Route of administration-dependent anti-inflammatory effect of liposomal alendronate

Innate immunity and inflammation are of major importance in various pathological conditions. Intravenous (IV) and intraperitoneal (IP) liposomal alendronate (LA) treatments have been shown to deplete circulating monocytes and peritoneal macrophages resulting in the inhibition of restenosis and endometriosis (EM), respectively. Nevertheless, the correlation between the extent of circulating monocyte depletion and liposome biodistribution is unknown, and the route of administration-dependent bioactivity in restenosis and EM has not been determined. We found that, LA treatment resulted in a dose-response modified biodistribution following both IV and IP administrations. The biodistribution of high-dose LA (10mg/kg), but not that of the low-dose (1mg/kg), was similar in healthy and diseased animals. It is concluded that LA impedes its own elimination from the circulation by depleting circulating monocytes and/or inhibiting their endocytic activity, in a dose-dependent manner. Both IV and IP administration of LA mediated by the partial and transient depletion of circulating monocytes effected inhibition of restenosis. Inhibition of EM was effected only by IP administration, which depleted both intraperitoneal and circulating monocytes. Thus, EM should be considered as a local inflammatory condition with systemic manifestations as opposed to restenosis, a systemic inflammatory disease.

Innate immunity has a dual effect on vascular healing: suppression and aggravation of neointimal formation and remodeling post-endotoxin challenge

BACKGROUND

Inflammation is important to vascular repair following injury, modulating neointimal proliferation and remodeling. Previously, we have shown that a low-intensity inflammatory response aggravates neointimal formation following balloon and stent injury. The present study examined whether modulation of the extent and timing of nonspecific inflammation mediates the local vascular response in an additive unidirectional or rather a bidirectional fashion.

METHODS AND RESULTS

Rabbits subjected to denudation and balloon injury of the iliac artery were treated with low (1 microg/kg) or high (100 microg/kg) doses of bacterial endotoxin (LPS) immediately after injury, or with early high-dose LPS administered 3 days prior to injury (preconditioning). Neointimal formation at 28 days was significantly increased in the low-dose group (0.537+/-0.059 mm(2)) as compared with controls (0.3+/-0.03 mm(2)). High-dose LPS did not significantly affect neointimal formation while early high dose significantly reduced neointima (0.296+/-0.033 and 0.194+/-0.025 mm(2), respectively, n=12-14/group). Arterial wall and systemically circulating interleukin-1 beta levels, and monocyte CD14 activation correlated with neointimal formation. Vascular remodeling was accelerated in animals treated with low- or high-dose LPS while not affected in the preconditioned group. Remodeling index inversely correlated with arterial matrix metalloproteinase-2 levels 6 days after injury.

CONCLUSIONS

The extent and timing of nonspecific inflammation that is concurrent with vascular injury can determine different and opposite vascular repair patterns.

Health needs of the Roma population in the Czech and Slovak Republics

In the growing literature on the human rights of Roma people in Central Europe, their relatively poor health status is often mentioned. However, little concrete information exists about the contemporary health status of the Roma in this region. We sought information on the health of the Roma in two of countries with significant Roma minorities, the Czech and Slovak Republics, by means of systematic searches for literature on the health of Roma people published in Czech or Slovak or by authors from the two countries. Published research on health of the Roma population is sparse. The topics that have received attention suggest a focus on concepts of contagion or social Darwinism, indicating a greater concern with the health needs of the majority populations with which they live. What limited evidence exists indicates that the health needs of the Roma population are considerable. With very few exceptions, the health status of Roma is worse than that of non-Roma population in both countries. The burden of communicable disease among Roma is high and diseases associated with poor hygiene seem to be particularly important. Evidence on health care suggests poor communication between Roma and health workers and low uptake of preventative care. The health needs of Roma lack visibility, not only because of the absence of research but also the absence of advocacy on their behalf. Since 1989, Czech and Slovak researchers have largely turned away from health research on particular ethnic groups. This probably reflects a growing sensitivity about stigmatising Roma, but it also makes it difficult to know how their circumstances might be improved. There is a need for further research into the health of Roma people with particular emphasis on non-communicable disease and for interventions that would improve their health.

