Islet function and insulin sensitivity in the non-diabetic offspring of conjugal type 2 diabetic patients

To determine whether the genetic predisposition towards Type 2 diabetes was associated with a defect in either islet-cell function or insulin action, 12 non-diabetic offspring each of whose parents both had Type 2 diabetes were studied, together with 12 control subjects matched for age, sex, and weight. Fasting plasma glucose was higher in the offspring (5.5 +/- 0.1 mmol l-1 (mean +/- SE)) than in the matched controls (5.1 +/- 0.1 mmol l-1) (p less than 0.05). Using an IVGTT insulin sensitivity was not significantly lower in the offspring compared with their controls (3.1 +/- 0.5 vs 3.8 +/- 1.0 min-1 mU-1 l 10(-4)). There was no significant difference in any of the measures of insulin secretion (first- and second-phase response to IV glucose, slope of glucose potentiation, and maximal glucose regulated insulin secretory capacity). Glucagon secretion measured before and after a stimulus of IV arginine at varying plasma glucose concentrations was virtually identical in the offspring and their controls. Among a total of 28 non-diabetic subjects of differing body-weights there was a significant inverse relationship between insulin sensitivity and insulin secretion. When adjusted for their generally lower insulin sensitivity, maximal insulin secretory capacity was reduced in the offspring (p = 0.038, one-tailed t-test). The results suggest that the genetic predisposition to Type 2 diabetes is not associated in young adults with any major pre-morbid impairment in insulin secretion or insulin action but the relationship between the two may be abnormal. Islet A-cell function appears to be normal.

Serotonin involvement in analgesia induced by transcranial electrostimulation

The experiments described here were intended to investigate whether serotonin (5HT) may be involved in analgesia induced by low current transcranial electrostimulation (TE). The TE stimulus is a 10 mu-ampere, 10 Hz, pulsed current transmitted via electrodes in the pinnae. Combinations of the following were given as intraperitoneal injections: 300 mg/kg p-chlorophenylalanine (pCPA) 48 hours before testing, 100 mg/kg 5-hydroxytryptophan (5HTP) 30 min before testing and the saline vehicle for these drugs. Rats were tested prior to and 30 minutes after TE or sham TE. Testing for analgesia consisted of putting progressively increasing pressure on the rat tail 1/4 inch from the tip with a pneumatically driven, right angle wedge. The amount of pressure at which the rat moved its tail was measured both before and after TE, or sham TE, and recorded as the difference in tolerated peak pressure (DTPP). TE produced analgesia as manifested by a 613 percent increase in DTPP compared with sham TE treatment values. Among TE treated rats, pretreatment with pCPA decreased DTPP 91.5 percent compared with saline control values, indicating 5HT involvement. 5HTP restored TE induced analgesia in pCPA treated rats to the level of saline treated control animals, confirming 5HT involvement.

The in vivo effect of nonsteroidal anti-inflammatory drugs, gold sodium thiomalate and methotrexate on neutrophil superoxide radical generation

The generation of superoxide radicals by activated peripheral blood polymorphonuclear leukocytes from patients with rheumatoid arthritis (RA) has been measured and the in vivo effect of nonsteroidal anti-inflammatory drugs (NSAIDs) and disease remittive agents studied. Generation of superoxide radicals from RA patients was significantly decreased when compared to a control population. This was principally due to the disease rather than medications in that patients with osteoarthritis receiving NSAID generated superoxide radicals similar to that seen in the control group. RA patients receiving NSAIDs and injectable gold or methotrexate therapy showed a significant trend to normalization of superoxide radical generation when compared to those with RA receiving NSAIDs alone. We conclude that the reduced generation of superoxide radicals on activated polymorphonuclear leukocytes from patients with RA is principally a feature of the disease and that this abnormality can be partially reversed by the use of a disease remittive agent in vivo.

Are thyrogastric autoantibodies associated with an increased susceptibility to developing type 1 (insulin-dependent) diabetes? A study in identical twins

To examine whether the presence of thyrogastric autoantibodies is associated with an increased susceptibility towards developing type 1 diabetes we have tested for thyroid (microsomal and thyroglobulin) and gastric-parietal cell antibodies in 86 pairs of identical twins, 47 discordant and 39 concordant for type 1 diabetes. Autoantibodies were detected in both twins of a pair in 35 and in neither twin in 45 pairs. In only 6 pairs (3 discordant) was there a discrepancy in the antibody results between co-twins. The frequency of antibodies was similar in twin pairs discordant, (21/44, 48%), and concordant, (14/36, 39%), for diabetes. Thyrogastric antibodies were not more frequent in pairs that were female, diagnosed above the age of 20, or had HLA DR3 as opposed to DR4. We conclude that thyrogastric autoantibodies are common in both type 1 diabetic patients and their non-diabetic identical twins. Their presence appears to be genetically determined but does not increase the susceptibility of developing diabetes. The presence of autoantibodies does not appear to indicate a separate aetiological type of diabetes.

