Resting energy expenditure before and after surgical resection of gut lesions in pediatric Crohn's disease

In pediatric Crohn's disease (CD), resection of gut lesions is necessary to remove stenoses and when frequent relapses occur despite nutritional support and medical treatment. After surgery, improved nutritional status and accelerated growth usually follow increased nutritional intake and lower doses of steroids. The aim of this study was to compare energy balance before and after surgery while nutritional intake and steroid therapy were unchanged. Eleven patients, aged 14.5 +/- 2.5 years and with mildly active CD, were explored 1 week before and 1 month after gut resection for stenosis (n = 7) and medical treatment failure (n = 4). Eleven matched children participated in the study as controls. Disease activity was assessed by the Pediatric Crohn's Disease Activity Index and serum orosomucoid concentration. Resting energy expenditure (REE) was measured by indirect calorimetry, and fat-free body mass (FFM) was measured by anthropometry. The patients' mean REE decreased from 46.6 +/- 10.5 kcal/kg FFM/day before surgery to 42.6 +/- 10.3 kcal/kg FFM/day after surgery, while the controls' mean REE was 39 +/- 7 kcal/kg FFM/day (analysis of variance, p = 0.02). After surgery, body weights were not significantly different, but the mean protein oxidation rate was reduced and arm muscle area was increased. Changes in REE per kilogram of FFM per day were not correlated with changes in orosomucoid serum concentrations (r2 = 0.35; p = 0.4). In conclusion, in children with mildly active CD, while nutritional intake and steroid therapy were maintained at preoperative levels, a significant decrease in REE and improved nitrogen utilisation were observed 1 month after resection of the CD gut lesion. This finding suggests better use of energy substrates when CD lesions are removed.

[Sleeping position, prevention of sudden death syndrome and gastroesophageal reflux]

Based on results of epidemiological studies, dorsal or lateral sleeping positions are now recommanded in the prevention of sudden infant death syndrome (SIDS). This raises an ethical question about the attitude towards the ventral positioning therapy for gastroesophageal reflux (GOR). The consensus conference considers that the ventral position should only be recommanded in GOR when the benefit appears to outweigh the risk of SIDS that it induces. The conference proposes that for infants with simple uncomplicated reflux, sleeping in the prone position should not be introduced in the first line treatment. Prone positioning should be restricted to complicated cases resistant to dietary and medical measures.

Current concepts and issues in the management of regurgitation of infants: a reappraisal. Management guidelines from a working party

Regurgitation in infants is a common problem. Recent issues, such as the increased risk of sudden infant death in the prone sleeping position, the finding of persisting occult gastro-oesophageal reflux with feed thickeners, and the increasing awareness of the cost-benefit ratio of medications may challenge the currently recommended management approach. A round table was organized to elaborate on the impact of (i) the pro supine sleeping campaigns in relation to sudden infant death and (ii) advancement in medical treatment on therapeutic strategies in regurgitating infants. The participants were opinion leaders from Europe and North America (Belgium, Canada, France, UK, Italy, Switzerland and The Netherlands). The importance of parental reassurance is stressed. As a consequence of the supine sleeping campaigns aiming to decrease the incidence of sudden infant death syndrome, the "prone elevated sleeping position" is no longer advised as a first-line therapeutic approach, although it is still recommended in "complicated reflux". It is emphasized that milk thickeners are an adequate therapeutic tool for regurgitation, but not in reflux disease. According to the literature, the efficacy of (alginate )antacids, although very popular in some countries, is questionable. These recommendations will be of interest to first-line paediatricians, since about 40% of their patients, according to the literature, present because of regurgitation.

Evidence for 5-HT1D beta but not 5-HT1D alpha receptor subtype expression in canine large coronary arteries and saphenous vein

OBJECTIVE

5-Hydroxytryptamine1D (5-HT1D) receptors are believed to play a major role in the vasoconstriction of vascular smooth muscle in human coronary arteries. However, unequivocal evidence as to which subtype of this receptor (5-HT1D alpha or 5-HT1D beta) is involved in these vasoconstrictory effects is lacking. The aim of this study was to identify in the dog the 5-HT1D receptor subtype encoding mRNAs expressed in several large coronary arteries and in the saphenous vein.

