Morphological study of the anatomical variations of anterior belly of digastric muscle in Brazilian cadavers

BACKGROUND

Cases of variations in anterior belly of the digastric muscle must be carefully identified to avoid misinterpretations and assist in the correct surgical or aesthetic procedure and help in the teaching of anatomy. The aim of this study was to describe the anatomical variations of anterior belly of digastric muscle in Brazilian cadavers.

MATERIALS AND METHODS

Thirty-one human heads were selected, from adult cadavers (18-80 years, 29 males and 2 females). The morphology of the anterior belly of the digastric muscle was observed, identifying the possible anatomical variations that were characterised and classified according to the amount of muscle bellies, fibre direction and place of origin and insertion. The morphometric measurements were performed using a digital calliper. To analyse the data obtained, photographic documentation, anatomical description and individual morphometric description of each muscle belly were performed. The incidence of anatomical variation was obtained in percentage (%).

RESULTS

The anatomical variation of the anterior belly of the digastric muscle was present in 6 cadavers (19.31%; 1 female and 5 male). All anatomical variations presented an accessory belly to the anterior belly. However, these accessory bellies were configured differently in the location, direction of muscle fibres and in their dimensions (length and width).

CONCLUSIONS

The gross anatomy of the anterior belly of the digastric muscle and their variations is important to assist in surgical procedures, pathological or diagnostic function. In addition, asymmetrical variations in the submental region must be carefully identified to avoid misinterpretations.

Foramen tympanicum prevalence in the population of Southeast Brazil: a morphological study in computed tomography scans

BACKGROUND

The foramen tympanicum is located on the anteroinferior region of the external acoustic meatus and posteromedial to the temporomandibular joint in children between the 1st and the 5th year of life. It is considered an anatomical variation when it persists in adults. The aim of this study was to verify the prevalence as well as to characterise the foramen tympanicum in computed tomography (CT) scans of the population from southeastern part of Brazil.

MATERIALS AND METHODS

A total of 78 CT scans of dry human skulls (20 female and 58 male) were used, which were selected randomly regarding the ages, ranged from 15 to 100 years. The foramen tympanicum was identified in the images of the axial plane and confirmed in the images of the coronal and sagittal planes. The largest diameter (in mm) was obtained. The descriptive statistics (in %), Fisher's test and χ2 test were performed to compare the prevalence of foramen tympanicum between sexes and sides. The probability value ≤ 0.05 was defined as a level of significance. Descriptive statistics were performed to verify the mean diameter of the foramen on the right and left sides of the skulls.

RESULTS

The prevalence of foramen tympanicum was higher in females (p = 0.0070), bilaterally, as the absolute values of females were lower in relation to males. Fisher's exact test showed that the prevalence of foramen tympanicum was significantly higher in females (45%) than in males (15.52%). On the right side, the mean axial diameter was 2.23 mm (range 0.93-3.75 mm). On the left side, the mean axial diameter was 2.22 mm (range 0.9-3.61 mm).

CONCLUSIONS

The knowledge of anatomical variations is extremely valuable for an accurate diagnosis, treatment plan and prognosis and a thorough preoperative assessment.

Human identification by the analysis of palatal rugae printed in complete dentures

The study of palatal rugae is shown to be scientifically valid to human identification due to the unique number and style of the palatal ridges. Dentures provide an array of data and specifics that allow for the individualization of their wearers. This article describes the identification of edentulous, skeletonized remains through the analysis of the palatal rugae printed on the complete upper denture and subsequent comparison with the palatal rugae of an old complete denture of an unknown missing person. The analyses focus on the form, classification, location, and size of the palatal rugae which, in conjunction with the information obtained from the anthropological examination, resulted in a positive identification of the cadaver. This method has a significant impact on the identification process, particularly when other identification methodologies and techniques cannot be implemented. This case report highlights the importance of palatal rugae in human identification in cases of edentulous cadavers.

Additional value of fetal magnetic resonance imaging in the prenatal diagnosis of central nervous system anomalies: a systematic review of the literature

OBJECTIVES

To analyze literature on the additional value of fetal magnetic resonance imaging (MRI) in assessing central nervous system (CNS) anomalies suspected by ultrasound.

