[Pyogenic liver abscess as a complication of Crohn's disease]

Pyogenic liver abscess in patients with Crohn's disease is not common, but the mortality has been reported to be high if diagnosis and treatment is delayed. Intra-abdominal abscesses, fistulous disease, and steroid therapy have all been reported to be important predisposing factors in the pathogenesis of this entity. We present a patient with Crohn's disease in whom multiple abscesses were encountered in the right lobe of the liver. The diagnosis of liver abscess was established by abdominal computed tomography and the patient was treated by percutaneous catheter drainage. Awareness of this rare complication is important because diagnosis is difficult to make and a high index of suspicion is required. Once suspected, aggressive diagnostic workup and treatment is indicated. Most patients with liver abscess can be successfully managed by percutaneous catheter drainage combined with antibiotic therapy if it is diagnosed before extensive necrosis has occurred.

Protein kinase inhibitors disrupt memory formation in two chick brain regions

The amnesic effects of protein kinase inhibitors (H-7, HA-156, TFP, W-9, and W-13) on memory formation for a one trial peck-avoidance task in chicks were investigated with bilateral and unilateral injections into either the left or the right intermediate medial hyperstriatum ventrale (IMHV) or the left or right lobus parolfactorius (LPO). All five inhibitors injected bilaterally 5 min pretraining into either the IMHV or LPO or unilaterally into the left IMHV produced amnesia. Unilateral injections into the right IMHV did not produce amnesia. Unilateral injections of W-9 or W-13 into the left but not the right LPO produced amnesia, H-7, HA-156, or TFP did not produce amnesia when injected unilaterally into either the left or right LPO. The time of onset of amnesia produced by injecting TFP and W-13 into the LPO occurred 45 min after training, whereas H-7 produced amnesia significantly later (90 min after training). Amnesia induced by TFP, W-13, and H-7 injected into the LPO occurred significantly later than amnesia produced when these agents were injected into the IMHV. Together these data suggest that the IMHV and LPO process memory sequentially using various protein kinase activities.

Protein kinase C inhibitor chelerythrine disrupts memory formation in chicks

Chelerythrine (CHELE), a specific, potent protein kinase C (PKC) inhibitor, disrupts memory formation for a one-trial peck-avoidance task. Three predictions were made about how CHELE, injected into chick brain near the time of training, would affect memory formation, based on previous work with two classes of protein kinase inhibitors (M. R. Rosenzweig et al., 1992; P. A. Serrano et al., 1994) and the in vitro inhibition of PKC by CHELE: (a) CHELE, injected into the intermediate medial hyperstriatum ventrale, would significantly impair memory formation; (b) the amnestic dose would be approximately 10 nmol; (c) CHELE would not produce amnesia for about 45 min after training, but significantly impair memory by 60 min. Experimental tests confirmed each prediction. This study adds to evidence that PKC activity is part of a cascade of neurochemical events initiated by learning and that PKC activity shortly after training is necessary for long-term memory.

[Carcinoma of the esophagus: risk factors of morbimortality following esophagectomy]

OBJECTIVE

To identify which perioperative risk factors are associated to postoperative morbidity and mortality in patients with carcinoma of the esophagus.

DESIGN

We analyzed 8 perioperative risk factors: age, preoperative hospital stay, intraoperative blood transfusions, tumor stage, histology, grade of tumor differentiation, prior respiratory disease, surgical treatment.

PATIENTS

Forty-six patients with esophageal carcinoma who underwent surgical resection.

RESULTS

1) Morbidity: There was statistical significance between the increase in postoperative morbidity and age > 75 years (p < 0.001), advanced stage of disease (p < 0.001), preoperative hospital stay higher than 20 days (p < 0.05) and severe respiratory disease (p < 0.05). 2) Mortality: There was a statistically significant increase in postoperative mortality in patients with preoperative hospital stay higher than 20 days and in patients > 75 years.

CONCLUSIONS

The incidence of postoperative morbidity and mortality in esophageal cancer varies according to age, prior respiratory disease, tumor stage and preoperative hospital stay.

