Altered ultrasonic vocalization and impaired learning and memory in Angelman syndrome mouse model with a large maternal deletion from Ube3a to Gabrb3

Angelman syndrome (AS) is a neurobehavioral disorder associated with mental retardation, absence of language development, characteristic electroencephalography (EEG) abnormalities and epilepsy, happy disposition, movement or balance disorders, and autistic behaviors. The molecular defects underlying AS are heterogeneous, including large maternal deletions of chromosome 15q11–q13 (70%), paternal uniparental disomy (UPD) of chromosome 15 (5%), imprinting mutations (rare), and mutations in the E6-AP ubiquitin ligase gene UBE3A (15%). Although patients with UBE3A mutations have a wide spectrum of neurological phenotypes, their features are usually milder than AS patients with deletions of 15q11–q13. Using a chromosomal engineering strategy, we generated mutant mice with a 1.6-Mb chromosomal deletion from Ube3a to Gabrb3, which inactivated the Ube3a and Gabrb3 genes and deleted the Atp10a gene. Homozygous deletion mutant mice died in the perinatal period due to a cleft palate resulting from the null mutation in Gabrb3 gene. Mice with a maternal deletion (m−/p+) were viable and did not have any obvious developmental defects. Expression analysis of the maternal and paternal deletion mice confirmed that the Ube3a gene is maternally expressed in brain, and showed that the Atp10a and Gabrb3 genes are biallelically expressed in all brain sub-regions studied. Maternal (m−/p+), but not paternal (m+/p−), deletion mice had increased spontaneous seizure activity and abnormal EEG. Extensive behavioral analyses revealed significant impairment in motor function, learning and memory tasks, and anxiety-related measures assayed in the light-dark box in maternal deletion but not paternal deletion mice. Ultrasonic vocalization (USV) recording in newborns revealed that maternal deletion pups emitted significantly more USVs than wild-type littermates. The increased USV in maternal deletion mice suggests abnormal signaling behavior between mothers and pups that may reflect abnormal communication behaviors in human AS patients. Thus, mutant mice with a maternal deletion from Ube3a to Gabrb3 provide an AS mouse model that is molecularly more similar to the contiguous gene deletion form of AS in humans than mice with Ube3a mutation alone. These mice will be valuable for future comparative studies to mice with maternal deficiency of Ube3a alone.

Surgical treatment of hepatic metastatic colorectal cancer

73 patients (men age 54 years, range 17-78), underwent an hepatic resection for metastatic, colorectal cancer. Operative mortality was 1.36% Overall 5 years survival rate (Kaplan-Meier) was 27%; 5 years disease free interval was equally 27%. This could demonstrate that 5 years survivors could be also considered free from the risk of metastatic recurrence. This is confirmed by our survivors over 5 years (70-79-94 months) that are still disease free.

Straight ileo-anal anastomosis with myectomy as an alternative to ileal pouch-anal anastomosis in restorative proctocolectomy

Restorative proctocolectomy with various types of reservoir is widely used in the elective surgery of ulcerative colitis and familial adenomatous polyposis. Both, advantages and disadvantages of this procedure are well known and documented. Straight ileo-anal anastomosis (IAA) yields unsatisfactory clinical results due to the lack of storage capacity of the distal ileum and the frequency of bowel movements related to high pressure ileal waves. In an attempt to create an alternative to the above procedures, we have performed a straight ileo-anal anastomosis with two rectangular (10 cm x 1 cm) myectomies down to 2 cm, above the anastomotic line. The two myectomies are spaced at 120 degrees to each other and to the mesenteric border of the ileal loop. The rationale of this approach is to reduce the peristaltic drive of the ileum by weakening the muscular wall. This study presents the results in three patients operated on with this new method in the last year.

[Proctocolectomy and mechanical ileo-anal anastomosis without mucosectomy]

The present study compared the outcome in a small series of patients (7 cases) who underwent total proctocolectomy without mucosal proctectomy and stapled ileal pouch-anal anastomosis, constructed at the apex of the anal transitional zone, with our previous experience (17 cases) in which the ileal pouch was anastomosed at the dentate line after mucosectomy. Though not statistically significant, our limited experience showed excellent clinical results with better continence and discriminating ability between gas and faeces in the former group. The resting anal pressure profile showed no chances in the postoperative period. The operation time was significantly reduced compared with our previous approach which was a time-consuming procedure. Furthermore, a reduced risk of complications (pelvic sepsis, haemorrhage) was observed.

Proctocolectomy and stapled ileo-anal anastomosis without mucosal proctectomy

The present study compared the outcome of a small series of patients (7 cases) who underwent total proctocolectomy without mucosal proctectomy and stapled ileal pouch-anal anastomosis made at the apex of the anal transitional zone, with our previous experience (17 cases) in which the ileal pouch was anastomosed at the dentate line after mucosectomy. Though not statistically significant, our limited experience showed excellent clinical results with better continence and discriminating ability of flatus from faeces in the former group. The resting anal pressure profile was not changed postoperatively. The operation time was significantly reduced compared with our previous approach which was a time-consuming procedure. There was an indication that risk of complications (pelvic sepsis and haemorrhage) was less.

