Growth failure and decreased levels of insulin-like growth factor I in obstructive jaundice are reversed by bile diversion

Insulin-like growth factor I (IGF-I) is one of the principal stimuli of linear growth. Growth failure in children with chronic cholestatic jaundice may be related to decreased hepatic synthesis of IGF-I. It was hypothesized that (1) biliary obstruction would lead to growth retardation and decreased circulating IGF-I levels; and (2) surgical drainage of the obstructed biliary system would reverse these effects. To test this hypothesis, the following study of male Sprague-Dawley rats (135 g; 10 animals per group) was performed. Group I underwent common bile duct ligation (CDL); group II underwent choledochoduodenostomy 2 weeks following CDL; group III were sham-operated and fed with CDL rats; and group IV were sham-operated and fed ad libitum. Daily food intake and weekly body weight were recorded. Statistical analysis was by repeated-measures analysis of variance and individual comparisons were evaluated by Student's t test. Biliary obstruction results in decreased food intake, rate of weight gain, and IGF-I levels. A significant reduction in IGF-I levels was also noted in the pair-fed sham-operated rats (group III). Relief of obstructive jaundice by surgical drainage results in a reversal of these changes. It is concluded that the growth failure and decreased IGF-I levels associated with obstructive jaundice can be reversed by surgical drainage of the obstructed biliary system and, in part, are due to inadequate nutrition.

Impaired clearance and organ localization of Candida albicans in obstructive jaundice

Sepsis is a major cause of morbidity and mortality in infants with cholestatic jaundice. This may be attributed to altered host defense mechanisms. Fungal infection frequently occurs in immunocompromised patients. This study evaluates the effect of biliary obstruction on blood clearance and organ localization of radiolabeled viable Candida albicans. Male Sprague-Dawley rats (140 to 150 g) were placed in 2 groups. Group I (n = 30) were sham-operated controls. Group II (n = 90) underwent ligation and division of the distal common bile duct (CDL). At 1, 2, and 3 weeks following CDL, 10(7) cells/mL radiolabeled viable C albicans were injected via the tail vein. The final distribution of the organisms was calculated and expressed as the mean percent of radiolabeled organisms per gram and per total organ. Blood clearance of C albicans was similarly rapid in both groups. However, there was a significant decrease in the trapping of fungi by the rat liver Kupffer cells (20.3% +/- 7.9% v control 42.5% +/- 15%; P greater than .001), and increased pulmonary localization of bacteria 3 weeks following CDL (53.6% +/- 13.2% v control 41.4% +/- 6.4%). The significant decrease in liver trapping and increased lung localization of C albicans in CDL rats, may result in systemic reemergence of fungi and play a role in the susceptibility to fungal infection in jaundiced subjects.

Intralipid adversely affects reticuloendothelial bacterial clearance

Lipid emulsion is a major caloric source in patients receiving total parenteral nutrition. Cleared by the Kupffer cells of the reticuloendothelial system (RES), lipid emulsion may adversely affect the RES function by decreasing its ability to remove blood-borne bacteria. This study evaluates and compares the blood clearance and organ localization of viable radiolabeled [35S] Escherichia coli following slow intraperitoneal (IP) and more rapid intravenous (IV) administration of a 20% fat emulsion (FE). Sixty male Sprague-Dawley rats weighing 150 g were placed in 6 experimental groups (10 rats per group). Group 1 received IP normal saline (3 mL/d for 3 days); group II received IP FE (20%) (4 g/kg/d for 3 days); and group III received normal saline IV (3 mL/d for 3 days). The remaining animals received a slow (15-minute) IV infusion of FE (4 g/kg/dose) prior to bacterial challenge: group IV at 4 hours; group V at 24 hours; and group IV at 4 and 24 hours. E coli (10(9)/mL) were injected via the tail vein. Blood samples were obtained for clearance study. At 10 minutes, tissue samples (50 to 100 mg) of liver, spleen, kidney, and lung were obtained and processed for liquid scintillation counting. Although rapid bacterial blood clearance was found in all the groups, there was a significant change in organ localization of bacteria. Normal distribution of bacteria in group I was as follows: liver 70.1% +/- 6.2%, spleen 5.2% +/- 1.2%, kidney 0.2% +/- 0.04%, and lung 1.6% +/- 0.6%. There was a slight increase in lung localization of bacteria in rats receiving IP FE (3.7% +/- 1.5%; P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Sex differences in the management of coronary artery disease. Survival and Ventricular Enlargement Investigators