Lack of association between anti-V3 loop antibodies and perinatal transmission of HIV-1 in Kampala, Uganda

This study evaluated the association between reactivity of maternal antibody to human immunodeficiency virus type 1 (HIV-1) V3 loop peptides and perinatal transmission in Uganda. Plasma from 40 HIV-1-infected mothers (20 transmitting and 20 nontransmitting mothers) and 31 uninfected mothers in Uganda were tested for reactivity and antibody titer to synthetic peptides representing V3 loop sequences from HIV-1 strains MN, SF2, LAI, ZR6, and CM235 and consensus peptides CA, CB, and CD. No significant differences were found between 20 transmitting mothers and 20 nontransmitting mothers in terms of percent reactivity or titer of antibody to any of the V3 loop peptides tested. Use of a multivariable logistic model to adjust for beta-2 microglobulin level as a confounding variable of stage of infection did not help demonstrate an association except possibly for the ZR6 peptide. These data suggest that neither reactivity nor maternal antibody titer to V3 loop peptides are protective against perinatal transmission of HIV-1 in Uganda.

Terazosin in the treatment of benign prostatic hyperplasia. Terazosin Benign Prostatic Hyperplasia Study Group

OBJECTIVE

To evaluate the efficacy and tolerability of terazosin, a long-acting selective alpha 1-receptor antagonist, in patients with benign prostatic hyperplasia.

DESIGN AND SETTING

Randomized, double-blind, multicenter (eight government and private facilities), placebo-controlled study.

PATIENTS

Men aged 45 years or older, with qualifying signs and symptoms of benign prostatic hyperplasia (n = 160).

INTERVENTIONS

Terazosin or placebo once daily, with terazosin dosage titrated to the patient's response. After a 4-week placebo lead-in, 1 to 10 mg of terazosin or placebo was administered for 24 weeks.

OUTCOME MEASURES

Decreases in mean Boyarsky scores for obstructive and irritative symptoms and total scores and increases in peak urine flow rate.

RESULTS

Terazosin-treated patients had decreases in Boyarsky obstructive, irritative, and total scores of 3.3 (52%), 1.3 (29%), and 4.6 (42%), respectively, compared with decreases of 0.7 (12%), 0.4 (9%), and 1.1 (11%), respectively, in the placebo group (P < .05). Peak urine flow increased by a mean of 2.6 mL/s (30%) in terazosin-treated patients and 1.2 mL/s (14%) in placebo-treated patients (P < or = .05). Adverse events that differed significantly in the two groups were dizziness (19% in the terazosin group vs 5% in the placebo group) and urinary tract infection (1% in the terazosin group vs 10% in the placebo group).

CONCLUSIONS

These results suggest that terazosin given once daily in doses up to 10 mg alleviates symptoms and improves peak urine flow rate in men with benign prostatic hyperplasia and has an acceptable adverse event profile.

Effect of total parenteral nutrition on amino acid and glucose transport by the human small intestine

OBJECTIVE

The effect of total parenteral nutrition (TPN) on small intestinal amino acid transport activity was studied in humans.

SUMMARY BACKGROUND DATA

Studies in humans receiving TPN indicate that a decrease in the activities of the dissacharidase enzymes occurs, but morphologic changes are minimal with only a slight decrease in villous height.

METHODS

Surgical patients were randomized to receive TPN (n = 6) or a regular oral diet (controls, n = 7) for 1 week before abdominal surgery. Ileum (5 controls, 5 TPN) or jejunum (2 controls, 1 TPN) were obtained intraoperatively and brush-border membrane vesicles (BBMV) were prepared by magnesium aggregation/differential centrifugation. Transport of L-MeAlB (a selective system A substrate), L-glutamine, L-alanine, L-arginine, L-leucine, and D-glucose was assayed by a rapid mixing/filtration technique in the presence and absence of sodium.