METHODS

Degenerate oligonucleotide primers that selectively recognized only mammalian 5-HT1D alpha and 5-HT1D beta receptor sequences were used in RT-PCR experiments to study 5-HT1D receptor subtype expression in endothelium-denuded saphenous vein and large coronary arteries from beagle and alsatian dogs. Resulting PCR products were analysed and identified by Southern blots and sequencing.

RESULTS

An identical PCR product whose sequence closely resembles that of the human 5-HT1D beta receptor (98% amino acid identity) was obtained from reverse-transcribed RNA isolated from either saphenous vein or coronary arteries, irrespective of dog race. Absence of 5-HT1D alpha expression was confirmed by Southern blot analysis. Control experiments using canine genomic DNA as template illustrated, nonetheless, that the primers chosen could amplify both 5-HT1D alpha and 5-HT1D beta sequences.

CONCLUSION

Using RT-PCR, we isolated from dog vascular smooth muscle a cDNA fragment whose nucleotide sequence would encode a previously-unreported canine homologue of the 5-HT1D beta receptor. We illustrated that this subtype is the only 5-HT1D receptor subtype expressed in dog saphenous vein and large coronary arteries. The implications of these findings are discussed in light of results from functional studies of 5-HT1-like receptor-mediated effects in these canine blood vessels.

Pharmacological profile of benzodiazepine site ligands with recombinant GABAA receptor subtypes

Using [3H]flumazenil as a probe we investigated how benzodiazepine site pharmacology of alpha beta gamma ternary combinations of GABAA receptors can be influenced upon expression of different isoforms of alpha, beta and gamma subunits. The nature of the beta subunit did not alter the pharmacology of this site in that the affinities of alpha 5-containing GABAA receptors for various benzodiazepine modulatory ligands were essentially unchanged upon a comparison of different beta-variant forms (alpha 5 beta 1 gamma 2, alpha 5 beta 2 gamma 2 and alpha 5 beta 3 gamma 2). In contrast, both alpha and gamma variants contributed to notable differences in benzodiazepine site pharmacology. Thus alpha 1 beta 2 gamma 2, alpha 3 beta 2 gamma 2 and alpha 5 beta 2 gamma 2 receptors showed high, intermediate and low affinities for zolpidem, respectively. Exchanging gamma 2 for gamma 3 reduced the affinities of alpha 1 beta 2 gamma and alpha 3 beta 2 gamma receptors for zolpidem by factors of > 150 and > 5.8, respectively. The alpha 1 beta 2 gamma 3, alpha 3 beta 2 gamma 3 and alpha 5 beta 2 gamma 3 receptors exhibited, in contrast, higher affinity for CL218872 than their corresponding gamma 2 receptors. The information on these different recombinant GABAA receptor pharmacological profiles should help in the elucidation of native GABAA receptor subtype diversity.

[Synovial cyst involving isolated paralysis of the infraspinatus muscle. Ultrasonographic diagnosis and MRI]

A case of entrapment neuropathy of the inferior branch of the suprascapular nerve in the spinoglenoid notch is described. Ultrasonography and MRI examination showed a ganglion cyst in the spinoglenoid notch with an extension to the glenohumeral joint. The lesion was confirmed by surgical and pathological examination.

Comparative effects of cholesterol and cholesterol sulfate on hydration and ordering of dimyristoylphosphatidylcholine membranes

The comparative effect of cholesterol (CH) versus cholesterol sulfate (CS) on dimyristoylphosphatidylcholine (DMPC) membranes has been investigated by optical microscopy, freeze-fracture electron microscopy, x-ray diffraction, and solid state 2H and 31P nuclear magnetic resonance (NMR). The sulfate analogue extends the lamellar phase domain toward high water contents, and substitution of 30 mol % CH by CS in DMPC lamellae induces the trapping of 30 wt % additional water. The greater swelling of the CS-containing systems is evidenced by determination of lamellar repeat distances at maximal hydration: 147 +/- 4 A and 64 +/- 2 A in the presence of CS and CH, respectively. 2H-NMR of heavy water demonstrates that CS binds approximately 12 more water molecules at the interface than CH whereas NMR of deuterium-labeled DMPC chains reveals that 30 mol % CS orders the membrane as 15 mol % CH at high temperature and disorders much more than CH at low temperatures. The various effects of CS versus CH are discussed by taking into account attractive Van der Waals forces and repulsive steric/electrostatic interactions of the negatively charged sulfate group.

