New Quantitative Trait Loci for the Genetic Variance in Circadian Period of Locomotor Activity between Inbred Strains of Mice

Provisional quantitativetrait loci (QTL) for circadian locomotor period and wheel-running period have been identified in recombinant inbred (RI) mouse strains. To confirm thoseQTLand identify newones, the geneticcomponent of variance of the circadian period was partitionedamongan F2 intercross of RI mouse strains (BXD19 and CXB07). First, a genomic survey using 108 SSLP markers with an average spacing of 15 cM was carried out in a population of 259 (BXD19 · CXB07)F2 animals. The genome-wide survey identified two significant QTLfor period of locomotor activity measured by infrared photobeam crossings on mousechromosomes 1 (lod score5.66) and 14 (lod score4.33). TheQTL on distal chromosome 1 confirmed a previous report based on congenic B6.D2-Mtv7a/ Ty mice. Lod scores greater than 2.0 were found on chromosomes 1, 2, 6, 12, 13, and 14. In a targeted extension study, additional genotyping was performed on these chromosomes in the full sample of 341 F2 progeny. The 6 chromosome-wide surveys identified 3 additional QTL on mouse chromosomes 6, 12, and 13. The QTLon chromosome 12 overlaps with circadian period QTLidentified in several prior studies. For wheel-running period, the chromosome-wide surveys identified QTLon chromosomes 2 and 13 and one highly suggestive QTLon proximal chromosome 1. The results are compared to other published studies of QTL of circadian period.

Mapping a locus for alcohol physical dependence and associated withdrawal to a 1.1 Mb interval of mouse chromosome 1 syntenic with human chromosome 1q23.2-23.3

Physiological dependence and associated withdrawal episodes are thought to constitute a motivational force perpetuating continued alcohol use/abuse. Although no animal model duplicates alcoholism, models for specific factors, like the withdrawal syndrome, are useful to identify potential determinants of liability in humans. We previously detected quantitative trait loci (QTLs) with large effects on predisposition to physical dependence and associated withdrawal following chronic or acute alcohol exposure to a large region of chromosome 1 in mice (Alcdp1 and Alcw1, respectively). Here, we provide the first confirmation of Alcw1 in a congenic strain, and, using interval-specific congenic strains, narrow its position to a minimal 1.1 Mb (maximal 1.7 Mb) interval syntenic with human chromosome 1q23.2-23.3. We also report the development of a small donor segment congenic that confirms capture of a gene(s) affecting physical dependence after chronic alcohol exposure within this small interval. This congenic will be invaluable for determining whether this interval harbors a gene(s) involved in additional alcohol responses for which QTLs have been detected on distal chromosome 1, including alcohol consumption, alcohol-conditioned aversion and -induced ataxia. The possibility that this QTL plays an important role in such diverse responses to alcohol makes it an important target. Moreover, human studies have identified markers on chromosome 1q associated with alcoholism, although this association is still suggestive and mapped to a large region. Thus, the fine mapping of this QTL and analyses of the genes within the QTL interval can inform developing models for genetic determinants of alcohol dependence in humans.

Characterization of the quantitative trait locus for haloperidol-induced catalepsy on distal mouse chromosome 1

We report here the confirmation of the quantitative trait locus for haloperidol-induced catalepsy on distal chromosome (Chr) 1. We determined that this quantitative trait locus was captured in the B6.D2-Mtv7a/Ty congenic mouse strain, whose introgressed genomic interval extends from approximately 169.1 to 191.3 Mb. We then constructed a group of overlapping interval-specific congenic strains to further break up the interval and remapped the locus between 177.5 and 183.4 Mb. We next queried single nucleotide polymorphism (SNP) data sets and identified three genes with nonsynonymous coding SNPs in the quantitative trait locus. We also queried two brain gene expression data sets and found five known genes in this 5.9-Mb interval that are differentially expressed in both whole brain and striatum. Three of the candidate quantitative trait genes were differentially expressed using quantitative real-time polymerase chain reaction analyses. Overall, the current study illustrates how multiple approaches, including congenic fine mapping, SNP analysis and microarray gene expression screens, can be integrated both to reduce the quantitative trait locus interval significantly and to detect promising candidate quantitative trait genes.

