[Malignant tumors of the ampulla of Vater. Results of radical excision. A study of 39 cases]

STUDY AIM

From 1971 to 1995, 39 patients underwent curative resection of a malignant tumor of the ampulla of Vater. The aim of this retrospective study was to report long-term results and to determine factors influencing survival in these patients.

PATIENTS AND METHODS

Data was collected from patient record analysis, correspondence with patients, their family or general physician. Kaplan-Meier method was used to compare survival data by the log-rank test. Multivariate analysis evaluated the impact of each variable on survival. Values with a P value of 0.05 or less were considered statistically significant.

RESULTS

Resection consisted of pylorus preserving pancreaticoduodenectomy (n = 21) or pancreatico-duodenectomy associated with an antrectomy (n = 18). Overall mortality rate after resection was 10% (n = 4). General and specific morbidity rates were 71% and 2.5%. During the course of the follow-up (completeness: 100%) mean survival was 80 months (median: 37 months, range: 6-227 months). Five-year survival rate was 35%. Factors favorably influencing long-term outcome were exposed protruding and well differentiated tumors (P = 0.03, P = 0.01, respectively) and negative lymph node status (P = 0.0001). Prognosis was poorer if tumor was extended into the pancreas (P = 0.04). Among proposed histoprognostic classifications (classifications of Martin, Talbot, Shiraï, Yamaguchi), an excellent correlation was obtained only with TNM classification (P = 0.0001).

CONCLUSION

Results of the present study suggest that prolonged survival can be obtained following radical resection of a malignant tumor of the ampulla of Vater, especially for exposed protruding and well differentiated tumors, without extension into the pancreas or lymph node metastasis. TNM classification provides an excellent predictive value and should be used more systematically.

Stability study of fotemustine in PVC infusion bags and sets under various conditions using a stability-indicating high-performance liquid chromatographic assay

The stability and compatibility of fotemustine, a nitrosourea anticancer agent, in 5% dextrose solution with polyvinyl chloride (PVC) containers and administration sets were studied under different conditions of temperature and light. The drug was diluted to 0.8 and 2 mg ml(-1) in 100 or 250 ml 5% dextrose injection solutions for 1-h simulated infusions using PVC bags and administration sets with protection from light. After preparation in the PVC bags containing 5% dextrose, fotemustine was also prepared at the same concentrations and stored at 4 degrees C for 48 h and at room temperature (22 degrees C) or at sunray exposure ( > 30 degrees C) over 8 h with or without protection from light. The solution samples were removed immediately at various time points of simulated infusions and storage, and stored at -20 degrees C until analysis. The physical compatibility with PVC and chemical stability in solution of fotemustine were assessed by visual examination and by measuring the concentration of the drug in duplicate using a stability-indicating high-performance chromatographic assay. When admixed with a 5% dextrose solution, fotemustine 2 and 0.8 mg ml(-1) was compatible and stable over 1-h of simulated infusion using PVC bags through PVC administration sets with protection from light. On the other hand, in the same diluent, fotemustine was compatible and stable with PVC bags for at least 8 h at 22 degrees C with protection from light and for at least 48 h at 4 degrees C with protection from light. There were no pH variation, no visual change, no color change, no visible precipitation and no loss of the drug. Conversely, when the solutions were exposed to light (ambient or solar), the drug concentration decreased rapidly, leading to the production of a degradation product as shown by mass spectral analysis and a discoloration of the solutions. Finally, in all cases, no DEHP (di-2-ethylhexyl phthalate) was detected in the injection solution.

Azithromycin impact on neutrophil oxidative metabolism depends on exposure time

Several antimicrobial agents have already been investigated relating to their influence on neutrophil ROS generation. Azithromycin provides, a dose-related anti-oxidant effect, after 15 min incubation, with the stimulating agent FMLP, as well with PMA or S. aureus. This finding was however obtained with concentrations not considered in therapeutics. Since short incubation times are not representative of the physiological situation, and since azithromycin is characterized by prolonged high concentrations within phagocytes, the same experiments were performed over 2 and 4 h exposures. A time-dependent anti-oxidant effect was then reported. The maximum effect was obtained with PMA (IC50 were 856 and 30 micrograms/ml for 15 min and 4 h incubation times respectively). Time-dependent modifications of neutrophil oxidative metabolism seem to be correlated with intracellular concentrations. Depressed oxidative metabolism might be related neither to azithromycin cellular toxicity, nor to superoxide scavenging properties. By increasing exposure periods, therapeutic concentrations could therefore lead to an anti-inflammatory effect, potentially of clinical interest since associated with bacteriostatic activity.

