Acquired hypoganglionosis after soave endorectal pull-through procedure--a case report

A case of acquired neurogenic megacolon in a child is reported. The condition resulted after a Soave endorectal pull-through procedure for Hirschsprung's disease and was secondary to hypoganglionosis which developed in the pulled-through segment. The clinical, radiological, and pathologic features as well as the successful surgical management of this case are described.

Convulsions may alter the specificity of kappa-opiate receptors

Morphine, a mu-opiate agonist, and ethylketazocine, a kappa-opiate agonist, produce distinct behavioral, pharmacologic, and biochemical effects. In the mouse, large doses of morphine produce convulsions that are usually lethal and that cannot be blocked by naltrexone, whereas ethylketazocine produces nonlethal clonic convulsions that can be blocked by naltrexone. Moreover, mice made tolerant to morphine failed to show cross-tolerance to ethylketazocine, suggesting that the convulsions induced by these drugs are not mediated via a common opioid mechanism. Following a series of electroconvulsive shocks, both morphine and ethylketazocine produced clonic convulsions that were not lethal and that could be blocked by naltrexone. Furthermore, electroconvulsive shock-treated animals made tolerant to morphine-induced convulsions showed cross-tolerance to ethylketazocine. These data suggest that electroconvulsive shock may alter kappa-opioid systems in such a way as to allow mu-agonists to be functional at these sites.

Neuroblastoma: report on a 21-year experience

This is a review of 80 patients with neuroblastoma managed at the American University of Beirut Medical Center between 1963 and 1983. Three patients had ganglioneuroblastoma of whom one showed histologic evidence of maturation into a ganglioneuroma. Four patients were less than 1 month of age and 33 were less than 2 years of age. The site of origin was intra-abdominal in 56 patients of whom 34 were intra-adrenal. Intraspinal involvement was noted in 12 patients, of whom one was a newborn. Treatment and adequate follow-up were possible in 63 patients. Total excision of the tumor was performed in 17 patients, and partial excision in 14. The 2-year and 5-year survival rates were 36% and 25%, respectively. Age, site of the tumor, and degree of cellular differentiation were the only independent variables affecting survival. Eleven of 14 patients younger than 1 year were alive 5 or more years after diagnosis. Cervical, thoracic, and pelvic tumors had a better prognosis than abdominal tumors. Other factors affecting survival were the stage and the mode of therapy. Infants with stage IV-S congenital neuroblastoma had a very poor prognosis. The initial urinary VMA level as well as the presence or absence of calcifications within the tumor had no bearing on prognosis.

Changes in responsiveness to mu and kappa opiates following a series of convulsions

After a series of seven electroconvulsive shocks, mice (C57BL/6J) showed a marked change in their response to opiates. Although very large doses of mu agonists induce convulsions in normal control mice, our evidence indicated that this was accomplished through nonopiate mechanisms: they could not be blocked by naltrexone and the pattern of drug potencies (codeine greater than morphine greater than levorphanol) was not consistent with an opiate response. In contrast, after electroconvulsive shock small doses of mu agonists induced convulsions that could be blocked by naltrexone and the pattern of drug potency (levorphanol greater than morphine greater than codeine) was consistent with an opiate mechanism. Kappa drugs, on the other hand, produced convulsions in both control and ECS animals, although there was an enhanced responsiveness in the latter. Furthermore, the convulsions produced by kappa drugs were blocked by naltrexone and showed stereoselectivity in both control and ECS animals. The changes in responsiveness to mu and kappa opiates cannot be explained on the basis of a general increase in seizure susceptibility, as sensitivity to the nonopiate convulsant, strychnine, was not enhanced after electroconvulsive shock. The results point to a qualitative change in response to mu agonists after electroconvulsive shock, but only a change in sensitivity to kappa agonists.

Spinal cord compression in neuroblastoma

Twelve of 80 patients suffering from neuroblastoma who were treated during a 21-year period had intraspinal involvement. Mediastinal tumors have a greater tendency to extend to the spinal canal; however, distant spread of the tumor is rare in patients presenting with intraspinal extension. Patients with intraspinal extension also survive longer than those without. Other factors affecting survival are age, stage of disease, duration of neurological symptoms, degree of histologic differentiation, and mode of therapy. In the absence of osseous metastasis, total excision of the primary lesion and its intraspinal components is usually followed by a favorable outcome; residual neurological deficits among survivors, however, are relatively common.

