Female rats show an increased sensibility to the forced swim test depressive-like stimulus in the hippocampus and frontal cortex 5-HT1A receptors

Affective disorders are more common in women. The forced swim test acts like a depressive stimulus. Hippocampus and frontal cortex 5-HT1A receptors of female and male Wistar rats subjected to the forced swim test were compared with a sham group. The forced swim test diminishes (P<0.05) the hippocampus 3H-8OH-DPAT bound in the female rats (184+/-16 fmol/mg protein) with respect to the male rats (309+/-41 fmol/mg protein) and to the female sham rats (255+/-20 fmol/mg protein). The forced swim test increases the frontal cortex 5-HT1A receptors in the female rats with respect to the female sham group (40.4+/-5 versus 24.7+/-4 fmol/mg protein, P<0.05). An increased sensibility of the 5-HT1A receptors to depressive-stimulus may be one mechanism underlying the higher prevalence of depression in female.

[123 I-MIBG myocardial sympathetic innervation scintigraphy and Parkinson's disease. Preliminary results]

OBJECTIVES

Cardiac sympathetic function in patients with Parkinson's disease (PD) is significantly impaired. Cardiac scintigraphy with 123I-metaiodobenzylguanidine (123I-MIBG) is used to assess cardiac sympathetic function.

METHODS

A total of 29 consecutive patients with PD and 10 control subjects without neurological disease were studied. Myocardial imaging with 123I-MIBG was performed to evaluate cardiac sympathetic function. Early and delayed images of the anterior view were obtained at 15 min. and 4 h. after injection of 123I-MIBG, respectively. 123I-MIBG uptake was quantified qualitatively and semiquantitatively by calculating a heart-to-mediastinum (H/M) ratio.

RESULTS

The heart/mediastinum ratio was markedly reduced in patients with PD (I to IV on the Hoehn and Yahr scale) when compared to the control subjects (p < 0.05). This finding was independent of the length and severity of the disease or the pharmacological treatment of the patients. None of the control subjects showed decrease in myocardial 123I-MIBG uptake.

CONCLUSIONS

Our findings indicate that a decrease in myocardial accumulation of 123I-MIBG was observed in the early stages of PD. This suggests that the measurement of 123I-MIBG may help the early diagnosis of PD, and can be used to detect cardiac autonomic dysfunction, especially in patients without typical signs and symptoms.

EMA: a differentiation antigen related to node metastatic capacity of breast carcinomas

Epithelial membrane antigen (EMA), also known as MUC1, is a mucinous glycoprotein fixed to the luminal domain of the epithelial cell membrane of normal breast ducts. However, in breast cancer cells, it is usually dispersed in the cytoplasm. EMA staining patterns of 330 breast carcinomas were examined, and three groups formed: lineal (16%), cytoplasmic (75%), and negative (9%). Although these patterns were somewhat related to histological cancer types, this was not statistically significant. However, EMA showed statistically significant univariate relationships to tumor grade, tumor size, estrogen and progesterone receptors, and nodal stage. Logistic regression analysis showed that among these variables, all of which were univariately related to node metastasis, only tumor size and EMA were independent nodal stage predictors. A combined analysis of these two factors revealed that the statistical probability of a tumor metastasizing to four or more nodes increased in each tumor size group from 0.9% to 12% for pT1, from 2% to 29% for pT2 and from 10% to 63% for pT3, depending on the EMA staining. The tumors showing a lineal pattern were the least metastasizing, while the EMA-negative tumors were the most. After recognizing these relationships between EMA staining patterns and other well-known differentiation markers and the lymph node metastatic capacity of carcinomas, and considering the results obtained by others on survival, one might conclude that EMA is both a differentiation marker and a histological prognostic factor.