A QTL for the genetic variance in free-running period and level of locomotor activity between inbred strains of mice

Many genes support the manifestation of the circadian period in mice. In a multiple-gene trait all genes contributing in a minor way to this characteristic are quantitative trait loci (QTL). Screens of both the BXD and the CXB panels of recombinant inbred mice suggested that distal chromosome 1, between 90 and 100 cM, contained a QTL, Cplaq3, for a difference in the circadian period of locomotor activity between the C57BL/6J and the DBA/2J and between the BALB/cBy and the C57BL/6By progenitor strains. The mice studied were a commercially available congenic strain, B6.D2-Mtv7a/Ty, from 50 to 100 days old. This congenic strain contains a small DBA/2J genomic insert that covers the region of the provisional QTL in a 99.9% C57BL/6J background. The congenic mice had a shorter period than C57BL/6J mice, confirming that this region has a QTL for the difference in period between the C57BL/6J and the DBA/2J strains. In addition, these data suggest that this region has a QTL for the mean amount of daily activity and for the pattern of locomotor activity.

Provisional QTL for circadian period of wheel running in laboratory mice: quantitative genetics of period in RI mice

Wheel running was monitored in B x D recombinant inbred (RI) mice under dark-dark (DD) conditions, and the mean circadian period was calculated for each strain. There were significant differences for this trait among B x D recombinant inbred strains (p < .0001) and a narrow-sense heritability of 21%. Analysis of strain means and variances indicates that at least four segregating loci contribute to the genetic variance for the free-running circadian period in this population. Correlation of the strain means for the circadian period of wheel running for each RI strain against the distribution of markers at over 1500 loci along the mouse genome identified a number of provisional quantitative trait loci (QTL). There were provisional QTL for wheel running at p < .001 on chromosome 11 and at p < .01 on chromosomes 1, 6, 9, 17, and 19. Most were in agreement with a second analysis done under similar conditions.

Provisional quantitative trait loci (QTL) for the Aschoff effect in RI mice

Mice of the CXB recombinant inbred (RI) panel were phenotyped for period of locomotor activity in continuous dark (tau) and in continuous 10-lux light (tauLL). There were significant differences in the effect of light on period, delta tau (tauLL-tau), among CXB RI strains and their progenitors. By comparing strain means for delta tau in the CXB RI strains with typed genetic loci using a product moment correlation, it was possible to hypothesize quantitative trait loci (QTL) important to the genetic variance in the effect of constant low-level light on circadian period. Some of the candidate genes linked to statistically associated markers are neuropharmacologically interesting. Provisional QTL for delta tau were found on proximal Chromosome 8 and mid Chromosome 11 in regions near QTL identified in a similar analysis of the BXD RI panel. This provides additional evidence for the importance of loci on Chromosomes 8 and 11.

Genomic DNA from mice: a comparison of recovery methods and tissue sources

Our aim is to identify an extraction method and the source of mouse tissue(s) that could allow a high-resolution genomic scan from a living mouse. We compared and optimized two methods for yield, purity of DNA, and their use in the polymerase chain reaction (PCR) of DNA extracted from different mouse tissues. In addition to whole blood, tissue samples from the brain, liver, testis, and tail were included in this study. The Rapid Method (RM) is preferable for the whole blood samples and testis and brain tissue samples because it is quicker, less toxic, and more cost-effective than the proteinase K method (PM). For liver the PM produced higher yields of DNA with less degradation than the RM. For tail tip, the PM produced a higher yield of DNA, but the RM resulted in a higher yield of PCR product. From a living mouse, a tail snip generated a sufficient amount of DNA for several hundred PCRs but not a complete genomic scan. We suggest that the RM can be used to extract genomic DNA for a complete genomic scan which requires either testicular tissues or repeated blood samples from the suborbital sinus over several months without sacrificing the animal.

The microevolution of mouse salivary androgen-binding protein (ABP) paralleled subspeciation of Mus musculus

Mouse salivary androgen-binding protein (ABP) is a major secretory product of the submaxillary glands. Although it is a common salivary protein among rodents generally, the function of ABP has yet to be determined. Here we report a comparison of the DNA coding sequences and putative amino acid sequences they determine for the three common alleles of the Alpha subunit gene (Abpa), alleles that appear to be diagnostic for the three subspecies of Mus musculus. Three other unique sequences were found in the species M. caroli, M. spretus, and M. spicilegus. Comparison of the six sequences shows that 8 of the 20 base substitution sites produce a high degree of variability in amino acids 32, 33, 36, and 39, a variability that creates unique sequence combinations in each species and subspecies. We compare the possibilities that selection or genetic drift caused this unusual microevolution and argue that selection is the more likely explanation. We speculate on the potential significance of this with respect to the proposal that ABP is involved in assortive mate kin selection.