Conservative management of primary cervical lymphoma using combination chemotherapy: a case report

A 22-year-old nulligravida presented with a stage IE/IIIB primary malignant lymphoma of the cervix which measured 8 cm in diameter. In order to preserve reproductive potential, a 12-week course of methotrexate with leucovorin rescue, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin was administered. One month later a 4-cm-diameter left parametrial mass was excised at laparotomy; no tumor was detected in the specimens obtained. Menses resumed after an additional 6 months. The patient was clinically disease-free at the 33-month follow-up.

Treatment of recurrent nightmares by the dream reorganization approach

Dream reorganization is introduced as a new theoretical and treatment approach to the alleviation of recurrent nightmares, derived from the principles of the Seligman and Yellen (1987) theory of dream construction. The cognitive-behavioral dream reorganization treatment package consists of two treatment components. Systematic desensitization with coping self-statements is employed to alter the emotional episode by counterconditioning a relaxation response to anxiety-evoking nightmare content. Guided rehearsal of mastery endings to dream content hierarchy items is added to modify the secondary visual stimuli associated with recurrent nightmares. The dream reorganization approach is presented in the case of a 10-year-old male with a fear of sleeping alone due to recurrent nightmares. Following treatment, the client reported 100% reduction in nightmares and demonstrated 100% reduction in night time arrival in the parents' room. The present report provides a theoretical rationale for dream reorganization, and future directions for research in the treatment of recurrent nightmares.

Gastric heterotopia causing airway obstruction

Two infants are reported each with a mass of heterotopic gastric tissue in the hypopharynx causing airway obstruction. Endoscopic laser removal of the tumours proved a satisfactory method of treatment. Gastric heterotopia in the head and neck region is rare but should be considered as a cause of stridor in infants.

Mothers' attitudes and their children's behaviors in 3-year-olds born prematurely and at term

A sample of 94 mothers and their 3-year-old children participated in a cross-sectional study to measure maternal overprotective attitudes and children's behavior problems. Mothers in the full-term group (n = 47) were matched to mothers in the preterm group (n = 47) on maternal age, maternal education, and marital status. The groups were balanced for the child's gender, birth order, and mother's nationality. The subjects answered the Mother-Child Relationship Evaluation (MCRE) to measure maternal attitudes and the Behavior Screening Questionnaire (BSQ) to measure behavior problems in preschoolers. Overall, children born prematurely have the same incidence of behavior problems as children born full-term. However, the subgroup of preterms who had respiratory distress syndrome (RDS) had a higher incidence of behavior problems. Conversely, the results suggest that mothers of children born prematurely without RDS have more overprotective attitudes towards their children. Maternal overprotection is minimally associated with behavior problems.

Canadian surgeons lay claim to world's first successful bowel transplant

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Islet-cell antibodies as predictors of the later development of type 1 (insulin-dependent) diabetes. A study in identical twins

To determine the value of islet-cell antibodies, both complement-fixing and non-complement-fixing, in predicting the later development of Type 1 (insulin-dependent) diabetes, we studied different groups of identical twins. Twelve twins have developed diabetes and 11 of these had non-complement-fixing islet-cell antibodies before diagnosis, and eight out of nine tested had complement-fixing islet-cell antibodies. Of the twins who have remained non-diabetic for many years and are now unlikely to develop diabetes, twelve have had non-complement-fixing islet-cell antibodies at some stage but only four have ever had complement-fixing antibodies. In 29 non-diabetic co-twins tested within 5 years of the diagnosis of diabetes in the affected twin the presence of islet-cell antibodies, especially complement-fixing, predicted the progression to frank diabetes with a high specificity (100%), sensitivity (88%) and predictive value (100%). In pairs remaining discordant the antibodies were found more frequently in the diabetic than the non-diabetic twin. We conclude that the presence of islet-cell antibodies is not genetically determined and can occur without progression to diabetes. However, the presence of islet-cell antibodies, especially complement-fixing, in non-diabetic twins tested soon after the diagnosis of their co-twin, indicates a high risk for the development of diabetes.