Differential effects of protein kinase inhibitors and activators on memory formation in the 2-day-old chick

Thirteen protein kinase inhibitors (PKIs) were investigated in chicks for their in vitro effects on PKC activity and for their in vivo effects on memory formation for a peak-avoidance task. Amnesia occurred by 15-30 min post-training when agents that inhibit primarily Ca2+/calmodulin were injected into brain. Amnesia occurred by 60 min post-training when agents that inhibit PKC-, PKA-, and/or PKG-dependent protein kinases, but not Ca2+/calmodulin, were injected. Enhancement of memory formation was accomplished by injecting bradykinin, but not forskolin. Both of these agents, however, attenuated the amnesia produced by H-7. These results are discussed as relevant neural processes involved in memory and synaptic plasticity.

Short-term, intermediate-term, and long-term memories

This paper focuses on the temporal dimension of memory formation and storage. Is the usual two-fold separation between short-term memory (STM) and long-term memory (LTM) sufficient to encompass all the phenomena of memory? The traditional view is that STM grades into LTM. Evidence for an intermediate-term memory (ITM) has been proposed by some investigators. We have used both rats and chicks to investigate the stages of memory formation. In this paper, the advantages of chicks for this type of research are briefly discussed. Using a paradigm that produces weak training, the retention function for control chicks appears to be made up of four successive components which we have interpreted as representing the memory buffer, STM, ITM, and LTM. In experiments using a variety of kinase inhibitors, we have obtained evidence that ITM and LTM depend on different classes of protein kinase activities. Agents that act on calcium/calmodulin kinase cause amnesia in the ITM range--15 to 30 min post-training. Another class of inhibitors act on one or more of the kinases PKA, PKC, or PKG and cause amnesia by 60 min post-training, so we interpret this group of inhibitors as inhibiting the formation of LTM. However, the three-stage model of memory may be over-simple. For example some agents including [Leu]enkephalin and MK801 cause amnesia 4 or more h after training.(ABSTRACT TRUNCATED AT 250 WORDS)

[Determination of the tumor marker CA 72-4 in gastric carcinoma]

In this study, the authors determined the sensitivity and specificity of the new tumor marker CA 72-4 in detecting adenocarcinoma of the stomach. CA 72-4 serum levels were investigated in 279 patients consisting of: 100 control subjects, 88 patients with benign gastrointestinal disease and 91 patients with gastrointestinal cancer (31 with gastric cancer). We used a cut-off of 5 U/ml. The specificity of CA 72-4 was 91% and the sensitivity was 68%. Highest levels of CA 72-4 were found in patients with more advanced tumor (stages III-IV) and four of 5 patients with stage I had elevated levels of this tumor marker. These findings suggest that the use of serum CA 72-4 measurements may be more useful than other tumor markers in the diagnosis, prognosis and detection of recurrence in patients with gastric cancer. Although CA 72-4 can be elevated in other gastrointestinal adenocarcinomas, it can be useful in alerting the clinician to the possible presence of an intraabdominal neoplasm.

Comparative study of roles of the lobus parolfactorius and intermediate medial hyperstriatum ventrale in memory formation in the chick brain

Two discrete areas of the chick brain, the intermediate medial hyperstriatum ventrale (IMHV) and lobus parolfactorius (LPO), were found to have different functions during the formation of memory for a 1-trial peck-avoidance paradigm. Glutamate, ouabain, and emetine, known to disrupt short-, intermediate-, and long-term memory when injected into the IMHV, were injected into the cerebellum and LPO. All amnestic agents investigated produced amnesia when injected into the IMHV; only one of these agents produced amnesia when injected into the LPO, and none of the agents produced amnesia when injected into the cerebellum. The chick brain was also found to exhibit hemispheric asymmetries: The left IMHV and LPO were more sensitive to the amnestic agents than their corresponding right structure. From these data, hypotheses for the roles of these structures during memory are proposed.

