Controlled transdermal delivery of fentanyl: characterizations of pressure-sensitive adhesives for matrix patch design

Transdermal delivery of fentanyl from various adhesive matrix formulations to achieve a steady-state skin flux was investigated. For this purpose, various pressure-sensitive adhesives selected from the three chemical classes of polymers (polyisobutylene (PIB), acrylate, and silicone adhesives) were characterized with respect to fentanyl's solubility, diffusion coefficient, and permeability coefficient. The solubility of fentanyl in various pressure-sensitive adhesives at 32 degrees C was determined by the drug absorption-desorption method. The solubilities of fentanyl in these adhesives were in the following order: acrylate > silicones > PIB. The permeability coefficient and diffusion coefficient of fentanyl in these adhesives were determined by the membrane diffusion method. The diffusion coefficient rank order was silicone-2920 > silicone-2675 > or = acrylate > PIB. The release profiles of fentanyl in the aqueous buffer from these adhesives with 2-4% drug loading was evaluated. The release rate of fentanyl from the acrylate polymer was significantly higher than those of silicone and PIB adhesives. The in vitro flux of fentanyl through cadaver skin from various adhesives with 2% drug loading was determined at 32 degrees C using modified Franz diffusion cells. The skin fluxes of fentanyl from silicone-2920 and PIB adhesives were 6.3 +/- 0.7 and 3.1 +/- 0.3 micrograms/cm2/h, respectively. On the other hand, the skin fluxes of fentanyl from acrylate and silicone-2675 adhesive matrices were about 1 microgram/cm2/h. The effect of drug loading on skin flux was investigated using PIB as a model adhesive. The drug released in the phosphate buffer (pH = 6.0) increased linearly as the drug loading in the PIB was increased from 1% to 4%; and as the drug loading exceeded 4%, an initial burst effect followed by a zero-order release was observed. The skin flux of fentanyl increased proportionally as the drug loading in the PIB adhesive was increased from 1 to 4%, and a plateau was reached beyond 4% drug loading. These results suggest that fentanyl concentration in the PIB adhesive might have reached saturation above 4% drug loading and that the optimum skin flux was accomplished from such a system because of attainment of maximum thermodynamic activity.

Epidemiology of HTLV-I infection in Spain. HTLV Spanish Study Group

BACKGROUND

The human T-lymphotropic virus type I (HTLV-I) has been implicated in the genesis of tropical spastic paraparesis (TSP), adult T-cell lymphoma (ATL), and some cases of uveitis, subacute arthropathies, chronic dermatitis and lymphocytic alveolitis. The virus is endemic in some areas of the Caribbean basin, Japan, subSaharan Africa, Central and South America, Middle East and Melanesia. Given that HTLV-I is transmitted through similar ways to HIV, screening in blood donors is recommended in some countries.

MATERIALS AND METHODS

The clinical, epidemiological and virological characteristics of 27 patients with HTLV-I infection were identified in Spain up to September 1995.

RESULTS

Eighteen cases were Spanish natives and 9 were immigrants from endemic areas. Fifteen were male and 12 were female. The majority (12/18; 66.7 percent) of subjects born in Spain had resided in endemic areas or had had sexual partners from these regions. Four patients had TSP, three had ATL and one developed lymphomatous granulomatosis and T-cell lymphoma. The remaining HTLV-I subjects were asymptomatic at the time of diagnosis. Four cases were identified from screening of blood donors.

CONCLUSION

HTLV-I is present in Spain, affecting natives and, less frequently, immigrants from endemic areas. Both neurological and lymphoproliferative diseases have been recognized in a quarter of patients.

New variant Ph translocation in chronic myeloid leukemia: t(Y;22)(p11;q11)

A 4-year-old boy with chronic myeloid leukemia (CML) was shown to have a variant Ph t(Y;22)(p11;q11). To our knowledge, this is the first report of a variant Ph translocation involving Y. Molecular analysis showed that the breakpoint on chromosome 22 is in the breakpoint cluster region (bcr), typical of CML with the classic t(9;22), suggesting that it might be a complex Ph translocation with the involvement of 9q34.

Variant (8;22) translocation in lymphoblastic lymphoma

Occasional cases with the chromosomal translocations that juxtapose the c-myc oncogene to Ig genes have been reported in large cell, small lymphocytic, immunoblastic, and follicular lymphomas. In this report, we present a 20 year-old female with lymphoblastic lymphoma of B-cell type and a translocation t(8;22), in which cytogenetic, immunologic, and molecular studies were performed. To the best of our knowledge this is the first report of this association.

Stereoselective metabolic pathways of ketoprofen in the rat: incorporation into triacylglycerols and enantiomeric inversion

The enantiomeric bioinversion of ketoprofen (KP) enantiomers and their incorporation into triacylglycerols were investigated in the rat (1) in vitro, using liver homogenates, subcellular fractions, and hepatocytes, and (2) in vivo, in different tissue samples after oral administration of the radiolabelled compounds. In liver homogenates or subcellular fractions, the enantiomer (S)-ketoprofen (S-KP) was recovered unchanged, whereas (R)-ketoprofen (R-KP) was partially converted into its Coenzyme A (CoA) thioester and inverted to S-KP. Both processes occurred mainly in the mitochondrial fraction. This supports the mechanism of inversion via stereoselective formation of CoA thioester of R-KP, already described for other non-steroidal anti-inflammatory drugs. Incorporation into triacylglycerols was detected after incubation with intact hepatocytes in the presence of added glycerol. The process was stereoselective for R-KP vs. S-KP (covalently bound radioactivity 26,742 +/- 4,665 dpm/10(6) cells vs. 6,644 +/- 3,179 dpm/10(6) cells, respectively). However, no incorporation was found in liver samples after oral administration of either R-KP or S-KP. On the contrary, in adipose tissue samples a significant and stereoselective formation of hybrid triacylglycerols was observed: 11,076 +/- 2,790 dpm.g-1 for R-KP vs. 660 +/- 268 dpm.g-1 for S-KP. The incorporated R/S ratio, higher in adipose tissue (R/S = 17) than in hepatocytes (R/S = 4), indicates that fat may be the main tissue store for the xenobiotic R-KP in rats.