Serological profiles in the connective tissue diseases in Zimbabwean patients

The serological profiles of 104 Zimbabwean patients with clinically diagnosed connective tissue diseases were determined. The prevalence of rheumatoid factor was less than would have been expected in other geographical groups, but the prevalence of antinuclear antibodies was similar. Despite considerable racial, socioeconomic, and genetic differences in our patient group compared with other previously published studies the specificity and sensitivity of antinuclear antibodies, notably to DNA and Sm, correlated well with clinical diagnoses. This study validates the use of these serological tests in the investigation of this group of patients.

Levels of adult alcohol consumption induced by interactions with child confederates exhibiting normal versus externalizing behaviors

Investigated levels of distress and alcohol consumption in Ss interacting with problematic vs non-problematic child confederates. Social drinkers were randomly assigned to interact with boys trained to enact behaviors characteristic of either normal or attention-deficit disorder/conduct disorder (ADD/CD) children. Mood data were collected before and after the interaction. Ss engaged in ad lib beer consumption for 20 min, while anticipating another interaction with the same boy. Children in the ADD/CD role produced comparably distressed moods for both male and female Ss. However, only men drank to higher blood-alcohol levels in the ADD/CD vs. normal child condition. Results suggest that higher rates of drinking observed in fathers of ADD/CD children may be partly a function of their particular response to the distress associated with interactions with such children.

A psychometric study of positive and negative nominations and the pupil evaluation inventory

Two peer evaluation measures, the Pupil Evaluation Inventory (PEI) and positive and negative nominations were compared in a sample of 260 children in grades 1 to 5. Stabilities of the measures were assessed over a 4-month period. In the total sample, PEI factors and negative nominations were more stable than positive nominations, and PEI Aggression and Withdrawal scores were more stable than negative nominations. PEI Aggression and Withdrawal scores were more stable in grades 3 and 5 than in grade 1, and the Likability factor was more stable in grades 2 to 5 than in grade 1. Negative nominations were most strongly correlated with the PEI Aggression factor, and positive nominations were more strongly correlated with Likability than with Aggression. Implications for the use of these nomination measures are discussed.

Pediatric prehospital care in a southern regional emergency medical service system

A retrospective review of 2,302 ambulance run reports from the Birmingham Regional Emergency Medical Service System indicated that 6% of all runs are for patients in the pediatric age group (less than 18 years of age). Injuries related to emergencies were responsible for more than 65% of pediatric runs, and 30% were related to motor vehicle accidents. Surprisingly, 8% of calls were for seizure disorders, a figure much higher than in the adult population. Approximately 38% of the runs involved children between the ages of 6 and 12 years. Significantly more male than female patients were involved. This descriptive epidemiologic study is antecedent to effective planning and implementation of pediatric prehospital care programs. Training of emergency personnel should be targeted toward treating motor vehicle injuries, seizures, poisoning, and upper airway obstruction in children.

Chronic angiotensin converting enzyme inhibition in the two-kidney, one clip hypertensive rat

Treatment with an angiotensin converting enzyme (ACE) inhibitor in renovascular hypertension produces acute effects on renal function; however, the long-term consequences of this are not known. We have studied the effect of chronic enalapril treatment on renal structure and function in the two-kidney, one clip model of renovascular hypertension in the rat. Four weeks after the left renal artery was clipped, the hypertensive rats were randomly allocated to treatment with enalapril, minoxidil or to no treatment. The drug dose was titrated for maximal hypotensive effect. After 4 months of treatment blood pressures were 129 +/- 3 mmHg (enalapril), 193 +/- 5 mmHg (minoxidil) and 220 +/- 4.8 mmHg (no treatment). Twelve months later survival was 84% (enalapril group), 48% (minoxidil group) and 15% (untreated group). Split kidney function (51Cr-EDTA clearance, ml/min) of the clipped kidneys was 0.0 (enalapril group), 0.26 +/- 0.23 (minoxidil group) and 0.74 +/- 0.13 (untreated group). The clipped kidney from enalapril-treated rats weighed 0.46 +/- 0.1 g, much less than in the minoxidil-treated group (1.2 +/- 0.07) or the untreated group (1.14 +/- 0.10). Enalapril treatment was withdrawn for 2 weeks in five rats, but the clipped kidney remained small and non-functional. Histological examination revealed marked interstitial fibrosis and tubular atrophy in clipped kidneys from both enalapril groups, in contrast to minor changes in the minoxidil-treated and the untreated groups. We conclude that chronic enalapril treatment of two-kidney, one clip hypertension in the rat improved survival and preserved total renal function, but was associated with irreversible fibrotic atrophy of the clipped kidney.