[Role of surgery in the treatment of pleural mesothelioma]

The authors present a review of the cases of pleural mesothelioma diagnosed and treated in the Institute of Special Surgical Pathology of the University of Ancona. They confirm the causative role of asbestos in the aetiology of this disease and indicate that the surgical approach is the best diagnostic means available via open biopsy and that the only curative procedure is pleuropneumonectomy. Such surgery, however, is confined to patients properly studied according to the scheme proposed by Butchart, namely stage I patients in excellent physical condition.

Anticysticercous antibodies in serum and cerebrospinal fluid in patients with cerebral cysticercosis

Fifty-one cases of cerebral cysticercosis proved by surgery or CT scanning were studied prospectively with the ELISA test in order to detect anticysticercous antibodies in blood and CSF. The ELISA test was also performed for detection of antibodies in 20 control patients who had CSF withdrawn during a myelogram and in 119 serum samples of asymptomatic subjects. We found an overall sensitivity of the ELISA test in the blood of 87% with a specificity of 90%. In the CSF we found a sensitivity of 87% with a specificity of 100%. However, when we compared patients with cerebral cysticercosis of a benign type with patients with cerebral cysticercosis of a malignant type we found a serum sensitivity of 75% for the benign group as compared to 93% of the malignant group. The CSF sensitivity was 80% in the benign group and 93% in the malignant group. This difference was statistically significant.

[Lyophilized amino acids versus solutions of crystallized amino acids in total parenteral nutrition]

The authors considered the possibility, for purposes of total parenteral nutrition, to use lyophilized amino-acids as an alternative to the traditional amino-acid solutions, and resolved to check their nutritional and metabolic effectiveness. For this purpose, they appraised some parameters concerning the proteic metabolism in two homogeneous groups of surgical patients, subjected to T.P.N., one with crystallized amino-acids in solution and the other with lyophilized amino-acids. The supply in glucides and in lipides was identic in both groups. It appears evident from the results that the lyophilized amino-acids not only show the advantage of being administrable in nutritional mixtures with reduced volume, but also represent a valid plastic source, and can surely replace the traditional commercial amino-acid solutions.

Ineffectiveness of vasopressin in the treatment of memory impairment in chronic schizophrenia

A vasopressin derivative or placebo was administered to 21 chronic schizophrenia patients for 3 weeks in a randomized crossover double-blind design. The patients were divided into those above and below the median on baseline memory measured by the Wechsler memory scale. Vasopressin treatment did not improve memory either in those patients with below median baseline memory or in the group as a whole.

Effect of occupational exposure to epichlorohydrin on the frequency of chromosome aberrations in peripheral lymphocytes

The relationship between the level of occupational exposure to epichlorohydrin (ECHH) and the clastogenic effect was studied on a group of 33 workers. The effect of ECHH was assessed by differences in the frequency of chromosome aberrations in peripheral blood lymphocytes in ECHH-exposed and control groups. In the group exposed to the average ECHH concentration, 0.384 mg X m-3, during the last 6 months, the cytogenetic analysis revealed 2.00 +/- 0.23% AC (aberrant cells) (0.0203 B/C, breaks per cell) as compared with 1.68 +/- 0.23% AC (0.0172 B/C) in the matching controls. These results indicate that an average concentration lower than 0.40 mg X m-3 ECHH in the working atmosphere has no significant clastogenic effect on human peripheral lymphocytes.

Leukotriene D4: a potent coronary artery vasoconstrictor associated with impaired ventricular contraction

Leukotriene D4 (2 c 10(-9) mole), injected into the left circumflex coronary artery of anesthetized sheep, produced profound coronary vasoconstriction and impaired regional ventricular wall motion. This cardiac effect was neither inhibited by prior treatment of the sheep with a cyclooxygenase inhibitor nor associated with thromboxane B2 release into the coronary sinus. Intravenous FPL 55712 completely abolished the coronary vasoconstriction of leukotriene D4, but a significant reduction of regional wall shortening persisted.

