Impact of pain in other body regions on the foot-specific quality of life in patients with hallux valgus

OBJECTIVES

The purpose of this study was to clarify the prevalence of pain outside the foot, and to determine the associations of pain outside the foot with foot-specific quality of life (QOL) in patients with hallux valgus.

METHODS

Patients scheduled to undergo hallux valgus surgery were recruited. Patients answered whether they experienced disabling pain in 13 body regions other than the foot. Foot-specific QOLwas assessed using the Self-Administered Foot Evaluation questionnaire (SAFE-Q). Foot pain was quantified using the visual analogue scale (VAS). Patient characteristics, including age, sex, comorbidity, anxiety, and depression, were also surveyed. The association between pain elsewhere and the SAFE-Q and pain VAS scores were assessed using univariate and multivariate analyses.

RESULTS

Of 102 patients, 55 (54%) experienced pain other than the foot. All SAFE-Q subscale scores were lower, and pain VAS was higher in patients with pain elsewhere than in patients without. In the multivariate analysis, an increase in the number of pain regions was independently associated with a decrease in SAFE-Q scores and an increase in pain VAS.

CONCLUSION

More than half of the patients with hallux valgus experienced pain elsewhere. The presence of pain elsewhere was associated with poorer foot-specific QOL and severer foot pain.

Fosphenytoin alleviates herpes simplex virus infection-induced provoked and spontaneous pain-like behaviors in mice

In this study, we investigated the effects of fosphenytoin (fPHT) a water-soluble prodrug of phenytoin, on the pain responses of a mouse herpes zoster (HZ) pain model. Transdermal herpes simplex virus type 1 (HSV-1) inoculation induced mechanical allodynia and hyperalgesia of the hind paw and spontaneous pain-like behaviors, such as licking the affected skin. Intravenous injection of fPHT (15 and 30 mg/kg) alleviated HSV-1-induced provoked pain (allodynia and hyperalgesia). The suppressive effects of fPHT on provoked pain were weaker than those of diclofenac and pregabalin which were used as positive controls. fPHT, diclofenac, and pregabalin significantly suppressed HSV-1-induced spontaneous pain-like behaviors. Among them, high-dose fPHT (30 mg/kg) showed the strongest suppression. Intravenous fPHT may become a viable option for an acute HZ pain, especially for spontaneous pain.

In Silico Screening Identified Novel Small-molecule Antagonists of PAC1 Receptor

Pituitary adenylate cyclase-activating polypeptide (PACAP) and its receptors are present in the spinal dorsal horn and dorsal root ganglia, suggesting an important role of PACAP signaling systems in the modulation of spinal nociceptive transmission. Previously, we found that intrathecal injection of PACAP or maxadilan, a selective PACAP type I (PAC1) receptor agonist, induced transient aversive responses followed by a long-lasting mechanical allodynia in mice, suggesting that PACAP-PAC1 receptor systems are involved in chronic pain and that selective PAC1 antagonists may become a new class of analgesics. Although several PAC1 antagonists, such as PACAP 6-38, have been reported, all of them are peptide compounds. In the present study, we identified new small-molecule antagonists of the PAC1 receptor using in silico screening and in vitro/vivo pharmacological assays. The identified small-molecule compounds, named PA-8 and PA-9, dose dependently inhibited the phosphorylation of CREB induced by PACAP in PAC1-, but not VPAC₁- or VPAC₂-receptor-expressing CHO cells. PA-8 and PA-9 also dose dependently inhibited PACAP-induced cAMP elevation with an IC₅₀ of 2.0 and 5.6 nM, respectively. In vivo pharmacological assays showed that intrathecal injection of these compounds blocked the induction of PACAP-induced aversive responses and mechanical allodynia in mice. In contrast, the compounds when administered alone exerted neither agonistic nor algesic actions in the in vitro/vivo assays. The compounds identified in the present study are new and the first small-molecule antagonists of the PAC1 receptor; they may become seed compounds for developing novel analgesics.