Alterations in T-lymphocyte subpopulations in type I diabetes. Exploration of genetic influence in identical twins

To evaluate factors influencing the alteration in subsets of T-lymphocytes, we studied 24 pairs of identical twins discordant for insulin-dependent (type I) diabetes mellitus. Subsets were assessed by monoclonal antibodies and a pure preparation of peripheral blood mononuclear cells obtained by centrifugation of heparinized whole blood with a Ficoll/Triosil gradient. In 12 pairs studied within 5 yr of diagnosis, we observed a reduction in the percentage of cells reacting with OKT8 (recognizing the CD8 antigen present on the suppressor/cytotoxic subset) (P less than .05), but a similar level was detected in their nondiabetic cotwins. In 12 pairs studied greater than 5 yr after the diagnosis and in whom the nondiabetic twin is less likely to develop diabetes, the percentage of cells reacting with OKT8 was reduced in both the diabetic (P less than .05) and the nondiabetic (P less than .01) twins. Reductions were also seen with OKT3 (recognizing the CD3 antigen present on the total T-lymphocyte population) and OKT4 (recognizing the CD4 antigen present on the helper/inducer subset), but only in the diabetic twins from the group with longer discordance. We conclude that a reduced percentage of suppressor/cytotoxic cells is associated with type I diabetes, but the reduction appears to be genetically determined. Total T-lymphocytes are also reduced but mainly in the helper/inducer subset and only in diabetic patients of long duration. Such a reduction cannot therefore be primarily genetically determined.

The effect of in vivo and in vitro methotrexate on lymphocyte proliferation as measured by the uptake of tritiated thymidine and tritiated guanosine

In several studies methotrexate therapy of patients with rheumatoid arthritis has not been found to depress the lymphocyte response to mitogens measured by the uptake of tritiated thymidine. We have postulated two effects of methotrexate on stimulated lymphocytes in vitro: a decrease in cell proliferation, but also a relative increase in thymidine uptake reflecting a specific decrease in the intracellular thymidine pool. The increased incorporation of tritiated guanosine by mitogen-stimulated lymphocytes was found to be markedly depressed by methotrexate (1 x 10(-7) M) in vitro whereas the incorporation of thymidine was often unchanged. Thymidine uptake of lymphocytes may not be an appropriate measure of stimulation in the presence of methotrexate.

Defects in beta-cell function and insulin sensitivity in normoglycemic streptozocin-treated baboons: a model of preclinical insulin-dependent diabetes

During the preclinical period of human insulin-dependent diabetes, both impaired pancreatic beta-cell function and increased insulin resistance are found, although normoglycemia is preserved. To better understand the changes in beta-cell function and insulin sensitivity that occur in preclinical insulin-dependent diabetes, we performed a panel of in vivo beta-cell function tests and measured insulin sensitivity in adolescent male baboons both in normal health and after a small dose of streptozocin which did not induce hyperglycemia. Nine animals were studied before (stage 1) and 1 week after receiving a low dose of streptozocin (stage 2). There was no change in fasting plasma glucose or insulin. The mean glucose disposal rate (Kg) remained within the normal range, but dropped from 2.0 +/- 0.2% +/- SE) to 1.2 +/- 0.1%/min (P less than 0.01), the acute insulin response to arginine (AIR(arg)) fell from 67.7 +/- 19.4 microU/mL (485.8 +/- 139.2 pmol/L) to 32.8 +/- 7.2 microU/mL (235.3 +/- 51.7 pmol/L; P less than 0.05), and the acute insulin response to glucose (AIR(gluc)) fell from 881 +/- 243 microU/mL.10 min (6321 +/- 1744 pmol/L.10 min) to 334 +/- 82 microU/mL.10 min (2396 +/- 588 pmol/L.10 min; P less than 0.01). The most dramatic change, however, was in the ability of hyperglycemia to potentiate AIR(arg) (expressed as the slope of potentiation). This was reduced by 94% from 1.8 +/- 0.5 to 0.1 +/- 0.1 (P less than 0.01), with almost no overlap in values between stages 1 and 2. Insulin sensitivity was also lower 1 week after streptozocin treatment. When the animals were restudied 8 weeks after streptozocin treatment (stage 3) most measures of beta-cell function were not significantly different from those in stage 1. The fasting plasma glucose level was 85.4 +/- 4.3 mg/dL (4.7 +/- 0.2 mmol/L), Kg was 1.8 +/- 0.3%/min, fasting plasma insulin was 35.9 +/- 8.5 microU/mL (257.6 +/- 61.0 pmol/L), AIR(arg) was 67.0 +/- 15.4 microU/mL (480.7 +/- 110.5 pmol/L), and AIR(gluc) was 615.3 +/- 265.3 microU/mL.10 min (4413 +/- 1901 pmol/L.10 min), and tissue insulin sensitivity was 2.7 +/- 0.4 x 10(4) min/microU.mL. These values show extensive overlap with those of stage 1, from which they are not significantly different. The slope of glucose potentiation, however, remained low in all animals at stage 3.(ABSTRACT TRUNCATED AT 400 WORDS)

