Characterization of muscarinic receptor subtypes in human tissues

The affinities of selective, pirenzepine and AF-DX 116, and classical, N-methylscopolamine and atropine, muscarinic cholinergic receptor antagonists were investigated in displacement binding experiments with [3H]Pirenzepine and [3H]N-methylscopolamine in membranes from human autoptic tissues (forebrain, cerebellum, atria, ventricle and submaxillary salivary glands). Affinity estimates of N-methylscopolamine and atropine indicated a non-selective profile. Pirenzepine showed differentiation between the M1 neuronal receptor of the forebrain and the receptors in other tissues while AF-DX 116 clearly discriminated between muscarinic receptors of heart and glands. The results in human tissues confirm the previously described selectivity profiles of pirenzepine and AF-DX 116 in rat tissues. These findings thus reveal the presence also in man of three distinct muscarinic receptor subtypes: the neuronal M1, the cardiac M2 and the glandular M3.

Polyclonal B-cell activation by influenza A/Texas virus-specific human T-cell clones

A previously described proliferating class-II-restricted CD4+ human T-cell clone (TA4) specific for the N2 neuraminidase of the influenza A/Texas virus was tested for its ability to induce B cells to polyclonal immunoglobulin (Ig) production. The data reported in the present study show that, when stimulated by T-depleted autologous peripheral blood mononuclear cells (E-) and A/T virus, the TA4 clone was able to induce B cells to polyclonal Ig production. This effect was also seen using another class II-restricted human T-cell clone specific for the H3 haemagglutinin of the A/Texas virus and autologous polyclonal T cells. This Ig production was MHC-restricted at the inductive level, i.e., the stimulating-virus-treated E- population and the clones or the T cells had to share the same HLA-DR determinants. However, the responding B cells could be allogeneic provided the helper T cells were activated in the presence of autologous irradiated virus-infected E- cells.

Increased left ventricular stiffness impairs filling in dogs with pulmonary emphysema in respiratory failure

In a chronic canine model of pulmonary emphysema, we studied the interaction between left ventricular (LV) mechanics and pulmonary disease during severe hypoxemia. The hypoxemia was similar to that which may occur during a severe exacerbation of chronic obstructive lung disease. In six dogs with papain-induced emphysema and in seven dogs without emphysema, LV mechanics were examined when a hypoxic gas mixture was inspired to reduce PO2 to about 35 mmHg (hypoxic study) and during nonhypoxic conditions (room air study). In both groups, LV diastolic compliance was reduced during the hypoxic study by a similar amount. This finding could not be explained in terms of ventricular interdependence. Our analysis suggested that hypoxia decreased diastolic compliance (i.e., increased LV diastolic stiffness) by impairing LV relaxation. The primary effect of hypoxia was to decrease the extent to which LV relaxation occurred for a given end-diastolic pressure, while the rate of LV relaxation was decreased just slightly. This study indicates that severe hypoxemia because of respiratory failure may impair myocardial relaxation leading to a decrease in LV filling.

Characterization of muscarinic receptors in human submandibular salivary glands

We studied the binding of the muscarinic antagonist [3H]N-methyl-scopolamine [( 3H]NMS) in order to characterize muscarinic receptors located in human submandibular salivary glands obtained from intrasurgical biopsy. [3H]NMS bound with a Kd value of 1.56 nM to a single class of muscarinic receptors (Bmax 37.3 fmol/mg protein) since pirenzepine exhibited a homogeneous binding profile.

Hemodynamic effect of hydralazine in interstitial lung disease patients with cor pulmonale. Immediate and short-term evaluation at rest and during exercise