[Chromatic computerized analysis is an early predictor of cardiovascular risk associated to hypercholesterolemia]

INTRODUCTION AND OBJECTIVES

Early detection of cardiovascular disease is a major goal of contemporary medicine in efforts to prevent coronary heart disease. The goal of this study was to look for a number of changes that could be detected in the neurons of the 19 Brodman area by means of chromatic computerized analysis (CCA) as a consequence of a neurobiological dysfunction, which induced a failure in the chromatic perception, which, in turn, expressed the existence of hypercholesterolemia through numeric qualification and therefore, a cardiovascular risk.

PATIENTS AND METHOD

. We studied 208 patients (Group 1) (153 men and 55 women) with pre-study plasma cholesterol levels in excess of 200 mg/dl. The control group (Group 2) also consisted of 208 subjects (153 men and 55 women) but with a cholesterol level below 200 mg/dl. They were performed by CCA, previously ruling out any systemic or ophthalmological pathology.

RESULTS

All global indexes were highly correlated in both groups. The direct relation between cholesterol levels and 19 area, reached a canonical correlation of 0.825 with a sensitivity of 90% and especifity of 93%. The results of the multiple regression taking total cholesterol as a dependent variable and the most significative parameter of CCA, as an independent variable was R = 0.89 (p < 0.001), with a test variability of 81%.

CONCLUSIONS

This study determines a strong association between hypercholesterolemia and the visual areas of the cerebral cortex.

Topographic variations in normal skin, as viewed by in vivo reflectance confocal microscopy

Near-infrared confocal microscopy is a new tool that provides skin images in vivo, with high resolution and contrast at a specific depth. Regional variations in live human skin viewed by confocal microscope have not been studied so far. In vivo reflectance confocal microscopy was performed in 10 adults (eight males, two females) of various skin phototypes. Six topographic sites were studied in each subject: forehead, cheek, inner and outer forearm surfaces, lower back and leg. Epidermal thickness at suprapapillary epidermal plates and rete pegs was measured during real-time imaging and the number and diameter of epidermal keratinocytes in each epidermal cell layer as well as the characteristics of dermal papillae were defined from the grabbed images. Stratum corneum appeared brighter in sun-exposed than in sun-protected areas and particularly pronounced in heavily pigmented individuals. The epidermal thickness at rete pegs, but not the suprapapillary epidermal plate, was greater in sun-exposed areas than in sun-protected sites except forearm flexor surface. The en face numerical density of granular keratinocytes is greater on the face as compared with all other sites, whereas the surface density of spinous keratinocytes is greater on sun-protected sites. Additionally, the number of basal keratinocytes per millimeter length of dermoepidermal junction is greater in sun exposed areas. Interestingly, the dermal papillae shape varies and their sizes increase in circumference from sun-exposed to sun-protected sites, as observed at a specific depth below the stratum corneum. In summary, our results demonstrate that near infra-red reflectance confocal microscopy is a feasible tool for microscopic analysis of skin morphometry in vivo.

Inducible myocardial ischaemia in asymptomatic Type 2 diabetic patients

BACKGROUND

to define the prevalence of inducible myocardial ischaemia in asymptomatic Type 2 diabetic patients and its relation to urinary albumin excretion rate (AER).

METHODS

98 Type 2 diabetic patients aged 56+/-7 years, and 20 non-diabetic volunteers were recruited. Dypiridamole plus exercise thallium-201 myocardial single photon emission computed tomography (SPECT) was performed in all participants. Exclusion criteria were: age <30 or >70 years, evidence of cardiovascular disease, anomalous ECG, autonomic neuropathy or serum creatinine level >177 micromol/l.

RESULTS

36 out of 98 diabetic patients (37%) showed abnormal thallium SPECT (considered as inducible myocardial ischaemia), versus one out of 20 (5%) in control group (odds ratio 7.3 (95% CI 1.1-50.5), P<0.005). Among diabetic patients, prevalence of inducible ischaemia was greater in those with higher urinary AER (AER <30:30-300:> 300 mg/24 h: 26: 53: 88%, and greater in the normoalbuminuric group compared to the control group (26 vs. 5%; P<0.05). An AER >30 mg/24 h was the only independent factor associated with inducible myocardial ischaemia in the multivariate analysis (P=0.009).