The effect of pregnancy on disease development and mortality in B/W F1 mice

Pregnancy was encouraged in 15 B/W mice (Group 1) and the rate of development of FANA, anti-DNA antibodies, and proteinuria compared with that seen in 15 control mice (Group 2). The mean number of pregnancies for Group 1 mice was 5.2. No difference was seen in mortality rate or in the onset of serologic or urinary abnormalities between the 2 groups.

Beta-cell function and insulin sensitivity in nondiabetic HLA-identical siblings of insulin-dependent diabetics

Insulin secretion and insulin sensitivity were compared in 12 HLA-identical siblings of insulin-dependent diabetics and nondiabetic controls. Only the maximum acute insulin response to intravenous arginine was lower in the siblings than in the matched controls (P less than .05); other measures of insulin secretion, including the acute insulin response to glucose or arginine, the second-phase insulin response to glucose, and the slope of glucose potentiation, were not significantly different. Insulin sensitivity, derived from an intravenous glucose tolerance test with a minimal-modeling technique, was lower in the siblings (P less than .01). In a large group of nondiabetic controls of various adiposity, insulin secretion and insulin sensitivity were inversely related. In view of the difference in insulin sensitivity between siblings and matched controls, a direct comparison of beta-cell function tests may be inappropriate, and the measures of insulin secretion were compared with those of nondiabetics when adjusted for differences in insulin sensitivity. This analysis revealed that all measures of insulin secretion were significantly lower in the siblings. We conclude that HLA-identical siblings of insulin-dependent diabetics show evidence of both insulin resistance and impaired beta-cell function and that analysis of beta-cell function in relation to insulin sensitivity shows a greater frequency of beta-cell secretory abnormalities than previously appreciated.

Spine and femur density using dual-photon absorptiometry in US white women

Bone mineral density (BMD) of the spine (n = 892) and femur (n = 634) was measured using dual-photon absorptiometry in normal white women from seven diverse locations. The same model commercial scanner with a 153Gd source was used in all locations (SD = 1.3% among locations). There was not an age-associated decrease of spinal BMD during young adulthood (20-40 years); the correlation of age and femoral BMD in this period was low but significant (r = -0.21). There was a narrow range of intra-population variation at all ages (10-12%). The cross-sectional data showed an average diminution of about 20% in the spine and 25% in the femur between 40 and 70 years of age, followed by a continued but slower, decrease of density in older women. Adjustment of values for height and weight was called for mainly at extremes of body size.

Reversal of depressed neutrophil superoxide production in Felty's syndrome after gold therapy

Six patients with Felty's syndrome were reevaluated after a course of chrysotherapy. In 5 patients, white cells and absolute neutrophil counts had returned to normal. In 4 of these, there was significant concomitant improvement in neutrophil function as assessed by the ability of cells to generate superoxide radicals.

Suppression of superoxide generation by normal polymorphonuclear leukocytes preincubated in plasma from patients with Felty's syndrome

Polymorphonuclear leukocytes (PMN) isolated from patients with Felty's syndrome (FS) generate fewer superoxide anions (O-2) upon stimulation with fmet-leu-phe than PMN from normal controls or patients with rheumatoid arthritis (RA). In this study, plasma samples were obtained from 12 patients with RA and 12 patients with FS. Incubation of normal PMN in plasma from Felty patients resulted in a significant reduction in both the rate and total quantity of O-2 generation when activated with fmet-leu-phe. This was not observed with plasma from RA patients. The capacity of a plasma sample to suppress O-2 generation correlated with plasma IgG-PMN-binding activity (IgG-PBA) and, to a lesser extent, with the content of circulating immune complexes (CIC). These data suggest that IgG-PBA and possibly CIC have a pathogenetic role in both qualitative and quantitative defects in PMN in Felty patients.

Depressed superoxide radical generation by neutrophils from patients with rheumatoid arthritis and neutropenia: correlation with neutrophil reactive IgG

Neutrophils of 31 patients with neutropenia and rheumatoid arthritis (RA) have been studied to assess their ability to generate superoxide radicals (O-2) on activation. Seventeen patients had classical Felty's syndrome and 14 presumed chrysotherapy related neutropenia. Results were compared with those from age and sex matched controls with uncomplicated RA and from normal subjects. Neutrophils from patients with Felty's syndrome had a significantly reduced ability to generate superoxide radicals when compared with the other three groups. In addition, serum levels of IgG polymorphonuclear leucocyte binding activity (IgG PBA) were also raised in the group with Felty's syndrome. A statistically significant inverse correlation existed between O-2 generation and IgG PBA. It is concluded that neutrophil reactive IgG may have an important role in both quantitative and qualitative defects in neutrophil function in Felty's syndrome.