BACKGROUND

Despite the fact that coronary artery disease is the leading cause of death among women, previous studies have suggested that physicians are less likely to pursue an aggressive approach to coronary artery disease in women than in men. To define this issue further, we compared the care previously received by men and women who were enrolled in a large postinfarction intervention trial.

METHODS

We assessed the nature and severity of anginal symptoms and the use of antianginal and antiischemic interventions before enrollment in the 1842 men and 389 women with left ventricular ejection fractions less than or equal to 40 percent after an acute myocardial infarction who were randomized in the Survival and Ventricular Enlargement trial.

RESULTS

Before their index infarction, women were as likely as men to have had angina and to have been treated with antianginal drugs. However, despite reports by women of symptoms consistent with greater functional disability from angina, fewer women had undergone cardiac catheterization (15.4 percent of women vs. 27.3 percent of men, P less than 0.001) or coronary bypass surgery (5.9 percent of women vs. 12.7 percent of men, P less than 0.001). When these differences were adjusted for important covariates, men were still twice as likely to undergo an invasive cardiac procedure as women, but bypass surgery was performed with equal frequency among the men and women who did undergo cardiac catheterization.

CONCLUSIONS

Physicians pursue a less aggressive management approach to coronary disease in women than in men, despite greater cardiac disability in women.

Relationship between Ca(2+)-transport and ATP hydrolytic activities in guinea-pig pancreatic acinar plasma membranes

Partially purified plasma membrane fractions were prepared from guinea-pig pancreatic acini. These membrane preparations were found to contain an ATP-dependent Ca(2+)-transporter as well as a heterogenous ATP-hydrolytic activity. The Ca(2+)-transporter showed high affinity for Ca2+ (KCa2+ = 0.04 +/- 0.01 microM), an apparent requirement for Mg2+ and high substrate specificity. The major component of ATPase activity could be stimulated by either Ca2+ or Mg2+ but showed a low affinity for these cations. At low concentrations, Mg2+ appeared to inhibit the Ca(2+)-dependent ATPase activity expressed by these membranes. However, in the presence of high Mg2+ concentration (0.5-1 mM), a high affinity Ca(2+)-dependent ATPase activity was observed (KCa2+ = 0.08 +/- 0.02 microM). The hydrolytic activity showed little specificity towards ATP. Neither the Ca(2+)-transport nor high affinity Ca(2+)-ATPase activity were stimulated by calmodulin. The results demonstrate, in addition to a low affinity Ca2+ (or Mg2+)-ATPase activity, the presence of both a high affinity Ca(2+)-pump and high affinity Ca(2+)-dependent ATPase. However, the high affinity Ca(2+)-ATPase activity does not appear to be the biochemical expression of the Ca(2+)-pump.