Assessment of the trypsin-like human prostatic kallikrein, also known as hK2, in the seminal plasma of infertile men: respective contributions of an ELISA procedure and of Western blotting

Human seminal plasma (SP) is a unique source of kallikreins. Prostate-specific antigen (hK3), which is a chymotrypsin-like human prostatic kallikrein (CHPK), and its cousin protein (hK2), which is recognized as a trypsin-like human prostatic kallikrein (THPK), have been assessed in infertility disorders to test the hypothesis that oligoasthenoteratozoospermia (OAT) is associated with an abnormal prostatic function. Monoclonal antibodies specific for THPK (hK2) were produced by Immunova, Canada, and used to develop a new enzyme-linked immunosorbent assay procedure and to perform Western blot analyses in SP. The immunoradiometric assay from Hybritech Inc., San Diego, Calif., was selected for CHPK (hK3) measurements in SP. Determinations of the THPK and of CHPK contents in SP from four groups of subjects were performed after validation of the assays. The concentration of both kallikreins was similar in three groups of infertile men, and no statistical difference from the control group was recorded. Western blot analysis confirmed the existence of different molecular forms of both kallikreins in SP. Generally, these molecular forms were not affected by infertility disorders except when obstructive azoospermia led to the exclusion of seminal vesicles, which are the sources of protein C inhibitor (PCI). No THPK-PCI complex was observed because THPK, unlike CHPK, is bound mainly to PCI within a few minutes after ejaculation. These data suggest that measurements of kallikreins in the SP of infertile men are much less useful than evaluation of their different molecular forms. Specifically, the absence of THPK-PCI appears to be a reliable feature of obstructive azoospermia, and this test should be routinely practiced in andrology laboratories.

Determination of cyclohexamone after derivatization with 2,4-dinitrophenyl hydrazine in intravenous solutions stored in PVC bags by high performance liquid chromatography

A high performance liquid chromatographic procedure is described for the determination of cyclohexanone leached in intravenous solutions from the poly(vinyl chloride) bags. After derivatization with 2,4-dinitrophenylhydrazine and extraction with pentane, the cyclohexanone derivative was analysed on a C18 BDS Hypersil column using mobile phase mixture of acetonitrile:water (55:45). Ultra-violet detection was performed at 368 nm. The limit of quantification was 30 ng/mL and the assay was linear from 0.05 to 50 micrograms/mL. The recovery was better than 95%. The proposed method is satisfactory in its accuracy and precision with particularly relative standard deviations (RSD) for intra-assay and inter-assay of below 10%. This method has been successfully used for the determination of cyclohexanone in aqueous solutions such as sodium chloride (0.9%) and glucose (5%) stored in PVC containers. The values obtained varied between 2.04 and 44.9 micrograms/mL according to solutions and volume.

In vitro interaction between spiramycin and polymorphonuclear neutrophils oxidative metabolism

PMNs are a major component of body defense against microbial invasion, involving reactive oxygen species in great quantity, which could benefit from antibiotic therapy. Recently, possible antibiotic effects on phagocyte functions (impairment or stimulation of reactive oxygen species production) were studied. In our study, an in vitro evaluation was made on macrolide activity on phagocyte respiratory burst functions, using assay of superoxide anion (O2.-) in response to four stimuli systems: N-formyl Met-Leu-Phe (fMLP), an analogue of bacterial chemotactic factors; 4 beta-phorbol 12-myristate 13-acetate (PMA), a direct activator of protein kinase C (PKC); calcium ionophore (A23187), which acts directly on calcium influx; and a bacterial strain, Staphylococcus aureus. We have shown that spiramycin, at therapeutic plasma concentrations, increased O2.- generation by bacteria and fMLP-stimulated PMNs, with rate of 26% for 1 microgram ml-1 and 34% for 5 micrograms ml-1, respectively. This pro-oxidant effect, however, weaker, was observed when PMNs were stimulated by PMA. A weak anti-oxidant effect was observed with A23187. For higher concentrations, spiramycin decreased strongly O2.- production, with IC50 values of 74 micrograms ml-1, 154 micrograms ml-1, 296 micrograms ml-1 and 400 micrograms ml-1 when PMNs were stimulated with bacteria, A23187, fMLP and PMA, respectively. The effect of spiramycin seemed to result from an intracellular mechanism by intervention of PMN oxidative metabolism (NADPH-oxidase activation), rather than a simple chemical interaction, because no effect has been observed in acellular models. For higher spiramycin concentrations, the decrease of O2.- production observed could not be taken into consideration because this concentration was not used in therapy. The enhanced of O2.- production observed could be used in therapy, so as to increase PMNs bactericidal activity.