Sarcoidosis presenting as prepatellar bursitis

A 61-year-old woman complained of a subcutaneous mass in her right knee. MR images revealed a well-defined subcutaneous mass in the prepatellar region, containing some fluid and foci of short T2. The lesion showed some marginal contrast uptake after an administration of meglumine gadopentetate (Gd-DTPA), consistent with prepatellar bursitis. The pathological specimen, however, revealed subcutaneous sarcoidosis involving the bursa.

Circulating transforming growth factor beta 1 as a predictor of liver metastasis after resection in colorectal cancer

Plasma transforming growth factor beta1 (TGF-beta1) has been reported to be correlated with the extent of disease in colorectal cancer, but it is not known whether measuring this cytokine can help predict liver metastasis after curative resection. We prospectively studied whether plasma TGF-beta1 levels could predict liver metastasis in 117 patients with colorectal cancer before and after curative resection. Blood samples were drawn before and 2 weeks after surgery to determine the cytokine levels. Abdominal ultrasonography or computed tomography was done every 3 months after surgery. The primary end point for follow-up was recurrence. Seventy-seven of 117 cases (66%) had preoperative levels of the cytokine higher than the borderline limit of 7.5 ng/ml. Postoperative levels were >7.5 ng/ml in 29 of 117 patients (25%). The median follow-up period was 42 months (range, 5--66 months), with follow-up of all 117 patients. No recurrence was observed in 13 patients with Dukes' stage A lesions. Liver metastasis occurred in 18 of 104 patients (17%) with Dukes' stage B or C disease. Fourteen of 18 patients (78%) who developed liver metastasis had shown a postoperative plasma TGF-beta1 level of >7.5 ng/ml. Cox proportional hazards regression analysis showed that the postoperative level was a significant predictive factor for liver metastasis (P < 0.001). A single point measurement of plasma TGF-beta1 levels at 2 weeks after curative resection seems to be able to predict liver metastasis in colorectal cancer. This finding suggests the value of a prospective trial of liver-targeted adjuvant therapy for patients with elevated postoperative plasma TGF-beta1 levels.

Successful resection of a liver metastasis from gastric leiomyoblastoma: report of a case

A 20-year-old woman was referred to our hospital for detailed investigation of a gastric submucosal tumor. A leiomyoma was preoperatively diagnosed and laparoscopic-assisted enucleation was performed. The resected tumor was 4 x 3 x 1.5 cm in size and postoperative histological examination identified it as a gastric leiomyoblastoma. Therefore, a secondary resection in the form of a distal gastrectomy was carried out. No tumor cells were found in the gastric specimen or in the lymph nodes; however, 5 months after the operation, an abdominal computed tomography scan revealed a recurrence in the liver, and she was readmitted for further examinations. The lesion was diagnosed as a single liver metastasis from the gastric leiomyoblastoma and successfully resected. The histopathological findings of the liver tumor resembled those of the primary gastric tumor. Her postoperative course was uneventful and she has been well, without any evidence of recurrence, to date. Only 12 other cases of leiomyoblastoma of the stomach with liver metastasis have been reported in Japan, all of which were associated with a very poor prognosis. Therefore, patients with this unusual disease entity should be carefully followed up after resection of the primary tumor.

Endoscopic observation of squamous metaplasia of the stomach: a report of two cases

Squamous metaplasia of the stomach is a rare clinical entity that occurs during healing of gastric ulcers or chronic inflammation. We have treated two patients with this condition, which has only occasionally been observed endoscopically. The first was a 60-year-old woman who initially presented with multiple gastric ulcers. Two months after treatment, a white patch about 4 cm in diameter was found in the lesser curvature of the cardiac region of stomach. The second patient was a 65-year-old woman, who also developed a white patch in the same region. Two months later, a small ulcer and inflamed mucosa were seen near the lesion. The white areas in both patients were stained with Lugol's iodine solution, and biopsy specimens confirmed squamous epithelium. The squamous metaplasia was observed as a white mucosal area in the stomach, and the metaplastic area stained positively with Lugol's iodine solution.