Aging lengthens TauDD in C57BL/6J, DBA/2J, and outbred SWR male mice (Mus musculus)

The effect of aging on the free-running period (TauDD) of a circadian rhythm for wheel-running activity was observed in two inbred strains (DBA/ 2J and C57BL/6J) and one outbred strain (Tac: (SW)fBR) of laboratory mice (Mus musculus). TauDD in the DBA and C57 mice was monitored at approximately age 100 days and age 300 days. TauDD in the outbred strain was monitored at approximately age 100 days and age 600 days. TauDD increased with age in all three strains. Most studies of age effects in rodent species have shown a shortening of TauDD with age, with th exception of the C57BL inbred mice. These results show that the lengthening of TauDD with age in laboratory mice is not limited to the C57BL strain and may be a general characteristic of this species, in contrast to other rodent species examined.

Hypothetical quantitative trait loci (QTL) for circadian period of locomotor activity in CXB recombinant inbred strains of mice

The locomotor activity of male mice (Mus musculus) of 13 CXB (BALB/cBy x C57BL/6J) recombinant inbred (RI) strains and their progenitor strains was monitored for 4 to 6 weeks by infrared photoelectric beams under constant dark. The circadian period (tau) of locomotor activity was calculated and used in quantitative trait locus (QTL) analysis of strains' means. Results were compared with potential QTL found in a previous study of the BXD RI series. The mean tau of 13 CXB RI mouse strains (three to six animals per strain) in constant dark had a unimodal distribution suggesting polygenic inheritance. A number of potential QTL were found for this trait. There were two associations at p < .001. H23 on chromosome 3 and Pmv16 on chromosome 16. A region of chromosome 1 was associated with tau in both CXB and BXD RI series. There was also a conjunction with a locus determined from QTL analysis of the previously reported tau of wheel running activity in seven CXB RI strains (Schwartz and Zimmerman, 1990).

Quantitative trait loci (QTL) for circadian rhythms of locomotor activity in mice

The locomotor activity of male mice (Mus musculus) was monitored by infrared photo-electric beams under three lighting regimens: LD (12 h of light and 12 h of dark), DD (constant dark), and LL (constant broad-spectrum light, 10 lux). Circadian period of locomotor activity (tau) was compared among 3 inbred strains of mice, C57BL/6J (B6), BALB/c (C), and DBA/2J (D2), and 26 recombinant inbred strains B x D (B6 x D2). The tau under both continuous low-intensity light and continuous darkness varied significantly among strains. Under DD the mean tau was 23.8 h for B6, 23.7 h for D2, and 23.6 h for C. Under LL the mean tau was 25.1 h for B6, 23.9 h for D2, and 25.5 h for C. Frequency histograms of the mean tau of 26 B x D RI mouse strains (three to seven animals per strain) in either DD or LL and the difference between them, delta tau, had distributions which appeared unimodal, suggesting polygenic inheritances. The narrow-sense heritability determined using 26 strains of B x D RI mice was about 55% for tau and about 38% for both tau in LL and delta tau. An estimated four loci contribute to the variance of tau in constant darkness and five to the variance of tau in constant low-intensity light among the strains studied. Quantitative trait locus (QTL) analysis identified several potential genetic loci associated with tau in constant darkness, tau in constant low-intensity light, and delta tau. The associations of highest probability for each of these traits were the D1Nds4 locus (p < .001) on mouse chromosome 1, the D5Ncvs52 locus (p < .05) on mouse chromosome 5, and the Pmv12 locus (p < .01) at 70 cM on mouse chromosome 5, respectively. A QTL identified for tau was associated (p < .05) with the D2NDS1 marker at 45 cM on chromosome 2 near the Ea 6 marker at 46 cM associated (p < .05) with that reported for the period of wheel running activity in seven C x B RI strains (Schwartz, W.J., and Zimmerman, P., J. Neurosci. 10:3685 1990).

[Are food preferences affected by body mass index, age, sex or tobacco?]