Verapamil inhibits elastase release and superoxide anion production in human neutrophils

In response to activation of phagocytic cells and during inflammatory disorders, some proteases and very reactive oxygen species are produced. These proteases and oxidants are involved in many diseases like tissue injury or atherosclerosis. We have shown in vitro that verapamil, a calcium channel blocker, had antielastase and antioxidant properties. This drug inhibited the release of elastase by neutrophils in a dose-dependent manner when these cells were stimulated by phorbol-myristate-acetate (PMA), by N-formyl-methionyl-leucylphenylalanine (fMLP) and by the calcium ionophore A23187 (Ca.I). In addition, verapamil inhibited superoxide anion when human neutrophils were stimulated by PMA, fMLP, dioctanoylglycerol (DiC8), Ca.I or by opsonised zymosan (OZ). Verapamil did not act by scavenging elastase or oxidants as demonstrated in cell-free models which showed no direct antielastase or antioxidant effect involved by verapamil. Superoxide anion and elastase inhibition by verapamil has been considered to the mobilization of cytosolic calcium and inhibition of protein kinase C. The results suggest that verapamil might contribute help the development and progression of atheroma where oxidants and elastase are involved.

Simultaneous bilateral oophorectomy does not improve prognosis of postmenopausal women undergoing colorectal resection for cancer

PURPOSE

Synchronous or metachronous ovarian metastases are common along the natural course of colorectal carcinoma. We attempted to prospectively assess the prognostic impact of simultaneous bilateral oophorectomy in postmenopausal women undergoing curative resection for colorectal cancer.

METHODS

Between 1980 and 1990, simultaneous bilateral oophorectomy was proposed in each postmenopausal woman referred to our institution for treatment of colorectal cancer. A subset of 92 patients underwent a curative resection. Therefore, two groups were designed for comparison of the procedure. Group I included 41 patients who accepted surgical castration, and Group II consisted of the 51 remaining patients who refused. Prospective analysis of all patients was performed. Results were assessed with a follow-up of 60 months after surgery, with 97.9 percent completion. Local recurrence and liver metastases rates were compared by the chi-squared test. Survival in each group was calculated by the Kaplan-Meier method and compared by the log-rank test.

RESULTS

One patient (1/41; 2.4 percent) had ovarian metastases detected on the operative specimen. Local recurrence or liver metastases rates were not affected by oophorectomy (P = 0.73; P = 0.25). Five-year actuarial survival rates were not significantly different whether patients had oophorectomy (81.6 percent) or not (87.9 percent; P = 0.62).

CONCLUSIONS

Our results suggest that microscopic synchronous ovarian metastasis is rare at the time of curative resection of a colorectal carcinoma in postmenopausal women. Because simultaneous bilateral oophorectomy does not modify prognosis, this procedure seems to be unwarranted.

[Early postoperative morbidity after hemorrhoidectomy using the Milligan-Morgan technic. A retrospective studies of 1,134 cases]

Milligan and Morgan's procedure is commonly used for the surgical management of haemorrhoids. The aim of our study was to evaluate short term postoperative morbidity. Between 1975 and 1990, 1,134 patients were operated on. Two patients died after operation. The most frequent complications were pain (71%) and urinary retention (16.4%). Hemorrhages (7.6%) resulting in a re-operation occurred in 1% of cases. Other complications were rare and always cured by a specific treatment (stenosis: 2.9%, anal fissure: 0.5%, abscess: 0.6%, fistula in ano: 1.2%). Two patients had anal incontinence partially improved by biofeedback. Hemorrhoidal was 2%. Short term postoperative morbidity is generally low after Milligan and Morgan hemorrhoidectomy, with careful supervision in a surgical department and repeated postoperative care.

