Effect of alteration in loading conditions on both normal and abnormal patterns of left ventricular filling in healthy individuals

Doppler analysis of mitral flow provides a means of analyzing left ventricular (LV) diastolic function. While experimental studies have suggested that changes in left atrial pressure may affect the normal pattern of early diastolic filling, the effect of such changes on abnormal patterns of filling is unknown. Accordingly, the Doppler pattern of LV filling was analyzed in 20 subjects with LV hypertrophy (mean age 59 +/- 13 years, +/- standard deviation), in 25 healthy normal subjects (29 +/- 6 years) and in 11 elderly subjects (68 +/- 5 years). All underwent Doppler examination of LV inflow at rest and immediately after postural changes. In all 3 groups, head-down positioning increased early diastolic flow velocity (E) (p less than 0.001), and raised the E to late diastolic flow velocity (A) ratio (p less than 0.01). However, an abnormal E/A ratio never approached a normal resting value. Likewise, although E and the E/A ratio decreased significantly in normal subjects with head-up positioning, it did not become abnormal. The magnitude of change in E, A and E/A ratio did not differ among the 3 groups in response to postural changes. Thus, alterations of LV loading conditions alter the pattern of LV filling, whether normal or abnormal at baseline. The magnitude of change appears to be independent of the resting flow pattern. Although loading conditions may affect the Doppler pattern of filling, simple changes in venous return do not "normalize" an abnormal pattern, nor do they "abnormalize" a normal pattern.

Alcohol use and the appearance of alcohol problems among first offender drunk drivers

Drinking patterns among first offender drunk drivers are described using two quantitative dimensions, drinking frequency (the number of occasions on which alcohol was consumed) and continuation (the probability that the drinker will go on to drink several drinks once one drink has been consumed). The two independent dimensions of drinking patterns are shown to be differentially related to demographic characteristics of the subject population. Further, the patterns of drinking described by the two dimensions predict the appearance of alcohol related problems. It is demonstrated that demographic characteristics of the sample are also related to reports of alcohol problems independent of drinking frequency and continuation.

Linkage analysis of multiple endocrine neoplasia type 1 with INT2 and other markers on chromosome 11

We evaluated linkage between the locus for multiple endocrine neoplasia type 1 (MEN1) and several polymorphic DNA markers on chromosome 11 in a single large pedigree. On the basis of the finding of a basic fibroblast growth factor (bFGF)-like substance circulating in plasma of MEN1 patients, we chose a bFGF-related gene known to be localized to 11q13 as one of the markers. This gene locus, INT2, was found to be closely linked to the MEN1 gene. Pairwise and multipoint analyses with INT2 confirm the recent finding by C. Larsson et al. (1988, Nature (London) 332: 85-87) of MEN1 linkage to another marker, skeletal muscle glycogen phosphorylase, at 11q13.

Rett syndrome: a literature review and survey of parents and therapists

A survey of 25 parents of girls with Rett Syndrome and 33 physical and occupational therapists treating those girls was conducted to gain a better understanding of the medical, developmental and therapy issues critical to this population. Twenty-two (92%) of the parent questionnaires and twenty-seven (82%) of the therapist questionnaires were returned. Questionnaire items judged to be critical to the daily management and therapeutic intervention of these girls were selected and analyzed. Descriptive statistics were employed for data analysis. The survey results are discussed in light of the current literature, and implications for pediatric physical and occupational therapy practice are offered.

Dynamic inversion of the forefoot and dorsiflexion of the big toe treated by transfer of extensor hallucis longus

Dynamic hyperextension of the big toe and supination of the forefoot may occur in the swing phase of walking in children with various neurological disorders. Symptoms arising from this have been successfully corrected in 13 feet of 11 children by transfer of extensor hallucis longus to the insertion of peroneus brevis.