CONCLUSIONS

raised urinary AER in asymptomatic diabetic patients is a risk factor for present myocardial ischaemia demonstrated by thallium dypiridamole tomography. The prevalence of inducible myocardial ischaemia in asymptomatic diabetic patients without known coronary disease is much higher than in non-diabetic population.

Importance of estrogen receptors for the behavior of invasive micropapillary carcinoma of the breast. Review of 68 cases with follow-up of 54

The aggressiveness of invasive micropapillary carcinomas of the breast (MPCa) is still controversially discussed. Therefore, we investigated a total of 68 cases and studied the evolution of 54. MPCa were frequently well-differentiated cancers with the following positivities for immunohistochemistry: 74.5% estrogen receptor (ER+), 46.3% progesterone receptor (PR+), 66% Bcl2+, and 36.4% C-erbB-2+. However, in 90.5% of the cases lymph nodes were involved at diagnosis, and 70.6% of T1 tumors showed wide metastatic spread. After a mean follow-up of 52.6 months, 55.6% of the patients were disease free (DF), 7.4% had disseminated disease and 37% had died. Univariate analysis showed significant differences. Thus, the DF group of patients included 90% of those having tumors with an associated colloid pattern, 73.3% of the ER positive tumors, none of the C-erbB-2 positive tumors, and 100% of the tumors with no axillary metastasis, 77.8% of those with metastasis to up to 3 nodes, and 47.2% of those metastasizing to 4 or more nodes. However, using Cox's regression model for survival analysis, ER was the only factor associated with duration of survival (p = 0.0175). In conclusion, although long-term survival in MPCa is determined by involvement of lymph nodes, as is the case in any other breast cancer type, their short-term evolution is influenced by other factors, mostly by estrogen receptors.

Stereological age-related changes in neurons of the rat dorsal lateral geniculate nucleus

Quantitative methods were used to compare the changes taking place in the volume of the dorsal lateral geniculate nucleus (dLGN) and corresponding neurons of young, adult and old rats. The study was carried out on male albino rats aged 3, 18, 24 and 28 months. In order to estimate the volume of the dLGN, neuronal volume density, numerical density and total number of neurons, we used serial sections stained according to the Klüver-Barrera technique and stereological methods. We found that dorsal lateral geniculate nucleus volume increases between 3 and 28 months, with a larger increase between 24 and 28 months. Neuronal volume density and numerical density of neurons are greater at 3 months and undergo a significant decrease between 24 and 28 months. Finally, the total number of neurons is shown to be smaller in adult and old animals than in younger ones, even though no significant variations are found between 18 and 28 months. Furthermore, this study confirms the need to analyze the total number of neurons and not just neuronal density if we want to correctly evaluate some of the microscopic changes occurring during senescence.

An extract of Polypodium leucotomos appears to minimize certain photoaging changes in a hairless albino mouse animal model. A pilot study

Chronic ultraviolet B (UVB) exposure of human or murine skin is known to induce cutaneous photoaging and enhanced carcinogenic risk. An extract of Polypodium leucotomos (PL), a tropical fern plant, has been known to exhibit interesting antioxidant and photoprotective properties against acute exposure to ultraviolet radiation. The objective of this preliminary (or pilot) study was to determine the photoprotective role of topically applied Polypodium leucotomos extract in the prevention or amelioration of cutaneous changes of photoaging in hairless mice. PL-treated mice showed significant reduction of skinfold thickness than those observed in PL-untreated controls. Additionally, PL-treated mice showed a significantly lower degree of histologic parameters of photoaging damage, including dermal elastosis, compared with positive control mice. Interestingly, PL treatment also showed reduction in the number of mice showing skin tumors at 8 weeks after the cessation of the UVB exposure protocol. The results of this preliminary study illustrate that PL treatment helped to ameliorate and to partially inhibit some of the histologic damage associated with photoaging of skin and appeared to contribute to a decrease in the prevalence of UVB-induced skin tumors in mice.

