Hypothalamic-pituitary-adrenal (HPA) axis function in patients receiving long-term intra-articular corticosteroids

The hypothalamic-pituitary-adrenal (HPA) axis function of eight patients with rheumatoid arthritis receiving regular intra-articular methyl prednisolone acetate was studied. Tests of the HPA axis 5-7 weeks after the last injection revealed suppression in two patients. Some patients receiving intra-articular corticosteroids may therefore have abnormal responses to stress.

Combined reconstruction of the vertebral and carotid artery in one single procedure

Patients suffering from vertebrobasilar insufficiency frequently have multiple areas of involvement in the extracranial circulation. Eight patients admitted to Henry Ford Hospital had symptoms suggestive of vertebrobasilar insufficiency and angiograms showing multiple abnormalities. A combined operation that reconstructed the carotid and vertebral circulations in one single procedure was completed in all patients with minimal morbidity and no mortality. The surgical procedure is described in detail.

Carcinoma of the breast and meningioma. Association and management

An association between carcinoma of the breast and meningioma has been recognized recently. Three more cases are added to the few previously reported in the literature. An awareness of this association together with modern techniques of investigation, particularly CAT scanning, may permit earlier diagnosis and treatment of more cases. Meningioma as well as carcinoma of the breast is more common in women and the incidence of both tumors reaches a peak in the fifth and sixth decades. Both are related to pregnancy and have an estrogen-receptor protein. Lesions of the central nervous system following the diagnosis and treatment of breast cancer are usually presumed to be metastatic. Therefore, these lesions may be irradiated without complete clinical investigation. If the clinician is aware of this association, appropriate diagnostic procedures could lead to the surgical removal of a benign meningioma. Skull x-rays, bone scan, brain scan, CAT scan, and cerebral angiograms are useful in making a diagnosis. Besides surgery, radiation therapy and hormonal therapy may play a role in the management.

Deficient slowing of the heart among very heavy social drinkers

Very heavy social drinkers demonstrated less slowing of their heart rate than controls while exhaling after a maximal inhalation. While this suggests defective autonomic control of the heart, clarification of the mechanism and significance of this reflex and its impairment must await sophisticated study.

High-dose computed tomography in the evaluation of low attenuation lesions in the neck

Recent reports have established the clinical utility of computed tomography (CT) in the evaluation of jugular vein thrombosis. Other abnormalities of the soft tissues in the neck can mimic this condition. This study reviews the pertinent normal soft tissue and vascular anatomy of the neck and describes the use of high-dose CT in the evaluation of low attenuation lesions in this area. Various abnormalities are compared and contrasted, including cystic hygroma, neoplasm, abscess, and venous thrombosis.

Effects of 12-O-tetradecanylphorbol 13-acetate (TPA) on a clonal human teratoma-derived embryonal carcinoma cell line

The response of a human embryonal carcinoma cell line LICR LON HT39/7 to 12-O-tetradecanylphorbol 13-acetate (TPA) has been studied. Cells treated with 5 ng/ml of TPA undergo marked morphological changes, becoming flattened with nuclear enlargement and developing a grainy and often vacuolated cytoplasm. Parallel changes in the cell surface phenotype of the treated cells also occur. These include the appearance of membrane fibronectin, the embryonic antigen SSEA-1, and a glycoprotein antigen recognised by a monoclonal antibody. There is also increased expression of histocompatibility antigens. Other membrane molecules, such as peanut agglutinin receptor(s) and a 200 000 membrane glycoprotein appear to be removed from the membrane following TPA treatment. The high levels of alkaline phosphatase normally present in LICR LON HT39/7 are also reduced by TPA. Changes in the ultrastructure of the cells have also been observed, such as increases in nuclear complexity and in the number of intermediate filaments in the treated cells. This latter observation has been confirmed by immunofluorescent staining of the cells for prekeratins, which show an extensive network following the addition of TPA, but not before. 2-Dimensional gel electrophoresis of the proteins synthesized by LICR LON HT39/7 before and after addition of TPA has shown that there are a number of alterations in the proteins synthesised by the treated cells. Furthermore, immunoprecipitation of the culture supernatants from these cells has shown that TPA induces the synthesis and secretion of fibronectin. The alterations in the phenotype of LICR LON HT39/7 induced by TPA are irreversible and the altered cells, whilst they stop dividing, can be maintained for at least three weeks in culture. The analogue of TPA 12-O-tetradecanylphorbol 13-myristate does not produce the effects described above.

