Localization of the gene for familial adenomatous polyposis on chromosome 5

Colorectal cancer is the second most common cancer in the United Kingdom and other developed countries in the West. Although it is usually not familial, there is a rare dominantly inherited susceptibility to colon cancer, familial adenomatous polyposis (FAP; also often previously called familial polyposis coli). During adolescence affected individuals develop from a few hundred to over a thousand adenomatous polyps in their large bowel. These are sufficiently likely to give rise to adenocarcinomas to make prophylactic removal of the colon usual in diagnosed FAP individuals. Adenomas may occur elsewhere in the gastrointestinal tract and the condition is often associated with other extracolonic lesions, such as epidermoid cysts, jaw osteomata and fibrous desmoid tumours. Adenomata have been suggested to be precancerous states for most colorectal tumours. Knudson has suggested that the mutation for a dominantly inherited cancer susceptibility may be the first step in a recessive change in the tumour cells, and that the same gene may be involved in both familial and non-familial cases of a given tumour. Following up a case report of an interstitial deletion of chromosome 5 in a mentally retarded individual with multiple developmental abnormalities and FAP, we have now shown that the FAP gene is on chromosome 5, most probably near bands 5q21-q22.

Localization of the gene for familial adenomatous polyposis on chromosome 5

Colorectal cancer is the second most common cancer in the United Kingdom and other developed countries in the West. Although it is usually not familial, there is a rare dominantly inherited susceptibility to colon cancer, familial adenomatous polyposis (FAP; also often previously called familial polyposis coli). During adolescence affected individuals develop from a few hundred to over a thousand adenomatous polyps in their large bowel. These are sufficiently likely to give rise to adenocarcinomas to make prophylactic removal of the colon usual in diagnosed FAP individuals. Adenomas may occur elsewhere in the gastrointestinal tract and the condition is often associated with other extracolonic lesions, such as epidermoid cysts, jaw osteomata and fibrous desmoid tumours. Adenomata have been suggested to be precancerous states for most colorectal tumours. Knudson has suggested that the mutation for a dominantly inherited cancer susceptibility may be the first step in a recessive change in the tumour cells, and that the same gene may be involved in both familial and non-familial cases of a given tumour. Following up a case report of an interstitial deletion of chromosome 5 in a mentally retarded individual with multiple developmental abnormalities and FAP, we have now shown that the FAP gene is on chromosome 5, most probably near bands 5q21-q22.

Rational-emotive therapy: an excellent counseling theory for NPs

Rational-emotive therapy (RET) is a comprehensive, multimodal, active-directive and relatively brief form of psychotherapy that is particularly suited for use by nurse practitioners. RET theory assumes that people have innate tendencies to think rationally and irrationally; therefore, people have the ability to fulfill and actualize themselves and to easily upset and defeat themselves. The basic tenets of RET help people distinguish between their own rational and irrational beliefs, and their consequent appropriate and inappropriate emotions and behaviors. Many cognitive, emotive and behavioral methods are used to help clients minimize their symptoms of anxiety, depression, self-hatred and rage. Nurse practitioners using RET can help their clients make profound philosophic changes that prevent future emotional problems and encourage maximum health and self-actualization.

A cognitive neuropsychological case study of anomia. Implications for psychological models of word retrieval

The case of a neurological patient with severe anomic word-finding difficulties is reported. A detailed cognitive neuropsychological investigation of the patient's ability to name objects to confrontation was carried out in an attempt to determine where his cognitive deficits might lie. In contrast to the findings of recent case studies of word-finding difficulty (e.g., Howard and Orchard-Lisle, 1984), it was observed that the patient seemed to have a clear understanding of the items that he was trying to name, suggesting that his problems in word-finding were not semantically based. Indeed, the patient would often generate partial phonological information about the sought-after word, indicating that he had a specific target in mind, and this was reminiscent of 'tip-of-the-tongue' states in normal word-finding. A difficulty in retrieving complete phonological forms of words is considered as the probable locus of his anomia. A distinction is made between semantically-based and phonologically-based anomias.