RESULTS

Vesicles demonstrated approximately 18-fold enrichments of enzyme markers, classic overshoots, transport into an osmotically active space, and similar 1-hour equilibrium values. TPN resulted in a 26-44% decrease in the carrier-mediated transport velocity of all substrates except glutamine across ileal BBMVs. In the one patient receiving TPN from whom jejunum was obtained, there was also a generalized decrease in nutrient transport, although glutamine was least affected. Kinetic studies of the system A transporter demonstrated that the decrease in uptake was secondary to a reduction in carrier Vmax, consistent with a decrease in the number of functional carriers in the brush-border membrane.

CONCLUSIONS

TPN results in a decrease in brush-border amino acid and glucose transport activity. The observation that glutamine transport is not downregulated by 1 week of bowel rest may further emphasize the important metabolic role that glutamine plays as a gut fuel and in the body's response to catabolic stresses.

Kinesins in the spindle: an update

Eukaryotes contain a superfamily of microtubule-based motor proteins comprising kinesin and a number of related proteins that are thought to participate in various forms of intracellular motility, including cell division and organelle transport. The role of various members of the kinesin superfamily in chromosome segregation and spindle morphogenesis was described in TCB last year in parts of a series on cytoplasmic motor proteins. In this brief update, Helen Epstein and Jon Scholey comment on new findings that have improved our understanding of the functions of kinesin-related proteins in mitosis and meiosis.

Cloning and expression of Drosophila HP1 homologs from a mealybug, Planococcus citri

The mealybug chromosome cycle is one of the most dramatic examples of genomic imprinting known. In embryos that are to become male the entire paternal chromosome set becomes heterochromatic and inactive at the blastoderm stage, while the maternal set remains active and euchromatic. HP1 is a protein from Drosophila melanogaster, which binds preferentially to heterochromatin on polytene chromosomes and is likely to be a modifier of position effect variegation. This paper describes the isolation and sequencing of two cDNA clones encoding HP1 homologs from the mealybug, Planococcus citri. The protein product of the cDNA clone that was closer to HP1 in sequence was expressed as a fusion protein in Escherichia coli, and polyclonal rat antibodies were raised against it. Immunohistochemistry to mealybug squash preparations showed that this protein was a male-specific nuclear protein, but that it was not specifically associated with the heterochromatic set of chromosomes.

Acute reversible hypoxemia in systemic lupus erythematosus

OBJECTIVE

To determine the frequency of unexplained reversible hypoxemia in patients with systemic lupus erythematosus and to assess the relation between hypoxemia and elevated plasma levels of complement split products.

DESIGN

Cohort study.

SETTING

Inpatient and outpatient facilities of the New York University Medical Center/Bellevue Hospital and the Hospital for Joint Diseases.

PATIENTS

Case patients were 22 patients hospitalized with disease exacerbation and no evidence of parenchymal lung disease on chest roentgenogram. Four patients with stable disease were followed in the outpatient clinic, and five healthy normal volunteers served as controls.

MEASUREMENTS

Plasma levels of complement split products (C3a, factor Bb fragment), alveolar-arterial (A-a) Po2 gradients, and pulmonary function were measured.

MAIN RESULTS

Nine episodes of hypoxemia or hypocapnia (mean A-a gradient, 30.4 +/- 4.8 mm Hg) or both (despite normal chest roentgenogram results) were noted in six hospitalized patients (group 1). Gas exchange improved within 72 hours of steroid therapy (mean A-a gradient, 11.6 +/- 4.3 mm Hg; P less than 0.01). These patients had an elevated initial mean C3a level (938.4 +/- 246.8 ng/mL) that decreased within 72 hours (407.8 +/- 80.9 ng/mL; P less than 0.01), concomitant with improved oxygenation. Ventilation-perfusion scans, obtained for four of six group 1 patients, excluded pulmonary emboli. Four hospitalized patients (group 2) had a normal A-a gradient (mean, 7.5 +/- 2.7 mm Hg). The mean C3a level of this group (358.3 +/- 39.2 ng/mL) was lower than that of group 1 (P less than 0.05). Four patients with stable disease (group 3) had a mean A-a gradient and a mean C3a level of 3.3 +/- 2.7 mm Hg and 237.8 +/- 105.7 ng/mL, respectively, similar to values found in five normal volunteers, in whom the mean A-a gradient was 3.7 +/- 1.7 mm Hg and the mean C3a level was 124.8 +/- 9.2 ng/mL.