Prevalence of abnormal levels of serum tumour markers in elderly people

The study was conducted to evaluate the prevalence of abnormal levels of several serum tumour markers in an institutionalized elderly population. Serum tumour markers assay of carcinoembryonic antigen (CEA), the carbohydrate antigens CA 19-9, CA 72-4 and CA 15-3 (Enzymun-test, Boehringer Mannheim GmbH Diagnostic), alpha-fetoprotein (AFP) and prostate specific antigen (PSA) (Abbot Diagnostic Division) were performed in 228 unselected, institutionalized elderly subjects, whose mean age (SD) was 82.4 (5. 79) range (66-99 years). Patients with acute or neoplastic diseases were excluded from the study. The serum markers were also measured in 52 healthy young adults (controls). Using the established threshold values, 92 subjects (40%) were found to have at least one elevated marker. PSA was elevated in 33%, CA 19-9 in 16%, CEA in 11. 5%, CA 15-3 in 11%, CA 72-4 in 8% and AFP in 3%. We found a significant difference in the serum levels between the two groups for CEA, CA 19-9. CA 15-3, and PSA (p < 0.0001). Healthy aged people appear to have an elevated prevalence of elevated levels of serum tumour markers. The results suggest that apart from PSA, elevated antigen levels in elderly subjects are related to the ageing process itself rather than to occult pathology.

Mechanisms involved in the spasmolytic effect of extracts from Sabal serrulata fruit on smooth muscle

1. The effects of two extracts from Sabal serrulata fruits [total lipidic (L) and saponifiable (S)] on smooth muscle contractions have been assayed. 2. Both extracts (0.1-1 mg/ml) relaxed the tonic contraction induced by norepinefrine (30 nM) on rat aorta [EC50, 0.53 +/- 0.05 mg/ml (L) and 0.5 +/- 0.04 mg/ml (S)] and by KCl (60 mM) on rat uterus. The Sabal extracts (0.3-1 mg/ml) also antagonized the dose-response curve of contractions induced by acetylcholine (0.1-100 microM) on urinary bladder. 3. dL-Propranolol (1 microM) but not the inactive (R)-(+)-propranolol(1 microM) potentiated the Sabal extracts relaxant effect by lowering the EC50 (0.35 +/- 0.2 vs 0.20 +/- 0.01 mg/ml for L and 0.43 +/- 0.02 vs 0.19 +/- 0.02 mg/ml, P < 0.01, for S extract). 4. Cycloheximide (10 micrograms/ml) antagonized the effect of extracts from Sabal. However, actinomycin D (5 micrograms/ml) significantly (P < or = 0.01) antagonized the effect of the total lipidic extract without modifying that of the saponifiable extract. 5. The relaxant effect of both extracts was not modified by the tyrosine kinase inhibitor genistein (10 microM) or the ornithine decarboxylase inhibitor alpha-difluoromethyl-ornithine (10 mM).

Functional serotonin 5-HT1D receptors and 5-HT1D beta receptor mRNA expression in human umbilical vein endothelial cells

Pharmacological evidence has suggested the presence of 5-hydroxytryptamine (5-HT, serotonin), 5-HT(1D) receptors on endothelial cells but these receptors have never been identified unambiguously on this type of cells. We now report that human umbilical vein endothelial cells (HUVEC) express 5-HT(1D) receptors coupled to inhibition of cyclic AMP formation. 5-HT and 5-HT(1D) receptor agonists 5-carboxamidotryptamine (5-CT) and sumatriptan were approximately equipotent at inhibiting forskolin-stimulated cyclic AMP accumulation in HUVEC (mean pEC50 7.6-8.2, maximal effect 30% inhibition). The 5-HT(1A) receptor antagonist, 8-OH-DPAT was clearly less potent (pEC50 6.2) and less efficacious. The selective 5-HT(1D) receptor agonist, GR127935 (1 nM) markedly inhibited the effect of 5-HT (apparent pK(B) 10.8). Reverse transcription-polymerase chain reaction analysis showed the mRNA for 5-HT(1D beta) receptors to be expressed in HUVEC. These results demonstrate the presence of functional 5-HT(1D) receptors and the expression of 5-HT(1D beta) receptor mRNA in HUVEC. They support the involvement of 5-HT(1D beta) receptors in endothelial-mediated responses to 5-HT.