Surgical evaluation of Henoch-Schönlein purpura. Experience with 110 children

Henoch-Schönlein purpura is a disorder of unknown origin that is probably related to an autoimmune phenomenon. This report concerns 110 children (mean age, 6.2 years; range, 6 months to 14 years) with Henoch-Schönlein purpura. Seventy-two (65%) had abdominal pain associated with nausea and vomiting, bloody stool, and upper gastrointestinal bleeding. Sixty patients with abdominal pain were evaluated and treated conservatively. However, 12 patients underwent laparotomy. Six underwent unnecessary appendectomy for wrongly diagnosed appendicitis. Bowel resection was performed in one patient for an obstructive ileal lesion. Six additional patients had intussusception; surgery was required in three, while barium enema reduction was successfully accomplished in three others. Massive gastric hemorrhage required ligation, vagotomy, and pyloroplasty in two instances. One child with severe scrotal pain, hemorrhage, and swelling underwent unnecessary scrotal exploration. Four additional patients with similar symptoms avoided operation after a testicular scintiscan demonstrated good blood flow. A high index of suspicion and early diagnosis of Henoch-Schönlein purpura based on clinical, roentgenographic, and laboratory findings may avoid unnecessary operations in most cases. However, life-threatening complications (hemorrhage, obstruction, and intussusception) may occur and require operative intervention. All of the patients survived.

Active life expectancy for 10,000 Caucasian men and women in three communities

Active life expectancies (ALEs) were calculated using increment-decrement life table techniques for 10,000 Caucasian men and women from three geographic areas. This technique is more appropriate than the single decrement model originally used, and resulting ALE was substantially greater among initially independent men and women aged 65 years: from 9.3 for men and 10.6 for women to 11.3 to 13.0 for men and 15.5 to 17.1 for women. These increases may be attributable to factors other than the change of method, however, including the change in time from 1975 to 1982 and the change from one state to three communities. The sex differences suggest that the added years of life that women have enjoyed over men are neither solely added years of vigor nor solely added years of disability, but added years with the same mix of independence/dependence that the shorter-lived males experience. The age patterns suggest that at any age the future presents a relatively constant expectation of the total duration of dependency, and concordantly, as one ages, there is a relatively uniform decrease in the proportion of active life to remaining years.

Prostaglandin release by normal and osteomyelitic human bones

The release of prostaglandin E (PGE) and prostacyclin (as 6-keto PGF1 alpha) by human osteomyelitic bone, compared with normal (control) bone, incubated in vitro was evaluated. Prostacyclin was the main arachidonic acid metabolite released by normal human bone, and similar quantities were released by osteomyelitic bone. However, PGE production was 5-30-fold higher in osteomyelitic bone, compared with control, thus becoming the major prostanoid in this disease. It is concluded that PGE production is probably involved in the inflammatory and/or bone resorption processes that occur in osteomyelitis.

Isolation and characterization of the calcium- and phospholipid-dependent protein kinase (protein kinase C) subtypes from bovine heart

Protein kinase C was isolated from bovine heart by chromatography on DEAE-Sephacel, phenyl-Sepharose, poly(L-lysine) agarose, and hydroxylapatite. Estimates based upon enzyme recovery indicate 10-20 nmol/min of protein kinase C activity per gram of bovine ventricular myocardium. Hydroxylapatite column chromatography resolved the preparation into two peaks of calcium- and phospholipid-dependent protein kinase activity. By Western blot analysis, peaks 1 and 2 contained subtypes II (beta 2) and III (alpha), respectively. No cross-reactivity was observed, indicating that separation was complete. Type III, the major subtype detected, was subsequently purified to apparent homogeneity by chromatography on phosphatidylserine (PS) acrylamide. Type II activity could not be recovered following phosphatidylserine affinity chromatography. Phospho amino acid analysis showed that type III autophosphorylated at serine residues, whereas type II autophosphorylated at both serine and threonine residues. Among the various phospholipids tested for activity, PS was the most effective. Both subtypes were activated by 1-stearoyl-2-arachidonylglycerol (SAG) in the presence of phosphatidylserine and calcium. Activation of both subtypes occurred at calcium concentrations of less than 1 microM. In addition to several similarities, these two subtypes showed differences in activation and kinetic properties: type II was activated by cardiolipin, 1,2-and 1,3-dioleoylglycerol, and both cis- and trans-unsaturated fatty acids. Type III was activated to a lesser degree by cardiolipin and showed no response to 1,3-dioleoylglycerol. Type III was activated to a greater extent by 1,2-diacylglycerols and by cis-unsaturated fatty acids. In the presence of PS and SAG, type II exhibited substantial activity in the presence of 1 mM ethylene glycol bis(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid (EGTA) without added calcium. Activation of types II and III by unsaturated fatty acids was independent of phospholipid and showed a lower apparent calcium affinity than that observed for activation by phosphatidylserine. These results show that cardiac protein kinase C subtypes II and III were functionally distinguishable and may play unique roles in the regulation of cardiac function.

