Capsaicin effects on substance P and CGRP in rat adjuvant arthritis

The effects of capsaicin on the sensory neuropeptides substance P and calcitonin gene-related peptide were analyzed in the ankle joints and dorsal root ganglia (L2-L6) of adult female Lewis rats. The study included 23 normal rats and 23 arthritic rats, all injected subcutaneously with capsaicin (total dose 200 mg/kg bw). Another two groups of animals from a previous study, i.e., 23 normal rats and 23 arthritic rats not given capsaicin served as controls. Adjuvant arthritis was induced by inoculation with heat-killed mycobacteria. The morphological distribution of sensory neuropeptides was assessed by immunohistochemistry and the tissue concentrations were determined by radioimmunoassay. In normal rats, capsaicin significantly reduced the concentrations of substance P and calcitonin gene-related peptide in ankle joints (54 and 36%, respectively) as well as dorsal root ganglia (40 and 54%, respectively). In arthritic rats those pretreated with capsaicin had significantly lower concentrations of substance P and calcitonin gene-related peptide in dorsal root ganglia (19 and 42%, respectively) compared to the arthritic controls. In the ankle joints, however, only the SP concentration was reduced (42%). Notably, this was accompanied by a 40% reduction in inflammatory response as assessed by comparing the ankle joint weights of the experimental groups. In general, there was a good correlation between the neuropeptide concentrations in ipsilateral ankle joints and the corresponding dorsal root ganglia as assessed in individual rats. The present study of adjuvant induced arthritis shows that capsaicin administration reduces the otherwise up-regulated levels of sensory neuropeptides in dorsal root ganglia and ankle joints. However, capsaicin at the dose given can only mitigate, not completely prevent the development of joint inflammation. Nonetheless, the findings suggest that antineuronal therapy targeted against specific neurotransmitters may prove useful in inflammatory joint disease.

Effects of surgical denervation on substance P and calcitonin gene-related peptide in adjuvant arthritis

The occurrence of substance P (SP) and calcitonin gene-related peptide (CGRP) was assessed in the ankle joints and dorsal root ganglia (L2-L6) by immunohistochemistry and radioimmunoassay (RIA) after unilateral sciatic nerve section in adjuvant arthritis. Nerve section in arthritic rats had no clear-cut effect on warmth, redness, and swelling of ankle joints, but significantly affected the occurrence of SP and CGRP. Immunohistochemical analysis showed an almost complete disappearance of SP-positive fibers in the ipsilateral ankle joint in normal rats after axotomy, whereas in arthritic rats occasional SP-positive fibers remained. In dorsal root ganglia, only occasional SP-positive cells could be detected in normal and arthritic rats after axotomy. A similar but somewhat less pronounced effect of axotomy was noted for neuronal CGRP-LI. RIA showed a decrease in SP in ankle joints by 45% in normal rats and 58% in arthritic rats; the decrease in CGRP was 41% and 47%, respectively. In dorsal root ganglia, the decrease in SP after surgical denervation was 25% in normal rats and 54% in arthritic rats; the decrease in CGRP was 18% and 27%, respectively. The tissue concentrations of SP and CGRP in ipsilateral ankle joints and dorsal root ganglia were consistently correlated in normal as well as arthritic rats. The present study shows that an interruption of the nerve supply to joints cannot fully prevent the development of arthritis, although it significantly reduces the occurrence of sensory neuropeptides.

A protein that activates expression of a multidrug efflux transporter upon binding the transporter substrates

Multidrug transporters are membrane proteins which, by an unknown mechanism, recognize diverse toxic compounds and efflux them from cells. We found that two substrates of the Bacillus subtilis multidrug transporter Bmr, rhodamine 6G and tetraphenylphosphonium (TPP), enhance Bmr expression at the level of transcription. Gene knock-out experiments demonstrated that an open reading frame located immediately downstream of the bmr gene is required for this enhancement. The protein product of this open reading frame, BmrR, shows distinct sequence homology to several known bacterial transcription activator proteins, such as MerR and TipAL. Gel-mobility shift and DNase protection assays indicated that BmrR binds specifically, as a dimer, to the bmr gene promoter. Furthermore, the affinity of this binding was enhanced by rhodamine and TPP, thus suggesting that these structurally dissimilar molecules interact directly with BmrR. Indeed, we found that BmrR bound rhodamine 6G stoichiometrically, one rhodamine molecule/BmrR dimer, and that TPP competed with rhodamine for this binding. Our results indicate that the enhancement of Bmr expression by some of its substrates is due to the ability of the regulatory protein, BmrR, to bind structurally dissimilar compounds resulting in enhanced transcription of the transporter gene.