[Association between myocardial infarction and angiotensin converting enzyme gene polymorphism in young patients]

BACKGROUND

Different studies have shown a relationship between an insertion-deletion polymorphism of the angiotensin converting enzyme (ACE) gene and the risk of ischemic heart disease, although there are no data on this association in the Spanish population.

MATERIALS AND METHOD

We have studied three groups of patients: I, healthy volunteers (n = 56, mean age 36.20 +/- 4.20 years); II, patients having presented an acute myocardial infarction (MI) < or = 50 years (n = 59, mean age 42.30 +/- 5.30 years), and III, patients with MI over the age of 50 years (n = 60, mean age 66.36 +/- 9.47 years). In all patients the genotype ACE gen was determined by an assay based on the polymerase chain reaction.

RESULTS

The distribution of the ACE genotype between the three groups were not significative. Comparing the ratio of DD/II-DI in groups II and III there were 26/33 versus 15/45 (p = 0.02864). There was no difference in the smoking, hypercholesterolemia and hypertension between groups II and III; there were only differences in familial history of ischemic heart disease; diabetes mellitus was more prevalent in the III group. A multivariate analysis showed that smoking familial history of ichemic heart disease, hypercholesterolemia and DD genotype were more prevalent in young patients (OR 3.92, 2.85, 2.36 and 1.77), whereas diabetes mellitus was more prevalent in the group of older patients. There were no differences in the ACE genotype with respect to infarct location or gender.

CONCLUSIONS

In our population DD ACE genotype is associated with MI in young patients, although smoking, family history and hypercholesterolemia show a more powerful association.

Thrombomodulin and induced tissue factor expression on monocytes as markers of diabetic microangiopathy: a prospective study on hemostasis and lipoproteins in insulin-dependent diabetes mellitus

Vascular complications are the main cause of morbidity in diabetes mellitus. To evaluate lipoprotein and hemostatic parameters and their relationship with clinically detectable microangiopathy, we studied 58 insulin-dependent diabetes mellitus patients and 60 controls matched for age, sex, and body mass index. Thirteen patients presented clinically detectable microangiopathy (8 retinopathy and 5 both retinopathy and microalbuminuria). A cross-sectional study of lipid profile, coagulation parameters, and a flow-cytometric evaluation of tissue factor expression in normal monocytes induced by patient plasma were performed. Patients were re-evaluated for microangiopathy in a 3-year median follow-up. Patients showed triglyceride enrichment in low (P = 0.00002) and high density lipoproteins (P = 0.004) and increased levels of D-dimer (P < 0.00001), prothrombin fragment 1 + 2 (P < 0.00001), and thrombin-antithrombin III complex (P = 0.0001). Patients with clinically detectable microangiopathy had increased type 1 plasminogen activator inhibitor (P = 0.00001), thrombomodulin (P = 0.02), and induced monocyte tissue factor expression (P < 0.00001). Nine patients developed clinically detectable microangiopathy in the follow-up and the only predictive variable was increased induced tissue factor expression. In conclusion, in these patients elevated thrombin and fibrin generation reflects a hypercoagulable state but clinically detectable microangiopathy seems related to endothelial cell injury markers and to increased induced tissue factor expression on monocytes.

Medical therapy of Graves' disease: does thyroxine prevent recurrence of hyperthyroidism?