Electrocardiographic and histologic abnormalities in canine ceroid-lipofuscinosis (CCL)

Electrocardiograms were recorded in a longitudinal study on six adult dogs with canine ceroid-lipofuscinosis (CCL) and compared with those of four unaffected animals. Two dogs exhibited minor conduction abnormalities, QRS-notching and LVH at 12 months of age. By 24 to 25 months of age, the underlying cardiac rhythm was that of a pronounced sinus arrhythmia. Some dogs developed premature atrial beats, A-V dissociation or tachycardia. No gross cardiac abnormalities were noted at necropsy, but histologically, autonomic ganglion cells in the atrium, near the conducting system and in ventricular myocardial cells were filled with autofluorescent lipopigments. Quantification by micro-spectrophotometry showed peak emission at 538 nm. At the ultrastructural level, these fluorescent particles consisted of collections of curvilinear and lamellar profiles, similar to those present in other viscera. Ceroid-lipofuscinosis has been utilized for many years as a model for human ceroid-lipofuscinosis and the results described here are similar to those previously reported in hearts of patients with this disease. Because related lipopigments accumulate in normal aging of the heart and contraction/conduction abnormalities develop with time, the canine model may also be useful in aging studies as well. The studies described here are the first to demonstrate possible structural-functional relationships in the heart of dogs with CCL.

Cardiac output and muscle blood flow in exercising dogs

Average blood flow (q) was determined by trapping of 15 micron radioactive microspheres in the vastus lateralis, the gastrocnemius-flexor digitorum superficialis and the triceps brachii of five 18 kg untrained mongrel dogs at rest and during graded treadmill running. Oxygen uptake (VO2) and cardiac output (Qco) were simultaneously determined. q leveled off in all investigated muscles at 60-100 ml X 100 g-1 X min-1 when VO2 was ca. 70% of peak VO2. Qco increased linearly with VO2 up to peak VO2. The regional blood flow (qR) distribution pattern within the muscle was found to be extremely scattered around q, both at rest and at heavy exercise. qR ranged from approximately 5 to approximately 55 ml X 100 g-1 X min-1 at rest and from approximately 10 to approximately 200 ml X 100 g-1 X min-1 at maximal exercise. No significant topographic pattern was observed in the qR distribution of the gastrocnemius muscle which was essentially similar to that previously found for the isolated-perfused muscle preparation. The results indicate that maximal limb muscle blood flow and/or its uneven distribution may be the primary limiting factor to peak VO2 in untrained running dogs.

Culture of retinal pigment epithelium from chorio-retinal biopsies

The recently devised methods for surgical sampling of chorio-retinal tissue permits morphological evaluation of retina in various diseases. In the present report it is demonstrated, that the retinal pigment epithelium in such samples can be isolated as a viable cell population, and that the cell mass can be increased sufficiently in culture to permit biochemical as well as morphological studies. This procedure thereby expands the diagnostic potential of the sample tissue.

The genetics of peptic ulcer

Non-malignant ulceration of the stomach and duodenum was, until relatively recently, considered to be one disease and was known by the all-embracing term peptic ulcer. Evidence from several sources tends to support the idea that even the broad divisions of gastric and duodenal ulcer may themselves be the end results of multiple separate disease processes. Genetic studies have helped considerably in the characterisation of these individual conditions.