[Systemic granulomatous reaction in hip prosthesis. Apropos of 2 anatomoclinical cases]

PURPOSE OF THE STUDY

The production of particulate wear debris is a recognised complication of joint arthroplasty. Focus was made on local tissue reactions. Systemic distribution of wear debris are less know. We report two new cases of distant granulomatous reaction.

MATERIAL

The first case concerned a 71-year-old man with lymph node histiocytosis incidentally discovered during the staging of a prostatic carcinoma. The second case concerned a 61-year-old man with a visceral granulomatosis reaction (liver, spleen and lymph node) associated to hepatic ans splenic enlargement.

METHODS

We realised an histological analysis of several tissue specimens for these two patients and for one case an inductively coupled plasma-mass spectrometry technique (ICPMS).

RESULTS

In all specimens we identified a foreign body granulomatous reaction characterized by the presence of particles coming from hip arthroplasty. The ICPMS identified titanium in spleen.

DISCUSSION

Distant granulomatous reaction are generally localised in regional lymph nodes and discovered by accident. A systemic granulomatous reaction attributable to wear particles raises the question of long term biocompatibility of prosthetic materials.

CONCLUSION

Besides local reaction, it is of utmost importance that physicians involved in prosthetic field take into consideration the possible systemic adverse effect of wear particles from arthroplasty.

[Position and sudden death of the infant]

In western countries, the sudden infant death syndrome (SIDS) is the leading cause of mortality in infants under one year of age. In an official statement on prevention from the French Ministry of Health, sleeping in the supine position or on the side is recommended for all infants unaffected by a particular medical condition. This clear restrictive recommendation is based on valid epidemiological data but raises questions in the minds of paediatricians and general practitioners since the most recent recommendations for treatment of gastro-oesophageal reflux indicate that the prone position at a 30 degrees angle is the first preventive measure to be taken. We present here an objective view point on this complex problem which others may find helpful in developing a sound approach to each individual case. First it must be emphasized that multiple factors are involved in SIDS. While the confirmed correlation between the supine sleeping position and reduced incidence of SIDS is a valid rationale for population-based preventive measures, it does not indicate any causal relationship. Secondly, epidemiological data is valid for a given geographical area but cannot be extrapolated to other areas without taking into account intercurrent factors such as soft bedding, use of feather-bed quilts, excessive bedroom temperature and passive smoking. The public campaign for the prevention of SIDS should be encouraged as an effective low-cost measure, but both physicians and parents should be aware of its multifactorial nature in order to avoid psychologically catastrophic consequences of the guilt syndrome. For infants with uncomplicated simple gastro-oesophageal reflux, a formerly well-known condition but currently less well tolerated by modern parents, it is essential to explain the physiological nature of the reflux to parents then to propose formula thickeners, antacids or prokinetic agents in particularly symtomatic cases. Sleeping in the 30 degrees prone position should not, in this particular case, be introduced as a preventive measure since the risk induced would probably be greater than the beneficial effect. For complicated reflux, after careful exploration and elimination of other causes of vomiting, treatment should be optimized first, followed by discussion on placing the infant in the 30 degrees prone position which should be considered as a therapeutic tool with the same risk of secondary effects as expected with drugs.

[Primary amyloidosis of bones. MRI aspects]

Primary systemic amyloidosis is a rare cause of vertebralcollapse. We describe a patient who presented multiplecollapsed vertebrae. Magnetic resonance imaging (MRI) demonstrated a diffuse bone marrow abnormality. A diffuse low signal throughout the vertebral bodies on T1 and T2 weighted spin-echo images were observed. A bone biopsy confirmed the suspected diagnosis of vertebral involvementby amyloid. MR imaging can be of interest to evaluate the bone spreading of a known amyloidosis and to help in the diagnosis of amyloidosis in the case of non traumatical vertebral fractures.