METHODS

A search was performed of PubMed, EMBASE, Cochrane library and the reference lists of identified articles. Inclusion criteria were CNS anomalies suspected/diagnosed by ultrasound, MRI performed after ultrasound, and postmortem examination by autopsy or postnatal assessment. MOOSE guidelines were followed. Outcomes assessed were positive/negative agreement between ultrasound and MRI, additional information provided by MRI, and discordance between ultrasound and MRI. Pooled sensitivity and specificity of MRI were calculated using the DerSimonian-Laird method. Postnatal/postmortem examinations were used as the reference standard.

RESULTS

We identified thirteen articles which included 710 fetuses undergoing both ultrasound and MRI. MRI confirmed ultrasound-positive findings in 65.4% of fetuses and provided additional information in 22.1%. MRI disclosed CNS anomalies in 18.4% of fetuses. In 2.0% of cases, ultrasound was more accurate than MRI. In 30% of fetuses, MRI was so different from ultrasound that the clinical management changed. Agreement was observed mainly for ventriculomegaly (51.3%). Disagreement was noted mainly for midline anomalies (48.6%). Pooled sensitivity of MRI was 97% (95% CI, 95-98%) and pooled specificity was 70% (95% CI, 58-81%).

CONCLUSIONS

MRI supplements the information provided by ultrasound. It should be considered in selected fetuses with CNS anomalies suspected on ultrasound.

Impact of cord entanglement on perinatal outcome of monoamniotic twins: a systematic review of the literature

OBJECTIVE

To review the current literature concerning perinatal outcome of monoamniotic pregnancies with cord entanglement.

METHODS

A search in PubMed, EMBASE and MEDLINE for articles published between January 2000 and December 2011 was performed, using the following keywords: monoamniotic/monochorionic pregnancy(ies); twins; cord entanglement; fetal ultrasound/surveillance. Inclusion criteria for the study were: monoamniotic twins with documented cord entanglement at delivery, and perinatal outcome reported as proportional rates. Exclusion criteria were: higher-order multiple pregnancy; selective feticide; presence of twin reversed arterial perfusion sequence; conjoined twins; fewer than four cases in the series; and non-English language publication. Survival rates were stratified for method of prenatal management, sonographic diagnosis of cord entanglement and delivery mode. A meta-analysis was also performed using data from articles that stratified outcome according to the presence or absence of cord entanglement at birth. Comparison between neonates with cord entanglement and controls was deemed significant if the 95% CI of the pooled odds ratios did not encompass 1. MOOSE (Meta-analysis Of Observational Studies in Epidemiology) guidelines were followed.

RESULTS

Nine articles met the inclusion criteria for this review, including a total of 114 monoamniotic twin sets (228 fetuses) with cord entanglement. The overall survival rate was 202/228 (88.6%). Perinatal mortality occurred in 26 (11.4%) fetuses; of these, 17 (65%) died in utero and nine (35%) died at birth. Five neonatal deaths occurred as a result of prematurity, two were related to structural abnormalities and two were caused by cord entanglement. Sonographic visualization of cord entanglement did not improve outcome. Four articles were included in the meta-analysis, with no significant difference in mortality between controls (n = 66 fetuses) and twins with cord entanglement (n = 82 fetuses), and higher morbidity in controls.

CONCLUSIONS

Cord entanglement does not contribute to prenatal morbidity and mortality in monoamniotic twin pregnancies.

Pharyngeal airway space and frontal and sphenoid sinus changes after maxillomandibular advancement with counterclockwise rotation for Class II anterior open bite malocclusions

OBJECTIVES

The purpose of this study was to cephalometrically evaluate the pharyngeal airway space and frontal and sphenoid sinus changes after maxillomandibular advancement counterclockwise rotation for class II anterior open bite malocclusion.

METHODS

The study included 49 patients (98 lateral teleradiographs; 36 females and 13 males) who were analysed in the pre-operative (1 week before surgery) and post-operative (6 months after surgery) periods. In each lateral teleradiography, the dimensions of the inferior and superior pharyngeal airway space, TB-PhW1 [the point between the posterior aspect of the tongue to the dorsal pharyngeal wall (oropharynx) (TB) and the point on the dorsal pharyngeal wall closest to TB (PhW1)] and UP-PhW2 [and the point between the posterior aspect of the soft palate to the dorsal pharyngeal wall (nasopharynx) (UP) (PhW2)] measurements were evaluated, as well as the dimensions of the frontal and sphenoid sinuses. The differences between the two operative times were evaluated by Student's t-test.