Tuberous sclerosis associated with histologically confirmed ocular and cerebral tumors

The clinical, neuroradiologic, and pathologic features of an unusual retinal and cerebral giant cell astrocytoma in a 24-year-old man with tuberous sclerosis are reported. The patient was referred at 3 years of age because of partial seizures from the first months of life, severe mental retardation, and left microphthalmos. The microphthalmic eye presented slow growth from 9 years of age and was enucleated at age 18 years because of exophthalmos and pain. At age 23 years, the patient experienced sudden and severe headache. Magnetic resonance imaging revealed a voluminous cystic tumor in the region of the foramen of Monro, lateral ventricle, and basal ganglia of the right cerebral hemisphere. Pathologic examination of the enucleated eye and of the cerebral tumor disclosed the same histologic findings in both locations, a giant cell astrocytoma.

Prevalence of human T-cell lymphotropic virus type 1 (HTLV-1) and HTLV-2 infection among Spanish drug users measured by HTLV-1 assay and HTLV-1 and -2 assay. HTLV-1 and HTLV-2 Spanish Study Group

The prevalence of human T-cell lymphotropic virus type 1 (HTLV-1) and HTLV-2 infection in 1992 and 1993 was determined by testing 2,152 specimens from injection drug users living in 11 geographic areas in Spain. Results obtained by an authentic HTLV-1 and -2 test were compared with those obtained by an HTLV-1 assay. HTLV infection was identified in 7 of 11 regions, with an overall prevalence of 2.5% (range, 0.4 to 11.5%). Fourty-four (81%) of 54 subjects were infected with HTLV-2; the viral strains in the remaining 10 subjects could not be serologically typed. Underestimation of HTLV infection because of the low sensitivities of HTLV-1 enzyme immunoassays for HTLV-2 antibody was relatively low (< 20%). Therefore, previous epidemiologic findings generated with HTLV-1 enzyme immunoassays appear to be reasonably accurate. Our results suggest that the rate of HTLV infection may have been increasing recently among Spanish drug users.

Pulmonary involvement in rheumatoid arthritis

Pulmonary involvement is one of the extra-articular manifestations of rheumatoid arthritis (RA) and includes pleurisy, parenchymal nodules, interstitial involvement, and airway disease. Rheumatoid pulmonary vasculitis is rare. Pulmonary disease also may be observed as a toxic event consequent to treatment for RA. Although RA is more common in women, rheumatoid lung disease occurs more frequently in men who have long-standing rheumatoid disease, positive rheumatoid factor and subcutaneous nodules. Pleural involvement, usually asymptomatic, is the most common manifestation of lung disease in RA and may occur concurrently with pulmonary nodulosis or interstitial disease. The clinical features and course of pulmonary fibrosis in RA are similar to those of idiopathic pulmonary fibrosis. Bronchiolitis obliterans organizing pneumonia (BOOP), which has been recently described in RA patients, has nonspecific clinical features. The histological patterns correspond to proliferative bronchiolitis in the airway and organizing pneumonia in the alveoli. Obstructive lung disease in RA includes obliterative bronchiolitis (OB) and bronchiectasis. OB is an acute illness characterized histologically by a constrictive bronchiolitis. It may be idiopathic or induced by D-penicillamine or intramuscular gold compounds. Methotrexate (MTX)-pneumonitis is an uncommon complication of MTX treatment. Its clinical presentation is not specific, and diagnosis must be made after exclusion of other causes of pulmonary diseases. It is uncertain if preexisting lung disease predisposes RA patients to MTX-pneumonitis. Treatment of lung disease in RA is empirical. Corticosteroids are usually administered and immunosuppressive drugs are often added when pulmonary disease progresses and/or steroid side-effects appear.

Primary degeneration of the granular layer of the cerebellum. A study of 14 patients and review of the literature

Primary degeneration of the granular layer of the cerebellum is an autosomal recessive disorder exhibiting characteristic clinical features: hypotonia, strabismus, delayed motor development, nonprogressive ataxia, delayed language development with dysarthria and mental retardation. We studied fourteen children, seven of each gender. Neuroimaging tests including pneumoencephalography, computed tomography (CT) and magnetic resonance imaging (MRI) showed severe cerebellar atrophy in all. MRI best demonstrated the cerebellar lesion, revealing great uniformity amongst the cases. Vertebrobasilar angiography was performed in two cases and showed marked hypoplasia of the cerebellar arteries, predominantly the posterior inferior cerebellar artery (PICA) and its branches. Necropsy was performed in three cases; cerebellar atrophy with loss of granular cells and diverse abnormalities of the Purkinje cells was found in two. The third, the sister of one of the other two cases, had a similar but shorter clinical course and died at three months of age. Her sister, who died at 5 years of age, presented a severe cerebellar atrophy with typical changes in the granular cell layer and Purkinje cells. In the third patient, who lived three months, only focal cerebellar folial atrophy with no microscopic changes in the granular cell layers was present. Though this case cannot objectively be included in the cerebellar atrophy syndrome with granular cell loss, her family history and clinical picture suggest the same disease. The findings observed in our series and the study of cases described in the literature, suggest that there are several forms of this disease which differ mainly in severity and neurological evolution. The cerebellar lesion seems to be a progressive atrophic process with the most severe changes during the early years of life.