In recent decades the percentage of energy derived from dietary fat has increased. The aim of this study was to explore the relationship between food taste preferences, BMI, age, gender and smoking habits. A computerized questionnaire using a hedonic scale (range 0 to 8) to quantify the liking for sweet and savoury, lean and fat foods, was filled by 233 adults: 171 normal weight (131 women, 40 men) and 62 overweight subjects (BMI > 25 kg/m2 42 women, 20 men). The majority of the subjects had a general preference for savoury lean food irrespective of their BMI or gender. Similarly, preference for sweet lean food was not influenced by the magnitude of the BMI. In contrast, overweight subjects had a preference for sweet fat food (p = 0.05) as well as for savoury fat food (p < 0.05). At any age or BMI, men preferred sweet fat food (p < 0.01). This was not the case for women. Overweight men over forty preferred savoury fat food, in contrast to overweight women of the same age (p < 0.01). The same difference existed between normal weight smokers and non-smokers. This study demonstrates that fat food preference plays a potential role in the development of obesity.

Ambulatory blood pressure monitoring as a means to avoid overtreatment of elderly hypertensive patients

Do elderly similarly to younger hypertensive patients tend to be overtreated if therapeutic decisions are based exclusively on blood pressure measured by the physician in his office? Eighteen hypertensive patients (10 previously treated) aged 70 years or more had repeatedly office systolic blood pressure greater than or equal to 170 mm Hg and/or diastolic blood pressure greater than or equal to 100 mm Hg. The physicians in charge were asked to reduce blood pressure within 4 months to a target of less than or equal to 160/95 mm Hg using any drug regimen. Blood pressure was monitored during daytime using a noninvasive blood pressure recorder, but the results of the recording were not available to the physicians until the end of the study. At the outset, 11 patients had a mean ambulatory recorded blood pressure less than 170/100 mm Hg. Those patients who exhibited high blood pressures only in the doctor's presence did not reduce their ambulatory blood pressure when antihypertensive therapy was initiated or intensified in order to reduce office blood pressure. This contrasted with the significant fall in ambulatory blood pressure observed in the presence of the doctor. Thus ambulatory blood pressure monitoring seems useful to avoid overtreatment not only of younger but also of elderly hypertensive patients.

[Biliary calculi in a cohort of autopsies (Lausanne 1974-1981)]

In a sample of 5892 consecutive autopsies of adults (3676 men and 2216 women) performed at the pathology department of the university of Lausanne 1469 instances of cholelithiasis and/or cholecystectomy were noted (686 men and 783 women). The total frequency was 24.1% (18.6% for men, 35.3% for women, sex ratio 1:1.9). These figures, constant over the observation period, are actually among the highest ones in Europe. In comparison with other studies they demonstrate that a marked increase in the incidence of cholelithiasis occurred in Switzerland since the beginning of this century.

Long-term Result of Treatment of Prader-Willi Syndrome by Scopinaro's Bilio-pancreatic Diversion. Study of Three Cases and the Effect of Dextrofenfluramine on the Postoperative Evolution

The Prader-Willi Syndrome shortens the life of patients due to the morbid obesity which it entails. The compulsive hyperphagia associated with it makes a dietetic treatment or a gastroplasty difficult. This study presents the case histories of three patients suffering from the Prader-Willi syndrome who were operated on by means of a Scopinaro's bilio-pancreatic diversion. Following a marked reduction the first year, the weight loss stabilized and then tended to diminish. The observation of three cases which continued for two and a half to six years did not reveal any considerable metabolic problems. The deficiency of iron, vitamins D and B12 as well as folic acid had to be made up by supplementation. These results are comparable with the most favorable ones in the literature. Even if the effect on the weight loss is not spectacular, the operation manages to hold off the development of the obesity, inexorable for those with the Prader-Willi syndrome, and prevents lethal complications, without having notable side effects. Lifting coercive dietary measures improves the quality of life.