Pancreatic pseudocyst: successful treatment by percutaneous external catheter drainage

A pseudocyst of the pancreas in a 6-year-old girl persisted for 2 months despite bowel rest and nutritional support. Following percutaneous introduction of a catheter into the cyst under ultrasound guidance and external catheter drainage for 11 days, the pseudocyst resolved completely and permanently. Nonoperative percutaneous techniques for drainage of pancreatic pseudocysts in children may be an effective alternative to surgical intervention.

Impaired hepatic bacterial clearance is reversed by surgical relief of obstructive jaundice

Sepsis is a major cause of morbidity and mortality in infants with cholestatic jaundice. Previous studies have shown that biliary obstruction in rats causes a significant decrease in hepatic phagocytosis of viable Escherichia coli. This study tests this hypothesis and further evaluates whether the impaired function of the reticuloendothelial system of the liver (Kupffer cells) can be reversed by the relief of the biliary obstruction. Male Sprague-Dawley rats (weighing 140 to 150 g) were placed in three groups. Group I (n = 10) consisted of sham-operated controls. In Group II (n = 30), ligation and division of distal common bile duct (CDL) was performed. Group III (n = 30) underwent choledochoduodenostomy 2 weeks following ligation and division of common bile duct. At 1, 2, and 3 weeks following the operation, 10(9) 35S-radiolabeled viable E coli were injected intravenously via the tail vein. At 10 minutes, bacterial distribution in the liver, spleen, kidneys, and lungs was determined. Tissue samples (50 to 100 mg) from each organ were processed for liquid scintillation counting. The final distribution of bacteria was calculated from the input specific activity (dpm/bacteria) and expressed as the mean percentage of injected viable E coli per gram of tissue and per total organ weight. There was a significant decrease in the trapping of bacteria by the liver's Kupffer cells in rats in group II, at 2 and 3 weeks following CDL (45.0% +/- 14.0% and 15.1% +/- 4.9%, respectively, v controls 75.9% +/- 13.7%; P less than .005).(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium transport activity of rat cardiac sarcoplasmic reticulum isolated in the presence of dithiothreitol

We examined the effect of dithiothreitol (DTT) on the isolation and calcium transport properties of rat cardiac sarcoplasmic reticulum (SR). DTT at a concentration of 4 mM was included in the homogenization/initial isolation and the high-salt (KCl) buffers used in the preparation of the SR fraction. The inclusion of DTT in the SR isolation media did not affect the total amount of SR protein isolated from ventricular tissue. However, SR isolated in the presence of DTT exhibited a significantly increased (p less than 0.05) rate of calcium transport at free calcium concentrations ranging from 0.1 microM up to 2.0 microM, and a 26% increase in the apparent affinity of the SR calcium transport system for CA2+. DTT included in the calcium-transport reaction medium did not significantly alter the rate of SR calcium transport in SR preparations isolated in the absence or presence of DTT. These results demonstrate that functionally important sulfhydryl groups of the SR calcium transport pump may be oxidized during the isolation of the membrane fraction and that such oxidation can be reduced by including DTT in the isolation buffers.