CONCLUSION

A syndrome of reversible hypoxemia, unassociated with parenchymal lung disease, is unexpectedly common in acutely ill, hospitalized patients with systemic lupus erythematosus. The pathogenesis of this syndrome is unclear, although the data are compatible with the hypothesis that hypoxemia may be related to pulmonary leukoaggregation.

The human class I MHC gene HLA-F is expressed in lymphocytes

Genomic and cDNA clones encoding a human, non-classical class I gene, Dew3, have been isolated. The complete coding sequence has been determined. The sequence is capable of directing expression of a protein with high sequence homology to HLA-A,B,C molecules but with a shortened cytoplasmic tail. Sequence comparisons demonstrate that this gene is from a separate locus to the 'classical' HLA-A,B,C and 'non-classical' HLA-E and HLA-G loci. Dew3 is equally distantly related to all of these previously described, functional class I genes. It is, however, extremely homologous to a third 'non-classical' gene, HLA-5.4, and to the chimpanzee gene, Ch28. The RNA species it transcribes is shorter than that of the classical genes, due to an altered acceptor splice site which results in the loss of exon 7. The transcription of Dew3 RNA shows a unique pattern of tissue distribution, being expressed in B cell lines and peripheral blood lymphocytes and absent from T cell lines, fibroblasts and a myelomonocytic leukaemia. A Dew3 protein product was detected after transfection into a human EBV-transformed B cell line but was located intracellularly. The HLA-5.4 gene has been recently designated HLA-F. The Dew3 and X5.1 clones thus represent two new alleles of the HLA-F locus in man. Sequence comparison with its chimpanzee homologue suggests that selective pressure for conservation of amino acid sequence is still maintained at this locus.

Volume adjustment of mechanics and diffusion in interstitial lung disease. Lack of clinical relevance

Relationships of lung mechanics and diffusion to lung volume were examined in 38 patients with interstitial lung disease to determine whether patterns of reduction relate to severity of disease, distinguish histologic characteristics or predict prognosis for reversibility. Normal volume-related values for both mechanics and diffusion were seen throughout the range of severity of disease. The ratio of mechanics to lung volume did not correlate with the ratio of diffusion to lung volume in the same patient. Volume relationships of mechanics and diffusion failed to distinguish pathologic predominance of fibrosis or inflammation/granulomas. These ratios failed to predict reversibility in patients who had repeated tests. These results suggest that in patients with interstitial lung disease the significance of "volume-adjustment" of mechanics and diffusion should be viewed with caution; these parameters do not appear to contribute to the assessment of pathophysiology or correlate with clinical spectrum of interstitial lung diseases.

Expression and function of HLA-A2.1 in transgenic mice

We have derived a number of transgenic mouse lines which express the human major histocompatibility complex class I gene HLA-A2.1. Two lines carry the complete human HLA-A2.1, the others bear a recombinant gene in which the HLA-A2.1 coding regions are fused to the H-2Kb promoter. Analysis of transgenic spleen cells by immunofluorescence demonstrates that these mouse cells express HLA-A2.1 on their surface in association with mouse beta 2-microglobulin (beta 2m), confirming that HLA-A2 does not require human beta 2m to be expressed at the cell surface. The cells contain more HLA mRNA than endogenous H-2 class I mRNA. There is also a large pool of non-beta 2m-associated HLA heavy chain inside the cell. In contrast the amount of HLA:beta 2m complex is low. Thus, in transgenic mice HLA-A2 seems to compete poorly with H-2 heavy chains for mouse beta 2m. The HLA-A2.1 transgenic mice do not produce influenza-virus-specific cytotoxic T cells (CTL) restricted to the HLA transgene, at least in sufficient numbers to be measured in a direct bulk CTL assay. The dominance of H-2-restricted clones may be the result of quantitative rather than qualitative factors. However, HLA-A2.1 transgenic spleen cells are effective in stimulating an allogeneic CTL response in normal mice. This response is not H-2 restricted. Cold target inhibition studies show that there are at least two populations of CTL, one of which is specific for HLA-A2.1 on mouse cells. This result suggests that at least some allo-CTL are directed against major histocompatibility complex plus "self-peptide".