RESULTS

All measurements showed excellent reproducibility for the intraclass correlation coefficient (ICC > 0.9; p < 0.0001). There was an increase in the measurements TB-PhW1 and UP-PhW2 and a decrease in the dimensions of the frontal and sphenoid sinuses after orthognathic surgery.

CONCLUSIONS

The morphology of the superior and inferior pharyngeal airway space and frontal and sphenoid sinuses changes after 6 months of maxillomandibular advancement counterclockwise rotation for class II anterior open bite malocclusion.

Neonatal outcomes of twins according to birth order, presentation and mode of delivery: a systematic review and meta-analysis

BACKGROUND

The optimal mode of delivery for twins is undetermined.

OBJECTIVE

To review literature regarding the neonatal outcomes following twin delivery.

DATA SOURCES

Searches were conducted in PubMed, Medline, Embase, Cochrane library and reference lists.

SELECTION CRITERIA

Studies selection criteria were: both twins alive at labour, outcomes stratified for birth order, presentation, planned and actual delivery mode. Eighteen articles were included in the meta-analysis (39, 571 twin sets).

DATA COLLECTION AND ANALYSIS

The Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Interstudy heterogeneity (I(2) ) was tested. A fixed model was generated whenever I(2)<25%. Pooled odds ratios (OR) with 95% CI were computed. Intergroup comparison was significant if 95% CI did not encompass 1. The first and second twins were indicated as Twin A (TA) and Twin B (TB), respectively.

MAIN RESULTS

Neonatal morbidity was lower in TA than TB (3.0 versus 4.6%; OR 0.53; 95% CI 0.39-0.70). TA experienced neonatal death less often than TB (0.3 versus 0.6%; OR 0.55; 95% CI 0.38-0.81). No differences were noted between vertex and non-vertex and attempted vaginal delivery versus planned caesarean section in either TA or TB. In TA, neonatal morbidity was lower after vaginal delivery (1.1%) than caesarean section (2.2%; OR 0.47; 95% CI 0.27-0.82). Neonatal death was not associated with actual delivery mode. In TB, morbidity following combined delivery (19.8%) was higher than after vaginal delivery (9.5%; OR 0.55; 95% CI 0.41-0.74) or caesarean section (9.8%; OR 0.47; 95% CI 0.43-0.53). When outcomes were stratified for both presentation and delivery mode, mortality rate was lower after vaginal delivery than caesarean section for both vertex and nonvertex TB. AUTHOR'S CONCLUSION: An attempt at vaginal delivery should be considered in twin pregnancies with vertex/vertex presentation.

Cavum veli interpositi cyst: prenatal diagnosis and postnatal outcome

OBJECTIVE

The cavum veli interpositi (CVI) is a space within the double-layered tela choroidea of the third ventricle. Occasionally, this space is fluid-filled and sonographically visible as an interhemispheric anechoic cyst. Because of its rarity, the incidence of CVI cyst is undetermined and the outcome of affected individuals has been found to be variable. The aim of this study was to report our experience of the sonographic findings and outcome of fetuses affected by CVI cysts.

METHODS

In five fetuses with a CVI cyst, we performed targeted prenatal ultrasound scans of intracranial structures and a detailed anatomical survey to rule out associated malformations. Follow-up consisted of neurological examination and neurosonography.

RESULTS

The CVI cyst appeared as a well-defined anechoic lesion without adjacent mass effect. In all fetuses the cyst was single and in two cases it enlarged slightly during pregnancy. The cyst was isolated in three fetuses and associated with borderline ventriculomegaly in two. A single umbilical artery was the only associated extracranial anomaly and this was detected in only one fetus. Neurosonography confirmed the presence of CVI cysts in all cases after delivery. During postnatal follow-up (range 10-48 months), the cyst regressed in one case within 1 month after delivery while the size of the others remained stable. No infant developed psychomotor disorders.

CONCLUSIONS

Prenatal sonographic diagnosis of CVI cysts is feasible. Its finding in isolation is consistent with favorable postnatal outcome.