Angiotensin converting enzyme (ACE), characterization by 125I-MK351A binding studies of plasma and tissue ACE during variation of salt status in the rat

Angiotensin converting enzyme (ACE) was measured in rat plasma and tissues by analysis of the binding of the radio-inhibitor 125I-MK351A, a tyrosyl derivative of enalaprilic acid. Labelled 125I-MK351A bound to plasma and tissue ACE preparations and was displaced in a concentration-related manner by MK351A. Scatchard analysis yielded a single line from which MK351A binding sites/mg protein and MK351A dissociation constant were calculated. Tissue and plasma ACE from Sprague Dawley rats was studied over a wide range of sodium intakes (low salt, 0.026 +/- 0.012 mmol/24 h; normal salt, 0.58 +/- 0.09 mmol/24 h; and high salt, 10.4 +/- 1.3 mmol/24 h) and during high salt and DOCA treatment. Across the range of sodium states studied there were no consistent changes in plasma, lung, aorta, brain, epididymis or kidney MK351A binding sites/mg protein, or equilibrium dissociation constant. Calculated MK351A binding sites (nmol/mg protein) were 1.64 +/- 0.14 in lung, 0.47 +/- 0.04 in aorta, 0.44 +/- 0.05 in epididymis, 0.18 +/- 0.01 in brain and 0.053 +/- 0.004 in kidney preparations (n = 24 in each group) reflecting reported ACE enzymatic activity in these tissues. Equilibrium dissociation constant KD was uniform within each tissue, but varied between organs. The KD (mol/l X 10(-12)) was 50 +/- 2 in aorta, 57 +/- 2 in lung, 58 +/- 2 in epididymis, 61 +/- 3 in brain, 62 +/- 2 in plasma and 84 +/- 3 in kidney (n = 24 in each group).(ABSTRACT TRUNCATED AT 250 WORDS)

Chlorpropamide-alcohol flush reaction and isoenzyme profiles of alcohol dehydrogenase and aldehyde dehydrogenase

To investigate the enzymatic basis of the chlorpropamide-alcohol flush reaction (CPAF) we compared the isoenzyme profiles of alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) from liver biopsies, and of ALDH alone from erythrocytes and leucocytes, in CPAF-positive and CPAF-negative subjects. No differences were seen in ADH or ALDH phenotypes, or in the relative activities of the isoenzymes, between the two groups before chlorpropamide was given; in particular, no subjects showed the 'null' ALDH phenotype that is associated with the alcohol flush reaction in oriental subjects. There was a significant decrease in erythrocyte ALDH activity after 7 days' treatment with chlorpropamide in CPAF-positive individuals but no such difference was seen in CPAF-negative subjects. These results indicate that CPAF has a different enzymatic basis from the alcohol flush reaction of oriental subjects and suggest that in CPAF-positive subjects erythrocyte ALDH may be particularly susceptible to inhibition by chlorpropamide.

Further evaluation of the Scolitron treatment of idiopathic adolescent scoliosis

One hundred forty-two patients were treated by the Scolitron method of lateral electric surface stimulation (LESS) for scoliosis. Using 10 degrees progression as a failure point, clinicians reported the following: 56.3% of patients were classified as failures, 26.8% as successes; and 16.9% were still under treatment. When broken down into individual groups, true protocol patients, at risk for progression, had the lowest success rate; whereas those that were nonprotocol, and least at risk, had the highest success rate. This method should still be considered experimental and cannot be considered an alternative to bracing at this time.

Effects of gold compounds on function of phagocytic cells. Comparative inhibition of activated polymorphonuclear leukocytes and monocytes from rheumatoid arthritis and control subjects

The effect of sodium aurothiomalate and auranofin on the generation of superoxide anions (O2-) by polymorphonuclear leukocytes (PMNLs) and adherent mononuclear phagocytic cells (AMNCs) has been investigated. Sodium aurothiomalate at final concentrations of 1, 10, and 100 micrograms Au/ml and auranofin ranging from 0.1 to 2.0 micrograms Au/ml were used in the reactions involving all cell types. Results have been compared between cells drawn from normal controls and patients with active rheumatoid disease. The effect of gold compounds on both cell types was assessed following activation by phorbol myristate acetate (1 X 10(-8) M) and N-formyl-methionyl-leucyl-phenylalanine (1 X 10(-4) M) using a cytochrome c reduction method. Sodium aurothiomalate at the maximum concentration modestly inhibited O2- generation by PMNLs but not AMNCs. Auranofin inhibits O2- generation by both cell types. Inhibition of cells from patients with rheumatoid arthritis was greater than that seen with cells from normal controls.