Hydralazine was administered short-term to 13 patients who had stable interstitial lung disease (ILD), pulmonary arterial hypertension (PAH); mean pulmonary arterial pressure ( [PAP]=26 +/- 9 mm Hg), and cor pulmonale (CP). All patients were studied at rest and during exercise. After intravenous hydralazine at rest, there were statistically significant increases in cardiac index (CI) (p less than 0.001), arterial oxygen saturation (SaO2) (p less than 0.01), and mixed venous saturation (S-vO2) (p less than 0.01). Pulmonary vascular resistance (Rp) (p less than 0.005) and systemic resistance (Rs) decreased (p less than 0.001), and PAP did not change. During exercise, PAP did not change; however, CI (p less than 0.01), PaO2 (p less than 0.001), and S-vO2 (p less than 0.01) increased further. The increase in Rp was significantly reduced (p less than 0.01). After continuation of oral hydralazine therapy in 12 patients for 7 days, PAP at rest was not statistically different from control; Rp and Rs remained decreased (p less than 0.001). The same results were found for CI, PaO2, S-vO2, and Rs during exercise. Although PAP did not change from control values, the drug significantly reduced the increase in Rp (p less than 0.005). Vasodilator therapy with hydralazine could be useful in patients with stable ILD who have inflammation with minimal to moderate fibrosis and PAH and might be used as an adjunct to conventional therapy for ILD and CP.

Mitral valve prolapse secondary to right ventricular enlargement in patients with pulmonary hypertension after toxic rapeseed oil ingestion

A high incidence of mitral valve prolapse (MVP) has been reported in various entities which produce important right ventricular (RV) enlargement with normal or decreased left ventricular (LV) volume. To evaluate the importance of RV enlargement in the genesis of MVP in these cases, we analyzed the echocardiographic studies from 176 patients with 'Síndrome Tóxico'. These patients underwent M-mode, cross-sectional and pulsed Doppler examination because of the suspicion of having dietary pulmonary hypertension, a complication which occurred in almost 20% of patients with this epidemic poisoning and which showed a course of gradual resolution in most of them. RV size was classified according to the RV/LV maximal short-axis dimension ratio as normal, border-line, moderately enlarged and severely enlarged. MPV was diagnosed according to standard M-mode and cross-sectional echocardiographic criteria. A second echocardiographic examination was obtained in 38 patients 12.5 +/- 5.3 months after the first one. The incidence of MVP was 9.3% in patients with normal RV size (N = 107), 9.5% in patients with border-line RV size (N = 23), 30% in patients with moderate RV enlargement (N = 30) and 56% in patients with severe RV enlargement (N = 16) (P less than 0.001). Fourteen (77%) of the 18 patients with MVP and moderate or severe RV enlargement (N = 16) (P less than 0.001). Fourteen (77%) of the 18 patients with MVP and moderate or severe RV enlargement had holosystolic MVP. At pulsed Doppler examination, no patient showed signs of mitral regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain levels of tofizopam in the rat and relationship with benzodiazepine receptors

The effect of tofizopam on 3H-flunitrazepam binding was studied in rat hippocampus and cerebellum. Tofizopam (at a concentration of 10(-7) M) increased 3H-Flu binding through a 30% rise in the Bmax with no modification of Kd in either brain area. Similar results were obtained when the binding was measured in tofizopam (50 mg/kg p.o.) pretreated rats. Even though tofizopam has no anticonvulsive action against pentetrazol-induced convulsions, it significantly potentiated the action of diazepam but with no modification of brain diazepam levels and metabolism. The brain levels of tofizopam are reported and compared to plasma levels after oral administration of 5 and 50 mg/kg to rats.

The epidemiology of Entamoeba histolytica in a rural and an urban area of Mexico. A pilot survey II

Stocks of intestinal amoebae grown in monoxenic culture, were compared against each other and against those previously reported from Mexico City. These were isolated from subjects in San Cristobal de las Casas, Chiapas (rural area) and hospital patients in Merida, Yucatan (urban area). Electrophoretic patterns of the four enzymes: glucose phosphate isomerase (GPI), phosphoglucomutase (PGM), L-malate: NADP+ oxido-reductase (oxalacetate-decarboxylating) (ME) and hexokinase (HK) demonstrated the presence of five groups (zymodemes) of Entamoeba histolytica already described from Mexico City, together with two new zymodemes, one of which gave a recognizable pathogenic pattern, whilst the other gave a contradictory pattern. Zymodemes of Entamoeba coli, Entamoeba hartmanni, Iodamoeba buetschlii and Dientamoeba fragilis, previously described were also isolated. One new zymodeme of D. fragilis was demonstrated.