Twin-twin transfusion syndrome

Twin-twin transfusion syndrome (TTTS) is a condition unique to monochorionic pregnancies, although very few case reports described the syndrome in dichorionic placentas. The aetiology of TTTS relies in the presence of at least 1 arterio-venous placental anastomosis, through which unequal blood exchange from one twin (donor) to the co-twin (recipient) occurs. The diagnosis of TTTS relies on the sonographic detection of oligohydramnios in the donor's sac and polyhydramnios in the recipient's sac in the second trimester, although signs of TTTS are present since the first trimester. Treatment options for TTTS include serial amnioreduction, septostomy, selective feticide of the apparently sick twin, and selective photocoagulation of placental vessels (SLPCV). Because of the growing evidence that SLPCV is the most efficacious therapy compared to amnioreduction with/without septostomy, the authors reviewed in details the effects of SLPCV on fetal growth and circulation. The authors further explore literature with regard to the prognostic factors. Finally, because Quintero staging system is actually under debate, they discuss the most recent findings on this topic and propose a new staging system to assess severity of TTTS at presentation (Rossi staging system). New topics for future research, which would probably further clarify the natural history of TTTS, are also proposed.

The ultrasound assessment of adipose tissue deposition in fetuses of "well controlled" insulin-dependent diabetic pregnancies

OBJECTIVE

To assess differences in adipose deposition in fetuses from normal pregnancies and women with diabetes.

RESEARCH DESIGN AND METHODS

The study group consisted of 15 well controlled insulin-dependent women with diabetes and 16 controls with a normal glucose. Ultrasound measurements were taken of subcuticular tissue thickness at the abdominal and suprascapular level at 31 and 37 weeks gestation. Triceps and subscapular skinfold thickness were also measured at birth.

RESULTS

Gestational age at delivery and birthweights were not significantly different. At 31 weeks, fasting glucose levels were 5.0 +/- 1 mmol/l for diabetic vs. 3.3 +/- 0.3 mmol/l for controls (P < 0.01), post-prandial 5.6 +/- 0.4 vs. 5.1 +/- 0.3 mmol/l (P < 0.01). At 37 weeks, they were 4.6 +/- 0.2 mmol/l vs. 3.8 +/- 1.1 mmol/l (P < 0.01) and 6.0 +/- 0.6 mmol/l vs. 5.3 +/- 0.3 mmol/l (P < 0.01). Abdominal and suprascapular subcuticular thickness were 4.4 +/- 0.1 mm vs. 3.7 +/- 0.1 mm (P < 0.05) and 4.3 +/- 0.2 mm vs. 3.5 +/- 0.2 mm (P < 0.05) at 31; 5.6 +/- 0.2 mm vs. 4.8 +/- 0.1 mm (P < 0.05) and 5.4 +/- 0.2 mm vs. 4.4 +/- 0.1 mm (P < 0.05) at 37 weeks. At birth, triceps and suprascapular skinfolds were 4.7 +/- 0.1 mm vs. 4.1 +/- 0.1 mm (P < 0.05) and 4.7 +/- 0.2 mm vs. 3.8 +/- 0.1 mm (P < 0.01).

CONCLUSION

Adipose tissue disposition is increased in fetuses of women with well-controlled diabetes. This may be a reflection of higher maternal glucose levels in these women and may explain why even well-controlled diabetic pregnancies are at risk of macrosomia.

The value of ultrasonographic examination of the uterine cervix in predicting post-term pregnancy

OBJECT

To assess whether transvaginal ultrasound is helpful in predicting the post-term onset of labor (> or = 1 weeks).

SETTING

Antenatal clinic of a University hospital and referral center. SUBJECT AND MEHODS: One hundred and twenty singleton uncomplicated pregnancies in primiparous women were enrolled at 37 weeks of gestation. Ultrasound examination of the cervical length by a transvaginal probe was performed at recruitment and at weekly intervals until 40 completed weeks. Subjects were divided into Group A (those with spontaneous onset of labor < or = 1 completed weeks) and Group B (those not in labor by that date).

RESULTS

Eighty women delivered < or = 41 completed weeks, forty were not in labor by that date. The cervix was significantly shorter at 39 and 40 weeks in group A, but no particular cervical length was predictive of post-term delivery.