Evidence of pin implantation as a means of verifying death during the Great Plague of Marseilles (1722)

The evidence obtained for the methods used in verification of death during the Great Plague of Marseilles in 1722 is presented here. This evidence was gathered during the excavation of a mass grave dating from this epidemic, and is based on two adjacent interments. The technique used at that time was the implantation of bronze pins into the toes. This method is precisely described in the medical treatises dating from this period, which list different death verification methods. The fear of "false death" and the burial of still living people characterized the end of the 17th and the 18th centuries. It should be noted that the main cause of apparent death is presented in the same medical treatises as the plague. This observation is the first anthropological evidence of the use of this forensic method to verify the fact of death.

[Demonstration of a cranial autopsy performed during the Great Plague of Marseille (1720-1722)]

The excavation of the mass grave from the Monastery of the Observance dating from the Great Plague of Marseilles revealed the first evidence of an autopsy on the skull of a 15-year-old boy, performed during the spring of 1722. The reconstruction of the skull allows us to reconstitute the anatomic technique used, which is identical to those described in a surgical book dating from 1708. This research highlights the interest in correlating the biological and historical archives, and brings new anthropological data to the debate on the contagious nature of the plague.

Immunological and biological properties of recombinant Lol p 1

BACKGROUND

Current forms of allergy diagnosis and therapies are based on the use of natural allergenic extracts. Despite strong evidence that higher therapeutic efficacy may be achieved with purified allergens, the purification of multiple allergic components from extracts is a fastidious and sometimes an impossible task. However, the use of recombinant allergens may be an alternative to overcome this problem.

OBJECTIVE

In this study, we compared the immunological properties of recombinant (r) Lol p 1 with those of the natural protein.

METHOD

We cloned directly the gene encoding Lol p 1 from genomic DNA of ryegrass pollen. This gene was subcloned into the expression vector pMAL-c and expressed as fusion protein. Subsequently, rLol p 1 was cleaved from maltose-binding protein using factor Xa. Using binding inhibition and proliferative assays, we assessed the immunological properties of the recombinant allergens. The capacity of rLol p 1 to trigger basophil histamine release and to elicit a skin reaction was also assessed and compared to those of its natural counterpart.

RESULTS

We found that the Lol p 1 gene has no introns since we amplified this gene directly from genomic DNA. We demonstrated that the binding sites of anti-Lol p 1 monoclonal antibody, specific human IgG and IgE antibody are well conserved on rLol p 1 as no difference in the binding inhibition profile was observed when using either natural or recombinant protein. At the T-cell level, rLol p 1 elicited a T-cell response in mice comparable to that observed with the natural protein. In addition, we demonstrated that the biological characteristics of rLol p 1 were comparable to those of the natural counterpart, in that rLol p 1 elicited a skin wheal reaction and induced basophil histamine release in grass-allergic patients only.

CONCLUSION

The data indicate that natural Lol p 1 and rLol p 1 shared identical immunological and biological properties.

Antioxidant activities of polyphenolic extracts from flowers, in vitro callus and cell suspension cultures of Crataegus monogyna

Numerous plants synthesize among their secondary metabolites phenolic compounds which possess antioxidant effects. The aim of the present work was to assay the antioxidant activities of phenolics from Crataegus monogyna Jacq. flowers and in vitro tissue culture (calli and cell suspensions) extracts. In the case of tissue culture extracts, the phenolic production is studied at three different stages of one subculture period (initial growth period, increasing and maximal phenolic synthesis phases). Attention was paid to the main categories: flavonoids and proanthocyanidins, and to the principal individual components. Total phenolic amounts decrease in the order: fresh flowers > cell suspension cultures > callus cultures. The antioxidant activities of these different extracts against H2O2 and HOCl, have been determined in vitro. All the extracts are efficient and the scavenging capacity is clearly related to the total phenol content. The scavenging effects of the cell suspension extracts are similar to those of the flowers. Among individual compounds, the flavanol-type derivatives, specially the proanthocyanidin B2, are more efficient. Thus, in vitro plant tissues could be an interesting source of bioactive molecules.