Characterization of the fibronectin synthesized by human germ cell tumors

The ability of the human germ cell tumor cell lines Tera 1, Tera 2, PA-1, LICR LON HT 39/7, LICR LON HT3B1, and LICR LON HT 53 to synthesize and secrete fibronectin has been studied. The presence of cellular fibronectin was examined using indirect immunofluorescence, whereas the synthesis and secretion of the protein were studied using specific immunoprecipitation from cultures radioactively labeled with [35S]methionine. Two of the cell lines, LICR LON HT 39/7 and Tera 1, did not synthesize fibronectin, whereas all the other cell lines did. Plasma membrane fibronectin could not be demonstrated on any of the cell lines, although cytoplasmic fibronectin was easily demonstrable. The cells appear therefore to synthesize fibronectin but not retain it. Sodium dodecyl sulfate:polyacrylamide gel electrophoresis of the secreted fibronectin produced by the human teratoma cell lines showed that it had an apparent molecular weight greater than that produced by adult human breast fibroblasts or human plasma fibronectin. Peptide mapping of this secreted germ cell tumor fibronectin, by partial proteolytic cleavage, yielded peptide patterns similar to those obtained from either human plasma fibronectin or adult human breast fibroblast fibronectin. The difference in molecular weight between the fibronectins may therefore be due to changes in their patterns of glycosylation.

Measurement of enterolactone and enterodiol, the first mammalian lignans, using stable isotope dilution and gas chromatography mass spectrometry

Methods are described to extract and measure 2,3-bis(3-hydroxybenzyl)-gamma-butyrolactone (enterolactone) and 2,3-bis(3-hydroxybenzyl)butane-1,4-diol (enterodiol) from physiological fluids. They are based on the use of stable labelled analogues of each compound as internal standards with end point assay being by gas chromatography mass spectrometry. The methods were developed to quantify enterolactone and enterodiol in experiments designed to investigate the significance and source of these compounds in man and animals. Examples of studies on human ovarian blood and investigations of their excretion in urine following dietary manipulation are described.

Electrophysiologic properties of furosemide in man

Furosemide has been extensively used in the treatment of heart failure and its effect on cardiovascular dynamics are well established. Clinical relief of the symptoms of pulmonary congestion frequently precedes any demonstrable diuretic effect, suggesting that extra renal factors may also be involved. More recent studies on the extra-renal action of furosemide showed an increase of venous capacitance as an early hemodynamic effect of the drug. In spite of furosemides wide use in the treatment of heart failure and hypertension, there is no information on the electrophysiologic properties of the drug in man. The present study involving 8 human subjects was undertaken to determine what effect intravenously administered furosemide has on the human conduction system.

Elimination of carcinoma cells from human bone marrow

The value of a monoclonal antibody, LICR-LON-Fib-75 (Fib-75), which mediates complement lysis and recognises an antigen present on all epithelial-tumour cells so far studied but not on lymphoid cells or bone-marrow stem cells, in clearing infiltrated bone marrow was assessed. Chromium-51-release and trypan-blue-exclusion assays showed that no tumour cells were viable after exposure to Fib-75 and complement except when large clumps (greater than 500 cells) were present, whereas Fib-75 had no significant effect on bone-marrow cells, as judged by colony-forming-unit and pluripotential-stem-cell assays.

Serotonin-containing neurones in vertebrate retinas

It has been established by a combination of HPLC and electrochemical detection that frog, lizard, goldfish, rabbit, and bovine retinas contain both dopamine and serotonin. Immunohistological and immunoradiographical methods show that serotonin is localised in amacrine perikarya and processes situated in the inner plexiform layers of frog, lizard, and goldfish retinas. The amount of serotonin in the mammalian retina appears to be too low for detection in neurones. The serotonin in the bovine retina is located mainly in the inner nuclear and plexiform layers, suggesting that the amine is present in the same types of cells as found for frog, lizard, and goldfish retinas. Retinas incubated in [3H]serotonin showed that radioactivity is associated with processes in the inner plexiform layer and amacrine perikarya. These results suggest that the neuronal elements that contain endogenous serotonin also have the capacity to accumulate exogenous amine and are consistent with the opinion that serotonin has a neuronal function in retinas of a variety of vertebrates.