Serum levels of secretory IgA and in vitro production of IgA in rheumatoid arthritis

Twenty-three per cent of rheumatoid arthritis (RA) patients show an increase of serum IgA concentrations. To determine the role of mucous-associated lymphoid tissue (MALT) in the elevation of serum IgA in RA, we studied the serum secretory-IgA (s-IgA) in 63 RA patients and in 30 healthy controls. We also analysed the secretion of circulating B cells producing IgA, which is known to reflect mucous tissue activity, in a subgroup of 15 patients with increased serum IgA concentrations, and in control patients. The mean s-IgA in the RA patients was 0.046 mg/ml +/- 0.064, versus 0.002 +/- 0.004 mg/ml in controls (not significant). Active disease defined by clinical criteria was associated with an increase in serum s-IgA (p < 0.001). Furthermore, in a subgroup of RA patients with high serum IgA levels, we found an increase in in vitro IgA production by circulating blood lymphocytes (17.39 +/- 15.2 micrograms/ml), versus RA patients with normal serum IgA levels or controls (p < 0.001). These results were not modified by LPS or PWM. Our results further support the hypothesis of primary MALT activation following environmental antigenic stimulation in RA patients.

Hemi- or homozygosity: a requirement for some but not other p53 mutant proteins to accumulate and exert a pathogenetic effect

Activating mutations within the p53 gene cause stabilization and therefore increased steady-state levels of the p53 protein; some, but not all, also result in the generation of an epitope recognized by the antibody pAB240. We have shown here that in 70% of Burkitt lymphoma cell lines, but not in normal EBV transformed B cell lines, p53 protein is readily detectable by Western blot analysis using either an antibody directed against the 240 epitope or an antibody against wild-type p53. Genomic analysis of these BL cell lines demonstrated the presence of mutations within the p53 gene in all cell lines with detectable p53 protein. We have also shown that in the cell lines ST486, Raji, and TE 110, which are heterozygous for a neutral sequence codon polymorphism (Arg/Pro) that causes altered migration of an otherwise normal protein and also contain a heterozygous mutation, only the protein derived from the mutated allele is stabilized. Thus the dominant effect of the mutations present in these cell lines apparently does not result from sequestering of the normal protein by the abnormal protein, and therefore presumably is a consequence of a gain-of-function resulting from the mutation. Although all cell lines with stabilized p53 also contained p53 mutations, three lymphoid tumors (two cell lines and one fresh B-CLL) with a heterozygous mutation at codon 248 did not express elevated levels of p53. In contrast, p53 was readily detectable in Western blot analysis from cell lines KK124, Namalwa, and CA46, which had homo- or hemizygous mutations at codon 248, and from PP1084, a cell line with a codon 273 mutation and a carboxyl-terminal truncation in the other allele. These results suggest that mutations at codon 248, unlike those in cell lines ST486 and TE110, are stabilizing only in the absence of the wild-type p53. Heterozygous mutations at codons 248 have been described in the germline of individuals belonging to cancer-prone families described by Li and Fraumeni (see ref 18), but tumors detected in such individuals are homozygous, i.e., contain only mutated p53. This is consistent with the possibility that such mutations exert a pathogenetic effect only in the absence of the wild-type protein, and are coupled to our findings that stabilization of p53 is a necessary component of the oncogenic pathways relevant to p53. However, whereas some mutations are stabilizing in the presence of the normal p53 protein, others are stabilizing only in the homozygous state.

Accelerated nodulosis and systemic manifestations during methotrexate therapy for rheumatoid arthritis

OBJECTIVES

Methotrexate is successfully used in the treatment of arthritis but little is known about its effects on extra-articular manifestations of rheumatoid arthritis. We focused this work on the incidence and clinical course of extra-articular manifestations during long-term treatment with methotrexate.

METHODS

The effect of methotrexate on extra-articular manifestations was investigated in 176 patients with rheumatoid arthritis who had obtained, in a prospective study, a good clinical response to methotrexate (10 mg/week) taken for 33 months (range 4-68).

RESULTS

Before taking methotrexate, 44 patients (25.1%) had extra-articular manifestations: nodules (n = 40) and vasculitis (n = 9). With methotrexate, nodulosis and vasculitis were stable in 31 cases, improved in 3 and worsened in 10 (23%). Among the 132 patients without extra-articular manifestations before methotrexate therapy, 15 (11%) developed accelerated nodulosis preferentially located on the fingers, 7 had a vasculitis and 3 a pericarditis during methotrexate therapy. Extra-articular manifestations occurred between 1 and 24 months of initiating methotrexate therapy. Rheumatoid factor was positive in 88% of the patients with extra-articular manifestations. No relationship was noted between extra-articular manifestations and HLA type or antinuclear antibodies. In 3 out of 4 patients who developed accelerated nodulosis while taking methotrexate, the addition of hydroxychloroquine (400 mg/day) resulted in a significant reduction in the number and size of the nodules within 3 to 10 months after starting combined therapy.

CONCLUSION

These data suggest that methotrexate is not effective in the treatment of extra-articular manifestations in rheumatoid arthritis and that nodulosis may occur in about 11% of patients taking methotrexate therapy for rheumatoid arthritis. The combination of hydroxychloroquine and methotrexate may have a beneficial effect on nodulosis that needs to be evaluated.

Effects of androgens on isolated rat uterus

The 5 alpha- and 5 beta-dihydrotestosterone (DHT) androgens relax KCl-induced tonic contraction in rat uterus, in a dose-dependent way. The 5 alpha and 5 beta-DHT relaxing effect is counteracted by CaCl2 (0.1-10 mM). The 5 alpha-DHT, but not the 5 beta-DHT, effect was reduced by cycloheximide (10 micrograms/ml) and by actinomycin D (5 micrograms/ml). Flutamide at 10(-6) M shifted the effect of 5 alpha-DHT to the right. However, other doses of flutamide or cyproterone acetate did not modify the effect of both androgens. We suggest a non-genomic effect of 5 alpha-DHT and 5 beta-DHT in rat uterus contraction but that intracellular and genomic actions play a part in the relaxing effect of 5 alpha-DHT.