Quantification of alpha 1-adrenoceptor subtypes in human tissues by competitive RT-PCR analysis

Alpha 1-Adrenoceptors are a heterogeneous subfamily of receptors comprising at least three pharmacologically- and structurally- distinct subtypes named alpha 1a-, alpha 1b- and alpha 1d-adrenoceptors. A competitive reverse transcription-polymerase chain reaction methodology using subtype selective competitor RNAs as reference internal standards was adopted to determine the absolute amounts of each of the three cloned to date alpha 1-adrenoceptor subtype encoding mRNAs in selected human tissues. Our data demonstrated that each of these alpha 1-adrenoceptor subtypes exhibits a distinctive tissular expression pattern.

Modulation of the gamma-aminobutyric acid type A receptor by the antiepileptic drugs carbamazepine and phenytoin

We report here that carbamazepine and phenytoin, two widely used antiepileptic drugs, potentiate gamma-aminobutyric acid (GABA)-induced Cl- currents in human embryonic kidney cells transiently expressing the alpha 1 beta 2 gamma 2 subtype of the GABAA receptor and in cultured rat cortical neurons. In cortical neuron recordings, the current induced by 1 microM GABA was enhanced by carbamazepine and phenytoin with EC50 values of 24.5 nM and 19.6 nM and maximal potentiations of 45.6% and 90%, respectively. The potentiation by these compounds was dependent upon the concentration of GABA, suggesting an allosteric modulation of the receptor, but was not antagonized by the benzodiazepine (omega) modulatory site antagonist flumazenil. Carbamazepine and phenytoin did not modify GABA-induced currents in human embryonic kidney cells transiently expressing binary alpha 1 beta 2 recombinant GABAA receptors. The alpha 1 beta 2 recombinant is known to possess functional barbiturate, steroid, and picrotoxin sites, indicating that these sites are not involved in the modulatory effects of carbamazepine and phenytoin. When tested in cells containing recombinant alpha 1 beta 2 gamma 2, alpha 3 beta 2 gamma 2, or alpha 5 beta 2 gamma 2 GABAA receptors, carbamazepine and phenytoin potentiated the GABA-induced current only in those cells expressing the alpha 1 beta 2 gamma 2 receptor subtype. This indicates that the nature of the alpha subunit isoform plays a critical role in determining the carbamazepine/phenytoin pharmacophore. Our results therefore illustrate the existence of one or more new allosteric regulatory sites for carbamazepine and phenytoin on the GABAA receptor. These sites could be implicated in the known anticonvulsant properties of these drugs and thus may offer new targets in the search for novel antiepileptic drugs.

MRI of intramedullary cavernous haemangiomas

We reviewed 11 cases of intramedullary cavernous haemangiomas (IMCH) studied by MRI, to assess its diagnostic value in these lesions. Follow-up MRI was obtained in five patients 7 days-2 years following the initial study. In one case a postoperative examination was obtained. The diagnosis was pathologically proven in ten cases, and supported in the last by a family and personal history of cavernous haemangiomas. A reticulate appearance with areas of mixed signal intensity in both T1- and T2-weighted images was the most common finding. Homogeneous high, low or intermediate signal intensity was each found in one case. Two small lesions gave low signal. A rim of low signal was less common than in cerebral cavernous haemangiomas. In one case, the brain showed more than 20 lesions with the MRI appearances of cavernous haemangiomas. In two of five patients, serial preoperative MRI showed progressive disappearance of high-signal areas on both T1- and T2-weighted images. To find a haemorrhagic intramedullary lesion on MRI is not rare. Although the appearances are not pathognomonic, an IMCH can be suggested. We suggest that the following characteristics may help: (1) a personal and/or family history of cavernous haemangiomas; (2) typical MRI appearances of mixed acute, subacute and chronic haemorrhage; (3) a tendency for signal intensity to decrease on follow-up; (4) normal spinal angiography; and (5) associated brain lesions.

[Treatment of gastroesophageal reflux]

Several therapeutic means are available for the treatment of pathological gastroesophageal reflux (GOR): positional therapy, thickening the feedings, dietetic modifications, antacids, mucosa-protecting agents, gastrokinetic drugs, antisecretory drugs, and surgery. In uncomplicated GOR, simple measures must be used first, associating positional therapy, thickening the feedings and a mucosa-protecting agent or an antacid; a gastrokinetic drug will be added if these measures are insufficient after 2 or 3 weeks. Peptic esophagitis requires a more drastic treatment, using antacid, prekinetic and antisecretory drugs; in addition, its cure should be assessed by esophagoscopy. When GOR is associated with life-threatening events, treatment may be completed with an atropine derivative in case of vagal hypertonia, and its efficiency must be verified by monitoring of oesophageal pH under treatment. In infants, the medical treatment should be maintained until complete cure, which usually occurs when walking is achieved. Surgery is indicated in complicated GOR (esophagitis, life-threatening event, pulmonary complication) with failure of the medical treatment, or as first-line treatment in the case of severe esophagitis in children with severe psychomotor impairment.