[Stimulation of the central dopaminergic receptor in essential hypertensive patients using amantadine]

At present, evidence has been accumulating that point out that some central nervous structures, of oblongata to the limbic system, are primarily involved in the control of systemic arterial pressure (AP). In agreement with several experimental and clinical works, a hypothesis has been suggested that a functional defect of the central dopaminergic system could be involved in the etiopathogenesis of essential hypertension (EH). With the objective of analyzing this hypothesis, the effect of dopamine (DA) agonist, amantadine (Am) on heart rate (HR), AP, plasma catecholamines (CA, PCA), urinary DA, noradrenaline (NA), adrenaline (A), vanilmandelic acid (VMA) and homovanillic acid (HVA), was studied in 19 females with established EH. The study included 2 periods: "placebo" and "drug", each one lasting 22 days, with a register of HR and AP in clino and orthostatism, taken every 3-4 days; at the end of each period, CA and their metabolites were measured. During the drug period, oral Am clorhidrate (300 mg/day, t.i.d.) was administered. With the drug, HR was not change with respect to the placebo period; but the AP in both positions, just as PCA, DA, NA and HVA, showed a highly significant decrease; A and VMA displayed a less significant decrease from the statistical point of view. The obtained results and literature data support the hypothesis that in EH there probably exists a genetic disfunction of the inhibitory central dopaminergic receptor of peripheral sympathetic activity, which is susceptible to compensation by use of several dopaminergic agonists, such as Am.

[Pheochromocytoma and catecholamines. Experience in 63 cases studied for 25 years]

The usefulness of fluorimetric techniques in the diagnosis of pheochromocytoma was investigated. In the 63 cases studied during 25 years by measuring simultaneously various aminergic parameters, including plasma catecholamines and urinary adrenaline (A), noradrenaline (N) and vanilmandelic acid (VMA), we were able to establish the diagnosis of pheochromocytoma in all cases. Adrenaline excretion was found to be higher in patients with tumors located on the adrenal region, whereas N excretion was predominantly increased in patients with extra-adrenal tumors. In patients having tumors smaller than 50 g, A + N excretion was higher and VMA was lower than in those whose tumors were heavier; therefore in cases with small tumors the ratio VMA/A + N was lower than in those with larger tumors. It is concluded that simultaneous measurements of PC, A, N and VMA allow the diagnosis to be made in the most patients with this tumor. On the other hand, the predominant increase in A excretion is suggestive of adrenal pheochromocytoma.

[Effect of inhibition of converting enzyme by captopril on arterial pressure, renin and aldosterone in essential hypertension]

The response of arterial blood pressure, plasma renin activity (PRA) and plasma (PA) or urinary aldosterone (UA) concentrations to the administration of captopril, was studied in patients with established essential hypertension. Captopril was effective in lowering significantly the blood pressure (189.4/111.2 +/- 23.9/9.7 to 163.4/98.1 +/- 20.7/8.6 mmHg. mean +/- SD, p less than 0.01/0.001). Normal arterial blood pressure values (140.4/86.5 +/- 20.7/10.8 mmHg, were achieved by the addition of hydrochlorothiazide. Captopril administration was followed by a decrease in PA and in UA and an increase in PRA, suggesting the inhibition of angiotensin II formation. Captopril attenuated hypokalemia and hyperaldosteronism produced by the simultaneous administration of hydrochlorothiazide.

[Primary aldosteronism. Diagnostic aspects and treatment]

Despite the relatively low frequency of primary aldosteronism, its diagnosis is of great importance because surgical treatment results, in the majority of cases, in the disappearance of arterial hypertension. We present in this paper six cases with this type of secondary hypertension. The disease was suspected by the coexistence of hypertension and hypokalemia. The decrease in serum potassium after an oral load of salt proved to be of great value for the diagnoses. In the five patients treated surgically, the removal of the tumor produced the normalization of the arterial pressure and corrected the biochemical alterations. In four of the patients the tumor was located in the left adrenal gland and in one in the right adrenal gland. The patient not treated surgically has remained normotensive with spironolactone. This data confirm what has been described in the medical literature and emphasizes the importance of a correct diagnosis and treatment in patients with this form of hypertension.

