detector is described. The neuraminic acids contained in the samples are released in the presence of 2 M CH3COOH by means of microwave hydrolysis (only 10 min required) and are subsequently converted using 1,2-diamino-4,5-methylenedioxybenzene, a fluorogenic reagent for alpha-ketoacids, into highly fluorescent derivatives. In order to optimize the release of sialic acids and to minimize the effect of destruction, the following analytical variables were investigated: temperature, time, and concentration of the acid. Within 12 min after derivatization, the compounds were separated on a reversed-phase column by means of isocratic elution using a mobile phase of water (pH 3 with H3PO4)-methanol-acetonitrile (86:6:8, v/v). Fluorescence detection was performed at an excitation wavelength of 373 nm and an emission wavelength of 448 nm.

Surfactant-modified graphite surfaces in biological analysis: ionic strength and ion charge effects

Previous work with rough pyrolytic graphite and glassy carbon electrodes demonstrated that surfactant assembly at these two structurally and chemically different surfaces was similar, with surfactants adsorbing head on. Improvement in response of biological molecules was attributed to the formation of a dynamic, renewable surface. Furthermore, surfactants provided a favorable hydrophobic-hydrophilic environment for the response of selected catechols. Surfactants could also be used to control selectivity if needed. In this work ionic strength and cation charge effects on response of catechols in surfactant solutions are investigated. The results illustrate the relative importance of electrostatic and hydrophobic interactions at graphite to the response of probes with combined hydrophobic and hydrophilic properties. Furthermore, the results show that although catechol-surface interactions are significantly affected by ionic strength and electrolyte charge, surfactant-surface and surfactant-probe interactions are not significantly affected, indicating that surfactants serve as an effective ionic buffer. The results presented here indicate that surfactant assembly at the surface is best at low ionic strength. These results also verify the importance of a favorable hydrophobic and hydrophilic environment to catechol response which can be provided by the surfactants when needed.

Ni2+ impairs thrombin-induced signal transduction by acting on the agonist and/or receptor in human platelets

We have investigated the effect of NiCl2 on platelet activation induced by thrombin, phorbol 12-myristate 13-acetate, and calcium ionophores. Besides blocking Ca2+ influx, NiCl2 inhibited platelet aggregation, intracellular Ca2+ mobilization, and phospholipase C activation induced by thrombin in a dose-dependent manner. In contrast to ionomycin, NiCl2 completely blocked the platelet aggregation and intracellular Ca2+ mobilization induced by A23187. A23187 was not able to translocate Ni2+ across the plasma membrane. Ni2+ also inhibited phorbol myristate acetate-induced platelet aggregation. The results with staurosporine and low NiCl2 concentrations are in agreement in that increases in intracellular Ca2+ concentration and protein kinase C activation are necessary for full platelet activation mediated by thrombin.

[Alcoholism. Aspects of its pharmacology, clinical picture and therapy]

In every age and culture, people have had to distinguish between positive and negative consequences of the use of psychoactive substances. Since the ancient times it was known that alcohol, easily available in wide quantities, could facilitate social contacts. The abuse and the addiction represent, on the other hand, a complicated social phenomenon and are the expression of physiological adaptive mechanisms brought to the extreme point. The high level of diffusion and the complexity of these problems made it necessary to create diagnostic classifications to classify illnesses on the basis of definite and reliable principles, with the main goal of obtaining therapeutic progress. The consequences of alcohol abuse are both physical and psychic, thus therapeutic approaches must take into account these two points. Some pharmacological agents may lead to cross-tolerance with alcohol and, besides, they are not necessary in case of a slight abstinence where brief psychotherapies are sufficient. Recent advances in the knowledge of the mechanisms which underlie alcohol addition suggest approaches particularly aimed to correct imbalances of neurotransmitters that can determine addiction. Among these, GHB acid seems to be particularly important. At the end, on the basis of the latest progress in psycho-immunopharmacology, the relationships between alcohol and disease are considered.