[Gestalt therapy of complaints]

People can express their suffering voicing it, complaining with their body, with gestures, movements; for alerts eyes it is even more comprehensive and true than words. Complaints that human beings are capable of expressing are not so many, there are only a handful, and this work intends to be exhaustive in its exposition. It is possible to complain against third persons. It is also possible to do so against oneself assuming either the intransigent attitude of a father who judges a son who does not fulfill his expectancies, or as a son who resents the paternal demands which he feels he cannot comply. Other kind of complaints include physical symptoms, either isolated (cephalea, dysnea, urticaria) or constituting syndromes or illnesses. Losses suffered are also a source of complaints, whatever the lost object might be (person, situation, material things or a part of oneself). It can be mourned because of its absence, or else by feeling guilty of the real or imaginary damage inflicted or else by feeling indisolubly linked to it with a phantom tie. Other types of complaints are the feeling of dependancy towards something oppressive, be it a substance, such as alcohol, smoking, drugs or overeating, or it may be a person or a situation. In view of the compulsive addiction characteristics with which the subject lives, it is possible to assimilate this dependancy and the feeling of oppression and damage to the link with a toxic.

Acute appendicitis during pregnancy

Case reports (1970--1977) of thirty-five pregnant women with acute appendicitis were reviewed. Eighty-eight per cent had symptoms less than 24 hours and were operated on within 12 hours. No maternal or fetal loss occurred. Morbidity and mortality should be minimal if, when appendicitis is suspected in a pregnant woman, immediate operation is performed.

Comparative nitrogen balance study between young and aged adults using three levels of protein intake from a combination wheat-soy-milk mixture

The protein requirement and the efficiency of protein used were studied in young and old adult human subjects. Protein intake levels (N X 6.25) of 0.4, 0.8, and 1.6 g/kg body weight per day from a combination wheat-soy-milk mixture were fed. Caloric intake was held constant at 40 kcal/kg body weight per day throughout the 11-day study of each dietary period. No significant differences were observed in their protein requirement, efficiency of protein use or the ability to adapt to changes of protein intake levels. Protein digestibility was not impaired in the aged. It is concluded that the protein requirement and the efficiency of protein use are not affected by the aging process.

[Value of computerized axial tomography in cranio-cerebral injuries]

Since May 1975 was have been working in the field of C.A.T. and its application to study head injuries. We are presenting differents groups of patients studied by C.A.T. I. -- DATA OF C.A.T. IN THE CASES OF EMERGENCY AND IMMEDIATE POST-OPERATIVE FOLLOW-UP OF HEAD INJURIES A) EMERGENCY STATE As soon as the clinical state of an head injured patient was supposed to need an operation, C.A.T. was realized; so differents abnormal scanners may be observed: 1. epidural hematoma, 2. subdural hematoma, 3. intra-cerebral hematoma, 4. acute subdural hematoma or contusion. We must do some comments: -- The Emi-scanner is pre-eminent in showing the exact topography of the lesion : so, the flap is easier to realise. -- In most cases the Emi-scanner is easier to interpret than angiogram for example contusion and hematoma. We know the goods results in hematomas and the poors results in surgery of contusions. -- But the senior advantage of C.A.T. is to provide all the informations in the totality of skull content. Emi-scanner shows bilateral lesions, ipsilateral lesion. C.A.T. is pre-eminent in showing the presence of this two lesions, more accurately than senior methods of investigations, so C.A.T. permits emergency neurosurgical treatment. B) C.A.T. AND FOLLOW-UP Repeated studies at post-intervals can be accomplished without risk to the patient, thus making follow-up simpler and more effective to the neurosurgical attitude. C) POST-OPERATIVE CONTROL AND C.A.T. Post-operative complications are always hard to diagnosis. C.A.T. is painless, quick and safe, and easier to interpret than an angiogram. II -- SEQUELLAE STADE AND C.A.T. In this field certains advantages of C.A.T. are immediatly apparents. In most cases the C.A.T. is the best screening method. Patients carried out are: -- psychiatric troubles, -- post-traumatic epilepsy. The results are not reliable. There is no anatomical-clinical relation in most cases. Differents pictures are observed: -- asymetrical ventricle enlargment, -- global ventricule enlargment, -- partial cerebral atrophy. III -- DISCUSSION 1. We are at the beginning of our study. 2. This not always possible to obtain a C.A.T. in emergency for a head injury, especialy at night. 3. Patients investigated following head trauma are among the most difficult to study with C.A.T. These invididuals send to be restless and uncooperative. Numerous artefacts produced by patient motion may lead to erroneous negative or positive diagnosis, so general anesthesia is often helpful. It is hoped that as a more rapid scanners become available this problem will be obviated. The C.A.T. alone is not capable, to provide all the necessary date concerning head injury. The C.A.T. is, however, re-adjusting our total investigation (E.E.G., angiograms) philosophy and practice rather than replacing the standard neuroradiological technique, except, may be, with epidural hematoma.