Immunohistochemical demonstration of peptides, serotonin and dopamine-beta-hydroxylase-like material in the nervous system of the leech Hirudo medicinalis

The central ganglia of the leech, Hirudo medicinalis, were processed for the immunohistochemical localisation of bombesin-, substance P-, cholecystokinin-, vasoactive intestinal polypeptide-, enkephalin-, serotonin- and dopamine-beta-hydroxylase-related substances. To varying extents all of the substances were localised in neuropile processes, and all, with the exception of substance P, were associated with specific perikarya. The most prominent neuropeptides, in terms of the number of immunoreactive neurones, were cholecystokinin and vasoactive intestinal peptide. The dopamine-beta-hydroxylase positive neurones are thought to be octopaminergic, and the serotonin monoclonal antibody revealed positive staining in the Retzius cells. We were unable to demonstrate the coexistence of pairs of substances in any neurones in the leech ganglia.

Endarterectomy of the vertebral artery from C2 to posterior inferior cerebellar artery intracranially

A new technical approach to endarterectomy of the vertebral artery at the cranial cervical junction is discussed. A patient had symptoms of vertebrobasilar insufficiency on clinical examination. Angiography demonstrated a stenotic plaque in the vertebral artery at the level of C1, and an additional tandem lesion at the origin of the posterior inferior cerebellar artery. He underwent vertebral endarterectomy and was symptomatically improved postoperatively. The surgical approach used and possible alternatives will be discussed in detail.

Gallbladder enhancement following angiography: a normal CT finding

The authors reviewed computed tomography (CT) studies that had been preceded within 2 days by angiography. Twenty-one patients were selected who showed no laboratory evidence of liver or renal disease. Eighteen patients received greater than 37 g of iodine at angiography. Eight of these underwent CT within 2 h of angiography and showed enhancement of the gallbladder wall, nine underwent CT 15 to 48 h after angiography and showed enhancement of the gallbladder contents, and one had no gallbladder enhancement. Three patients received less than 22 g of iodine at angiography and none had gallbladder enhancement on CT. The necessity of differentiating normal gallbladder enhancement from pathology on CT is stressed. In addition, the physiologic mechanisms responsible for gallbladder enhancement are presented, and the relationship of our findings to the total body opacification effect and to infusion tomography of the gallbladder is discussed.

Effect of isoetharine on cardiac conduction in man

The effects of isoetharine on the His bundle electrogram were studied in 10 patients with heart disease. Recordings were made at varied heart rates using atrial pacing. Isoetharine significantly reduced the AH interval with atrial pacing, but it had no effect on the HV interval. Second degree heart block occurred at higher pacing rates after isoetharine treatment as compared to the control state. The heart rate and blood pressure showed no significant change after isoetharine. The functional and effective refractory period were measured with the use of the extra-stimulus technique. The functional refractory period of the AV node, as well as the effective refractory period of the atrium, significantly decreased after isoetharine. Thus, isoetharine can improve conduction through the atrioventricular node. The drug does have a cardiac effect as measured by its action on the human conduction system.

Computed tomography of renal inflammatory disease

The value of computed tomography (CT) in patients with severe renal inflammatory disease has not been previously emphasized. This paper presents the authors' experience using this modality in 17 patients with acute intrarenal inflammatory conditions. A spectrum of various renal abnormalities and their CT appearance ranging from lobar nephronia (focal pyelonephritis) to xanthogranulomatous pyelonephritis is presented. These cases demonstrate that CT provides more precise anatomic information than does urography and is helpful in distinguishing uncomplicated patterns of renal infection from other types of renal inflammatory disease. In this way, patients who may be managed medically can be differentiated from those who require surgical intervention.