Effect of acetyl-L-carnitine treatment on brain adenylate cyclase activity in young and aged rats

The aim of the present study has been to evaluate the effect of acetyl-L-carnitine (ALCAR) on brain adenylate cyclase (AC) activity in adult and aged rats. In in vitro studies, ALCAR (1, 10 and 100 microM) did not exert any effect on frontal cortex basal AC activity. Acute and subchronic administrations of ALCAR were carried out in 4- and 25-month-old male Fisher rats and AC activity was determined in rat frontal cortex under both basal and stimulated conditions. The acute treatment of young rats with ALCAR (100 and 500 mg/kg s.c.) did not affect AC activity, whereas the subchronic administration of 250 mg/kg s.c. ALCAR enhanced the stimulation of AC by carbamylcholine (CCh), norepinephrine (NE) and dopamine (DA), without affecting the basal AC activity. Basal AC activity in old rats was lower than in young rats and was not modified by acute and subchronic ALCAR administration. Moreover, the response of the enzyme to CCh, NE and DA was potentiated by the subchronic administration of ALCAR. The concentration-response curve of CCh stimulation of AC activity in ALCAR-treated rats is shifted to the left in both young and aged rats. We conclude that ALCAR, subchronically administered, is able to enhance receptor-stimulated AC response in frontal cortex of both young and aged rats.

[Plasmapheresis and high-dose immunoglobulins in the treatment of acute demyelinating polyneuropathy]

The authors report two clinical cases of Guillain-Barré syndrome, treated with contemporaneous use of plasmapheresis and high dose gammaglobulin. An early diagnosis and immediate application of such a therapeutic association, are of paramount importance in order to obtain remission of the neurologic symptomatology within a short time. They report the therapies carried out to avoid complications connected with this syndrome as well as cause which led to quit steroid use in these patients.

Seroprevalence to some TORCH agents in a Sicilian female population of fertile age

The seroprevalence to Toxoplasma gondii (41.1%), rubella virus (88.2%), cytomegalovirus (86.0%), and herpes simplex virus (80.0%) has been evaluated in fertile women living in Catania (Sicily). The population group studied was divided into four age groups to quantify the risk of primary infection in each age group.

[Anxiety and the mechanisms of action of anxiolytics]

Anxiety disorders are widely present in general population. Epidemiology studies evaluated a 5-10% prevalence of these disorders, whose social impact needs an early diagnosis and an adequate treatment. In recent years, behavioural, neurochemical and pharmacological researches allowed the characterization of several types of pathological anxiety and a new consideration of nosography in order to establish a correct treatment. In particular, a remarkable progress of the knowledge of biological bases of anxiety resulted from study of anxiety animal models and of mechanisms of action of anxiolytic drugs. On this regard mechanism involving GABAergic, serotoninergic and cholecystokininergic were suggestive.

Modulation by GTP of basal and agonist-stimulated striatal adenylate cyclase activity following chronic blockade of D1 and D2 dopamine receptors: involvement of G proteins in the development of receptor supersensitivity

Rats receiving injections of specific antagonists of dopamine receptors (SCH 23390 for D1, haloperidol for D2, and haloperidol+SCH 23390) once daily for 21 days develop a selective supersensitivity of the blocked receptors. To study the molecular correlates of these adaptive changes, we evaluated the involvement of GTP-binding proteins in the development of supersensitivity of dopamine receptors. By means of adenylate cyclase studies, we tested whether any of the treatments modified the functional response to GTP in striata dissected from control and treated rats. Our data show that the chronic blockade of D1 and/or D2 receptors potentiates both basal and dopamine receptor-stimulated adenylate cyclase activity in response to GTP. D1 receptor up-regulation correlates with an increased adenylate cyclase response to GTP, whereas D2 receptor up-regulation is accompanied by an enhanced GTP-induced inhibition of enzyme activity, in both basal and receptor-activated conditions. This potentiation does not seem to match the changes in mRNA content of Gs and Gi alpha subunits. Unexpectedly, however, a significant increase in Gi alpha subunit mRNA was found after the chronic blockade of D1 receptors; this result could be explained by cross-regulation between GTP-binding protein-mediated pathways. This cross-regulation could serve as a protective mechanism whereby cells exposing up-regulated receptors protect themselves from a condition of hyperactivity of the adenylate cyclase enzyme.