[Intraosseous meningioma in a child]

The authors present a case of intra-osseous meningioma in a 10 years old boy, located on the level of the vertex in the fronto-interparietal region, with the shape of a hand mass, painless, free from all neurological, ophtalmological and angiographic signs. The x-rays examination permit a diagnosis of an osteoma of the cranial vault. The surgery enables the exeresis of a large tumor of the vault 3 cm thick, without any attachment to the dura-matter. The histological examination reveals that it is, in fact, an intra-osseous meningioma. From this observation the authors carried out a review of all litterature in this field, only 12 observations are found again, and none of them deal with children. These intra-osseous meningioma develop from Pacchioni granulations included in the diploic region. They bring about handly any clinical signs and the x-rays findings do not enable us to put forward or suggest the diagnostic of intra-osseous meningioma.

Diagnostic and therapeutic problems concerning tumors of the vault

We observed 36 tumors of the cranial vault in children (11 epidermoid and dermoid cysts, 3 meningiomas, 3 malignant tumors, 11 vascular tumors, 6 eosinophilic granulomas, 2 osteomas). The common clinical finding enabling us to include all 36 tumors in this study is a large tumefaction of the cranial vault, without our being able to determine its anatomical starting point or histological nature. These observations are described according to whether they have a bony, dural or cutaneous origin, differentiating tumors of embryological origin. In the majority of cases, internal and external carotid angiography was performed to help surgery, which remains the only cure.

[Surgical treatment of fractures of the acetabulum (personal experience)]

A hundred and thirty-five cases of fracture of the acetabulum seen from 1964 to date are analysed. Thirty-four were treated conservatively, a hundred-and-one by surgery. A clinical assessment of the cases treated was carried out. The different types of fracture (of the anterior column, of the posterior column, of the posterior wall and transverse fractures) are briefly described. In conclusion, treatment by surgery gives much better results because anatomical reconstruction of the acetabulum is possible or, at least, partial reconstruction which can be completed by the application of a hip-joint prosthesis at a later date.

Postoperative care: in hospital or at home? A feasibility study

This study was carried out, first, to determine the feasibility of postoperative home care for three elective operations and, second, to explore the feasibility of introducing postoperative home care as a more economical alternative for the following surgical procedures: herniorrhaphy, vaginal hysterectomy, and vein stripping. Clinical, environmental, operative, and socioeconomic criteria were applied to 487 outpatients of which 44 pairs were selected and matched by age, sex, diagnosis, environmental, and socioeconomic characteristics. Each member of a pair was randomly assigned to either hospital care or home care. The place of postoperative care was disclosed only after the operation. After three to five hours in the recovery room, the hospital care patient was transferred to the general surgical wards and the home care patient was transferred by ambulance to his home. There were two minor complications in the home care group and three in the hospital care group. The duration of convalescence was significantly shorter for home care patients with post–hernia repair and with hysterectomy. Economic analysis showed that from the hospital viewpoint, the average cost for both herniorrhaphy and hysterectomy home care patients is one–fourth of the average cost of hospital care. The home care alternative also provides for other savings which are described in the study.