Structure and expression of endogenous retroviral sequences in the permanent LMH chicken cell line

From DNA mapping data, four endogenous proviral loci have been observed in the chicken permanent cell line LMH. The locus corresponding to endogenous virus (ev) ev1 is present in duplicate whereas the locus corresponding to ev3 is present in one copy. The other loci are probably ev6 and a solitary long terminal repeat. A RNA Northern blot analysis revealed both ev3 and ev6 transcripts but no ev1 transcript was detected. Using avian leukosis virus (ALV)-based vectors, transcomplementing assays were performed. They demonstrate the correct expression and maturation of endogenous env proteins and the absence of production of functional gag and pol components, indicating that these cells are not competent for viral production.

Pharmacokinetics of intravenous omeprazole in children

This study was undertaken to define the pharmacokinetics of omeprazole in children and included 13 patients, heterogeneous in terms of age (0.3 to 19 years), underlying disease and biological constants, indication of omeprazole administration and associated therapy. The dose administered ranged from 36.9 to 139 mg.1.73 m-2. The pharmacokinetic parameters of omeprazole were: systemic clearance, 0.23 l.kg-1.h-1; volume of distribution, 0.45 l.kg-1; elimination half life 0.86 h; but were highly variable between individuals. Dosage, differences in hepatic and renal function and associated therapy may contribute to inter-individual variability. Within the range of doses administered, the pharmacokinetic parameters were similar to those reported in adults. The drug has been well tolerated in all children.

Prenatal gastrointestinal bleeding caused by esophagitis and gastritis

We report a case of a prenatal esophagitis and gastritis revealed at 33 weeks of gestation by the presence of bloody amniotic fluid and dilated intestinal loops that was confirmed by endoscopy at birth. Complete recovery occurred after treatment with ranitidine.

Expression of alpha 1-adrenoceptor subtypes in rat tissues: implications for alpha 1-adrenoceptor classification

We report here the mapping of the mRNA distribution of three different alpha 1-adrenoceptor subtypes (alpha 1b, alpha 1c and alpha 1d) in various rat tissues. cDNA fragments covering the region from the fifth to seventh putative transmembrane spanning domains of these three alpha 1-adrenoceptor subtypes were generated from rat hippocampus using reverse transcription coupled to polymerase chain reaction (PCR). These three alpha 1-adrenoceptor cloned cDNA fragments were then used as subtype-selective cDNA probes in Northern blot analysis. Of the three specific DNA probes only the rat alpha 1b-adrenoceptor probe hybridized to mRNA of rat liver. The rat alpha 1c-adrenoceptor probe hybridized to a mRNA species of 3.7 kb in tissues that have been reported to contain the classical pharmacologically-defined alpha 1A-adrenoceptor such as hippocampus, vas deferens, lung and salivary gland. Also, a major mRNA transcript of 2.7 kb was detected in hippocampus, vas deferens and lung, using the rat alpha 1d-adrenoceptor probe. In addition, pharmacological characterization of [3H]prazosin binding to three stably transfected mammalian cell-lines expressing one of the three alpha 1-adrenoceptor subtypes cloned to date (namely, alpha 1b--of the hamster smooth muscle DDT1-MF2 cell-line, the bovine brain alpha 1c--and the rat cerebral cortical alpha 1d-adrenoceptors) was performed. Of the three cloned alpha 1-adrenoceptor subtypes that alpha 1c-adrenoceptor showed a similar pharmacological profile to that of the classical alpha 1A-adrenoceptor of rat salivary gland. Our data on the pharmacological profile and expression pattern of the alpha 1c-adrenoceptor indicate, in contrast to earlier claims (Schwinn et al., J. Biol. Chem. 265, 1990), that this subtype is in fact the classical pharmacologically-defined alpha 1A-adrenoceptor subtype.