Effect of weight reduction in moderately overweight patients on recorded ambulatory blood pressure and free cytosolic platelet calcium

Although platelet cytosolic calcium has been shown to decrease during pharmacological treatment of hypertension, there is no evidence that cytosolic calcium also falls during a nonpharmacological reduction in blood pressure. To provide such evidence, we examined prospectively the relation between platelet cytosolic calcium and ambulatory blood pressure during weight reduction in moderately overweight (body mass index [BMI] greater than 25), mildly hypertensive individuals. The experimental group (responders: BMI reduction greater than 5%) consisted of 19 patients who lost 8.5 +/- 2.9 kg (mean +/- SD, p less than 0.05) during a 10-week hypocaloric diet, whereas the control group (nonresponders: BMI reduction less than 5%) consisted of 12 patients who showed no relevant change in body weight (-2.0 +/- 1.3 kg) during the same period of time. The moderate weight loss of the responders decreased blood pressure by 14/5 mm Hg (p less than 0.05), as measured by ambulatory monitoring, which renders a placebo effect unlikely. This nonpharmacological reduction in blood pressure was accompanied by a proportional 11% decrease (p less than 0.05) in platelet cytosolic calcium and also by significant (p less than 0.05) decreases in plasma catecholamines and serum cholesterol. These findings establish the concept of a nonpharmacological reduction in free cytosolic platelet calcium in humans and add further evidence suggesting a link between intracellular calcium homeostasis and blood pressure regulation.

Plasminogen activators and plasminogen activator inhibitors in liver deficiencies caused by chronic alcoholism or infectious hepatitis

Plasma concentrations of tissue-type plasminogen activator (t-PA), urokinase (u-PA), plasminogen activator inhibitor 1 (PAI-1) and PAI-2 were studied in 53 patients with liver deficiency caused by chronic alcoholism (n = 40), viral hepatitis (n = 10) or malignant disease of the liver (n = 3) and compared to that of a control group (n = 20) of healthy subjects. u-PA and PAI-1 levels were significantly increased in all patients with chronic alcoholism, whereas high t-PA was only observed in combination with disturbed liver function tests or with liver cirrhosis (two and six-fold above control values, respectively). A good correlation was observed between t-PA and gamma glutamyl transferase (r = 0.615; p less than 0.001). In patients with infectious hepatitis or with malignant disease of the liver t-PA was normal whereas u-PA and PAI-1 were increased. PAI-2 levels were close to or below the detection limit (15 ng/ml) in the control group and in most patients. However, in two patients with alcohol induced cirrhosis PAI-2 levels were approximately 45 ng/ml and in one patient with hepatocarcinoma even 66 ng/ml. Thus, in liver disease, marked elevations of t-PA, u-PA and PAI-1 levels may occur, with increased PAI-1 as an early marker of liver defects and t-PA a marker of severe liver defects.

[Non-ulcer dyspepsia and Campylobacter pylori]

Dyspepsia, defined as chronic vague upper abdominal symptoms, is a common condition. The pathogenesis of this syndrome remains poorly understood. The etiologic role of Campylobacter pylori and associated gastritis remain controversial though this organism colonizes the gastric antrum in one third to one half of patients with non-ulcer dyspepsia. Recent studies raise the prospect that treatment with bismuth improves gastritis and is successful in treating symptoms in the Campylobacter pylori positive and negative patients. To determine if Campylobacter pylori causes dyspepsia requires proof that long term eradication of the organism heals gastritis and abolishes symptoms.

[Disseminated nocardiosis due to Nocardia brasiliensis in an ambulatory patient]

We report the case of a 76-year-old man with generalized nocardiosis. The microbiologic pattern, the different clinical manifestations and the treatment of nocardiosis are discussed in general. In the particular case of our patient the disease manifested itself primarily as a subcutaneous abscess, a metastasis secondary to pulmonary nocardiosis. The disease was caused by a Nocardia brasiliensis, which is rarely seen in Europe and which does not usually cause a generalized form of nocardiosis.

Activity-wheel stress and serotonergic hypersensitivity in rats

Adult male Wistar rats were subjected to activity wheel stress: unlimited access to an activity wheel for up to twelve days and food for 30 to 60 min each day. Each treated rat was paired with a control, the latter being housed in home cages and given sufficient food to maintain a weight similar to the stressed partner. All rats were previously trained on a variable interval schedule for milk reinforcement. When the activity of the stressed rat increased rapidly then decreased suddenly, the pair was decapitated for biochemical analysis. Levels of the serotonin metabolite, 5-hydroxyindoleacetic acid, decreased by 50%, and the Bmax for ketanserin binding increased by 19% in frontal cortical homogenates from the stressed rats when compared to controls. These data support the concept that stress increases the sensitivity of central serotonin receptors.