Fecal clearance of alpha1-antitrypsin with lansoprazole can detect protein-losing gastropathy

Detecting plasma protein loss from the stomach is quite difficult by measuring fecal alpha1-AT clearance because alpha1-AT is rapidly destroyed in the gastric juice at values below pH 3. We examined protein loss from the stomach using fecal alpha1-AT clearance with lansoprazole, a proton pump inhibitor. A 38-year-old Japanese male presented with hypoproteinemia (total serum protein: 4.4 g/dl). Abdominal scintigraphy using technetium-99m-labeled albumin revealed distinct radioactivity accumulation in the small intestine. It strongly suggested excessive protein loss to the gastrointestinal tract. Although, regular fecal alpha1-AT clearance was within the normal range (<13 ml/day), the fecal alpha1-AT clearance with the administration of lansoprazole was 80.5 ml/day. The results indicated that this method using lansoprazole is simple and useful for detecting protein-losing gastropathy.

Esophageal small cell carcinoma with ectopic production of parathyroid hormone-related protein (PTHrp), secretin, and granulocyte colony-stimulating factor (G-CSF)

A patient with primary small cell carcinoma of the esophagus is reported, in whom we have studied the secretion of a variety of hormones and cytokines. The tumor was an intermediate cell type of small cell carcinoma and had either epithelial and neuroendocrinological characteristics. Furthermore, hypercalcemia and neutrophilia were present, and the tumor was shown to produce PTHrp, secretin, and G-CSF. The present case is the first report of primary small cell carcinoma of the esophagus with ectopic production of PTHrp, secretin, and G-CSF.

Possible evidence for transmembrane K(+)-H+ exchange system in guinea pig myocardium

The aim of this study was to obtain evidence for a transmembrane K(+)-H+ exchange system in Langendorff-perfused whole hearts and isolated ventricular myocytes of guinea pig. Effluent relation between K+ and pH in the whole hearts perfused with HEPES-buffered Tyrode's solution indicated a significant (p < 0.05) functional coupling of K+ uptake and H+ extrusion that was energy-dependent and omeprazole (OPZ)-sensitive. Administration of OPZ (0.3 mM) or dimethylamiloride (0.1 mM), an inhibitor of Na(+)-H+ antiport, to whole hearts subjected to the repetitive NH4Cl applications implied that both Na(+)-H+ and putative K(+)-H+ countertransports contribute to the regulation of intracellular pH. In isolated myocytes, voltage-dependent L-type Ca current (ICa) was inhibited by OPZ (0.3 mM) under K(-)- and Na(+)-free condition by 11 to 14%, and was inhibited to a greater extent (i.e., by 36 to 40%) by this agent in the presence of K+. OPZ-induced inhibition of the putative K(+)-H+ exchanger likely resulted in subsarcolemmal acidification which was responsible for the rate-independent suppression of ICa. In conclusion, these data provide functional evidence for a myocardial transmembrane K(+)-H+ exchanger.

Expression of vascular endothelial growth factor in human brain tumors

Compared to normal brain an increased expression of vascular endothelial growth factor (VEGF) has been reported in many types of brain tumors. However, the numbers of samples analyzed and information about the cellular distribution of VEGF have been limited. Here we used novel monoclonal antibodies against VEGF to analyze, using immunohistochemistry, Western blotting and enzyme-linked immunosorbent assay, its expression in 108 human brain tumors that included astrocytic tumors, meningiomas, pituitary adenomas, primary intracranial germ cell tumors and neuronal tumors. The results showed that 37 of 48 astrocytic tumors (77%) and 15 of 19 meningiomas (79%) were immunoreactive for VEGF, consistent with previous reports. However, in contrast to a previous report that analyzed only VEGF mRNA; all of our 15 pituitary adenomas showed specific immunoreactivity for VEGF. We also extended the studies to previously unanalyzed neoplasms: 13 of 15 primary intracranial germ cell tumors (82%), and 7 of 10 neuronal tumors (70%) were immunoreactive for VEGF. Direct protein analysis by Western blotting confirmed the expression of VEGF in those tumors, and showed differential expression of the isoforms of VEGF protein; a pituitary adenoma expressed both VEGF165 and VEGF189 proteins, a central neurocytoma expressed only VEGF165, while an immature teratoma expressed only VEGF189. The data herein show that VEGF is expressed in a wide spectrum of brain tumors and suggest differences among tumor entities in the mechanisms of VEGF up-regulation as well as their employment of distinct VEGF isoforms for neovascularization.