Stereoselective cyclooxygenase inhibition in cellular models by the enantiomers of ketoprofen

The pharmacological activity of rac-ketoprofen and its enantiomers was investigated in vitro using different cellular models. The effect of these compounds on arachidonic acid metabolism was assessed by measuring the inhibition of prostanoid generation under the action of several agonists. Thus, we have evaluated the inhibition of (1) thromboxane B2 synthesis in rabbit platelets and human polymorphonuclear leukocytes (PMNs), (2) prostaglandin E2 synthesis in three cultured cells, namely human umbilical vein endothelial cells (HUVEC), human keratinocytes, and mouse macrophage-like P388D1 cells. The IC50 values found for (+)-(S)-ketoprofen were in the range between 0.1 nM and 0.8 microM, being slightly lower in all models than those found for rac-ketoprofen (0.4 nM-3 microM). On the other hand (-)-(R)-ketoprofen showed inhibition of cyclooxygenase only at concentrations two or three orders of magnitude higher than those required for the (+)-(S) enantiomer. These results, obtained with cell types of relevance for inflammatory processes and with compounds of high optical purity, demonstrate that the prostanoid biosynthesis inhibition caused by the drug rac-ketoprofen is exclusively due to its dextrorotatory enantiomer.

Association of tumorigenic and nontumorigenic (immunogenic) variants in a mouse T-cell lymphoma with two distinct p53 mutations

An in vitro model system for xenogenization has been developed in which an immunogenic, nonmalignant phenotype was selected from a highly malignant T-cell line (S49). We showed by single-strand conformation polymorphism and DNA sequence analysis that specific point mutations in the p53 tumor suppressor gene correlated with a change from a tumorigenic to a nontumorigenic (immunogenic) phenotype. Specifically, we found that the highly malignant S49 cell line T-60 contains an Arg-->Gln substitution at residue 246 in exon 7 of p53. In contrast, nontumorigenic (immunogenic) variants (T-25-Adh and Rev-1) exhibited a Gly-->Ser substitution at residue 242 of p53. In two subsequent tumorigenic revertants derived from Rev-1, we again found the Arg-->Gln substitution at residue 246 that was found initially in the T-60 cells. Thus, mutation at residue 246 of p53 was associated with a highly malignant phenotype, whereas a novel mutation at residue 242 of p53 appeared to be associated with a nonmalignant phenotype and may have actually protected the host through immunization. We conclude that mutation of residue 242 may represent a new class of permissive (nonmalignant) mutations in the mouse that are analogous to the Li-Fraumeni mutation in humans.

Comparison of high titer Edmonston-Zagreb, Biken-CAM and Schwarz measles vaccines in Peruvian infants

In an effort to identify the optimal dose and strain of measles vaccination for early immunization, Peruvian infants were randomly assigned to receive one of three measles vaccines in varying doses at 5 to 6 or 8 to 9 months of age. Edmonston-Zagreb vaccines were significantly (P < 0.001) more immunogenic than equivalent or higher titers of Schwarz or Biken-CAM vaccines as determined by neutralization antibody response 3 months after vaccination. Eighty-two percent of infants who received high titer Edmonston-Zagreb vaccine at 5 to 6 months of age developed protective concentrations of measles antibody, a response rate similar to that observed after standard titer Schwarz (81%) or high titer Biken-CAM vaccine (81%) at 8 to 9 months of age. No significant differences in the rates of fever, rash or other adverse events were noted by vaccine group 10 to 14 days after vaccination. Although the high titer vaccines are more immunogenic in young infants than standard vaccines, long term safety must be assured before these vaccines can be put into widespread use.

Effects of androgens and antiandrogens on the inotropism induced by ouabain and isoproterenol on the left atrium of the rat in vitro

1. The effect of androgens 5 beta- and 5 alpha-dihydrotestosterone (DHT, 10(-9) M), and the antiandrogens cyproterone acetate (CPA, 10(-8)-10(-6) M), chlormadinone acetate (CMA, 10(-8)-10(-6) M), medroxyprogesterone acetate (MPA, 10(-8)-10(-6) M), spironolactone (SPI, 10(-5) M), flutamide (F, 10(-5) M) and cimetidine (C, 10(-5) M), on inotropic positive effect induced by ouabain (10(-8)-10(-5) M) and isoproterenol (10(-8)-10(-6) M), on electrically stimulated left atria of rat, has been assayed. 2. Ouabain (10(-6) M) did not modify the inotropic effect of isoproterenol (10(-8)-10(-6) M). 3. The androgens 5 beta- and 5 alpha-DHT (10(-9) M) and the antiandrogens SPI (10(-6) M), F (10(-5) M) and C (10(-5) M) inhibit the inotropic effect of ouabain and isoproterenol on electrically stimulated left atria of the rat. 4. The antiandrogens CPA, MPA and CMA to 10(-7) M, inhibit the inotropic effect of ouabain. The CPA (10(-8)-10(-6) M) inhibit, in a dose-dependent way the positive inotropic effect of isoproterenol. MPA and CMA (10(-8)-10(-6) M) also inhibit the inotropic effect isoproterenol but the inhibitory effect is greater with 10(-8) M than 10(-6) M of both drugs. 5. Taken together, our results suggest that steroidal hormones could modulate the cardiac contractility through interference with Na-pump in a non-digitalic site and/or with intracellular mediators in left atrium.