Interleukin-1 immunoreactive nerve fibres in rat joint synovium

The occurrence of interleukin-1 immunoreactive nerves in the synovial membrane of rat knee joints was investigated by immunohistochemistry. Synovial tissue sections from 11 rats consistently showed interleukin-1 positive nerve fibres. The majority of the fibres appeared in blood vessel walls. However, varicose interleukin-1 positive fibres were also seen to terminate amidst synoviocytes. The overall distribution resembled that of autonomic fibres previously identified in synovium. Further investigation by double staining disclosed the co-existence of interleukin-1 and neuropeptide Y in the synovial nerve fibres. It has been suggested that the nervous system is implicated in the pathogenesis of arthritis. Considering the role of the cytokine interleukin-1 in various immunogenic and inflammatory conditions, it may prove that neuronal interleukin-1 in the synovial membrane represents a pathway for mediating such effects in joint tissue.

Detection of Helicobacter pylori in endoscopic biopsies in Sudan

We studied the prevalence of Helicobacter pylori in Sudanese subjects with gastroduodenal inflammation. H. pylori was looked for in biopsy specimens taken from the antrum by two methods: rapid urease test [Campylobacter-like organism (CLO) test] and culture using Skirrow's selective supplement. One hundred subjects were studied. H. pylori was found in 80% of patients with gastritis, 56% of patients with duodenal ulcer, 60% of patients with duodenitis and 16% of normal control subjects. It was neither detected in patients with gastric ulcer, nor in patients with oesophagitis or in those with oesophageal varices due to schistosomiasis, when using culture. However, it was found in 50% of patients with oesophagitis, when using CLO test.

Dural arteriovenous malformations in the anterior cranial fossa

Two cases of dural arteriovenous malformation (DAVM) fed by the anterior ethmoidal artery in the anterior cranial fossa are reported, one of them examined by magnet resonance imaging (MRI). Only one other case with MRI findings so far has been published. Fourty-eight previously reported cases are reviewed. One of our patients presented with subdural haematoma (SDH) without subarachnoid or intracerebral haemorrhage. The other patient had a nasal bleed without any neurological manifestations. In comparison with previously reported cases, the clinical manifestation of our cases is infrequent (1 patient with nasal bleed, and 2 patients with pure SDH that is 2 and 4%, respectively, in the literature). Feeder was the anterior ethmoidal artery either unilateral or bilateral. Drainage of DAVMs was through a markedly dilated vascular sac into the superior sagittal sinus (SSS). The high incidence of haemorrhage from DAVM in the anterior fossa is related to this vascular sac. Magnetic resonance imaging (MRI) showed a flow void area in the left frontal region on T 1-weighted images in one case. These cases were treated by surgical excision of the malformation with good results. Aetiology, clinical presentation, and treatment of these rare DAVMs in the anterior cranial fossa is discussed.

Ventilatory instability in patients with congestive heart failure and nocturnal Cheyne-Stokes breathing

Many of the factors that appear to cause Cheyne-Stokes Breathing (CSB) in sleeping patients with congestive heart failure (CHF) are present during wakefulness. We studied the stability of ventilatory pattern in nine awake CHF patients (left ventricular ejection fraction 9-48%) who demonstrated CSB only while asleep and compared results with 13 age-matched normals. The test involved brief (30-50-second) exposure to hypoxia (end-tidal PO2 = 55 Torr) followed by breathing pure oxygen. During hypoxia, ventilation increased about 40% above air breathing control in both groups, whereas end-tidal CO2 declined to 92% of control in both groups. During hyperoxia, however, breathing pattern differed between groups. In the normals, ventilation gradually declined to air-breathing levels and did not significantly undershoot. In the patients, ventilation dropped more rapidly to baseline and an overshoot was present with ventilation being 72% and air-breathing control at 45 seconds of hyperoxia. Circulatory delay was calculated from the time interval between alveolar hypoxia and in increase in ventilation, and when corrections for circulatory delay were applied to ventilation during hyperoxia the differences between groups increased in that the patients' ventilation was less than baseline immediately after the delay. In the normals, the gradual decline in hyperoxic ventilation probably represents the decay of short-term potentiation (STP) activated by hypoxic hyperventilation. Results in the patients were compatible with absence of such STP decay, but could also have been due to a reduction in ventilatory drive early in hyperoxia related to prolonged circulation times.(ABSTRACT TRUNCATED AT 250 WORDS)

Cognitive rehabilitation of adults with severe and persistent mental illness: a group model

The authors report on a group treatment approach developed for adults with schizophrenia who live in a Community Mental Health Center supported group home. The goals of the group intervention included cognitive rehabilitation and the development of effective communication and social skills. A variety of outcome measures used to evaluate the effectiveness of treatment revealed that the group modality promoted improved functioning in cognitive processing, social skills, and verbal communication. Although the results of the study can only be viewed as suggestive due to a small sample size and lack of a control group, the authors present a detailed group treatment format that can be utilized and further developed by people working with a severe and persistent mentally ill population.