DISCUSSION

There is a significant difference in cervical length in women delivering at term compared with those due to have a post-term delivery. This difference is significant from 39 weeks of gestation onwards. We speculate that targeted transvaginal ultrasound may be useful in predicting the post-term onset of labor and possibly in assisting its active management.

Effect of insecticides and fungicides on the interaction between members of the mite families Phytoseiidae and Stigmaeidae on citrus

The study was carried out to evaluate the effect of some insecticides and fungicides on the interaction between predacious mites of the families Phytoseiidae and Stigmaeidae on citrus. Euseius citrifolius Denmark and Muma, Euseius concordis (Chant) (Phytoseiidae), and Agistemus aff. bakeri (Stigmaeidae) were the most abundant species of predacious mites. No significant reduction of the population of stigmaeids was detected following the pesticide treatment. On the contrary, the population of those mites increased after the application of methidathion, petroleum oil, deltamethrin, cupric oxychloride and cuprous oxide, as compared to the population of those mites in the control plots. The chemicals promoting increased stigmaeid populations are some of those that promoted reduction of phytoseiid populations. A significant negative correlation was found between the numbers of phytoseiids and stigmaeids on citrus leaves immediately before treatments, and 33, 50, 83 and 105 days after treatment. A clear negative linear correlation between the number of predacious mites from both families was detected for benomyl, cupric oxychloride, cuprous oxide, thiophanate methyl, and control. Phytoseiid-stigmaeid interaction on citrus orchard is discussed.

[Echographic measurement of subcutaneous adipose tissue as fetal growth index]

OBJECTIVE

To evaluate, by 3rd trimester ultrasound examination, fetal adipose tissue to predict fetal growth and birthweight.

PATIENTS AND METHODS

Thirteen pregnant women (group 1) with uncomplicated pregnancy and 9 diabetic women (group 2) have been enrolled. We have examined adipose tissue at the cross sectional level of arm, thigh and abdomen and at the longitudinal sectional level of shoulder. During 3rd trimester measurements were taken at the beginning (28-32 gestational weeks), at the middle (34-38 gestational weeks) and at term (39-41 gestational weeks). At birth we recorded the skinfolds of arm, thigh and shoulder and the neonatal weight. Subsequently, by regression analyses ultrasound parameters of physiological pregnancies were correlated to skinfolds measurements at birth, while abdomen thickness was compared to birthweight. In addition, ultrasound markers of the physiological pregnancies were compared to those of diabetic pregnancies by the t-test.

RESULTS

Fetal limbs examination had not a prognostic value at any gestational week. Shoulder ultrasound measurements appeared well correlated to the shoulder skinfold after birth since the 34th week. Diabetic mothers' fetuses presented much more adipose tissue than control cases, particularly of arm and thigh at 28-32 weeks, of shoulder at 34-38 weeks and in all the markers at term pregnancy.

CONCLUSION

Ultrasound examination of fetal adipose tissue seems to have a predictive value for fetal growth both in physiological and diabetic pregnancy.

FCE 23884, substrate-dependent interaction with the dopaminergic system. II. Preclinical biochemical studies

The effects of FCE 23884 [4-(9,10-didehydro-6-methylergolin-8 beta-yl) methyl-piperazine-2,6-dione] were examined using a variety of biochemical methods. In vitro assays showed that FCE 23884 bound to D-2, alpha-2 and 5-hydroxytryptamine1A sites with Ki values of 6.5, 4.0 and 4.0 nM, respectively. The affinity for D-1 and S-2 receptors was moderate (submicromolar range) and slight or negligible for alpha-1, cholinergic and sigma receptors. In normal rats, FCE 23884 accelerated markedly dopamine (DA) turnover in the neostriatum and nucleus accumbens as indicated by the increased ratios of dihydroxphenyl acetic acid/DA and homovanillic acid/DA. The compound enhanced DA synthesis and utilization rate. After gamma-butyrolactone treatment, a model to study DA autoreceptors function, FCE 23884 almost antagonized completely the gamma-butyrolactone reversal induced by apomorphine on l-dihydroxyphenylalanine accumulation in the two brain areas. In addition, FCE 23884 induced a rapid 20-fold increase of serum prolactin confirming its DA antagonistic profile in normal rats. In contrast with these antidopaminergic properties, FCE 23884 consistently stimulated basal adenylate cyclase activity in vitro (ED50 = 0.6 microM) and elicited a rapid increase of cyclic AMP formation in the neostriatum of normal (35%) and reserpinized (82%) rats in vivo. Furthermore in this last condition both the DA turnover and synthesis rate in the neostriatum and nucleus accumbens decreased after treatment with FCE 23884. These neurochemical data support the behavioral studies indicating that FCE 23884 possesses mixed DA antagonist and agonist properties depending on the experimental conditions, the distinguishing factor being presence or absence of DA.(ABSTRACT TRUNCATED AT 250 WORDS)