Helicobacter pylori antigen in the glomeruli of patients with membranous nephropathy

Renal biopsy specimens from patients with membranous nephropathy (MN) were studied using immunohistochemical labelling to clarify the aetiological significance of Helicobacter pylori antigen in this disease. Sixteen specimens were examined, from 7 male and 9 female MN patients. Renal specimens from patients with diabetic nephropathy and IgA nephropathy, and from autopsied patients without renal diseases were obtained as controls. Immunohistochemical labelling was performed using one polyclonal antibody and three monoclonal antibodies against H. pylori. Specimens from 11 of the MN patients revealed granular deposits along the glomerular capillary walls, which reacted positively with polyclonal antibody after trypsin pretreatment. None of the control specimens revealed positive labelling. The MN specimens showed no positive reaction with the primary antibody, which had been treated for immunoabsorption testing using sonicated H. pylori. We also determined H. pylori status in these MN patients histologically and/or serologically. Of the 11 patients whose glomeruli were positive for anti-H. pylori antibody, 7 were suitable for analysis, and all were regarded as positive for H. pylori infection. These results suggest that the presence of a specific antigen in the glomeruli of patients with MN and H. pylori infection may be involved in the pathogenesis of MN.

Coexistence of superficial esophageal carcinoma and leiomyoma: case report of an endoscopic resection

A case of a 61 year old man who developed early esophageal cancer on top of a leiomyoma located in the upper third of the esophagus is described. Both lesions were successfully treated by endoscopic resection, without recurrence on short-term-follow-up.

[Spinal intramedullary cavernous angioma associated with hematomyelia: case report with sequential MRI follow-up and histological verification of hematoidin deposits]

A 61-year-old woman first experienced sudden lower back and right leg pain 3 years prior to surgery. At this time, MRI showed an intramedullary cavernous angioma at Th10-11 with central T2 high and peripheral T2 low signal intensity. However, she completely recovered in two weeks. Four days prior to the present admission (day of the second hemorrhage), she again experienced severe lower back and right leg pain, followed by complete paralysis of the right leg. Despite vigorous medical treatment including administration of steroid, hemostatics and glycerol, her condition became aggravated with complete paraplegia and loss of sphincter control by the 4th hospital day. MRI taken two days after the second hemorrhage showed an increase of peritumoral T2 hypointensity and another area of T2 hypointensity in the lumbar spinal cord at L1-Th12 with cord swelling. MRI 13 days after the second hemorrhage showed that these areas of T2 hypointensity had changed to T1 and T2 hyperintensity suggesting conversion of deoxyhemoglobin to methemoglobin. Subsequent MRI showed longitudinal punctuate propagation of methemoglobin from the angioma down to the lumbar enlargement and into the conus medullaris, where a 30 x 6 mm spindle-shaped area of T1 and T2 hyperintensity indicating hematomyelia had formed. Total removal of the angioma was followed by gradual recovery and decrease in the size and signal intensity of the hematomyelia. Histopathological examination demonstrated the typical features of cavernous angioma with deposition of hematoidin. Propagation of extravasated blood from the ruptured thoracic cavernoma to the conus medullaris, with splitting of spinal cord nerve fibers, was demonstrated by MRI.