HLA-DR typing in coeliac disease: evidence for genetic heterogeneity

Sixty nine propositi from a family study of coeliac disease were typed for HLA-DR antigens. Sixty three (91%) were found to carry the antigen DR3, which was a significantly greater proportion (p = 9.6 X 10(-24] than among the 168 controls (26%). Concurrently 42 children with the disease were DR typed. Not only was the frequency of DR3 significantly increased in these patients (86% versus 26% in controls; p = 3.1 X 10(-12] but so also was the frequency of DR7 (patients 60%, controls 29%; p = 5.8 X 10(-4]. When those propositi whose coeliac disease presented before the age of 20 were combined with the childhood coeliac group and a comparison made between these patients and the remainder of the propositi, all of whom presented when they were older than 20, the childhood onset group had a significant excess of DR7 (p = 2.2 X 10(-3] and a significant deficiency of DR2 (p = 3.5 X 10(-3]. These findings indicate that childhood coeliac disease and adult coeliac disease are genetically heterogeneous.

Decreased cortical glucose utilization after ibotenate lesion of the rat ventromedial globus pallidus

Rats received unilateral injections of ibotenic acid (12 micrograms) or vehicle in the ventromedial globus pallidus to lesion the primary source of cortical cholinergic innervation. At 3 or 28-32 days postinjection, the regional cerebral metabolic rate for glucose (rCMRglu) was measured by the 2-deoxy-D-[14C]glucose technique in nine cortical areas, the anterior thalamus, and the dorsal hippocampus. Effects of oxotremorine (0.1 mg/kg i.p.) on rCMRglu in these areas were assessed in ibotenic acid-lesioned and sham-treated rats. Significant effects of ibotenic acid injections and hemispheric asymmetries in rCMRglu were observed in all cortical areas (p less than or equal to 0.05), but not in the anterior thalamus or hippocampus. Cortical rCMRglu generally was lower in the lesioned hemisphere 3 days after ibotenic acid injections, but not after sham treatments. Hemispheric asymmetries were not apparent 28-32 days after pallidal lesions. Oxotremorine produced significant effects in the frontoparietal cortex and anterior thalamic nuclei. In the frontoparietal cortex, rCMRglu was 32% lower in the ibotenate-lesioned hemisphere as compared with the contralateral hemisphere. Oxotremorine did not eliminate hemispheric asymmetry, but increased rCMRglu in the lesioned frontoparietal cortex by 38%. Results support the views that cortical metabolic decrements in Alzheimer's disease are due in part to loss of subcortical cholinergic innervation and that muscarinic agonists may partially reverse these decrements.

The management of equinus deformity in Duchenne muscular dystrophy

Equinus deformity of the ankle is one of the serious orthopaedic problems associated with Duchenne muscular dystrophy. Sixty-nine patients (age range 4 to 17 years) were treated, 43 conservatively and 26 operatively. They were followed up at six-monthly intervals for a minimum of two years and a maximum of six years. The patients were divided into three groups: independently mobile, mobile in calipers, and wheelchair-bound. It was found that conservative treatment could at best only minimise progression of the deformity. The indications for surgery, the operative procedure and the postoperative management are described; all varied according to the stage of the disease. The postoperative follow-up suggests that, though the deformity recurs, the patients have several years of benefit from the procedure.

Influence of N-acetylhomocysteine thiolactone on cultured retinal cells in canine neuronal lipofuscinosis. An ultrastructural study

An SH- group donor drug, N-acetylhomocysteine thiolactone (0.2 mg/ml), was added to retinal cultures from an adult dog affected with ceroid lipofuscinosis (NCL). This substance was applied every 3rd day to the culture medium. After 1, 2 and 3 weeks in culture the cells were fixed for electron microscopy. Ultrastructurally the NCL-specific lipopigments revealed extensive fading out or vacuolation, revealing randomly arranged lamellar or 'fingerprint' membranes as well as structures resembling degenerated mitochondria. Additionally extensive fragmentation of the pigment bodies was present. The significance of these results are discussed.