Posterior circulation revascularization. Superficial temporal artery to superior cerebellar artery anastomosis

Eight patients were evaluated for severe vertebrobasilar insufficiency (VBI). There were five males and three females, with an average age of 60.2 years (range 42 to 67 years). Three were diabetic and five hypertensive, including two patients who had both diseases. Seven of the eight had ongoing episodes of VBI refractory to anticoagulant and/or antiplatelet agents. Symptoms included two or more of the following in all patients: dizziness, diplopia, hemiparesis, hemihypesthesia, perioral numbness, bilateral visual blurring, dysarthria, and ataxia. Angiography revealed severe atherosclerotic stenosis of the proximal or midsection of the basilar artery in all patients. A 10-cm segment of the anterior or posterior division of the superficial temporal artery (STA) was anastomosed to a proximal segment of the superior cerebellar artery (SCA) through a right subtemporal approach. Seven of eight (87%) postoperative angiograms demonstrated patency as evidenced by filling of the SCA and, in most cases, of the basilar artery. Six of the eight patients were improved or asymptomatic after the operation, one was unchanged, and one died. The average follow-up period was 14 months, with a range of 4 to 23 months. Transient morbidity included temporal lobe swelling in four patients and a subdural hematoma in one. Anastomosis of the STA to the SCA is a feasible therapeutic option in the patient with VBI secondary to stenosis of the proximal or midsection of the basilar artery.

Computed measures on computed tomograms of the head

Measures of average parietal bone mass (APBM) and average parietal skull width (APSW) were developed using automatic image processing techniques and a special polar coordinate system. The precision of the technique is about 2%; the measures are obtained by processing one section of a computed tomographic head scan obtained without special apparatus. In males the APBM does not decrease with age; in females it splits into two groups of age, probably based on postmenopausal changes. The APSW in both males and females increases slightly with age. The clinical utility of the measures is discussed.

Effect of nebulized isoproterenol on cardiac conduction in man

The effects of Isuprel administered by means of a mistometer were studied in 8 patients with heart disease. Recordings were made at varied heart rates using atrial pacing. In addition, the functional and effective refractory periods were measured with the use of the extra stimulus technique. Four inhalations of the mistometer were administered to each patient (0.5 mg). The AH interval was 100 +/- 13 msec before and 93 +/- 23 msec 5 minutes after the Isuprel administration (p less than 0.05). Isuprel significantly reduced the AH interval with atrial pacing. The AH interval at an atrial pacing rate of 100/minute was 148 +/- 70 msec before and 131 +/- 51 msec after Isuprel (p less than 0.05). Isuprel had no significant effect on the HV interval. The effective and functional refractory period of the atrioventricular node was not significantly changed after Isuprel. The heart rate and blood pressure showed no significant change after Isuprel. No cardiac arrhythmias were seen. (The systemic absorption of the drug was probably minimal.) Isuprel administered by means of the mistometer can improve conduction through the atrioventricular node. Nevertheless, the potent bronchodilating effects of Isuprel and the absence of tachycardia and cardiac arrhythmias does attest to the safety of this agent.

133xe uptake in focal hepatic fat accumulation: CT correlation

Irregular fatty infiltration of the liver appears as focal areas of decreased attenuation on computed tomography (CT) and often cannot be distinguished from other, clinically more significant space-occupying lesions. Six patients with CT and clinical findings suggestive of fatty infiltration had xenon-133 ventilation scans of the liver. Four of these patients showed uptake and retention of 133Xe in the corresponding area of the liver, confirming the presence of fatty infiltration. The two patients in whom there was no uptake or retention of xenon by the liver were subsequently proven to have liver abscess and metastatic adenocarcinoma, respectively.

Paradoxical response to the vasodilators

A 52-year-old male was admitted to the hospital in congestive heart failure. Mitral stenosis as well as an aortic valve prosthesis were the underlying cardiac abnormalities. A Swan-Ganz catheter was inserted and various vasodilators were administered. Phentolamine, nitrates, nitroprusside, and hydralazine all produced an unexpected and at times an alarming increase in the pulmonary artery pressure. The explanation of this paradoxical hemodynamic response is unknown but demonstrates the importance of hemodynamic monitoring with vasodilator therapy