An insertion mutation in the pol gene of Moloney murine leukemia virus results in temperature-sensitive pol maturation and viral replication

An insertion mutation in the pol gene of Moloney murine leukemia virus (M-MuLV) was found to render the virus temperature-sensitive for replication. A provirus containing a 12-bp insertion at the boundary between the reverse transcriptase (RT) and integrase (IN) domains induced the formation of mutant virions containing a partially processed RT-IN fusion protein. Some proteolytic processing to form mature RT and IN was observed at 32 degrees, but only aberrantly processed proteins were detected at 39 degrees. The uncleaved precursor was found to exhibit DNA polymerase activity, even though it could not support replication of the virus in vivo at 39 degrees.

BioSYNTHESIS: bridging the information gap

BioSYNTHESIS is a prototype intelligent retrieval system under development as part of the IAIMS project at Georgetown University. The aim is to create an integrated system that can retrieve information located on disparate computer systems. The project work has been divided in two phases: BioSYNTHESIS I, development of a single menu to access various databases which reside on different computers; and BioSYNTHESIS II, development of a search component that facilitates complex searching for the user. BioSYNTHESIS II will accept a user's query and conduct a search for appropriate information in the IAIMS databases at Georgetown. For information not available at Georgetown, such as full text, it will access selected remote systems and translate the search query as appropriate for the target system. The search through various computer systems and different databases with unique storage and retrieval structures will be transparent to the user. BioSYNTHESIS I is complete and available to users. The design work for BioSYNTHESIS II is under development and will continue as a multiyear technical research effort of the proposed Georgetown IAIMS implementation project.

A novel method of electrophoresis for the separation of individual human serum glycoproteins

A method for the isolation of protein components by a combination of polyacrylamide gel electrophoresis and electro-extraction of slices of gel contained in cellophane dialysis tubing, using the H tube electrophoresis apparatus, is described. The method was applied to the purification of individual human serum glycoproteins. Although the glycoproteins have widely differing electrophoretic mobilities, they appeared to be antigenically interrelated judging from their complex "spurring" in Ouchterlony double gel diffusion tests.

Diagnostic amniocentesis and bacteraemia

Thirty antenatal patients with intact membranes were studied to determine the incidence of bacteraemia induced by transabdominal amniocentesis. No bacteraemias were detected following the procedure. Antibiotic prophylaxis is probably not warranted for immunocompetent hospitalized patients undergoing amniocentesis.

Hemangioma of the umbilical cord

Tumors of the umbilical cord are extremely rare. Only two types are recognized: hemangioma and teratoma. A case of hemangioma of the cord prompted a review of the world literature that uncovered 17 other cases, bringing the total number of known cases up to 18. Our case is the first to be diagnosed by ultrasonography and was associated with polyhydramnios.

The Mirizzi syndrome: preoperative diagnosis by sonography and transhepatic cholangiography

Common hepatic duct obstruction from an impacted calculus in the cystic duct is an uncommon cause of jaundice. The complimentary role of both transhepatic cholangiography and sonography can facilitate and assist the physician in making a preoperative diagnosis of Mirizzi syndrome and prevent an unnecessary choledochotomy and exploration of the common bile duct.