[Effect of sub-pressor doses of dopamine on renin secretion in the anesthetized dog]

The effects of dopamine, its precursor L-dopa, and the dopaminergic agonist bromocriptine (BEC), on plasma renin activity (PRA), in pentobarbital anesthetized male dogs were investigated. Infusion of dopamine at a dose which did not change blood pressure ( 4 ug/kg/min) had no effect on the secretion of renin, nor did it produce modifications in the PRA response to furosemide (10 mg i.v.). L-dopa, in single dose of 500 mg (p.o), significantly augmented PRA two hours after administration, and the renin values remained elevated throughout the observation period of 120 minutes. However, BEC (2.5 mg p.o.) produced no changes in PRA during this time period. We conclude that at the dose utilized, dopamine apparently has no influence on the secretion of renin, and does not modify the increase in PRA provoked by diuretic. It is possible that the L-dopa induced augmentation in PRA is due to stimulation of the juxtaglomerular cells, by the noradrenaline formed in peripheral tissues from administered L-dopa.

Dopamine excretion in benign pheochromocytoma

Dopamine excretion is reported in 27 patients with benign pheochromocytoma. In 21 patients the tumours were in the adrenal (one patient, bilateral), four were extra-adrenal, and two were assumed to be so since they were not found at laparotomy. Dopamine excretion was found to be higher in the patients with extra-adrenal tumours and in one patient--with bilateral pheochromocytoma. Slight increase of dopamine excretion was found in two of the remaining patients. These observations--indicate that while increased dopamine excretion may be present in patients with malignant pheochromocytoma it can be also increased in some patients with benign tumours.

[Hypotension, mental disorders and changes in catecholamine excretion observed during the administration of disulfiram in a case of pheochromocytoma]

A case of pheocromocytoma treated with disulfiram during ten days in described. Hypotensive and psychiatric effects were observed, which disappeared upon discontinuation of the drug. Urinary amines decreased while the drug was used, and upon interruption of its administration dopamine increased, as a rebound phenomena probably due to availability of tissue dopamine previously blocked by DBH inhibition. The effect of simultaneous administration of alpha-methyldopa is considered.

[Arterial damage and the renin-angiotensin system in essential hypertension. Study of 63 cases]

Brunner, Laragh et al. have suggested that essential hypertensives with low plasma renin activity (PRA) are at lower risk of myocardial infarction or cerebrovascular accidents than those with high or normal PRA levels. In this paper we report on 63 patients with essential hypertension in whom the relation between PRA and the ocurrence of cardiovascular events was studied. The patients were categorized in high (11%), normal (70%) or low (19%) PRA subgroups, according to their 24-hour sodium excretion. Coronary angiogram was performed in 24 subjects. The three subgroups showed no significant differences in diastolic blood pressure, serum cholesterol levels, smoking habits or obesity. The incidence of cardiovascular complications was similar in patients with high or low PRA levels (28.5% and 33.3% respectively). In those hypertensives in whom coronary angiogram was done, coronary lesions were observed in 80% of the low renin subjects and in 37.5% of those patients with normal PRA. Therefore, no relation between PRA levels and vascular complications was observed in this series of patients. It is conclude that patients with essential hypertension must be treated as soon and effectively as possible regardless of their PRA value.

[The renin angiotensin system in the pathology of arterial hypertension of aortic coarctation]

Nine patients with aortic coarctation were studied. On the fourth day of a low diet, blood samples were obtained for plasma renin activity (PRA) at 8:00 A.M., 11:00 A.M. and 5:00 P.M. On the same day a 24 hour urinary collection was obtained for the determination of aldosterone excretion. The following day 60 mg. of furosemide were given orally at 8:00 A.M. and another blood sample was drawn at noon. This study protocol was done before and after surgical correction of the aortic lesion. Mean systolic and diastolic blood pressure decreased significantly (P less than 0.005), while mean PRA and urinary aldosterone values showed no significant modifications after surgery. With these results, it is concluded that the renin-angiotensin-aldosterone system, does not seem to play a role in the chronic hypertension of the coarctation of the aorta. However, tests with angiotensin II specific blockers have to be performed before a definite conclusion can be drawn on this point.