Chronic inflammatory bowel disease, deep-venous thrombosis and antithrombin activity

Of 34 patients with chronic inflammatory bowel disease (CIBD), 4 developed well-documented episodes of deep-venous thrombosis. All 4 patients had active disease at the time of thrombosis. This group was studied to determine if the tendency to deep-venous thrombosis in patients with CIBD was associated with reduced antithrombin activity by measuring the concentration of three thrombin inhibitors, antithrombin III (AT III), alpha 2-macroglobulin (alpha 2 M) and alpha 1-antitrypsin. 2 patients had low AT III levels and 10 had low alpha 2 M levels. 2 patients who developed deep-venous thrombosis had significantly low levels of both AT III and alpha 2 M. It is suggested that in patients with diseases predisposing to thrombosis and associated with low AT III levels, the measurement of alpha 2 M in addition to AT III may predict those particularly at risk.

Evidence for a major dominance component in the variation of serum pepsinogen I levels

We report here a variance component analysis of the distribution of serum pepsinogen I levels in normal individuals, using a maximum-likelihood method on entire pedigrees. The results indicate a broad heritability of 91%, with some 74% being attributed to a dominance component. This is consistent with the hypothesis that the pepsinogen I level in normals is principally determined by the action of major genes, as also seems to be the case for duodenal ulcer patients and families.

Identification and measurement of molecular variants of cholecystokinin in duodenal mucosa and plasma. Diminished concentrations in patients with celiac disease

The amount and type of cholecystokinin (CCK) in duodenal extracts and plasma of celiac patients and normal subjects was studied by radioimmunoassay and gel filtration. In both groups there were similar patterns of molecular forms in extracts of duodenal biopsies, but concentrations in celiac disease were significantly depressed. In boiling water extracts of duodenal mucosa from both groups a factor with the properties of the COOH-terminal octapeptide of cholecystokinin predominated, but there were also significant amounts of a larger molecular weight form. In acid extracts of mucosa a factor with the properties of the 33 or 39 residue form was identified in amounts that were approximately 25% those of CCK8; there were also similar amounts of an acid-soluble form that had an apparent molecular weight higher than CCK39. Plasma immunoreactive cholecystokinin was studied after concentration by immunoaffinity adsorption and fractionation by gel filtration. In normal subjects fasting CCK-like immunoreactivity was less than 0.8 pmol/liter, and after a light breakfast increased to 2.0 +/- 0.7 (range 1.0 to 4.8) pmol/liter; CCK8-like activity accounted for all the increased immunoreactivity. In five of six celiac patients the concentrations of both fasting and postprandial CCK-like immunoreactivity in plasma were undetectable (less than 0.8 pmol/liter). We conclude that diminished production and release of CCK could account for the impaired pancreatic and gall bladder responses to intraluminal stimuli in celiac disease.

The in vitro metabolism of ethinyloestradiol, mestranol and levonorgestrel by human jejunal mucosa

1 Ethinyloestradiol was extensively metabolised in vitro by human jejunal mucosa to form ethinyloestradiol sulphate. 2 The amount of conjugation was directly related to the weight of biopsy tissue. 3 The degree of conjugation of mestranol and levonorgestrel was much lower than for ethinyloestradiol suggesting that the 17-position of the steroid nucleus is relatively inaccessible for conjugation. 4 No Phase I metabolism of ethinyloestradiol or levonorgestrel was apparent in the conditions used in these experiments.

Blood glucose monitors: a laboratory and patient assessment

The four blood glucose monitors available in the United Kingdom were compared by asking the opinions of 24 patients who used each monitor for two weeks, by correlating their blood glucose results with those obtained in the laboratory, and by having the monitors examined by an electronics engineer. Of the battery-operated monitors, patients preferred the Hypocount (15) to the Glucochek (9). The mains-operated units were less popular, with little to choose between Eyetone and Reflomat. Under field conditions the blood glucose results obtained with the Glucochek correlated poorly with the standard reference method. In contrast the Hypocount, Eyetone, and Reflomat machines produced good correlations. Poor results with the Glucochek were mainly due to faulty timing systems. The patients' preference for the Hypocount was supported by tests of performance under laboratory conditions and by the electronics engineer's report.