FCE 23884, substrate-dependent interaction with the dopaminergic system. I. Preclinical behavioral studies

FCE 23884, a newly synthetized ergoline derivative, shows dopamine (DA) agonist or antagonist properties depending on the functional state of the biological substrate. The compound behaves as a full DA antagonist in normal animals, but shows full agonist properties in denervated models in the same dose range. In normal animals, FCE 23884 impairs Sidmans avoidance in rats, reduces spontaneous locomotion in mice and monkeys and antagonizes apomorphine-induced climbing behavior in mice, yawning in rats, emesis in dogs and amphetamine-induced toxicity in grouped mice. After experimental procedures resulting in severe DA depletion, FCE 23884 behaves as a powerful DA-agonist mainly at D-1 receptors. FCE 23884 induces contralateral turning behavior in 6-hydroxydopamine-lesioned rats and reverses 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced akinesia in monkeys and reserpine-induced hypokinesia in mice. These results indicate that the antagonist or agonist activity of FCE 23884 is substrate-dependent and mostly related to the presence or absence of DA. This leads to the apparently paradoxical suggestion that the compound could be useful both in psychotic states and extrapyramidal diseases, i.e., in clinical conditions characterized by either excessive or impaired DAergic neurotransmission.

Synthesis and anticonvulsant and sedative-hypnotic activity of 4-(alkylimino)-2,3-dihydro-4H-1-benzopyrans and -benzothiopyrans

A series of 4-(alkylimino)-5-hydroxy-7-alkyl-2,3-dihydro-4H-1-benzopyrans and -thiopyrans were synthesized and evaluated for anticonvulsant activity. Preliminary screening of these compounds revealed that 2,2-dimethyl-4-[(2-hydroxyalkyl)imino]-5-hydroxy-7-pentyl-2,3- dihydro-4H-1-benzopyrans 19 and 29, the 7-butyl analogue 34, and the corresponding 7-pentyl-4H-1-benzothiopyrans 38 and 39 had the most promising anticonvulsant activity. Synthesis of both enantiomers of 29 and 39 indicated that the R isomers 30 and 40 were the most active and showed very good protection against MES, pentylenetetrazole, and mercaptopropionic acid induced seizures after oral administration in mice. In the Irwin test these compounds showed a generalized depressant activity but at dosages higher than those showing anticonvulsant activity, whereas acute toxicity after oral administration was low (LD50 higher than 400 mg/kg).

Injections of 6-hydroxydopamine in the substantia nigra of the rat brain: morphological and biochemical effects

Rats with unilateral injections of 6-hydroxydopamine (6-OHDA) into the substantia nigra pars compacta were classified as active and inactive according to the intensity of their spontaneous and/or apomorphine-induced turning behavior (TB), and sacrificed at different survival times for morphological and biochemical analysis. In active rats, at any survival time, dopaminergic fluorescence in the nigrostriatal system as well as dopamine (DA) and 3,4-dihydroxyphenylacetic acid (DOPAC) content of the nucleus caudatus-putamen drastically decreased on the brain side ipsilateral to the injection. Dopaminergic fluorescence as well as DA and DOPAC content of the mesolimbic system ipsilateral to the injection also decreased. In inactive rats, at any survival time, 6-OHDA-induced lesions only partially involved both nigrostriatal and mesolimbic systems. Our results are indicative of a good correlation between the intensity of TB and the extent of 6-OHDA-induced lesions, as assessed by morphological and biochemical analysis.