Hypercholesterolemia in long-term survivors of heart transplantation: an early marker of accelerated coronary artery disease

Coronary artery disease remains a significant long-term problem for survival after heart transplantation. Hyperlipidemia is a known risk factor for coronary artery disease in the general population, but the role of hyperlipidemia in cardiac allograft recipients has not been elucidated. To study this problem, we retrospectively reviewed 38 heart transplant recipients who survived more than 3 years after surgery and looked at age, development of diabetes, drug protocol, and development of hypercholesterolemia for a possible correlative or predictive value to the development of early coronary artery disease after heart transplantation. Eleven patients were identified as having coronary disease by the third year after transplantation. High-risk cholesterol values (in milligrams per deciliter) at 6 months after heart transplantation were defined as follows: for ages 10 to 20, 190; 20 to 30, 220; 30 to 40, 240; 40+, 260. We found a strong predictive value with high-risk lipid profiles (p less than 0.01) for the development of coronary artery disease by the third year. No significance was found for a low-risk value, the development of diabetes, or hypertension. All patients below the age of 20 years had coronary artery disease by the third year after transplantation. We conclude that a high-risk cholesterol value at 6 months after transplantation is a strong predictor for development of accelerated coronary artery disease and early graft failure. This has major implications for management of hyperlipidemia in the cardiac allograft recipient.

A non-specific Ca2+ (or Mg2+)-stimulated ATPase in rat heart sarcoplasmic reticulum

ATPase activity in rat heart sarcoplasmic reticulum was stimulated in a concentration-dependent manner by both Ca2+ and Mg2+ in the complete absence of the other cation. Increasing concentrations of Mg2+ produced an apparent inhibition of the Ca2(+)-dependent ATP hydrolysis. CDTA (trans-1,2-diaminocyclo-hexane-N,N,N',N'-tetraacetate) had no effect on these responses. The results indicate the presence of a low affinity non-specific divalent cation-stimulated ATPase in rat heart sarcoplasmic reticulum. However, sarcoplasmic reticulum vesicles transported Ca2+ with a high affinity (K0.5 Ca2+ = 0.41 microM) suggesting the presence of a high affinity Ca2(+)-transporting ATPase. Calmodulin did not stimulate rat heart sarcoplasmic reticulum ATPase activity over a range of Ca2+ and Mg2+ concentrations and failed to stimulate membrane phosphorylation and Ca2+ transport into sarcoplasmic reticulum vesicles. Calmodulin antagonists trifluoperazine and compound 48/80 did not affect the ATPase activity. Catalytic subunit of cAMP-dependent protein kinase was also ineffective in stimulating the ATPase activity. These results suggest the presence of an ATPase activity in rat heart sarcoplasmic reticulum with different properties from the high affinity Ca2(+)-pumping ATPase previously characterized in dog heart and other species.

Thoraco-abdominal enteric duplication with meningocele, skeletal anomalies and dextrocardia

We describe an infant with an enteric thoraco-abdominal duplication arising in the proximal jejunum and associated with a dorsal meningocele, dextrocardia, agenesis of ribs and hypoplasia of the left arm. Diagnosis was reached post-operatively and the infant died of cytomegalovirus pneumonitis. Results of the postmortem examination are presented. Awareness of this rare malformation is required in order to reach a timely diagnosis and to plan a suitable operative approach.

Genetic analysis of anthropometric measures in 11-year-old twins: the Medical College of Virginia Twin Study

We have conducted a cross-sectional analysis of the genetic and environmental contributions to the variance of anthropometric measurements in children during early adolescence. Univariate path analysis was used to estimate the relative contributions of genes, individual environment, and family environment to measures of childhood obesity in 259 11-y-old Caucasian twin pairs. Triceps, subcapular, and suprailiac skinfold thicknesses, as well as waist circumferences, ht, and wt were measured in a standardized protocol. In this sample, a parsimonious model that included only additive genetic effects and environmental factors unique to the individual provided an adequate explanation for the variation in ht, wt, quetelet index, and subscapular and triceps skinfolds. In this largely preadolescent population, different magnitudes of genetic effects were seen in males and females for waist circumference, biiliac diameter, and suprailiac skinfold.