Regression of duodenal mucosa-associated lymphoid tissue lymphoma after eradication of Helicobacter pylori

It is rare for low-grade lymphoma of mucosa-associated lymphoid tissue (MALT) to affect the duodenum, and no reports have mentioned any relationship between this disease and Helicobacter pylori infection. This case report describes a patient with multiple small erosions and diffuse erythema in the duodenal bulb diagnosed histopathologically as MALT lymphoma. Immunoglobulin (Ig) heavy-chain gene rearrangement was detected, and monotypic plasma cell proliferation (IgG kappa) was shown by immunohistochemistry. The lesion was localized to the duodenal bulb. Antibiotic therapy for H. pylori resulted in resolution of the morphological features of the lymphoma, as confirmed by endoscopic and pathological examination. Moreover, the gene rearrangement could not be detected after eradication of the bacterium. Although additional follow-up is needed, it is suggested that H. pylori eradication therapy may be effective for patients with MALT lymphoma in the duodenum as well as the stomach.

Lamina propria macrophages in the human gastrointestinal mucosa: their distribution, immunohistological phenotype, and function

In this study we systematically investigated the cellular distribution, immunohistochemical phenotype, and mucosal disposal function of macrophages in the lamina propria of the human gastrointestinal mucosa (lamina propria macrophages; LPMs). In all tissues examined, most of these LPMs accumulated beneath the epithelial layer that covered the apex of the lamina propria of the mucosa. These cells expressed normal levels of common macrophage markers such as CD68, LN5, lysozyme, ferritin, and alpha 1-anti-chymotrypsin. In addition, they expressed high levels of 25F9 (a market for a certain subpopulation of macrophages), MHC Class II molecules, and CD74 (MHC Class II-associated invariant chain). Interestingly, LPMs possessed some epithelial cell-associated antigens such as cytokeratin, carcinoembryonic antigen (CEA), and Ber-Ep4 in their cytoplasm. Ultrastructurally, these antigens were associated with cellular debris ingested by LPMs, which were recognized as apoptotic fragments by in situ end-labeling. Furthermore, double positive-labeled granules were seen in LPMs by double staining for epithelial cell-associated antigens and in situ end-labeling. These observations suggest that one of the major functions of LPMs is the disposal of apoptotic epithelial cells and that LPMs may be involved in the regulation of mucosal epithelial renewal.

Spinal giant intradural perimedullary arteriovenous fistula: clinical and neuroradiological study in one case with review of literature

BACKGROUND

Giant intradural perimedullary arteriovenous fistula with massive spinal cord compression is rare. The therapeutic difficulties include whether endovascular embolization or direct surgical excision should be selected. We present a patient with the largest giant spinal intradural perimedullary arteriovenous fistula shown by magnetic resonance imaging so far reported, who was successfully treated by a combination of endovascular embolization and direct surgery.

CASE DESCRIPTION

A 16-year-old girl presented with a giant intradural arteriovenous fistula (perimedullary Type II) at the C4-5 level, manifesting as progressive cervical myeloradiculopathy. The single-hole fistula was supplied by the anterior spinal artery and an ascending artery arising from both the costocervical and highest intercostal arteries with a rapid transit time, and drained superiorly to the foramen magnum, and inferiorly to the thoracic spinal canal, through a huge venous lake at the site of the arteriovenous connection. The patient was treated by transarterial embolization with platinum coils and silk, followed by surgical excision with excellent results at 12 months' follow-up.

CONCLUSIONS

We recommend that such a huge perimedullary arteriovenous fistula with a rapid transit time, and severe cord and root compression, should be treated with embolization followed by surgical excision.