[Renin-angiotensin-aldosterone system in the treatment of essential hypertension with a beta-adrenergic blocker: sotalol]

The administration of beta blockers has been useful in the treatment of essential hypertension. The anti-hypertensive effect of the beta-blocker sotalol was evaluated in 28 patients with essential hypertension. In all of the patients a determination of urinary aldosterone and plasma renin activity, before and after, three months of treatment with sotalol was done. In the pre-treatment tests, five patients (18%) had elevated renin values, in 13 (6%) renin was normal, and in 10 (36%) the renin activity in plasma was low. Treatment with sotalol caused normalization or significant lowering of diastolic pressure in the majority of cases with high or normal plasma renin. Patients with low plasma renin activity had less satisfactory results with the drug. Since there was no correlation between the lowering of arterial pressure and the degree of depletion of renin, we can conclude that anti-hypertensive mechanism of sotalol does not come from the decrease in secretion of renin. However our results suggest that patients with high renin respond better to treatment with sotalol, than cases with low renin levels.

[Plasma catecholamines; values in normal subjects and its use the localization of pheochromocytoma]

The results of plasma catacholamines obtained from a group of 79 healthy subjects, 35 females and 44 males varied from 2.4 to 26.5 ng/100 ml of plasma. There was no statistical difference due to sex or age. The value of plasma catacholamines in blood samples taken from catheterizations of inferior vena cava in patients with Pheochromocytoma was useful in the localization of the neoplasia in 4 cases which were studied. The maximum values coincide with the side or site of the localization of the neoplasia in the 4 cases. The clinical diagnosis of pheochromocytoma was suspected in the other three cases which were not catheterized and in those in which the clinical suspicion was evident. One of these cases was operated on and the tumor was found in the right adrenal gland. The other two patients have refused catheterization as well as the exploratory surgery. One of these is controlled with adequate medication while the other has refused all treatment.

Energy metabolism and hormonal profile in children with edematous protein-calorie malnutrition

Modifications in energy metabolism and endocrine homeostasis (plasma insulin and growth hormone values, glucose and free fatty acid levels, serum thyroxine and TSH, free thyroxine index, and urinary catecholamines) were investigated in eight children with edematous protein-calorie malnutrition. Caloric expenditure was low at admission and correlated linearly with increased caloric intake throughout the study. The hormonal changes at admission were characterized by a negligible insulin response to intravenous arginine or glucose and by markedly elevated growth hormone levels which were neither increased by arginine nor suppressed by intravenous glucose. Serum thyroxine values were low, but free thyroxine index and serum TSH levels were within normal limits. At admission to the study, 24-hour urinary excretion of dopamine and norepinephrine was relatively reduced in relation to the excretion of epinephrine. All these modifications were corrected at time of the recovery study. It is suggested that in edematous protein-calorie malnutrition, insulin acts as the primary regulator of peripheral fuel release and that the high, nonsuppressible growth hormone levels may form part of an important homeostatic mechanism to provide substrates for brain metabolism via lipolysis.

[Dopamine in essential arterial hypertension: excretion of its metabolite homovanillic acid]

The results obtained in a group of 66 hypertensive patients in which the AHV values were 5.7 plus and minus 0.4 mM/24 hrs., were reported. These values were compared to those obtained in 42 healthy subjects: 7.0 plus and minus 0.5 mM/24 hrs. The difference was statistically significant P less than 0.05. The values of excretion of urinary dopamine in both groups were also presented. A value of 225.7 plus and minus 13.0 mug/24 hrs. was obtained for the hypertensives, while the value for the healthy groups was 361.2 plus and minus 16.5. The statistical study in this case showed a high significance p smaller or less than 0.001. There were no changes in the levels of adrenaline and noradrenaline nor in the metabolite of these two amines, that is, AVM.