The importance of adverse reaction reporting by physicians. Suprofen and the flank pain syndrome

The role of spontaneous reporting in detecting the suprofen-associated flank pain syndrome was examined, including the specific effect of the "Dear Doctor" letter in accelerating the information-gathering process once the initial signal was generated. We believe this to be a noteworthy example of the ability of spontaneous reporting to produce a timely and unequivocal signal of drug-related risk. It also serves to demonstrate the need for vigilant postmarketing surveillance for all newly marketed drugs in the United States, even though considerable premarketing and postmarketing drug experience may exist from use in countries outside of the United States.

Receptor adaptive responsiveness in disease models: 6-OHDA lesioned and spontaneously hypertensive rats

We have examined the adaptive modifications of brain monoamine receptors in response to pathophysiological processes in animal disease models: 6-OHDA lesioned and spontaneously hypertensive rats (SHR). The two models share a similar increase in D-1 receptor densities, while noradrenergic receptors are affected in different way: alpha-1 and beta are supersensitive in 6-OHDA lesioned rats and only alpha-2 are increased in SHR. S-1 receptors too are up-regulated in SHR. We must notice that though receptor hypersensitivity in the 6-OHDA model is linked to massive decreases in neurotransmitter levels, this mechanism seems not to exist in the SHR model.

Ulcerogenicity of piroxicam: an analysis of spontaneously reported data

Previous reports have suggested that piroxicam may be more ulcerogenic than other non-steroidal anti-inflammatory drugs (NSAIDs) in use. Critics have attributed this putative relation to flawed comparisons of spontaneously reported data. In this study cases of upper gastrointestinal bleeding, perforation, and ulcer reported to the Food and Drug Administration's spontaneous reporting system over 12 years were examined. Reporting rates for eight NSAIDs were compared over identical periods of their marketing life cycles. After adjustments were made for the heterogeneity in the underlying reporting rates the difference in rates between piroxicam and the other drugs was considerably reduced but piroxicam retained its top ranking among the drugs; however, large and clinically important differences in the frequency of cases of upper gastrointestinal bleeding, perforation, and ulcer between piroxicam and the rest of the NSAIDs compared probably do not exist.

Opioid receptor binding profile of selected dermorphin-like peptides

The receptor binding profile of a selected group of dermorphin-like peptides was determined and correlated with the results of the guinea pig ileum (GPI) and mouse vas deferens (MVD) bioassays and with the currently used antinociception tests in the rat. For the peptides with the characteristic dermorphin D-Ala2-Phe3-Gly4 sequence, a linear negative correlation was found between the reciprocal of sodium shift and relative affinity for the mu-type opioid receptor. For the same peptides, a positive correlation was evidenced between relative potency on GPI and MVD and relative affinity for mu- and delta-type receptors, respectively.

Tremor at rest episodes in unilaterally 6-OHDA-induced substantia nigra lesioned rats: EEG-EMG and behavior

Twenty male adult Wistar rats were unilaterally lesioned in the substantia nigra (SN) with 6-hydroxydopamine (6-OHDA), and prepared with chronic cortical (ECoG) and neck muscle (EMG) electrodes. Longitudinal study over a period of up to 18 months demonstrated the emergence, in about two-thirds of the rats, of spontaneous repetitive episodes of head and neck tremor during awake at rest, of up to 20 seconds duration each, that were associated with spike and wave-like ECoG activities. These episodes of tremor at rest disappeared during sleep and REM sleep episodes, and also following the i.p. administration of L-DOPA. It is assumed that these tremor at rest episodes are analogous to those reported to occur in primates after experimentally induced dysfunction of the nigro-striatal, extrapyramidal system.

Antinociceptive and other opioid effects of a new series of dermorphin analogues after subcutaneous administration in the rat

A series of hepta-, hexa-, penta- and tetrapeptide analogues of dermorphin have been evaluated in the rat for antinociceptive activity after subcutaneous (SC) administration at the screening dose of 4 mg/kg. Effective doses (ED50) were calculated for the most active compounds. Presence of spontaneous movements, defecation, micturition and corneal reflex were also recorded. Syntheses and analytical data of new derivatives are briefly reported.