Designing the national resident assessment instrument for nursing homes

In response to the Omnibus Reconciliation Act of 1987 mandate for the development of a national resident assessment system for nursing facilities, a consortium of professionals developed the first major component of this system, the Minimum Data Set (MDS) for Resident Assessment and Care Screening. A two-state field trial tested the reliability of individual assessment items, the overall performance of the instrument, and the time involved in its application. The trial demonstrated reasonable reliability for 55% of the items and pinpointed redundancy of items and initial design of scales. On the basis of these analyses and clinical input, 40% of the original items were kept, 20% dropped, and 40% altered. The MDS provides a structure and language in which to understand long-term care, design care plans, evaluate quality, and describe the nursing facility population for planning and policy efforts.

Acetaminophen hepatotoxicity: is there a role for prostaglandin synthesis?

The hepatotoxicity of acetaminophen (APAP) overdose depends on metabolic activation to a toxic reactive metabolite via hepatic mixed function oxidase. In vitro studies have indicated that APAP may also be cooxidized by prostaglandin H synthetase. The present experiments were designed to assess the possible contribution of hepatic prostaglandin synthesis to APAP toxicity. Adult fed male mice were overdosed with 400 mg APAP/kg. Liver toxicity was estimated by measurement of serum transaminases. Hypertonic xylitol or sodium chloride (2250 mOsm/l), administered intragastrically to stimulate prostaglandin synthesis, increased APAP toxicity. By contrast, the cyclooxygenase inhibiting drugs aspirin (at 25 mg/kg) and indomethacin (at 10 mg/kg) protected against APAP-induced toxicity. APAP kinetics were not affected by hypertonic xylitol or indomethacin, nor were hepatic glutathione levels in overdosed mice. Imidazole, a nonspecific thromboxane synthetase inhibitor, also protected overdosed mice. This drug prolonged hexobarbital sleeping time and prevented the depletion of hepatic glutathione that followed APAP intoxication. Thus, the data support the conclusion that APAP-induced hepatoxicity may be modulated not only by inhibition of cytochrome P450 mediated oxidation, but also by controlling hepatic cyclooxygenase activity.

Improved resolution of the initial fast phase of heavy sarcoplasmic reticulum Ca2+ uptake by Ca2+:antipyrylazo III dual-wavelength spectroscopy

The effect of ATP upon difference absorbance due to Ca2+ and Mg2+ complexation with the metallochromic dye, Antipyrylazo III (AP III), was investigated. At divalent cation concentrations appropriate for Sarcoplasmic Reticulum Ca2+ transport, wavelengths (greater than 670 nm) were found whereupon the addition of up to 1mM nucleotide did not alter divalent cation:AP III difference absorbance. At these sample wavelengths an initial rapid uptake of Ca2+ by Heavy SR (HSR) was clearly resolved by dual wavelength spectroscopy of Ca2+:dye difference absorbance. Elimination of ATP interference of Ca2+:AP III absorbance by Mg2+ elevation (3-10mM) was shown to be an inappropriate general strategy for AP III spectroscopic studies of HSR Ca2+ transport due to Mg2+ inhibition of ryanodine receptor mediated Ca2+ release.

Familial Hirschsprung's disease--a report of 22 affected siblings in four families

Twenty-two infants, belonging to four families from Gaza, presenting with typical features of Hirschsprung's disease are reported. Eight patients died at home shortly after birth, prior to 1974, due to low intestinal obstruction. Fourteen patients were referred to Hadassah University Hospital after 1974 and diagnosed, by rectal biopsy, as having Hirschsprung's disease. Thirteen underwent laparotomy and multiple intestinal biopsies. Ten had total intestinal aganglionosis, two had total or near total aganglionosis, and in only one patient was the common rectosigmoid aganglionosis found. One patient died prior to surgery. This unusual familial disease, involving very long aganglionic segments, raises the possibility that these infants suffered from a unique variant of Hirschsprung's disease.