Hypercapnia in the obstructive sleep apnea syndrome. A reevaluation of the "Pickwickian syndrome"

The mechanisms of hypercapnia in eight patients with the "Pickwickian" syndrome and obstructive sleep apnea (OSAS) were evaluated pretherapy and posttherapy (tracheostomy in seven patients and chronic nocturnal use of nasal CPAP in one). Four patients (correctors) became eucapnic within two weeks of therapy. Four others (noncorrectors) remained hypercapnic. Neither residual apneas, changes in pulmonary function, change in anatomic dead space, nor changes in ventilatory chemoresponsiveness differentiated the two groups, nor did the last three factors account for return to eucapnia in the correctors. The results indicated two separate mechanisms exist for chronic hypercapnia in OSAS: a critical balance between the ventilation during the time spent awake and hypoventilation due to apneas, a mechanism removed by treatment for obstructive apnea; and sustained hypoventilation independent of the apnea phenomenon and therefore not correctible. The subset of patients with the second mechanism appears to represent the true "Pickwickian" syndrome and can be identified before therapy by measuring a low level of ventilation in the sustained awake state.

Oncocytoma in a horseshoe kidney

Renal oncocytoma is an unusual tumor that has been identified with increasing frequency during the last decade, and more than 150 cases have been reported in the literature, including multifocal and bilateral tumors. We report a case of oncocytoma in a horseshoe kidney. Oncocytoma and tumors in horseshoe kidneys are discussed.

Diagnosis of congenital syphilis by immunofluorescence following fetal death in utero

The etiology of fetal death may be difficult to identify, particularly with the presence of marked fetal maceration and autolysis. Immunofluorescence with human antitreponemal antibody was used in this case to establish a diagnosis of congenital syphilis.

MEA III presenting as pheochromocytoma and complicating pregnancy and the puerperium. A case report

A case of multiple endocrine adenopathy (MEA III) presenting as pheochromocytoma complicated the immediate puerperium. The patient presented with paroxysmal changes in blood pressure and episodic headaches with vertigo. Computed tomography identified a left adrenal mass that was diagnosed preoperatively as pheochromocytoma, with the diagnosis subsequently confirmed on histologic sections. Pheochromocytoma complicating pregnancy is rare, and fewer than 150 cases have been reported on. MEA III presenting as pheochromocytoma and complicating the puerperium is described here for the first time.

Multimodality, crossmodality, and dyslexia

It is argued that what we call intelligent behavior is based to a great extent on our ability to analyze multimodal and crossmodal information. Acquisition and utilization of those functions seem to appear and develop greatly during the 2-4 year period in humans. Among the functions are those frequently affected in dyslexic persons. It might be possible to diagnose potential dyslexics by testing for the adequacy of those functions at that early period. In addition, limitations on the number of concepts that can be handled simultaneously may be involved in information processing in such a way as to affect both multimodality and crossmodality; this limitation seems not to be generally taken in to account by educators, especially those working with dyslexic persons.

Relationship of functional residual capacity to static pulmonary mechanics in chronic obstructive pulmonary disease

Static pulmonary mechanics may not be the sole determinant of the functional residual capacity (FRC) in the chronic obstructive pulmonary diseases (COPD). To assess the relationship of FRC to pulmonary mechanics, pulmonary function tests such as spirometry, lung volumes, maximum expiratory flow volume curves, and single-breath diffusing capacity were related to compliance measurements in 65 patients with stable COPD. Compliance studies were examined over the range of tidal volume and at maximum lung inflation. The results showed that there was a poor correlation between the degree of hyperinflation at FRC and static compliance in the tidal range. However, there was a highly significant correlation between FRC and static lung mechanics at maximum lung inflation, as well as between FRC and diffusing capacity. Thus, in patients with stable COPD, FRC is a useful guide to static recoil properties of the lung as assessed at maximum lung inflation. Lung compliance measurement in tidal range may not reflect this relationship. An increase in FRC remains a useful index of pulmonary emphysema, even in the presence of chronic airway disease.