CD4+ T-cell lymphopenia in Q fever endocarditis

Valvular endocarditis is the most serious complication of chronic Q fever, an infectious disease due to Coxiella burnetii. Although its pathogenesis is poorly understood, the role of the immune system has been evoked. The aim of this study was to investigate lymphocyte subsets in the peripheral blood of infected patients by analyzing the distribution of T- and B-lymphocyte subsets. Since various infectious diseases have been found to be associated with modified antigen expression, we also measured the antigen density of the main lymphocyte markers by quantitative flow cytometry. The absolute values of CD3+ T cells and CD19+ B cells were lower in infected subjects than in controls. The decrease in the CD4+ T-cell count was more pronounced than that in the CD8+ T-cell count, leading to a significantly lower CD4/CD8 ratio in patients. The decreases in CD4+ T cells and CD19+ B cells were correlated with levels of C. burnetii-specific immunoglobulin G, showing that CD4+ lymphopenia is related to the activity of chronic Q fever. Quantitation of antigen expression on lymphocytes showed that CD3, CD4, CD8, and CD19 were expressed similarly in patients and controls. In contrast, CD2 and CD11a expression levels, which are both related to naive and memory phenotypes, were modified in patients. The study of CD45RO and CD45RA expression by CD4+ T cells provided evidence that lymphopenia preferentially affected unprimed lymphocytes.

Metabolism of clozapine by human neutrophils: evidence for a specific oxidation of clozapine by the myeloperoxidase system with inhibition of enzymatic chlorination cycle

The use of clozapine, an unique antipsychotic drug, raises the real problem of drug-induced polymorphonuclear neutrophil cytotoxicity. Clozapine prescription has been restricted due to a 1-2% incidence of drug-induced agranulocytosis. The exact mechanism of this adverse effect is not yet known. The myeloperoxidase-hydrogen peroxide system could play a key role in the initiation of agranulocytosis. Therefore, we have investigated the clozapine effects on hydrogen peroxide and hypochlorous acid, evaluated the peroxidase-mediated metabolism of clozapine by mass spectrometry analysis because myeloperoxidase uses hydrogen peroxide and chloride producing hypochlorous acid in its chlorination cycle, and thus could oxidise clozapine in its peroxidation cycle. First, evidence for inhibition of hypochlorous acid production and scavenging of hydrogen peroxide by clozapine were demonstrated in vitro, in different cell-free and cellular systems. Results are consistent with an inhibition of the myeloperoxidase chlorination cycle when clozapine is oxidised in the peroxidation cycle. Secondly, ion-spray mass spectrometry analysis allowed us to confirm clozapine oxidation by the myeloperoxidase system. Actually, clozapine N-oxide with a m/z at 343 was formed. It could be the final step of the metabolisation of clozapine via two successive univalent oxidations mediated by peroxidase. We suggest that generation of a free cation radical, CLZ(o+), was the initial step. CLZ(o+) is a very reactive species and may play an important role in the onset of agranulocytosis either by direct toxicity or via an immunological mechanism. However, this assumption does not exclude the possible role of other metabolic ways involving, in particular, N-desmethylclozapine.

In vitro interaction between dirithromycin or its metabolite, erythromycylamine, and oxidative polymorphonuclear metabolism

The direct stimulation by neutrophil-infectious bacteria induces an increase in the production of reactive oxygen species which is an important host defense mechanism. Antibiotics that enter rapidly and are concentrated in neutrophils, can stimulate or damage this function. In this study, an in vitro evaluation has been made of the macrolide, dirithromycin, and its active metabolite, erythromycylamine, on the superoxide anion generation by neutrophils in three systems of stimulation: the oligopeptide fMLP, an analogue of bacterial chemotactic factors; the phorbol ester PMA, a direct activator of protein kinase C; and a bacteria strain, Staphylococcus aureus. It has been demonstrated that dirithromycin, at therapeutic plasma concentrations, and its active metabolite have a significant pro-oxidant effect on the two systems: fMLP and bacteria. This effect is greater for dirithromycin than that for erythromycylamine. At higher non-therapeutic concentrations, these substances decrease superoxide generation in the three systems. The effects of these two agents seem to be the result of an intracellular mechanism resulting in the intervention of the oxidative metabolism of neutrophils since no effect was found in the cell-free systems. Therefore, this in vitro study suggests that at therapeutic concentrations, dirithromycin and erythromycylamine could benefit therapy by stimulation of the oxidative metabolism of neutrophils.