Sixty patients with Graves' disease (GD) hyperthyroidism were distributed in two randomized groups. Patients in group A (n = 30) received carbimazole by a titration regimen, and patients in group B (n = 30) were treated with higher doses of carbimazole plus T4. Clinical and analytical evaluations were done at baseline, during treatment (18.4 +/- 2.6 months), and after, until the relapse of hyperthyroidism, or for 4.98 +/- 1.6 yr in patients who did not relapse. There were no differences in clinical parameters, thyroid hormones, or TSH binding inhibitory immunoglobulins (TBII) levels between the two groups, either at baseline or at the end of treatment. Serum TSH persisted undetectable in 16 out of 60 patients (group A: 9; group B: 7), after treatment. Relapse occurred in 38 patients (63.3%), (group A: 18 (60%) vs. group B: 20 (66.7%)). Patients who relapsed had bigger goiters at baseline (P = 0.02) and at the end of treatment (P = 0.03). Eighty-seven percent (14/16) of patients with undetectable TSH after therapy relapsed, vs. 54.5% (24/44) of those with normal TSH (P = 0.01). Undetectable TSH at the end of treatment was the only independent variable in the logistic analysis to predict relapse. Treatment modality did not influence the relapse rate. This study has found that, in Spanish patients, the use of high doses of carbimazole with T4 offers no advantages in the treatment of GD hyperthyroidism.

Quantitative morphological changes in neurons from the dorsal lateral geniculate nucleus of young and old rats

BACKGROUND

We studied the morphological changes occurring in neurons from the dorsal lateral geniculate nucleus (dLGN) during aging by analysing the size and shape of cell bodies and nuclei.

METHODS

Male albino Wistar rats, aged 3, 18, 24, and 30 months, were used. After appropriate tissue preparation and following the usual histological procedure, the profiles of 1,920 neuronal bodies and nuclei were drawn using a camera lucida. Data was later recorded and processed with a semiautomatic image analyser.

RESULTS AND CONCLUSIONS

We observed that dLGN neurons do not change in size from the age of 3-24 months. Between 24 and 30 months, the soma and nucleus of the cell undergo hypertrophy, 32.8% and 35.6%, respectively, when compared to those from 3-month-old animals (P < 0.01). Furthermore, we found a high correlation between cell body size/nucleus size, which does not disappear with age. The r values (correlation coefficient) were 0.7998, 0.8662, 0.8433 and 0.7304, and R2 (determination coefficient) was equal to 0.6397, 0.7504, 0.7112, and 0.5335. These latter values show that in 63.97%, 75.04%, 71.12%, and 53.35% of cases, respectively, modifications in somata size were accompanied by similar changes in nucleus size, and vice-versa. The study of the shape of the soma and nucleus of the cell revealed that both structures have a rounded-oval configuration that does not change in a significant way from adulthood to old age.

Effect of S-adenosyl methionine on muscarinic receptors in young rats

In the present study we have investigated the effect of a chronic administration of S-Adenosyl Methionine (SAM) on muscarinic receptor subtypes in young rat forebrain, cerebellum, heart and lacrimal gland. Saturation binding experiments were performed using 3H-N-methylscopolamine (3H-NMS) to label the total population of muscarinic receptors in plasma membranes from forebrain, cerebellum, heart and lacrimal gland. 3H-Pirenzepine (3H-Pz) was used to label the M1 subtype in plasma membranes from forebrain. The results obtained in cerebellum, heart and lacrimal gland show no changes in the affinity (Kd) nor in the number of receptors (Bmax) of the treated versus control groups. Saturation experiments in forebrain show an increase in the number of receptors of the treated versus control groups when using 3H-NMS (Bmax 2117 +/- 63 versus 1643 +/- 104 fmol/mg protein) without changes in the affinity. Saturation experiments with 3H-Pz, show an increase in the number of M1 receptors in the treated group with no changes in the affinity (Bmax 421 +/- 16 versus 225 +/- 19 fmol/mg protein). From our results, we conclude that SAM increase the number of receptors in forebrain and this increase is mainly due to changes in the number of M1 receptor subtypes.