Structure of the gene encoding rat thyrotropin releasing hormone

The gene encoding the hypothalamic peptide thyrotropin releasing hormone (TRH) was isolated from two rat genomic bacteriophage libraries. Southern blot analysis indicates that the gene is present as a single copy in the rat genome. The transcriptional unit is 2.6 kilobases in size and contains three exons interrupted by two introns of approximately 750 and 450 base pairs. Exon 1 encodes the 5'-untranslated region of the mRNA, exon 2 encodes the signal sequence and the majority of the amino-terminal peptide, and exon 3 encodes the remainder of the amino-terminal peptide, five copies of the TRH sequence, the carboxyl-terminal peptide, and the 3'-untranslated region of the mRNA. The general structure of the TRH gene resembles that of three other polypeptide hormone genes, preproopiomelanocortin, preproenkephalin A, and preproenkephalin B. Further sequence analysis revealed that characteristic promoter elements are present in the 5'-flanking region of the TRH gene. In addition, sequence homologies with the glucocorticoid receptor binding site, the GC box hexanucleotide, and a portion of the flanking region of the thyroid stimulating hormone beta-subunit gene were also identified. These upstream sequences may be important for the regulation of TRH gene expression.

Acute leukemia: diagnosis, management, and potential for cure

Acute leukemia is an uncommon malignant disorder resulting from the clonal proliferation of hematopoietic precursors of the myeloid or lymphoid lineages. Of the two major subgroups, acute lymphoblastic leukemia is more common in children, while acute myelogenous leukemia predominates in adults. With modern chemotherapy 60%-70% of all children with acute lymphoblastic leukemia can be long-term survivors and are potentially cured. Although the prognosis in acute myelogenous leukemia is less favourable, recent therapy, including bone-marrow transplantation, offers possible cure in selected patient groups.

Differential production of high molecular weight sulfated glycoproteins in normal colonic mucosa, primary colon carcinoma, and metastases

Sulfated macromolecules synthesized in tumor and mucosa tissues derived from colorectal cancer patients were labeled with [35S]sulfate and separated into two fractions on DEAE-Sephacel: the slightly acidic peak (peak I) was eluted with 0.2 M NaCl and the highly acidic peak (peak II) was eluted with 0.5 M NaCl. A total of 40 specimens, which included primary colon cancer, liver metastases, and normal mucosa obtained at surgery (16 patients), were examined regarding the amount of peak I and peak II. The amount of peak I significantly decreased in the order of normal mucosa greater than primary tumors greater than metastases, while the amount of peak II did not significantly change among the tissues. Peak I was mostly resistant to chondroitinase ABC and nitrous acid treatment under acidic conditions, whereas combined chondroitinase-sensitive materials and nitrous acid-sensitive materials were greater than 80% of the radioactivity in peak II. The major radioactive component of peak I migrated at a position corresponding to Mr greater than 300,000 by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and became Mr less than 40,000 after alkaline borohydride treatment. The major component of peak I was likely to be a sulfated glycoprotein containing sulfate groups on alkaline labile carbohydrate chains. Peak II consisted of a mixture of heparan sulfate proteoglycans and chondroitin sulfate proteoglycans. Differential incorporation of [35S]sulfate into peak I among normal mucosa, primary colon carcinoma, and colon carcinoma metastasis was observed. Therefore, decreased peak I production may be a biochemical change associated with colorectal cancer progression and metastasis.

Foetal steroid sulphatase deficiency. A case report

A normal healthy male infant was delivered by caesarian section because of low maternal urinary oestrogen excretion. Postnatal follow up showed that the child developed ichthyosis and that there was a family history of x-linked recessive ichthyosis. It is suggested that unexplained low urinary oestrogens should prompt enquiry about a family history of 'dry skin'.

Treatment of valgus hindfoot in cerebral palsy by peroneus brevis lengthening

Twenty cerebral-palsied patients (30 feet) with hindfoot valgus due to muscle imbalance were reviewed and it was shown that the deformity can be reduced by peroneus brevis lengthening. The method of choice is intramuscular lengthening, which reduces the power of peroneus brevis by one point on the MRC grading and corrects the hindfoot valgus by one grade of severity. For full correction by tendon lengthening, the deformity must be treated while it is still mild. Repeat lengthening may be necessary if there is a severe muscle imbalance.