[Effects of exercise on mitral regurgitation in healthy subjects]

Transthoracic echocardiography including color Doppler echocardiography and graded exercise (supine bicycle ergometer) were performed to examine both the changes of mitral regurgitation (MR) flow during exercise and the effects of cathecholamine on the MR flow in 20 young males (mean age 19 years) and 9 male long-distance runners (mean age 20 years) with presumably normal hearts. MR flow was detected in 13 of the 20 young males at rest. The severity of MR was mild in 12 subjects, and moderate in 1. After exercise, MR flow vanished in 4 of the 13 subjects (group B). In the other nine subjects, MR flow lasted during and after exercise (group A). In the seven subjects without MR flow at rest, MR flow did not appear during and after exercise (group C). Group A had significantly lower left ventricular ejection fraction than group C at rest (A 64.9 +/- 4.25%, B 69.4 +/- 4.32%, C 73.9 +/- 3.46%; p < 0.05). However, no significant differences were observed in other echocardiographic parameters (including left ventricular end-diastolic dimension, mitral annulus diameter and left atrial diameter), heart rate and serum cathecholamine levels between the three groups before and after exercise. In the nine male long-distance runners, MR flow was detected in six of nine subjects at rest. The severity of MR was mild in all subjects. After exercise, MR flow vanished in two of these six subjects (group A). In the other four subjects, MR flow lasted during and after exercise (group B). In three subjects without MR flow at rest, MR flow did not appear during and after exercise (group C). There were no significant differences in echocardiographic parameters, heart rate and serum cathecholamine levels between the three groups before and after exercise. These data suggest that MR flow detected in healthy subjects correlates with tension and contractility of papillary muscle.

Effects of ajmaline on non-sodium ionic currents in guinea pig ventricular myocytes

The lack of currently available data stimulated us to investigate the electrophysiological effects of ajmaline, a classical class Ia antiarrhythmic agent, on various currents responsible for the action potential plateau and repolarization phases. The whole cell patch clamp recording technique was applied to guinea pig ventricular myocytes. Ajmaline suppressed the Ca2+ current (Ica) in a dose-dependent manner (Kd = 1.2 x 10(-5) M) without affecting the steady-state inactivation kinetics and the voltage dependency of the current-voltage relationship. Ajmaline inhibited the inward portion of the inward rectifying K+ current (IKl). Ajmaline decreased the delayed rectifier K+ current (IK) without altering the activation or deactivation time courses. All these inhibitory effects of ajmaline prolonged the action potential duration in a dose dependent manner. The inhibitory actions of ajmaline on the action potential upstroke and various currents responsible for the plateau and repolarization may contribute to the observed suppression of depolarization-induced abnormal automaticities by this agent.

[Interferon therapy after ablation of Kent bundle for a patient with chronic hepatitis type B complicated with WPW syndrome]

Cardiotoxicity of interferon-alpha or gamma, such as fatal arrhythmia and myocardial infarction, has been reported. Therefore cardiotoxicity of interferon should be seriously considered before administration for patients with a pre-existing heart disease. We treated a patient with chronic active hepatitis type B, coexisted with Wolff-Parkinson-White syndrome, who has had frequent attacks of paroxysmal atrial fibrillation. To prevent the occurrence of fatal arrhythmia with an interferon therapy in this patient, we performed radiofrequency catheter ablation of the Kent bundle. After the successful ablation, we could safely administered recombinant interferon alpha-2b for chronic hepatitis type B.

Magnetic resonance imaging of human spinal cord infarction

Magnetic resonance images obtained in two cases of spinal cord infarction are described: one with hemorrhagic thoracic cord infarct, the other with ischemic cervical cord infarct with sequential magnetic resonance imagings. An enlarged cord with strand-shape or longitudinal hypointensity on both T1- and T2-weighted images was noticed in the hemorrhagic infarct; hypointensity on the T2-weighted image was thought to be due to hemosiderin, which shortens T2 relaxation. In the ischemic infarct, a small, round area of hypointensity on T1-weighted images, and of hyperintensity on T2-weighted images, noted 9 hours postictus ("early infarct") changed on the 22nd day to a cephalocaudal strandlike hypointensity on T1-weighted image, which was enhanced by Gd-DTPA. The hypointensity suggested "pencil-like softening" in "medium" age infarct. On postictal day 49, it showed an extensive homogeneous hypointensity involving several segments of the cord on T1-weighted images and hyperintensity on T2-weighted images with negative Gd-DTPA enhancement suggesting "late transverse infarct." We considered that these changes are of value in diagnosing spinal cord infarcts on magnetic resonance imagings.