Human hypoxanthine-guanine phosphoribosyltransferase. Purification and characterization of mutant forms of the enzyme

Erythrocyte hypoxanthine-guanine phosphoribosyltransferase has been highly purified from five unrelated patients with a deficiency of this enzyme. Affinity chromatography using either GMP-Sepharose or an immunoadsorbent was the most productive step in the purifications. The specific activity of the purified enzyme was unchanged for patients L. P. and G. S., and slightly decreased for patient R. H., as compared to control subjects. Enzyme from patient I. V. and from patient E. S. exhibited markedly reduced specific activities when purified to near homogeneity. The level of immunoreactive protein in patient I. V. appeared to be significantly higher than normal. The apparent subunit molecular weight of the enzyme from patient G. S. was decreased by approximately 1000 while it was increased by approximately 400 from patient I. V. The isoelectric points of the subunit isozymes were shifted to higher pH values from patients I. V. and E. S., and to lower pH values from patient L. P.; the subunit isozymes from patient G. S. were identical with normal. These studies provide direct evidence for the existence of at least four different mutations in the structural gene for hypoxanthine-guanine phosphoribosyltransferase. The four different mutant forms of human hypoxanthine-guanine phosphoribosyltransferase that have been identified are named as follows: patient L. P., HPRTToronto; patient G. S., HPRTLondon; patient E. S., HPRTKinston; and patient I. V., HPRTMunich.

[Serum markers of B virus in chronic active hepatitis]

Serological B virus markers were determined by radioimmunoassay in 25 cases of chronic active hepatitis. One or more of these markers were identified in 13 out of 25 patients. Clinical correlation was made between the presence or absence of the markers. The marker most frequently encountered was anti hepatitis B Core antigen. In general those patients with hepatitis B surface antigen and hepatitis e antigen had a less favorable clinical course. Those patients who were serological negative to these markers showed frequent elevation of IgG.

Multiple transverse taeniamyotomy for diverticular disease

The indications for transverse taeniamyotomy, and the results obtained on a group of 11 patients, were analyzed. Intraluminal pressure recordings carried out before and one year after operation showed a significant decrease of the mean motility index after both natural and pharmacologic stimuli. The use of such a procedure, even in an early stage of the disease, should be considered.

[Intrahepatic calculosis]

After a short synthesis of the elements characterising intrahepatic calculosis, and evaluation of the five cases considered, the value of cholangiography (both intravenous and instrumental) and of radio-scintiscanning with Bengal Rose marked with I131 in pre-operative diagnosis is stressed. The intra-operative use of choledochoscopy in conjunction with cholangiography is recommended. With regard to treatment, it must ensure removal of the calculi and create an ample biliodigestive communication (papillectomy or, even better, hepaticojejunostomy on excluded Roux loop) in order to prevent recurrences. In order to visualise the intrahepatic branches of the bile ducts, the removal of the hilar plaque is advised, possibly combined with sagittal scissurectomy or mobilisation of the 4th segment. In conclusion it is asserted that correctly performed surgical treatment is the only means of offering permanent cure.

[Hemorrhages of the digestive tract. Diagnosis and treatment using selective arteriography and perfusion of intra-arterial vasopressin]

Diagnosis of GI bleeding can safely be done by selective angiography of abdominal vessels. Patients are studied during acute bleeding phase with the Seldinger-Odman technique. In our experience we have a success rate of 89.4% in cases of arterial bleeding. Once diagnosis has been made, the selective catheter can be used to perform an infusion of a vasoconstrictive drug or selective embolization to treat the bleeding. This technique gives good results in case of arterial bleeding and is only a paliative method in case of esophageal varices.

Plasma gonadotropins after administration of LH-releasing hormone in patients with renal or hepatic failure

The pituitary gonadotropin response to the administration of synthetic LH-releasing hormone (LH RH) in 10 patients with renal failure and 5 patients with hepatic insufficiency was determined. The basal plasma LH and FSH levels were either normal or slightly elevated in both groups compared with the controls, but after the administration of LHRH, the peak levels (mean +/- SE mIU/ml) of LH (72.0 +/- 16.6) and FSH (18.7 +/- 4.4) in the patients with renal failure, and of LH (61.5 +/- 20.8) and FSH (13.2 +/- 2.8) in patients with hepatic insufficiency, were not significantly different from those in 11 normal controls (LH, 75.6 +/- 12.0; FSH, 12.4 +/- 2.9). However, significant elevations in plasma gonadotropin levels persisted in these patients during the second and third hours after the administration of LHRH. These studies do not resolve the question of whether the prolonged elevation in plasma LH and FSH levels after LHRH administration is due to enhanced secretion, to a diminished rate of metabolic clearance of LHRH, and/or to the gonadotropins, or both. Evidence from this and previous studies suggests that there may be defects in the secretory functions of both the hypothalamus and pituitary gland in some of these patients.

[Elemental diet and external fistulae of, the digestive system]

An elemental diet is a food which provides the basic needs in calories, proteins, vitamins and minerals with two advantages: it is predigested and leaves minimal or no residue to provide bulk. The care of 20 patients, with an elemental diet, presenting 20 external fistulas (75 per cent with low output and 25 per cent with high output) succeeded to obtain a spontaneous healing in 75 per cent of the cases, and an improvement of the general conditions of 15 per cent of the patients who were operated on because of fistula persistency. The death rate was 10 per cent. We think that the elemental diet is a useful tool in the treatment of external fistulas of patients who have preserved their bowel movements and an output smaller than 500 ml. in 24 hrs.