Cystosarcoma phyllodes

We present four cases of cystosarcoma phyllodes in which mammograms revealed a small or large lobulated mass occupying the entire breast. Preoperative diagnosis was a benign lesion with a low probability of nodular carcinoma. Histologically, all tumors were classified as malignant. Although uncommon, cystosarcoma should be considered in the differential diagnosis of these masses, since local recurrence is frequent unless wide wedge resection or simple mastectomy is done.

Immune changes associated with insulin dependent diabetes may remit without causing the disease: a study in identical twins

Activation of T lymphocytes and islet cell antibodies were studied in two groups of insulin dependent diabetics and their non-diabetic identical cotwins. Group 1 comprised 12 "short term" twin pairs (diabetic twin diagnosed less than five years previously) in whom only a third of the cotwins were likely to develop diabetes; 10 of the 12 non-diabetic cotwins showed increased values of activated T lymphocytes, islet cell antibodies, or both. Group 2 comprised 10 "long term" twin pairs (diabetic twin diagnosed more than 11 years previously) in whom none of the non-diabetic cotwins was likely to develop diabetes; these pairs were selected because all the non-diabetic cotwins had shown islet cell antibodies at some time in the past, but only two still did so (one with an increased value of activated T cells). There was relative glucose intolerance in the cotwins of the short term group but not in those of the long term group. Non-diabetic cotwins of diabetics may show the immune changes associated with insulin dependent diabetes and relative glucose intolerance, but these changes may remit without leading to diabetes.

Pulmonary disease in Behçet's syndrome

Five patients with Behçet's syndrome presenting with haemoptysis and recurrent radiographic opacities are reported, with a review of 23 similar cases. All 28 cases conformed to a definite clinical pattern with haemoptysis, usually accompanied by pyrexia, chest pain and dyspnoea, being the major feature. Typically pulmonary disease was associated with active disease at other sites, although the patients often only complained of haemoptysis. Patients with Behçet's syndrome and haemoptysis, compared to those without haemoptysis, showed a marked male predominance, with thrombophlebitis and deep vein thrombosis being more common. Rarely pulmonary disease occurred in the absence of one or other of the so called 'major' criteria on which the diagnosis of Behçet's syndrome is usually made, as was so for four of our patients who did not have ocular disease. Immunopathological evidence suggests that the underlying pathogenesis is a pulmonary vasculitis which may result in arterial and venous thromboses, pulmonary infarction, pulmonary haemorrhage and pulmonary arterial aneurysm formation. A role for immune complexes in the pathogenesis of pulmonary disease in Behçet's syndrome is suggested by the finding of circulating immune complexes in association with active pulmonary disease. Corticosteroids were initially helpful in treating active disease in the lungs, and at other sites, in most of the patients in whom they were tried, including our five patients, but serious haemoptysis occasionally recurred, despite further treatment. Four of our patients were initially treated with anticoagulants for a presumed diagnosis of pulmonary embolism, but continued to have haemoptysis. One of these patients subsequently died following massive haemoptysis, despite good anticoagulant control. The haemoptysis in most of the 28 cases was notable for its severity, and in at least 11 (39.3 per cent), pulmonary haemorrhage was the probable cause of death. All deaths due to haemoptysis occurred within six years of the first episode. Whilst pulmonary disease with haemoptysis is infrequent, it carries a very serious prognosis and for this reason correct diagnosis and appropriate treatment is imperative. Pulmonary disease with haemoptysis should be included as one of the so called 'minor' criteria in the diagnosis of Behçet's syndrome.