CO2 rebreathing and exercise ventilatory responses in humans

The relationship between the resting response to CO2 rebreathing and the ventilatory response to CO2 production during exercise was examined in 20 healthy untrained male subjects and in six patients with obesity hypoventilation syndrome. Patients were chosen because of a severely reduced response to CO2 rebreathing. There was no correlation between the CO2 rebreathing response and the exercise ventilatory response in the normal subjects, the patients, or in the group considered as a whole. This lack of correlation could not be accounted for by differences in ventilatory and occlusion pressure responses nor by reporting responses as a function of a change in hydrogen ion concentration. The independence of the CO2 rebreathing response and the exercise ventilatory response suggests the CO2 rebreathing response does not measure the relevant parameters of ventilatory control during exercise.

Hürthle-cell tumor arising in the mediastinal ectopic thyroid and diagnosed by fine needle aspiration. Light microscopic and ultrastructural features

The light microscopic and ultrastructural features of a Hürthle-cell tumor arising in the ectopic mediastinal ectopic thyroid and diagnosed by fine needle aspiration are presented. Although it lacked clear-cut cytologic features of malignancy, the tumor was clinically malignant, having metastasized to the lungs. Hürthle-cell tumors of the thyroid are unpredictable in their biologic behavior, and the absence of clinical and/or pathologic evidence of malignancy at the time of diagnosis is no guarantee of a benign outcome.

Meperidine-induced sinusoidal fetal heart rate pattern and reversal with naloxone

A case of sinusoidal fetal heart rate (FHR) pattern in association with maternal intrapartum administration of meperidine is presented. The sinusoidal pattern was reversed after maternal intrapartum administration of naloxone. The significance of this problem and the management of patients with sinusoidal FHR are discussed. The conclusion is reached that iatrogenic causes may at times precipitate a sinusoidal FHR pattern and conservative management may be appropriate.

Regulation of ventilation in the obstructive sleep apnea syndrome

The recent recognition of the sleep apnea syndrome has forced a re-evaluation of the mechanism of hypercapnia and disordered respiratory control in obese patients. Thirteen obese patients with sleep apnea were studied in an attempt to relate the pattern of sleep abnormality and awake ventilatory control to the presence of chronic hypercapnia. Patients with hypercapnia and/or hypoxemia had reduced ventilatory responses to hypercapnic and hypoxic stimulation, respectively. The presence of hypercapnia, however, did not separate the patients with respect to type, duration, or frequency of apneas. The degree of awake chemical drives could not be related to the severity of the sleep apnea phenomenon. However, patients with intact ventilatory control demonstrated augmented ventilation after apneas, which may explain their eucapnic state.

Metastatic malignant fibrous histiocytoma in lung examined by fine needle aspiration: case report and literature review

Malignant fibrous histiocytoma appears to be emerging as one of the most common soft tissue sarcomas of late adult life. Cytologic features of a metastatic malignant fibrous histiocytoma in the lung, examined by fine needle aspiration, are reported. Essentially, four cell types in various proportions were observed: spindled cells, pleomorphic giant cells, undifferentiated mesenchymal-type cells and rare signet ring "lipoblast-like" cells. There also were several huge hyperchromatic and often bizarre naked nuclei.

Flow-volume curve contour in COPD: correlation with pulmonary mechanics

A study was designed to evaluate the diagnostic usefulness as well as the mechanical determinants of the flow-volume contour in chronic obstructive pulmonary disease (COPD). Twenty patients with COPD of varying etiology were divided equally into two groups. Group 1 had an airway collapse pattern (described in the text) designated type 1, and group 2 had a more curvilinear obstructive pattern designated type 2. Pressure, volume, and flow relationships were examined. The results of our studies showed that a type 1 flow-volume contour in a patient with obstructive airways disease suggests a critical combination of central and peripheral airway collapse at high lung volumes with loss of elastic recoil. However, not all patients with loss of recoil will exhibit this contour. Persistence of type 1 contour suggests that there is a component of airway instability which may be irreversible.

[Modern aspects of dental photography]

Potential areas of application for dental photography were described. The choice of the camera body depends on the intended use. The Medical Nikkor 5.6/200 and the Yashica Medical 100 lenses as well as an extension tube with approximately 100 mm focal distance may be used; the latter is best combined with a circular flash unit or one to two standard flash units. A cheek-holder and mirror are necessary. A few practical tips were presented.