Renal function changes in hypertensive patients with non-insulin- dependent diabetes mellitus

A group of 146 patients with non-insulin- dependent diabetes mellitus (NIDDM) was studied. They were divided into two groups of 73 age and sex matched patients, according to the presence or absence of hypertension. We recorded the presence of macrovascular and microvascular complications of NIDDM, family history, body mass index (BMI), glycemic control and lipidic profile. Renal parameters included plasma creatinine, urinary albumin excretion rate (UAER), glomerular filtration rate (GFR), effective renal plasma flow (ERPF) and filtration fraction. Hypertensive patients had a higher BMI (30 +/- 4.8 kg/m2 vs. 27.6 +/- 4.4 kg/m2, P < 0.005), total cholesterol (6.34 +/- 1.47 mmol/l vs. 5.72 +/- 1.14 mmol/liter, P < 0.01), creatinine (91.1 +/- 25.6 mumol/liter vs. 81.3 +/- 20.3 mumol/liter, P < 0.05) and UAER [63.7 (range 1 to 5160) mg/24 hr vs. 27.3 (3 to 5500) mg/24 hr, P < 0.001]. GFR was lower in the group with hypertension (113 +/- 35 ml.min-1.1.73 m-2 vs. 127 +/- 29 ml.min-1.1.73 m-2, P < 0.05), but there were no differences in ERPF. The difference in GFR was only apparent in patients without established diabetic nephropathy. Hypertensive patients had higher frequency of ischemic heart disease (18% vs. 6%, P < 0.05) and diabetic nephropathy (62% vs. 38%, P < 0.005). We conclude hypertensive NIDDM patients, when compared with normotensive NIDDM patients, are more obese, hypercholesterolemic and have a higher frequency of ischemic heart disease and diabetic nephropathy. Hypertensive NIDDM patients have a worse renal function than normotensives before clinical proteinuria appears. The deterioration of GFR in hypertensive NIDDM patients possibly has an important influence on the progression of diabetic nephropathy.

A technique for automatic/interactive assessment of the proliferating fraction of neoplastic cells in solid tumors. A methodological study on the Ki-67 immunoreactive cells in human mammary carcinomas, including a comparison with the results of conventional S-phase fraction assessments by means of DNA cytometry

Based on a computerized microscopy technique, a method has been devised which allows the practising pathologist to easily and rapidly assess quantitatively the relative number of actively proliferating neoplastic parenchymal cells in a tumor nodule. Our method has been tested on a series of 20 conventionally formalin-fixed and paraffin-embedded female mammary adenocarcinomas, using immunoreactivity with the MIB-1 monoclonal antibody against the cell proliferation antigen Ki-67. The values of the proportion of the MIB-1 immunoreactive cell nuclei were compared with those obtained DNA-cytometrically for the fraction of cells in the S-phase; a good correlation was found, although the MIB-1 values were consistently somewhat higher. A prerequisite for a success of the method was, of course, to achieve standardization of the MIB-1 immunostaining technique. By making simple adjustments of it, it could actually be improved to such an extent that almost the same color calibration and thresholding setup could be used. The measuring technique could be either interactive or automatic. The total number of immunoreactive and non-immunoreactive nuclei, as well as the total nuclear area of both cell types were registered in a computerized device. The data were accumulated sequentially for each measure field. To investigate the reproducibility of the immunostaining, two slides of each case were stained on different occasions. Each slide was measured three times; systemically randomly in the x- and y-axis-directions as well as in the subjectively defined histopathologically "most proliferative" area of the tumor. The values obtained were in good agreement with each other and obviously gave some valuable and objective supplementary pieces of information to that of the conventional clinical and histopathologic assessment of the degree of aggressiveness of a malignant neoplasm.

Study of certain clinical variables in patients with psoriasis and their relation to DNA content of keratinocytes

BACKGROUND

In a previous study of 26 patients with psoriasis we analyzed cytophotometrically the nuclear DNA content of the germinative compartment of involved and uninvolved skin by means of the Feulgen technique. These subjects were classified into three groups according to their DNA profile. Group 1 had a monomodal diploid profile, group 2 showed a significantly increased 2C-4C population, and group 3 demonstrated high proportions of 4C and hyperdiploid keratinocytes.

OBJECTIVE

Our purpose was to analyze clinical variables implicated in the development of psoriasis in reference to the three groups.

METHODS

Nuclear DNA content of each group by quantitative histochemical studies was analyzed and correlated with variables such as chronologic age, sex, age at onset, duration of flare during the study, stress, and the Koebner phenomenon.