Effect of diclofenac sodium, tolfenamic acid and indomethacin on the production of superoxide induced by N-formyl-methionyl-leucyl-phenylalanine in normal human polymorphonuclear leukocytes

The effect of three non-steroidal anti-inflammatory drugs, diclofenac, indomethacin and tolfenamic acid, on the production of superoxide (O2-), by normal human polymorphonuclear leukocytes (PMNL) was studied, in vitro. The cells were activated with N-formyl-methionyl-leucyl-phenylalanine (FMLP) and O2- production was measured as superoxide dismutase inhibitable cytochrome c reduction. Cell viability was checked with assays of liberated LDH. Concentrations of the drugs considerably higher than those of therapeutic plasma were required to inhibit O2- production. The drug concentrations producing a 50% inhibition (IC50) of total O2- production were: diclofenac 2.7 X 10(-4) M, indomethacin 4.0 X 10(-4) M and tolfenamic acid 4.2 X 10(-4) M. At drug concentrations causing a significant suppression of O2- generation, diclofenac showed a slight and tolfenamic acid a marked inhibition of [3H]FMLP binding to its cellular receptor; indomethacin has earlier been shown to inhibit FMLP-binding slightly. No dismutating activity of the drugs could be demonstrated. It is concluded that the inhibition of O2- production is due to a combined effect on FMLP binding and on cellular O2- metabolism. Because of the high drug concentrations required to inhibit O2- production, this phenomenon is obviously of little significance for the anti-inflammatory effect obtained with therapeutic doses of the drugs studied.

Reduced insulin sensitivity in nondiabetic, HLA-identical siblings of insulin-dependent diabetic subjects

Nondiabetic, HLA-identical siblings of insulin-dependent diabetic subjects have an increased risk of developing diabetes. Since insulin resistance is present in newly diagnosed diabetic subjects, we studied 12 HLA-identical siblings to determine whether they have impaired insulin sensitivity. Each sibling was carefully matched for age, sex, and body weight to a control from a nondiabetic family. The insulin sensitivity index (SI) was determined after an intravenous glucose tolerance test (IVGTT) using the minimal model of insulin kinetics. The insulin sensitivity index was significantly lower in the HLA-identical siblings compared with their matched controls.

Adriamycin cardiomyopathy in the rabbit: an animal model of low output cardiac failure with activation of vasoconstrictor mechanisms

Chronic administration of intravenous adriamycin (1 mg . kg-1 twice weekly for 8 weeks) to rabbits resulted in a cardiomyopathy which was similar to that occurring in patients with adriamycin cardiotoxicity. We studied systemic and renal haemodynamics and the activation of vasoconstrictor mechanisms reflected by changes in plasma renin activity (PRA), noradrenaline (NA) and vasopressin (AVP) levels during the development of heart failure in this animal model. By 8 weeks cardiac failure was clearly established. At postmortem all animals had dilated hearts, pleural and pericardial effusions, ascites and hepatic congestion. Heart weights were increased (8.1 +/- 0.7 g in treated animals n = 9 vs 6.0 +/- 0.2 g in controls n = 9 p less than 0.05). Cardiac output (measured by thermodilution) fell at 8 weeks from 799 +/- 61 ml . min-1 to 624 +/- 44 ml . min-1 (n = 6 p less than 0.05) with a parallel fall in mean blood pressure from 85 +/- 2 mmHg to 75 +/- 4 mmHg. Total peripheral resistance rose in four of the six rabbits. Renal blood flow fell from 108 +/- 4 ml . min-1 to 61 +/- 6 ml . min-1 (p less than 0.05) by 8 weeks. Renal vascular resistance increased in all animals. PRA increased from 5.1 +/- 0.5 ng AI . ml-1 . h-1 to 11.6 +/- 2.6 ng AI . ml-1 . h-1 by 4 weeks (p less than 0.05) and remained elevated thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)

Peer relationships in ADDH and normal children: a developmental analysis of peer and teacher ratings

Peer and teacher perceptions of younger and older ADDH and normal children were compared. Peer nominations on the Pupil Evaluation Inventory revealed that ADDH children received more nominations on the Aggression factor and fewer on the Likability factor. ADDH boys received more nominations on the Withdrawal factor. Generally, older children received fewer nominations, but age did not interact with diagnosis; that is, younger and older ADDH children were perceived by peers as equally deviant. Discriminant analyses showed that peer ratings were useful in discriminating between ADDH and normal boys, but not between ADDH and normal girls. Teacher ratings of peer behavior suggested that older ADDH girls were perceived as less disturbed than younger girls. However, teacher ratings of boys revealed no age by diagnosis interactions. Low to moderate correlations were found between peer and teacher ratings of ADDH boys, and the pattern of relationship varied with age.

Congenital dislocation of the hip in the American black

Between 1977 and 1982, 19 cases of congenital dislocation of the hip (CDH) were encountered in black infants. Six of these cases were associated with other anomalies (atypical CDH); 13 were typical CDH. The incidence of complete CDH in the white population studied is 1.5/1000; in the black population studied it is 0.46/1000. The increased incidence in comparison to previous studies may possibly reflect genetic heterogeneity in the control population relative to the African black.