[DAPI-DNA cytofluorometric study of glioma cells--application of DAPI-DNA cytofluorometry to paraffin embedded archival glioma tissue for nuclear DNA content analysis]

Using DAPI-DNA cytofluorometry, the author analyzed nuclear DNA content of formalin fixed, paraffin embedded, glioma material obtained from 14 glioma cases at surgery. Sections of 10 microns were deparaffinized. Following simultaneous DAPI (4,6-diamidino-2-phenylindole dihydroporphyrin chloride)/HP (hematoporphyrin) staining, DAPI binds DNA and DNA-DAPI complexes emit blue fluorescence when exited by ultraviolet (UV) light. Through Zeiss fluorescence microscope, the author measured nuclear fluorescence intensity with histological verification of glioma cells. A DNA histogram was obtained with fluorescence intensity recorded on the abscissa and number of cells plotted on the ordinate. Samples of 20 normal non-neoplastic astrocytes taken from apparently normal brain tissue included in the histological slide were used as diploid (2 C) control. Based on DNA content, tumor cells were classified into 4 groups: N-group composed of cells with 2 C DNA content (normoploid), S-group with less than 2 C (hypoploid), L-group more than 4 C (hypertetraploid), I-group between 2 C and 4 C (intermediate ploidy). Intermediate ploidy was significantly higher and normoploid was significantly lower in glioblastoma compared with those of benign astrocytoma. Thus, DNA content and histological malignancy were well correlated. Due to limitation of measuring diaphragm of turret in the microscope, some extra large cell could not be included in it and was excluded from the measurement.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro comparison of the neuromuscular antinicotinic and intestinal antimuscarinic effects of different nondepolarizing muscle relaxants

The postsynaptic antimuscarinic properties of different nondepolarizing muscle relaxants were compared with their postsynaptic antinicotinic effect. d-Tubocurarine, pipecuronium and vecuronium were the most selective antagonists on postsynaptic nicotinic receptors. Gallamine, diadonium and Duador (RGH-4201) had relatively greater effect on postsynaptic muscarinic receptors. Therefore, much less side effect is expected to occur when pipecuronium, d-tubocurarine or vecuronium are used.

Heterogeneity of presynaptic muscarinic receptors located on different tissue preparations

Three different tissue preparations were used to demonstrate the heterogeneity of presynaptic muscarinic receptors that modulate neurotransmitter release. The presynaptic antimuscarinic potency of several muscarinic antagonists was characterized with the enhancement of the neurotransmitter release evoked by electrical stimulation on the guinea-pig ileum Auerbach plexus, the guinea-pig atrium and the rat brain cortex. Presynaptic muscarinic receptors located on the Auerbach plexus proved to be different of those present on the cortical cholinergic interneurons and on the sympathetic plexus of the guinea-pig atrium.

Levels of insulin-like growth factors I and II in human cord blood

Levels of insulin-like growth factors I and II (IGF-I and IGF-II) and somatomedin peptide content (SMPC) were measured in 32 normal term and 11 preterm infants. After acid chromatography to remove somatomedin-binding protein, SMPC was measured by placental membrane radioreceptor assay, while plasma IGF-I and II concentrations were measured by specific RIAs. SMPC levels in term infants were significantly below normal adult levels [0.49 +/- 0.13 (+/- SD) U/ml for infants compared to 1.30 +/- 0.25 U/ml for adult males]. IGF-I levels in term infants were also low, averaging 113 +/- 35 ng/ml for infants; the normal adult levels is 184 +/- 32 ng/ml. The IGF-II level was 282 +/- 84 ng/ml for infants and 687 +/- 169 ng/ml for adults. Both IGF-I and II levels in preterm infants were lower than those in term infants. IGF-I, and IGF-II, and SMPC levels showed a positive correlation with birth weight in term infants. Both IGF-I and IGF-II levels showed a strong positive correlation with gestational age in all infants.