Ambulatory blood pressure monitoring in the elderly hypertensive patient

In this retrospective analysis, we assessed the usefulness of ambulatory blood pressure monitoring in the evaluation of elderly hypertensive patients. Thirty-eight untreated and 31 treated hypertensives aged 70 years or more had a systolic blood pressure greater than or equal to 160 mmHg and/or a diastolic blood pressure greater than or equal to 95 mmHg in the clinic. All 69 patients underwent blood pressure monitoring during their customary daily activities using a portable semi-automatic blood pressure recorder (Remier M2000). The mean of all blood pressures obtained with this device was taken as the ambulatory recorded blood pressure. Recorded blood pressures were greater than or equal to 160 mmHg systolic and greater than or equal to 90 mmHg diastolic in 17 untreated and 17 treated patients. In these patients, the introduction of antihypertensive therapy, or its modification, markedly reduced blood pressure during a 4-8 month follow-up. A further 21 untreated and 14 treated patients had recorded blood pressures of less than 160/90 mmHg. The treatment status of these patients was left unchanged for 4-8 months of follow-up. Nevertheless, office blood pressure in these groups, with no change in treatment, decreased significantly during the observation period. At the last visit to the outpatient clinic, there was no significant difference in blood pressure between the four subgroups of patients. Thus, ambulatory blood pressure monitoring appears to be useful in the elderly hypertensive patient in detecting those patients whose blood pressure is elevated only in the clinic. Blood pressure profiles obtained outside the clinic may therefore be useful in making therapeutic decisions in the aged hypertensive.

Atrial natriuretic peptide administered as intravenous infusion or bolus injection to patients with liver cirrhosis and ascites

The effect of a synthetic atrial natriuretic peptide (h-ANP, 25 amino acids, Wy-47.663) on blood pressure, renal electrolyte excretion, plasma catecholamines, and plasma renin activity was studied in nine patients with cirrhosis of the liver and ascites. The peptide was infused intravenously at 24-h intervals for 2 h in groups of four patients each in two different doses (0.015 and 0.075 micrograms/kg/min or 0.06 and 0.3 micrograms/kg/min). A control experiment with the vehicle was performed in all patients. In three patients h-ANP (1 and 2 micrograms/kg i.v.) was administered as an intravenous bolus injection. Consistent falls in blood pressure were observed during h-ANP infusion only with the two higher doses. The two lower infused doses induced a consistent natriuresis; this renal response was abolished when the two larger doses were used. When given as a bolus, h-ANP had a natriuretic effect comparable to that of the two lower doses of infused h-ANP. Plasma catecholamines and plasma renin activity increased during infusion of the two higher doses of h-ANP. It thus appears that in patients with cirrhosis and ascites, the natriuretic effect of infused h-ANP decreases rather than increases when the doses are raised. Bolus administration of h-ANP may be less prone to trigger counterbalancing responses and side-effects.

[Current role of biopsy in the diagnosis of hepatic disease]

The criteria for the use of liver biopsy as a diagnostic tool were retrospectively analyzed over a ten-year period in 390 consecutive patients. The four principal conditions in which this procedure was employed were alcoholism (33%), hepatitis (18%), abnormal hepatic tests (16%) and tumors (10%). The development of new, "non-invasive", investigative methods such as echography and tomodensitometry has led to an decrease in the number of liver biopsies performed annually, but no change in the relative frequency of the various indications. In this paper, evidence is presented which demonstrates that hepatic biopsy confirmed the clinical diagnosis in 62.4% of the cases reviewed and fundamentally modified the diagnosis in 20.2%. Based upon these findings, it can be concluded that liver biopsy remains an indispensable diagnostic procedure in the field of hepatology, since it can result in modification of the clinician's diagnosis in one out of five cases.

Are some hypertensive patients overtreated? A prospective study of ambulatory blood pressure recording

Ambulatory blood pressure (BP) was recorded in hypertensive patients whose physicians had been asked to reduce diastolic pressure measured in the office to 90 mm Hg or less. 34 hypertensive patients with a diastolic pressure measured by their physician of 95 mm Hg or more despite antihypertensive therapy had their treatment changed with the aim of achieving this pre-set goal within 3 months. At the beginning and the end of the study, ambulatory BP was monitored during the daytime with a portable non-invasive recorder. The results of the ambulatory recordings were not made available to the physicians until completion of the study. In half the patients the ambulatory diastolic pressure was already 90 mm Hg or less at the start. In these patients, treatment adjustment did not further decrease ambulatory BP. In contrast, patients who initially had an ambulatory diastolic pressure above 90 mm Hg had a significantly decreased ambulatory BP at the end of the study. Intensifying the therapy of hypertensive patients who have a normal ambulatory BP may result in overtreatment without any real gain in BP control.