Morphine responsiveness and seizure proneness

Previous research demonstrated that following amygdala kindling, animals showed a heightened sensitivity to morphine's convulsive effects and an exaggerated Straub tail response. These effects were evident to 3 months after their last convulsion and could be blocked by naloxone pretreatment. The present paper extends these findings by demonstrating that animals given metrazol or electroshock (ECS) convulsions also showed an enhanced morphine response that was blocked by naltrexone. Both metrazol- and ECS-treated animals convulsed in response to doses of morphine that produced little or no effect in control animals. In addition, it was shown that brain damage induced by electrode implantation or neocortex penetration by skull screws also increased an animal's sensitivity to morphine even in the absence of prior convulsions. This effect, however, could not be blocked by naltrexone. Finally, as opiate receptors vary with the diurnal rhythm, we determined that following amygdala kindling, animals are more sensitive to morphine's convulsive action during their dark phase when receptor number and sensitivity are highest. The results indicated that seizure proneness, whether induced by a history of prior convulsions or brain damage, increased sensitivity to morphine. This effect may be due to a change in opiate receptors only when prior convulsions have occurred.

Mast cell differentiation depends on T cells and granule synthesis on fibroblasts

Mast cell differentiation was generated in the following three experimental situations: (i) infection of mice with Schistosoma Mansoni or with Nippostrongylus brasiliensis and growth of the lymph node cells in the presence of the corresponding helminth antigen; (ii) immunization with horse serum and growth of blood and lymph node cells in the presence of the horse serum; (iii) exposure of T-cell-depleted suspensions of lymph node cells from unimmunized mice to T-cell factor (TCF) released into medium of the young cultures of (i) and (ii). This differentiation was also obtained when lymph node cells from athymic nude mice were exposed to TCF. The cell suspensions were plated on X-irradiated fibroblast monolayers prepared from embryonic mouse skin. Screening of the suspensions before plating on the fibroblasts in culture revealed no young forms of mast cells, and none were present in culture of nude mice lymph node cells maintained without TCF. Primordial appearance of metachromatic granules generally in the golgi zone was first seen in many 'large lymphoid cells' as early as 18 hr after plating. This was followed by increase in the cytoplasm volume, increase in granule number and mitosis, ending at 10-18 days with homogeneous populations of mature mast cells. When the mesenteric lymph node cells from mice infected with the helminths were grown in the absence of fibroblasts but in the presence of the antigen, homogeneous populations of cells with extended cytoplasm, filled with unstained vacuoles developed during days 7-13. These cells did not contain histamine (or at most 0.2 microgram per 10(6) vacuolated cells). When these cells were plated on fibroblast monolayers clear granule formation in all the vacuoles was seen 2 days later. It increased progressively in size and staining intensity, until the vacuoles transformed into typical mast cell granules. By the fourth day the vacuolated cells attained the typical mast cell morphology and the histamine content greatly increased (from 0.12 microgram per 10(6) vacuolated cells to 3.02 micrograms per 10(6) mast cells). These mast cells were readily degranulated by monoclonal anti-DNP-BSA IgE, and the antigen, releasing 90% of the histamine. The study shows that mucosal mast cells formation from 'large lymphoid-like' cells present in the blood and in the lymph, is stimulated by TCF. The condensation of the metachromatic material and histamine synthesis depends on other cells, presumably fibroblasts which comprise the principal cell in the embryonic skin monolayers. The mechanism of the fibroblast influence is not yet known.

Inhibition of suppressor T-cell development following deoxyguanosine administration

The expression of immunodeficiency in patients with specific purine enzyme defects indicates a crucial role of the purine salvage pathway in the acquisition and expression of normal immune function. One current hypothesis links the failure of normal lymphocyte development in these diseases to the accumulation of deoxynucleotide triphosphates. In our studies of human in vitro IgM responses, we observed that antigen-induced T-suppressor cell activity was abrogated in the presence of micromolar concentrations of deoxyguanosine (dGuo). In contrast, more than 1,000-fold higher resistance to dGuo was found for both noin-proliferative T-helper cell activity and the differentiation and proliferation of the precursor B lymphocytes for direct haemolytic plaque forming cells (PFC). To determine whether these observations could have in vivo relevance, we monitored the generation of murine T-suppressor cells, capable of abrogating a primary IgM response. It was found that dGuo (but not guanosine) selectively inhibited the in vivo development of T-suppressor cells.