Localized epidermal necrolysis (erythema multiforme-like reaction) following intravenous injection of vinblastine

We report a case of localized epidermal necrolysis that developed 24 hours after an intravenous injection of vinblastine. Clinically, the lesions consisted of erythematous macules, vesicles, and bullae with a linear arrangement over the injected vein. Histologically, the lesions showed features closely resembling erythema multiforme (epidermal necrolysis). We discuss the pathogenesis of this curious cutaneous drug reaction and review the literature concerning local cutaneous complications associated with intravenously administered chemotherapeutic agents.

Gangliogliomas: clinical study and evolution

We present 11 patients with intracranial gangliogliomas. The age ranged between 4 and 69 years with a mean of 32 years. The most frequent clinical manifestations were epilepsy in 7 cases and headache in 4 cases, and had begun from 15 days to 12 years before diagnosis. The gangliogliomas were located supratentorially predominantly in the temporal lobe (5 cases), except one, which was located within the cerebellum, which is extremely rare. EEG evidenced focality in 8 cases. The CT scan showed hypo or isodense images which were often associated with cysts, and that partially or totally enhanced with contrast administration in 7 cases (63.3%). Calcification was seen in only one case (9%). All our cases were treated surgically. Three patients were reoperated for recurrence. One case was reoperated twice and the histologic study showed astrocytoma grade II. Radiotherapy was given in two cases. In one case after subtotal surgery and in the other after the second operation for recurrence. Follow-up ranged between one and thirteen years, with a mean of 6.8 years. There was only one death. We used the CT scan for follow-up. However, nowadays MRI is more useful than the CT scan to distinguish recurrences.

Ifosfamide-induced neurotoxicity

Ifosfamide is an active chemotherapeutic agent in a wide range of gynecologic tumors; favorable response rates have been reported in ovarian (epithelial and germ cell), uterine, and cervical neoplasms. Central neurotoxicity is a known, but poorly described side effect. We report 23 patients who received a total of 75 cycles of ifosfamide, either as a single agent or in combination with other chemotherapeutic agents. Six of twenty-three (26%) experienced grade 4 neurotoxicity; clinical presentation included confusion, aphasia, hallucinations, and coma. All patients exhibited the first evidence of neurotoxicity by the end of the 24-hr infusion. Three of six patients with grade 4 neurotoxicity expired within 14 days of receiving ifosfamide. The neurotoxicity resolved over 2 to 4 days in the remaining patients. Serum albumin was normal (greater than 3.5 g/dl) in 63 cycles of ifosfamide not associated with neurotoxicity. When serum albumin was less than 3.5 g/dl, 6 of 12 cycles were associated with severe neurotoxicity (P less than 0.001). Low serum albumin (less than 3.5 g/dl) appears to be associated with a high risk of severe neurotoxicity in patients receiving single-dose ifosfamide therapy.

Measles-associated diarrhea in hospitalized children in Lima, Peru: pathogenic agents and impact on growth

Because the causes of measles-associated diarrhea are not well known, 0- to 5-year-old children presenting to the hospital with measles-associated diarrhea (cases, n = 77) or acute diarrhea only (controls, n = 77) were compared. Growth and diarrheal morbidity were evaluated for 1 month after acute illness. Campylobacter jejuni was more frequently isolated from cases (31%) than controls (16%; P = .03). Rotavirus was absent in all cases versus 28% of controls (P less than .001). Incidence density for new episodes of diarrhea was significantly greater in cases (6.5 vs. 4.1; odds ratio, 1.6; confidence intervals, 1.09-2.34; P = .01), as was duration of episodes (3 vs. 2 days, P = .02). Both groups showed similar positive cumulative percentage weight gains throughout follow-up. These data support the theory of measles as a risk factor for developing diarrhea. The bacteriologic and virologic findings may reflect the immunologic response of the host to measles infection.

Blockade of the antigen-antibody reaction using benzil condensation with the guanidyl residue of arginine

Benzil blockade of the guanidyl group of arginine was tried on sections of paraffin-embedded tissue fixed in two different fixatives, in an attempt to evaluate the relevance of this amino acid to the reaction of several proteins with their corresponding antibodies. The two fixatives were 10% formaldehyde, and Bouin's fluid without acetic acid. Both polyclonal and monoclonal antibodies against proteins or peptides (lysozyme, adrenocorticotropic hormone, growth hormone, placental lactogen, and prolactin) were used on human biopsies or material from autopsies. The blockade was effective when monoclonal antibodies were used, whereas no effect or only a small decrease of the intensity of the reaction was observed with polyclonal antibodies. The least definitive result was obtained with prolactin, where a complete blockade was never achieved with monoclonal antibodies. Calcitonin, a peptide that does not contain arginine, was used as a control not susceptible to benzil blockade; no blockade of immunostaining was observed.