A routine HPLC method for monitoring midazolam in serum

A routine high-performance liquid chromatographic method for measuring midazolam in human serum has been developed. The sample preparation procedure consisted of simple liquid-liquid extraction with dichloromethane, followed by evaporation under nitrogen. The mobile phase used was a mixture of acetonitrile at 0.02 M and sodium acetate at pH 3.0 (80:20, v/v) and a flow-rate of 1.2 mL/min. The separation was performed on two cyanopropyl columns (150 x 4.6 mm). The detection was by UV absorption at 240 nm. A linear range from 10 to 1,000 ng/mL and a quantification limit of 7.4 ng/mL of serum was reached. The mean intra-assay and inter-assay reproducibility from serum sample spiked with 100 ng/mL were 4.1 and 4.7%, respectively. The recoveries from serum sample spiked with 50, 100, 500 ng/mL were 85.46, 85.38 and 85.57%, respectively. This method was developed to allow pharmacokinetics study of midazolam in young patients in short surgical interventions.

Involvement of the extracellular calcium in the release of elastase and the human neutrophils oxidative burst

Some proteases (particularly elastase) and metabolites of very reactive oxygen species (superoxide anion, hydrogen peroxide, hypochlorous acid and hydroxyl radicals) are generated by polymorphonuclear neutrophils (PMNs) during inflammatory disorders. Divalent cations, especially calcium (Ca2+) play an important regulatory role in the different PMNs functions. The aim of this study is to determine the role of extracellular calcium during the liberation of elastase and of reactive oxygen species production by human PMNs. Consequently, in order to stimulate PMNs, phorbolmyristate acetate (PMA), formyl-methionyl-leucyl-phenylalanine (fMLP) and opsonized zymosan (OZ) have been used. PMNs stimulated by OZ did not release elastase to reverse the PMA and fMLP systems. The production of elastase by PMNs stimulated by PMA to reverse the fMLP system is independent from the extracellular calcium, between 0.0 and 1.5 mM. With various higher concentrations of calcium, varying from 1.5 to 4.0 mM, the release of elastase by PMNs stimulated by PMA is extracellular calcium-dependent to reverse the fMLP system. The superoxide anion (O2-) generated by PMNs activated by fMLP is dependent from the extracellular calcium in the medium, whereas O2- production by PMA or OZ stimulated neutrophils was extracellular calcium-independent. These observations suggest that an influx of calcium may play an important role in the production of elastase and in the capacity of PMNs stimulated by fMLP to produce O2- to reverse the PMA and OZ systems.

Effect of the protein kinase C inhibitor GF 109 203X on elastase release and respiratory burst of human neutrophils

1. The effects of bisindolylmaleimide GF 109 203X, reported to be a potent and highly selective inhibitor of protein kinase C (PKC), have been investigated on some human neutrophil functions. 2. GF 109 203X prevented O.2- production by NADPH-oxidase whatever the stimulus used for polymorphonuclear neutrophil (PMN) activation: directs PKC activators like phorbol myristate acetate (PMA) and dioctanoylglycerol, calcium ionophore (A23187), or receptor agonists like fMet-Leu-Phe (fMLP) and opsonized zymosan. 3. The effect of GF 109 203X was also examined on elastase exocytosis by neutrophils. PMA-mediated release was prevented by GF 109 203X. However, GF 109 203X had no effect on exocytosis induced by A23187 and the effect of this compound on the fMLP response changed according to its concentration. 4. These data suggest that PKC might be essential for stimulus-mediated O.2- production and also that PKC plays only a minor role in elastase secretion as compared to the role of the cytosolic calcium level.

Comparison of histamine-releasing factor recovered from skin and peripheral blood mononuclear cells of patients with chronic idiopathic urticaria

BACKGROUND

The pathogenesis of chronic idiopathic urticaria is characterized by defective histamine release. Skin mast cells show an increased release of histamine while circulating basophils are less responsive to immunologic stimulus.

OBJECTIVE

The purpose of the study was to examine and compare the production of the histamine-releasing factor in the skin and within the peripheral blood of patients with chronic idiopathic urticaria and normal control subjects, as a possible factor responsible for the difference observed in the releasability of both skin mast cells and basophils.