Chlordiazepoxide antinociception: cross-tolerance with opiates and with stress

Chlordiazepoxide (CDP) has been previously shown to possess antinociceptive properties that are resistant, except at high doses, to the opiate antagonist naloxone. The present study evaluated whether CDP's antinociceptive effects were subject to tolerance following repeated injections and whether cross-tolerance might develop between the antinociceptive action of CDP and that of either morphine or cold water swins. CDP increased flinch-jump thresholds following acute administration and exhibited tolerance following repeated injections. Neither morphine-tolerant nor cold water swim-adapted rats displayed an antinociceptive effect when tested with CDP. On the other hand, chronic pretreatment with CDP attenuated the antinociceptive effects of cold water swims, but did not produce any clear effect upon morphine analgesia.

Differential effects of hypophysectomy upon analgesia induced by two glucoprivic stressors and morphine

Pain threshold elevations induced in rats following acute exposure to stressful cold-water swims and to inescapable foot shocks are significantly attenuated by hypophysectomy. The present study investigated the effects of hypophysectomy upon the dose-dependent and time-dependent analgesia induced by morphine and by the glucoprivic agents, 2-deoxy-D-glucose (2-DG) and insulin. Two reflex pain tests, the tail-pinch and the flinch-jump were employed. In normal rats, insulin induced prolonged (180 min) analgesia at doses of 16 U/kg on the tail-pinch test and 256 U/kg on the flinch-jump test. However, the same agents induced small and brief pain threshold elevations in hypophysectomized animals. By contrast, though 2-DG increased both measures in both groups, its effects were more marked in hypophysectomized rats. Hypophysectomized rats also exhibited a potentiated analgesic effect on both tests following high doses of morphine. On the other hand, low doses of morphine transiently increased tail-pinch thresholds in normal, but not hypophysectomized subjects. These data provide further evidence of multiple pain-inhibitory mechanisms in which the pituitary plays a complex, but integral part.

Psoas abscess: thirty-four years after pyogenic osteomyelitis of the spine

Although purulent sequelae are common with pyogenic spinal osteomyelitis, they should not persist as chronic problems unless they are untreated or treated inadequately. In 1943 a man had a spinal fusion for spondylolisthesis and postoperatively had pyogenic osteomyelitis of the spine, a complication that cleared after three years of treatment. Thirty-four years later, and after 30 years of being free of symptoms, the patient had a psoas abscess that was relieved by surgical intervention.

Effect of treatment with azathioprine on the responses of rat lymphocytes to phytohaemagglutinin

The proliferative responses of rat peripheral blood lymphocytes (PBL) and spleen cells to phytohaemagglutinin (PHA) were studied after single or multiple (daily for 4 days) injections of azathioprine (AZ). Lymphopenia developed within 4 h of a single dose (78 mg/kg) of AZ and persisted for at least 72 h. There was no lymphopenia 24 h after the last of 4 daily injections. In vitro, PBL were more sensitive than spleen cells to the inhibitory effect of AZ. Likewise, the responses of PBL were relatively more depressed than those of spleen cells after single or multiple injections of AZ. The degree of depression was less than was expected from the effect of AZ in vitro. Multiple small doses were more depressive than multiple large doses. Serum from treated rats, used at 20% concentration, was more depressive than normal. Thus, rat lymphocytes are quite sensitive to AZ in vitro, but appear to be relatively resistant in vivo, this resistance resembling the resistance of the primary antibody response to AZ treatment.

Effect of hydrocortisone, cyclophosphamide, azathioprine and methotrexate on cutaneous delayed and arthus hypersensitivity in the rat