Effects of steroidal and non-steroidal antiandrogens on the left atrium of the rat in vitro

1. The effect of steroidal-cyproterone acetate (CPA, 10(-7)-10(-5) M), clormadinone acetate (CMA, 10(-7)-10(-5) M), medroxyprogesterone acetate (MPA, 10(-7)-10(-5) M) and spironolactone (SPI, 10(-7)10(-5)M) and non-steroidal-flutamide (F, 10(-7)-6 x 10(-5) M) and cimetidine (C, 10(-7)-10(-4)M) antiandrogens on contractile force of electrically stimulated left atria of the rat have been assayed. 2. CPA, CMA, MPA and F inhibit, in a dose-dependent way, the contractile force of left atria. SPI enhanced (P less than 0.01 at 10(-6) M), and cimetidine did not modify the contractile force. 3. F, but not CPA, CMA, MPA or SPI, inhibit the contractile force induced by CaCl2 (0.9-7.2 mM) on electrically stimulated left atria. 4. The inhibitory effect of CPA (10(-7)-10(-5) M) was significantly increased by atropine (10(-6) M) and diltiazen (10(-5) M), and significantly reduced by yohimbine (10(-7) M) and in reserpinized (2.5 mg/kg, 48 and 24 hr before experiments) rats. 5. Our results suggest that the negative inotropism of steroidal antiandrogens could be related to inhibition of noradrenaline release, presumably through an alpha 2 adrenergic effect. The negative inotropism produced by F is related to inhibition of calcium dependent process on left atria contraction.

Effects of androgenizing dairy heifers with ear implants containing testosterone and estrogen on detection of estrus

Lactating dairy cows in four lots were observed for sexual behavior for 6 mo. One freemartin heifer in each lot was implanted with testosterone propionate and estradiol benzoate to aid in detection of estrus. Blood samples were obtained from androgenized heifers every other week for determination of serum testosterone. The addition of an androgenized heifer to each lot increased the number of mounts and attempts to mount cows, both overall and within observation periods. Thus, the likelihood of detecting a cow in estrus was increased with the addition of the androgenized heifers. Greatest benefit was seen when one or two cows were simultaneously in estrus in each lot. Observational data and serum progesterone concentration of mounted cows indicated that androgenized heifers were selectively mounting open cows displaying estrus, whereas the remaining nonandrogenized cows were less selective with their mounting activity. Serum testosterone increased after heifers were implanted, but testosterone was not related to the proportion of sexual activity. Duration of sexual activity by the implanted heifers was approximately 90 d.

A multicentre study to introduce naltrexone for opiate dependence in Spain

A multicentre prospective study was performed in eight centres in Spain in order to assess the usefulness of naltrexone in the treatment of opiate dependents and abusers (113 dependents and 37 abusers) non-selected in terms of social class or professional skill. The fundamental criterion for evaluation of clinical outcome was the retention rate. At 6 months this parameter was 40%, i.e. higher than any previously reported for non-selected patients. The adverse effects were mild and did not lead to therapeutic failures. Non-pharmacological factors may have contributed to the good clinical results obtained.

An increment in unilateral carotid blood flow produces cerebral aneurysms in rats

To study the effect of haemodynamic stress on cerebral aneurysm development, three groups of adult Wistar rats were used: 1) One group with ligation of the right common carotid artery; 2) One with an end-to-side common carotid artery anastomosis and 3) Another group that was sham-operated. Blood flow through the left common carotid artery was measured with an electromagnetic flow transducer (0.85 mm in diameter) in anesthetized animals. Before the experimental intervention, the mean carotid blood flow was 2.8 +/- 0.14 ml/min. Following carotid ligation the blood flow in the patent carotid artery increased 25 +/- 5% after 7 +/- 0.3 days and 37 +/- 18% after 149 +/- 23 days; whereas following carotid anastomosis, carotid blood flow increased 102 +/- 16% after 9.6 +/- 2 days and 103 +/- 35% after 169 +/- 15 days. The sham operation did not significantly affect carotid blood flow. Control values for mean arterial pressure (102 +/- 3 mmHg) and blood gases (PaO2 = 106 +/- 3.4 mmHg, PaCO2 = 38 +/- 1.2 mmHg and pH = 7.32 +/- 0.02) were similar in the three groups of rats and did not change significantly over time after the experimental procedure. Necropsy was carried out 149 +/- 15 days after the experimental intervention. No cerebral aneurysms were found in the rats with carotid ligation or which had been sham-operated, however, three of the eight rats (p less than 0.05) with carotid anastomosis presented single aneurysms in the anterior cerebral-anterior communicating arterial complex.(ABSTRACT TRUNCATED AT 250 WORDS)

Neuroepithelial cyst in the optic nerve. Case report

A 34-year-old woman presented with progressive loss of vision in her left eye of 2 months' evolution. Computerized tomography showed a hypodense lesion in the suprasellar region. At surgery a cystic lesion was found inside the optic nerve. Histological study proved it to be a neuroepithelial cyst. The pathogenesis of a neuroepithelial cyst in such an exceptional site is discussed.

Alpha 2-adrenoceptor-mediated inhibition of platelet adenylate cyclase activity in heroin addicts in abstinence

The inhibition of basal and forskolin-stimulated platelet adenylate cyclase activity by (-)adrenaline was studied in ten heroin addicts during spontaneous withdrawal. Both basal and forskolin-stimulated enzyme activities were increased during heroin withdrawal and the inhibitory effect induced by (-)adrenaline was potentiated with parallel shifts to the left of the concentration-effect curves. The number of binding sites for [3H](-)adrenaline in platelet membranes was also increased during withdrawal. Treatment with clonidine markedly attenuated the inhibitory effect induced by (-)adrenaline on platelet adenylate cyclase activity. The results indicate that the heroin withdrawal syndrome induces supersensitivity of the platelet alpha 2-adrenoceptor-adenylate cyclase system.