Aluminum-induced decreases in choline acetyltransferase, tyrosine hydroxylase, and glutamate decarboxylase in selected regions of rabbit brain

The neuropathological and neurochemical effects of intracisternally administered aluminum-powder suspensions were studied in adult rabbits. The right half of each brain was fixed for neuropathological examination, and neurotransmitter-synthesizing enzyme activities were measured in homogenates of structures dissected from the left half of each brain. The neuropathological changes associated with aluminum-induced encephalomyelopathy, including neurofibrillary degeneration, were observed in several regions of the central nervous system of the aluminum-treated rabbits. The striatum was consistently free of changes. Decreases in choline acetyltransferase and tyrosine hydroxylase activities of more than 30% were observed in the striatum of animals within 14-21 d and at longer times after aluminum injection. The decrease in striatal choline acetyltransferase activity appears to be unrelated to pathological changes in the striatal cholinergic neurons. The decrease in tyrosine hydroxylase activity in the striatum may be unrelated to neuropathological changes in dopaminergic cell bodies in the midbrain. Significant decreases in glutamate decarboxylase activity in the cerebellum may be related to cell losses in this region, whereas choline acetyltransferase activity deficits in the whole hippocampus remain unexplained.

[Digitoxin-induced thrombopenia with recurrence after accidental reexposure]

One case of digitoxin-induced thrombopenia with relapse upon reexposure is reported. Cytopenia was each time rapidly reversible upon withdrawal of the medication. During the two episodes, blood digitoxin was superior to the generally accepted value. No thrombopenia was caused by administration of digoxin. The criteria for diagnosis and the difficulty of causal demonstration are discussed. Up to the present the literature has reported 11 cases of cardiotonic-induced thrombopenia. The features of these observations are reviewed.

[Education of the diabetic patient and its evaluation by a multiple-choice questionnaire]

37 insulin-dependent and non-insulin-dependent diabetics answered a multiple-choice questionnaire during inpatient educational sessions. 12 dietetic and 12 pathophysiologic questions had to be answered. Statistical analysis of factors influencing the number of errors can be summed up as follows: there is a direct correlation between age of the patient and number of errors; the older the patient, the greater the number of errors. However, insulin-dependent diabetics committed fewer errors than non-insulin-dependent subjects of the same age, which suggests greater motivation in the first group due to their treatment. The test likewise affords the patients an opportunity of reviewing unclear topics and enables the educational team to adapt their teaching to the patients.

[Dissolution of gallstones based on 6 months treatment with a single daily dose of ursodeoxycholic acid]

51 patients with radiolucent gallstones of diameter less than or equal to 15 mm were treated for 6 months with a new form of ursodeoxycholic acid (UDCA) in a single dose of 450 mg at bedtime. This new form has 3 components with fractionate liberation. The rate of partial and complete dissolution after 6 months was 63.4%, reaching 85% for gallstones of less than 5 mm diameter. The results show that a single dose of 450 mg UDCA at bedtime is as effective as UDCA at mealtimes in the dissolution of radiolucent gallstones. Administration of the drug once a day should be more acceptable to patients.

[Alcoholic hepatitis: histo-clinical evaluation]

The clinical and histological symptoms of alcoholic hepatitis diagnosed from liver biopsies are investigated and the results compared with the extent of the histological lesions classified as small, medium or large. Nonspecific symptoms were variable and were not found to be related to the histological damage. The only recurring symptom was hepatomegaly, which was present in 95% of the patients studied. Histo-clinical comparison showed the clinical symptoms to be very variable, and it is concluded that accurate diagnosis and knowledge of the severity of the lesion can only be obtained from liver biopsy samples.

[Treatment of refractory ascites by means of the LeVeen shunt]

Amongst the surgical treatments that have been suggested for refractory ascites, the one that has met with the greatest success is the LeVeen shunt. It nevertheless involves certain risks and might even be fatal. The authors' brief experience in this domain has confirmed its positive immediate effects and has also brought to light some of its drawbacks. The large number of potential complications leads one to conclude that the LeVeen shunt should be reserved for refractory ascites and hepato-renal syndrome, and should not be prematurely employed in other situations.