The effect of 4 immunosuppressive agents--hydrocortisone (HC), cyclophosphamide (CY), azathioprine (AZ) and methotrexate (MTX)--, on cutaneous delayed-type hypersensitivity (DTH) and Arthus reactions to the intradermal injection of ovalbumin (OA) in rats sensitized to OA in Freund's complete adjuvant (FCA) was studied. Multiple doses (daily for 4 days) were given either early, beginning on the day of sensitization, or late, beginning 9 days after sensitization. Single doses were given on the day of challenge with OA. All late multiple doses of drugs except HC depressed the DTH at 24 h in the following order of decreasing magnitude: MTX, CY, AZ. The DTH at 24 h was depressed by early multiple doses of MTX at all doses, by CY at all but the lowest dose, and by AZ at the intermediate dose; HC had no effect. When the drugs were given as single late doses, only CY at the lowest dose and MTX at the higher doses effectively depressed the DTH at 24 h. Increased Arthus reactions occurred after early and late multiple doses of HC and after a late single dose of CY at the highest dose. After late multiple doses the Arthus reaction was unaffected by either CY or MTX but was depressed by all doses of AZ. HC administered as 3 injections around the time of challenge markedly depressed the delayed and Arthus reactions. These results show that each of the 4 immunosuppressive drugs could depress DTH and Arthus reaction to OA, but the degree of depression varied with the time of drug administration relative to sensitization and challenge, and the dose of drug used. Histologic examination of skin test sites showed that an apparently negative reaction did not necessarily imply total absence of a cellular inflammatory response.

Effect of methotrexate on the response of rat lymphocytes to phytohaemagglutinin

The proliferative responses of rat peripheral blood lymphocytes (PBL) and spleen cells to phytohaemagglutinin (PHA) were studied following either single or multiple (daily for 4 days) doses of methotrexate (MTX). Lymphopenia developed 72 hr after a single dose of MTX. Multiple doses of MTX caused a dose-limited lymphopenia. In vitro, MTX depressed the response of PBL but enhanced the response of spleen cells to PHA. The administration of single or multiple doses of MTX led to increased responses of the remaining PBL and spleen cells. Folinic acid protected against the toxicity of multiple doses of MTX and the previously enhanced spleen cells were less responsive. In some conditions MTX treatment led to the enhancement of PBL responses by the serum of treated rats; in other conditions serum became inhibitory. MTX inhibited the primary antibody response to sheep erythrocytes. These studies demonstrate that MTX treatment initially enhances the proliferative response of lymphocytes to PHA and then causes depression at the onset of lymphopenia; that serum after MTX treatment has a variable effect on lympho-proliferative responses; and also that MTX is selectively more depressive of antibody formation than of responsiveness to PHA.

2-Deoxy-D-glucose-induced decrements in operant and reflex pain thresholds

Acute exposure to many environmental stressors induces significant analgesia. The present study examined whether 2-deoxy-D-glucose (2-DG), an antimetabolic glucose analogue, which induces glucoprivation and peripheral sympatho-adrenal discharge, would also produce analgesia as measured by either an operant liminal escape or a reflex tail-pinch procedure. In the liminal escape paradigm, 9 rats were tested at weekly intervals in 6 randomly selected testing conditions: 30 min pre-test injections of four 2-DG doses (100, 225, 350 and 700 mg/kg, IP) and 180 min pre-test injections of the 2 higher doses. Moderate analgesia occurred at the lower 2-DG doses 30 min after injection, while profound analgesia occurred at the higher doses. After 180 min, only the 700 mg/kg 2-DG dose produced moderate analgesia, which was further enhanced by food deprivation. Rats tested in the tail-pinch paradigm displayed a similar dose-dependent analgesia course. These results demonstrate that 2-DG decreases nociceptive sensitivity, possibly through stress-induced activation of an intrinsic pain-inhibitory system.

Effect of hydrocortisone on the response of rat lymphocytes to phytohaemagglutinin

The proliferative response of rat peripheral blood lymphocytes and spleen cells to phytohaemagglutinin (PHA) was studied following treatment with single or multiple doses of hydrocortisone. A transient lymphopaenia with a rapid recovery at 24 h occurred with both dose schedules. Hydrocortisone in vitro caused a dose-dependent depression of blood lymphocyte response to PHA but enhanced the response of spleen cells when the steroid was added after the mitogen. An inverse relationship between blood and splenic lymphocyte responses to PHA occurred after a single dose of hydrocortisone. Blood lymphocytes from multiple dose hydrocortisone-treated rats had an enhanced response to PHA. Serum collected within 5 min of injection from single dose-treated rats depressed normal rat blood lymphocyte responses. After multiple doses of hydrocortisone serum enhanced blood lymphocyte responses to PHA. The primary antibody response to sheep erythrocytes was only affected by near toxic doses of hydrocortisone.