Molecular mechanisms mediating the effects of L-alpha-glycerylphosphorylcholine, a new cognition-enhancing drug, on behavioral and biochemical parameters in young and aged rats

The behavioral effects of the acute and subchronic administration of L-alpha-glycerylphosphorylcholine (alpha-GPC) on passive and active avoidance behavioral tasks were investigated. When administered IP after training together with scopolamine 2 h before retest, alpha-GPC reverses the scopolamine-induced amnesia in the passive avoidance conditioning in young and old rats. Furthermore, the subchronic treatment with alpha-GPC positively and significantly influences the performance of both young and old animals in the active avoidance test. Moreover, in in vitro/ex vivo experiments alpha-GPC potentiates receptor-stimulated phosphatidylinositol hydrolysis in cortical synaptoneurosomes derived from young and old animals. In young but not old animals, alpha-GPC significantly potentiates potassium (40 mM)-stimulated intrasynaptosomal calcium oscillations in purified synaptosomes derived from the hippocampus. These results show that alpha-GPC improves the performance of animals in both active and passive conditioning tasks. Furthermore, subchronic treatment with the compound enhances in young and restores in aged animals the transduction of the signal, namely, the receptor-mediated production of inositol phosphate and the potassium-induced calcium mobilization. These modifications may represent at least part of the molecular mechanism of action of the compound.

[Multiorgan damage in exertion heatstroke]

The paper reports a fatal case of exertion heat stroke. The etiopathogenetic, clinical and therapeutic aspects of the case are described; although rarely observed, this pathology must be taken into account by the intensive care unit in order to ensure rapid aid and treatment in an attempt to modify the severe prognosis due to multiorgan damage which increases with the intensity and duration of hyperthermia.

[Update on benzodiazepines]

The Authors shortly review the benzodiazepine (BDZ) pharmacology and therapeutic. They start from the supposed mechanism of action, then the main indications, counterindications and side effects are reported. Finally, the pharmacokinetic and general classification of the drugs are examined.

Intracellular Ca2+ mobilization and not calcium influx promotes phorbol ester-stimulated thromboxane A2 synthesis in human platelets

Phorbol esters, potent activators of protein kinase C (PKC), greatly enhance the release of arachidonic acid and its metabolites (TXA2, HETES, HHT) by Ca2+ ionophores in human platelets. In this paper, we report the relationship between intracellular Ca2+ mobilization and external calcium influx into platelets and the ability of PMA plus A23187 to promote thromboxane A2 (TXA2) synthesis. The enhanced levels of TXA2 due to the synergistic stimulation of the platelets with A23187 and phorbol esters are not affected significantly by the presence of external Ca2+ or the calcium-chelator EGTA. PKC inhibitors, staurosporine and sphingosine, abolished phorbol myristate acetate (PMA) potentiation of TXA2 production which strongly supports the role of PKC in the synergism. Platelet aggregation is more sensitive to PMA and external calcium than TXA2 formation. PMA increased TXA2 production as much as 4-fold at low ionophore concentrations. The A23187-induced rise in [Ca2+]i was reduced by pretreatment of human platelets with phorbol esters, both in the presence and absence of EGTA, and staurosporine reversed this inhibitory effect. These results indicate that the synergistic stimulation of TXA2 production by A23187 and phorbol esters is promoted by intracellular Ca2+ mobilization and not by external calcium influx. Our data also suggest that PKC is involved in the regulation of Ca2+ mobilization from some specific intracellular stores and that PKC may also stimulate the Ca(2+)-dependent phospholipase A2 at suboptimal Ca2+i concentrations.

Electrical states in the rabbit brain can be altered by light and electromagnetic fields

The effect of low-frequency magnetic fields on the rabbit electroencephalograph (EEG) was studied using a quantitative procedure that permitted statistical evaluation of the response of individual animals. The field conditions used were those predicted by various theories to result in field-animal interactions; light and sham exposure were employed as positive and negative controls, respectively. Sixty-seven percent of the rabbits exhibited changes in the EEG power spectra when light was presented in 2-s epochs; none of the animals responded to sham exposure. When 1 Gauss, 5 Hz, was presented in 2-s epochs, 100% of the animals tested responded to the presence of the field. The rabbits did not respond when the magnetic-field frequency was higher than the physiological range (1-20 Hz) or when it was tuned for resonance of K+. The results showed that an electrical state function may be operationally defined for the rabbit brain, and used to assess the occurrence of an interaction between an animal and external magnetic fields.