METHODS

Using the skin chamber technique, histamine-releasing factor production and histamine concentration were assessed in normal-appearing skin of patients with chronic idiopathic urticaria (n = 12) and normal controls (n = 5) over a 2-hour observation period. In both groups, histamine-releasing factor production by peripheral blood mononuclear cells was also measured.

RESULTS

The weighted average of histamine-releasing factor production during the 2-hour observation period was higher in the non-lesional skin of patients with chronic idiopathic urticaria as compared with normal controls (5.6 +/- 1.4% versus 0.7 +/- 0.6%, P < .01). In contrast, less histamine-releasing factor was produced by peripheral blood mononuclear cells in chronic urticaria as opposed to normal controls (17.2 +/- 2.1% versus 25.7 +/- 2.8%, P < .03). Spontaneous histamine concentration was not significantly different in patients with chronic urticaria than in normal controls.

CONCLUSION

Histamine-releasing factor production is increased in the skin, and decreased in the peripheral blood of patients with chronic idiopathic urticaria when compared with nonatopic controls. The lower production of histamine releasing factor in the blood could be explained by the migration of activated T-lymphocytes in the skin.

Oxygen species scavenging activity of phenolic extracts from hawthorn fresh plant organs and pharmaceutical preparations

Different extracts of fresh vegetative and reproductive organs from Crataegus monogyna harvested during a whole season and from some pharmaceutical hawthorn preparations exhibit in vitro antioxidant activities using three different models of oxygen reactive species generation (superoxide anion, hydrogen peroxide and hypochlorous acid). All the tested samples show low IC50 values, the most efficient being fresh young leaves, fresh floral buds and pharmaceutical dried flowers. The activities seem to be especially bound to the total phenolic proanthocyanidin and flavonoid contents.

Determination of clozapine in serum by radioreceptor assay versus high-performance liquid chromatography: possible detection of hydroxy-metabolites

Clozapine is an antipsychotic drug with few extra-pyramidal motor side-effects, used to treat schizophrenia which is resistant to classical neuroleptic therapy. This report shows that norclozapine but not clozapine-N-oxide has the same D2 receptor affinity as clozapine. Assay results suggest a bimodal distribution which may be explained by CYP1A2 polymorphism. Extensive metabolizers could produce other active metabolites, probably other hydroxy-clozapine derivatives.

Left subpancreatic transplexus exposure of the proximal abdominal aorta

The authors report their experience based on the anatomical study of the celiac region and on the practice of abdominal multiorgan removal for transplantation. They particularly concentrate on the limits and the content of the celiac region of Luschka and particularly: -the position of the celiac axis in relation to the median arcuate ligament of the diaphragm, -the relations of the collateral branches of the abdominal aorta, -the place being taken by the celiac plexus and its situation in relation to the left renal v. From these elements, they describe an original transplexus surgical exposure of the origins of the celiac axis and of the superior mesenteric a. They show the importance of this approach in abdominal vascular surgery and during abdominal multiorgan removal in transplantation.

Free gadolinium and gadodiamide, a gadolinium chelate used in magnetic resonance imaging: evaluation of their in vitro effects on human neutrophil viability

Gadolinium (Gd3+) is known to be the most paramagnetic ion but is also a very toxic cation often used in pharmacology as a putative stretch-activated channel inhibitor. Gadodiamide, a nonionic Gd3+ chelate, is frequently injected i.v. into magnetic resonance imaging (MRI) to enhance contrast. To determine whether this complex is innocuous in humans, a cytotoxicity study was performed on artificially stimulated human neutrophils (HN). HN were incubated with gadodiamide and with free Gd3+ (GdCl3). The purpose of the study was to estimate possible cell damage after incubation, and to validate further trials based on stimulated cellular models. Measurement of lactate dehydrogenase (LDH) release and the Trypan blue exclusion test were used to assess viability. HN were separated from the blood of healthy volunteers and stimulated by phorbol 12-myristate 13-acetate, a pharmacological reactive which induces protein kinase C activation, superoxide generation, and degranulation by leukotcytes. This study demonstrated that an acellular model is necessary to interpret LDH results. In addition, the experimental conditions of the study demonstrated GdCl3 toxicity on HN viability, while gadodiamide was not harmful.