Structure-activity relationships of dermorphin synthetic analogues

A number of dermorphin analogues have been reviewed for antinociceptive activity after systemic administration. Analgesic peptides as potent as or more potent than dermorphin are found among the hepta- and tetrapeptide analogues, probably because of enhanced stability towards carboxyldipeptidases imparted by the Pro6 and D-Ala2 residues lying on the right and left side, respectively, of the point of cleavage. Hexapeptide analogues are practically inactive. [D-Arg2]derivatives are very potent, particularly in the tetrapeptide series. In binding studies dermorphin behaves as a pure opioid agonist, with a marked affinity and selectivity for the mu-type opioid receptors. In the heptapeptide analogues a direct correlation seems to exist between mu-selectivity and "sodium shift," and between lipophilicity and MVD/GPI potency ratio.

Discovery of new adverse drug reactions. A review of the Food and Drug Administration's spontaneous reporting system

Recently, several studies of spontaneous reporting systems (SRSs) have reported on the published literature's role in producing first reports of new adverse drug reactions. In order to provide further information on other components of SRS, the Food and Drug Administration's SRS was examined with regard to its effectiveness and efficiency in identifying new adverse drug reactions and the form, consistency, and timeliness of its communication of new adverse drug reactions to the medical community. While there was evidence that the literature was more effective in producing first reports of new adverse drug reactions for the years compared, there was reason to conclude that FDA's SRS was capable of making a contribution to the alerting process. Moreover, direct participation by practitioners in FDA's SRS was found to be the most efficiently obtained FDA source of new adverse drug reaction reports.

Effects of antihypertensive drugs on sexual behaviour of male rats

Equiactive antihypertensive doses of clonidine, alpha-methyldopa, hydralazine, propranolol and of a novel compound 355-1057 were tested in an experimental model in which sexual activity was stimulated pharmacologically by lisuride. It was found that those antihypertensive drugs known to cause disturbances in sexual function in men, i.e., clonidine, alpha-methyldopa, hydralazine and propranolol, inhibited lisuride-induced mounting behaviour in male rats, as measured by a decrease in the percentage of animals mounting or in the number of mounts per active animal. The novel antihypertensive compound 355-1057, that seemed in preliminary clinical trials to be devoid of sexual side-effects in men, had no significant effect on the mounting behaviour. It seems, therefore, that the present experimental model could be predictive for antihypertensive drug-induced sexual side-effects in man.

A method for post-marketing screening of adverse reactions to drugs: initial results

The FDA is pilot-testing a methodology for signaling previously unsuspected relationships between drugs and important adverse events. This method uses data it receives through the FDA spontaneous reporting program. Reviewing drugs used primarily on an outpatient basis, this screening methodology focuses on "tracer" adverse events and the organization of these reactions into body/functional systems. This review process enables a clinical evaluator to perceive more easily the clinically important drug-adverse event patterns. The method can incorporate drug use data; this enables a drug's proportional share of specific adverse events, relative to its therapeutic class, to be compared to its respective proportional share of drug use. The assumption is that the adverse event distribution of drugs in a therapeutic class should be the same as the distribution of drug use in that class, if all drugs in the class were to carry the same risk. Actual examples of drug-adverse event associations signaled by the screening method are presented. The potential uses of this methodology in other settings, and under other data situations, are discussed.

Azetidine derivatives of tricyclic antidepressant agents

Tricyclic derivatives of azetidine were synthesized and screened for their potential antidepressant activity. The active series had the tricyclic ring attached to position 1 and a basic group in position 3 of the azetidine. The most interesting compounds were comparable to the reference standards for reserpine antagonism in mice, the most active being the dextrorotatory methylamino derivative 84. The pharmacological profile classifies it as a CNS stimulant devoid of peripheral anticholinergic activity.

Relation of cigarette smoking to myocardial infarction in young women

To examine the relation between myocardial infarction and cigarette smoking in young women, we investigated the smoking habits of women under the age of 50 who had survived a recent myocardial infarction. They had not been using oral contraceptives, and other identifiable risk factors were excluded. Among 55 such women and 220 control matched for age and area of residence, the proportions of cigarette smokers were 89 per cent and 55 per cent respectively (P less than 0.001). A dose-response relation was evident; among women smoking 35 or more cigarettes per day the rate of myocardial infarction was estimated to be some 20-fold higher than among those who had never smoked. This study demonstrates that cigarette smoking is a risk factor for myocardial infarction in young women who are otherwise apparently healthy.