Normal in vivo eye dimensions by computed tomography

In vivo measurements of the eye were obtained in 55 normal adults using computed tomography. Means and standard deviations were established for the maximum transverse and the maximum anteroposterior dimensions. Our data indicate that the widely used methods of Sweet and Pfeiffer-Comberg (for intraorbital foreign body localization) underestimate the actual in vivo dimensions of the eye.

Species variation in dopamine receptor binding

Binding of 3H-spiroperidol, 3H-apomorphine and 3H-ADTN (2-amino-6,7-dihydroxytetrahydronaphthalene) associated with dopamine receptors has been evaluated in corpus striatal membranes of calf, rat and human brains. Substantial species differences are apparent for numberous agonists and antagonists in competing for receptor binding. In general, dopamine receptor antagonists are more potent in rat and agonists more potent in calf. In competing for 3H-spiroperidol binding sulpiride, molindone and metaclopramide show the most pronounced species differences, being 3--10 times more potent in rat and human than in calf. In all three species agonists compete for 3H-spiroperidol binding with Hill coefficients less than one while antagonists inhibit 3H-spiroperidol binding with Hill coefficients of about 1.0. Conversely, 3H-apomorphine and 3H-ADTN binding in all three species is inhibited by antagonists with Hill coefficients less than 1.0 while agonists display Hill coefficients of about 1.0. In general agonists are more potent in competing for binding of 3H-apomorphine and 3H-ADTN than 3H-spiroperidol. However, a small component of dopamine, apomorphine and ADTN inhibition of 3H-spiroperidol binding displays very high affinity (IC50 about 1 nM). In human amygdala 3H-spiroperidol appears to label serotonin receptors predominantly.

Narcolepsy: a family study

We obtained medical and psychological assessments and 48-hr polysomnographic recordings on five sisters, three of whom had narcolepsy. Of the three, two were identical twins. All three narcoleptic sisters cited emotional stress and environmental demands for sustained performance as the major factors which aggravated their symptoms, and corresponding to this, the illness followed a different life course in each of the three. Most striking were the differences between the twin sisters in clinical symptoms and polysomnographic signs. One sister suffered from all the symptoms of narcolepsy and her sleep recording showed the typical sleep onset REM periods of the disease. Her twin suffered only from excessive daytime drowsiness and her sleep recording was normal--at least by the usual criteria. The sleep of all three narcoleptic sisters, however, was significantly more fragmented than that of their normal siblings. Our data suggested that excessive sleep fragmentation was a basic feature of narcolepsy and that it betrayed a constitutional predisposition for sleep to dissociate into its components and to become distributed around the nycthemeron. This process could be aggravated by emotional stress and by environmental demands for sustained vigilance, and this in turn, created the differences in symptoms and signs between individuals with identical genetic predispositions.

Acetaminophen overdose: a growing health care hazard

Clinical reports support acetylcysteine as an effective agent in the prevention of severe hepatic necrosis and mortality in acetaminophen toxicity [2, 8, 13]. The agent is safe and easily administered to the patient. Further studies are needed before acetylcysteine is considered the agent of choice in the management of acetaminophen overdosage in this country.

A study of the quality of prescriptions issued in a busy pediatric emergency room

An analysis of 2,213 prescriptions written by physicians in a busy, urban pediatric emergency room revealed that only 110 or 5 percent had no errors or omissions of specifications. The quality of the prescriptions was evaluated according to the standards of acceptable prescribing for the following specifications: quantity, dosage, time interval between doses or specific hours to be given, and specific instructions. The hospital pharmacists, also under pressure, generally failed to monitor the prescriptions adequately--either they did not rectify the physicians' errors or at times they made incorrect changes. To improve the quality of prescriptions issued under pressure in an emergency room, several courses of action are recommended: Pharmacology departments of medical schools should place more emphasis on teaching students the art of writing explicit, comprehensible prescriptions. The physician and pharmacist should work as a team in the interest of providing patients with accurate and detailed prescriptions; or both the physician and the pharmacist should delegate the composition of prescriptions to an automated computer system, thereby reducing human error in writing and monitoring prescriptions and allowing both professionals more time for direct contact with patients.