Plasma Aluminum levels of patients on long term sucralfate therapy

Plasma aluminum levels of 17 patients with gastric and/or duodenal ulcers who had received four grams of sucralfate daily for eight to ten weeks were compared with those of six control subjects. Aluminum levels were determined by flameless atomic absorption spectrometry. Plasma of patients on long term sucralfate therapy contained 8.41 +/- 6.00 (SD) micrograms aluminum per liter and was not significantly different than that of the control subjects which contained 6.50 +/- 7.87 micrograms per liter. These values agreed well with normal values reported previously. In conclusion, long term ingestion of sucralfate in therapeutic doses does not result in an increase in plasma aluminum concentration.

Selective binding of sucralfate to gastric ulcer in man

Sucralfate is a basic aluminum salt of a sulfated disaccharide. In this study, patients with gastric ulcer were given oral multiple doses of sucralfate prior to partial gastrectomy, and binding of the drug to the ulcer lesion and to nonulcerated mucosa was estimated by chemical determination of aluminum and sulfated disaccharide. The ulcerated mucosa was found to contain, on the average, 6-7 times more sucralfate per square centimeter than the control mucosa (P less than 0.01 and less than 0.05 for aluminum and sulfated disaccharide, respectively). The high affinity of sucralfate for ulcerated mucosa, particularly the sucrose sulfate moiety, supports previous data that the beneficial effect of sucralfate in ulcer disease is due in part to complex formation between sucrose sulfate and proteins at the ulcer site.

Glucuronic acid pathway in alloxan diabetic rabbits. (I). Urinary excretion of metabolites related to the glucuronic acid pathway

Studies on the activity of the glucuronic acid pathway in alloxan diabetic rabbits were carried out. Amount of D-glucaric acid, L-ascorbic acid, and D-glucuronic acid in urine increased in the case of the alloxan diabetic rabbits. The transformation from D-glucuronolactone to D-glucaric acid was higher than normal in the diabetic animals. The expired 14-CO2 decreased and urinary excretion of labeled L-gulonic acid increased after administration of 6-14-C-glucuronolactone in the diabetic rabbits. L-Gulonic acid dehydrogenase, lactonase II, and beta-glucuronidase activities were reduced, and UDPGA-pyrophosphatase, D-glucuronic acid-1-phosphatase, and UDPGA-transferase activities increased in the diabetic rabbit liver. From these results, it may be concluded that an increase of endogenous D-glucuronic acid in the diabetic states could be attributed to a metabolid defect in the step of L-gulonic acid dehydrogenation and to the enhancement of UDPGA-pyrophosphatase and D-glucuronic acid-1-phosphate phosphatase activities.

Effect of D-glucaric acid derivatives on stability of rat liver lysosomes and erythrocytes

For studies on the lysosome-stabilizing effect of D-glucaric acid derivatives which have been found to have anti-inflammatory effect, the available and soluble enzyme activities of acid phosphatase of rat liver lysosomes were determined. Saliployed as standards. Lysosomes were incubated with drugs under specific conditions which allowed the data on the stabilizing activity of the drugs to be reproducible. The inhibitory effect of D-glucaro-1, 4-lactone, salicylic acid and phenylbutazone onover a wide range of concentrations. D-glucaro-1, 4-lactone as well as salicylic acid exhibited concentration-dependent lysosome-stabilizing effect whereas phenlybutazone had an optimum concentration for its lysosome-stabilizing effect. In addition, D-glucaro-1, 4-lactone,saliclicacid and phenylubtazone were also examined for their effects on heat-induced and saponin-induced hemolysis of rat erythrocyres. Both salicylic acid and phenylbutazone exhibited potent stabilziing and labilizing effects on heat-induced and saponin-induced hemolysis of eryhthrocytes, respectively. D-glucaro-1, 4-lactone, however, was incabale of affecting the hemolysis of erythrocytes. There appears to be a difference in the mechanism of the lysosome-stabilizing effects between D-glucaric acid derivatives and other anti-inflammatory drugs.