RESULTS

No significant differences in DNA profile were observed in the involved epidermis among the clinical variables. The only differences in the uninvolved skin pertained to the duration of the flare, where a statistically significant difference was observed between groups 1 and 3 in the basal (p < or = 0.0459) and suprabasal keratinocytes (p < or = 0.06), and in the Koebner phenomenon, which was induced in all subjects (100%) in groups 2 and 3 and in only 44% of subjects in group 1.

CONCLUSION

Uninvolved skin of patients with psoriasis should be included in analysis of the clinical behavior of the disease. Furthermore, the Koebner phenomenon is a good clinical indicator of the DNA profile of these subjects.

[The usefulness of the teriparatide acetate (Parathar) infusion test in the diagnosis of pseudohypoparathyroidism]

In pseudohypoparathyroidism there is a resistance to the action of the parathormone in its target organs. Patients with this disease show clinical and laboratory data of hypoparathyroidism with normal or high levels of parathormone. Three types of pseudohypoparathyroidism are known according to the site in which the disorder is localized, within the complex formed by the cell receptor for the hormone and the adenylate cyclase systems of the cell membrane: Ia, Ib and II. The response of plasmatic and urinary cyclic AMP to the administration of parathyroid hormone may be useful to establish the type of pseudohypoparathyroidism presented in determined patients. Three cases of pseudohypoparathyroidism in whom an intravenous stimulation test with the synthetic 1-34 fragment of the human parathormone [teriparatid acetate (PARATHAR)] are presented. These patients were diagnosed according to the responses of cyclic AMP of type I pseudohypoparathyroidism. The methodology followed for the study and the results obtained are commented.

Relapsing systemic infection due to Rhodococcus equi in a drug abuser seropositive for human immunodeficiency virus

A case of recurrent multisystemic infection due to Rhodococcus equi in a patient with antibody to the human immunodeficiency virus (HIV) but without AIDS is reported. This case, which occurred in a woman with a history of alcohol and drug abuse, is, to our knowledge, the first such case described. The infection involved the lungs, kidneys, brain, and bloodstream. Despite several courses of therapy with antibiotics to which her isolates of R. equi were susceptible in vitro, the patient experienced multiple relapses before her death. On the basis of this case and a few others reported in HIV-infected patients, we recommend an initial antibiotic course at least 6-8 weeks in duration, and we suggest that combination antibiotic treatment be considered. We also suggest that infection with R. equi be included in the diagnostic criteria for AIDS.

Influence of temperature on degradation kinetics of ceftriaxone in diluted and undiluted human serum

The stability of ceftriaxone in undiluted human serum and in human serum diluted 1/20 in 0.1 M phosphate buffer (pH 6.0) was measured at -70, -40, -20, 4, and 37 degrees C. Ceftriaxone in diluted human serum contained at least 90% of the initial activity after 3 months of storage at -20, -40, and -70 degrees C; unbuffered human serum contained 82.41, 84.92, and 88.96% of the initial activity, respectively. Ceftriaxone in unbuffered human serum and in diluted human serum showed 80.33 and 86.25% of the initial activity, respectively, after 55 days at 4 degrees C. After 120 h at 37 degrees C, this antibiotic in unbuffered human serum contained 33.08% of the initial activity, whereas samples of diluted human serum contained more than 60%. Consequently, the stability of antibiotic in human serum diluted 1/20 in 0.1 M phosphate buffer (pH 6.0) is increased.

Bronchodilator effect and serum theophylline level after combined treatment with fenoterol and theophylline in reversible chronic airflow obstruction

Sustained-release theophylline 10.1 mg/kg b.d. was given with placebo of fenoterol 2.5 mg t.d.s. to 12 patients with chronic airway obstruction. Fenoterol did not significantly affect the steady state serum theophylline trough level (11.84 micrograms/ml for fenoterol vs 11.10 micrograms/ml for placebo). Addition of fenoterol produced no further increase in spirometric function nor in clinical status.