The histological patterns of chronic active hepatitis--excluding cirrhosis--and their prognostic significance

In a retrospective clinico-pathological analysis of 30 cases of chronic active hepatitis, no significant correlation could be demonstrated between any histological feature and the end result of the evolution. The so-called "bridging" lesion, in particular, has no prognostic value. A possible effect of the therapy (cortico-steroids or not) on the final outcome could not be established. There is however a clearcut difference in the rate of development, be it favorable or not, between the slow progress of chronic aggressive hepatitis, and the rapidly changing subacute hepatitis. We therefore feel that such a distinction should be maintained, and question the nomenclature proposed by the International Association for Study of the Liver.

[Alcoholic hepatitis]

Alcoholic hepatitis is defined by histological findings, i.e. Mallory bodies, necrosis and polynuclear infiltration. It may be accompanied by steatosis and more or less advanced fibrosis. The clinical picture is variable, ranging from a total absence of symptoms to high fever, jaundice and encephalopathy. Laboratory findings reveal high polynuclear white cell counts, SGOT (but not SGPT) and glutamate dehydrogenase levels. The prognosis varies according to the series studied. The pathogenesis is unclear but cellular and humoral immunity mechanisms may play a role. Therapeutic possibilities are limited, corticosteroids only being useful in very serious cases. Alcoholic hepatitis is not a nosological entity but an acute inflammatory reaction of the liver due to cell necrosis caused by alcohol, and can therefore occur at any stage of alcoholic liver.

[Cirrhotic ascites and the renin-angiotensin system]

Plasma renin activity and plasma aldosterone have been measured in 31 patients in different clinical stages of alcoholic cirrhosis. Plasma renin activity and plasma aldosterone were within the normal range in patients with compensated cirrhosis and in patients with untreated cirrhosis and ascites. These results are not in keeping with the traditional concepts of reduced "effective' blood volume with stimulation of the renin-angiotensin system. In ascites treated with diuretics, and in the hepato-renal syndrome, the renin-angiotensin system was, however, stimulated. Peritoneo-venous shunt was followed by suppression of this stimulation.

[Plasma glucagon in alcoholic cirrhosis: cross reaction with IgG]

Glucagon secretion has been tested in 12 cirrhotic patients and the results have been compared with those obtained in 10 normal subjects. Two antisera reputed to be specific for glucagon (antiserum 30-K and antiserum RCS5) were used. The patients with cirrhosis exhibited significantly higher levels of plasma immunoreactivity for glucagon, suggesting hyperglucagonemia when using antiserum 30-K but not when using antiserum RCS 5. A positive correlation (r = 0.527, p less than 0.001) was found between plasma immunoreactive glucagon measured by antiserum 30-K and IgG. With antiserum RCS 5 there was no such correlation. These data suggest that hyperglucagonemia may be wrongly suspected when glucagon is measured with antiserum 30-K, due to cross-reaction with IgG. Cirrhotic patients exhibit only a slight increase of glucagon.

[Liver cirrhosis. Clinical and biological aspects]

The symptoms of cirrhosis are inconsistent and appear late in the course of the disease. Laboratory tests are also of variable value; generally speaking, cytolysis is observed infrequently. The gamma-GT test is the most sensitive in alcoholic cirrhosis, but may be more an expression of the degree of alcoholism than of the hepatic lesion per se. In cirrhosis, the best diagnostic method is a combination of laparoscopy and puncture biopsy. Endoscopy permits diagnosis not only of the hepatic lesion but also of the complications which may ensure, such as portal hypertension and ascites. Alcoholic abstinence appears to improve the prognosis of alcoholic cirrhosis. The prognosis in this condition may, in fact, be better than has been suspected.

[Therapy of duodenal ulcer with cimetidine, pirenzipine and placebo: report on a double-blind randomized study]

A double-blind randomized controlled study with pirenzepine (75 mg/day), cimetidine (1 g/day) and placebo was performed in 50 consecutive out-patients with duodenal ulcer. The patients also received an antacid containing aluminium hydroxide. Pirenzepine, cimetidine and placebo had similar effects on the 4-week healing rate. Dryness of the mouth was more frequent with pirenzepine than with the other two types of treatment. The incidence of other side effects did not differ in the three groups. A tendency towards more rapid disappearance of subjective symptoms in the patients treated with pirenzepine was not statistically significant. In conclusion, pirenzepine and cimetidine were not superior to placebo in the treatment of duodenal ulcer.