Annuloaortic ectasia and adult polycystic kidney. A frequent association

The association of annuloaortic ectasia and polycystic kidney in 18 consecutive patients who had intravenous pyelograms was 22 percent (4/18). Due to this high association rate, some type of work-up to study the kidney anatomy should be performed in every case of annuloaortic ectasia. For the same reasons, patients with adult polycystic kidney should have a careful cardiovascular evaluation.

Heroin increases the density and sensitivity of platelet alpha 2-adrenoceptors in human addicts

The density of platelet alpha 2-adrenoceptors, quantified by means of the binding of [3H]clonidine, and the aggregation response induced by adrenaline, was investigated in ten heroin addicts. The number of binding sites for [3H]clonidine was significantly increased during heroin abuse. Concomitantly, there was a potentiation of the adrenaline-induced platelet aggregation, which suggested that continuous heroin use (opiate dependence) is associated with supersensitive platelet alpha 2-adrenoceptors in human addicts. Spontaneous heroin withdrawal further increased in the same addicts the density of platelet alpha 2-adrenoceptors. These results suggest that platelet alpha 2-adrenoceptors may be used as a model to study receptor mechanisms of opiate dependence and withdrawal in humans.

Platelet alpha 2-adrenoceptors in heroin addicts during withdrawal and after treatment with clonidine

The density of platelet alpha 2-adrenoceptors, quantitated by means of the binding of [3H]clonidine and [3H]yohimbine, and the aggregation response induced by adrenaline were investigated in thirty-two heroin addicts during spontaneous withdrawal. The number of binding sites for [3H]clonidine, but not for [3H]yohimbine, was significantly increased during withdrawal and the increase followed a time course related to the severity of the abstinence syndrome. There was a positive and significant correlation between the severity of withdrawal and the density of platelet alpha 2-adrenoceptors. Concomitantly, the adrenaline-induced platelet aggregation was potentiated. Treatment with clonidine led to significant decreases in receptor densities as well as in functional responses. These results suggest that only alpha 2-adrenoceptors in the agonist state (i.e. number of binding sites for [3H]clonidine) are modulated during the development of the heroin withdrawal syndrome.

Infantile calcified cerebral aneurysm

A case of a calcified aneurysm of the posterior cerebral artery is reported. Frequency, aetiology, pathology, diagnosis and treatment of these aneurysms are discussed.

An actual rare brain granuloma: cerebral gumma

A case of cerebral gumma is reported. The appearance of this kind of lesion is exceptional at the present time. Gummas are the expression of localized meningovascular forms of neurosyphilis and their clinical symptoms and signs are similar to those of any other space-occupying intracranial lesion. Computed tomography scan showed a ring-enhancing lesion with intense cerebral edema. A criticism of computed tomography features of the reported cases in the literature is carried out. Surgical excision, whenever possible, is the treatment of choice since it achieves the removal of the mass and its histologic verification.

Cardiac rehabilitation after acute myocardial infarction. 9-year controlled follow-up study

Since the effect of cardiac rehabilitation (CR) on morbidity and mortality due to myocardial infarction on a long-term basis appears controversial, a controlled follow-up survey was conducted from 1973 to 1981 in 193 patients suffering a first acute myocardial infarction (AMI). The admission criteria included absence of contraindications to CR during the acute phase of AMI. Patients were divided into two matched groups: 93 patients followed a CR program, exercising 30 min three times a week (means 42; range 6-108 months) and the remaining 100 patients served as controls. Age, sex, location and extension of the myocardial damage, frequency of coronary risk factors and complications during the acute phase were comparable. At 9 years, there were 24 cardiac deaths (15 AMI, 7 sudden deaths and 2 heart failures) among the controls and 13 deaths in the CR group (7 AMI, 4 sudden deaths, 2 heart failures), mortality rates being 5.2 and 2.9% per year (p less than 0.1 greater than 0.05; NS), respectively. There were 23 recurrent AMI in the control versus 16 in the CR patients, the corresponding rates being 4.9 and 3.6% per year, respectively (NS). Nor were any differences observed in the incidence of myocardial ischemia, severe arrhythmias or cerebrovascular strokes between both groups, but the appearance of angina was significantly lower in the CR group compared with the controls (5.1 and 10.2% per year, respectively, p less than 0.005). It is concluded that CR on a long-term basis seems to improve the mortality rate of AMI and to reduce the frequency of anginal pain.

Combination chemotherapy with bleomycin, cyclophosphamide and dactinomycin for the treatment of osteogenic sarcoma

Thirteen patients with osteogenic sarcoma were treated with multiple drug chemotherapy consisting of bleomycin, cyclophosphamide and dactinomycin. The dosage schedule used was: bleomycin 12 mg/m2/day, cyclophosphamide 600 mg/m2/day, and dactinomycin 450 microgram/m2/day. All drugs were given intravenously for two consecutive days. Treatment was repeated every 2 weeks. Toxicity included severe nausea and vomiting (managed with antiemetics and intravenous hydration) and manifestations of bone marrow depression. Of 13 patients, eight were previously treated with high dose methotrexate with citrovorum factor rescue, cyclophosphamide and Adriamycin. Of these eight, three patients had objective evidence of tumor regression (37.5%). Five of five previously untreated patients had objective evidence of tumor regression. The overall response rate in osteogenic sarcoma patients to BCD was 61.5%. The combination of BCD appears to be more active against osteogenic sarcoma than cyclophosphamide alone or Adriamycin alone. The relative safety with which BCD can be administered makes this combination a valuable adjunct to high dose methotrexate with citrovorum factor rescue and Adriamycin in the treatment of osteogenic sarcoma.