Ki-1 large cell anaplastic lymphoma--a clinicopathological study

Ki-1 large cell anaplastic lymphoma is a recently described variant of malignant lymphoma. A retrospective study of 10 cases of Ki-1 lymphoma was carried out at the Armed Forces Institute of Pathology (AFIP) Rawalpindi to document its clinical and morphological features. The morphological features were evaluated by a study of paraffin embedded sections stained with haematoxylin and eosin stains. Immunohistochemical stains for BER-H2 and leucocyte common antigen (LCA) were performed in all cases. The age of the patients ranged from 2 to 60 years and male to female ratio was 2.3:1. Cervical lymphadenopathy was the most common presentation. Histologically, there was a complete effacement of the lymph node architecture in 8 cases. The Reed-Sternberg like cells were seen in 2 and histiocyte like cells in 7 cases. Immunohistochemically all cases were positive for BER-H2. It is suggested that the possibility of Ki-1 lymphoma should be considered in all cases of lymphoma with pleomorphic morphology.

Intestinal obstruction in adults at the Aga Khan University Hospital

During the period January, 1987 to June, 1991, 208 adults with mechanical bowel obstruction were managed at The Aga Khan University Hospital (AKUH). Post-operative adhesions accounted for 34% of the cases and were the most frequent cause of intestinal obstruction. External hemia (16%), malignancy (13.5%) and tuberculous stricture (10%) were the next most frequent causes. The predominance of adhesive intestinal obstruction at AKUH shows a trend towards a Western disease pattern. Socioeconomic status was a significant determinant of the cause of obstruction. The proportion of self paying to welfare patients was significantly lower in tuberculous obstruction as compared with adhesive or malignant obstruction and in obstruction caused by hernia as compared with that due to malignant disease (P < 0.05). The present study demonstrates the synchronal occurrence of old and new diseases in a population and points towards the epidemiological transition which is affecting urban areas in the developing world.

Extraction and quantitation of neuropeptides in bone by radioimmunoassay

The feasibility of extracting and quantifying neuropeptides in bone by radioimmunoassay was investigated in a study including 60 diaphyseal rat femora. Substance P, calcitonin gene-related peptide, neuropeptide Y and vasoactive intestinal polypeptide, previously identified in bone by immunohistochemistry, were extracted from separate homogenates of bone, periosteum and bone marrow in a solution of 4% EDTA and 2 M acetic acid. Measurable amounts of all four neuropeptides in bone, periosteum and bone marrow were obtained by radioimmunoassay in a reproducible manner. The neuropeptide immunoreactivities were characterized by reverse-phase high performance liquid chromatography. Among the four neuropeptides analyzed, neuropeptide Y consistently exhibited the highest concentrations in the different tissues. Overall, cortical bone showed the lowest neuropeptide concentrations. The concentration of vasoactive intestinal polypeptide was higher in periosteum than in bone marrow, whereas that of calcitonin gene-related peptide was uniform in these tissues. The distributional differences observed in bone tissue may be explained by a variety of physiological roles attributed to neuropeptides such as regulation of nociception, vasoactivity, immune function and local bone metabolism. The described methodology offers a new means of investigating a neuropeptidergic involvement in various disorders of the skeleton.

Amoebic appendicitis--a rare entity

Appendectomy is the most common surgical procedure performed in routine general surgical practice. However, not all the appendices removed, are submitted for histopathological examination in this part of the world. We reviewed 1400 appendices received by our department from within our hospital and from outside the hospital. Of these 13 cases were reported as amoebic appendicitis. These patients did not have any different clinical presentation from the patients who were reported as acute appendicitis without amoebae. Microscopically these appendices had minimal neutrophil polymorph infiltration accompanied by tissue necrosis and amoebic trophozoites within the appendiceal wall. After histological diagnosis, different tests (IHA and stool examination) were done to exclude a possibility of secondary involvement of the appendix, on 8 patients from our hospital which were negative, thus confirming that these patients had primary appendiceal involvement. Hence we recommend that all the appendices removed should be subjected for histological examination, since ths may help in subsequent management of these patients.

Effect of inhaled 3% CO2 on Cheyne-Stokes respiration in congestive heart failure

Cheyne-Stokes respiration (CSR) in severe stable congestive heart failure (CHF) may be associated with significant nocturnal arterial oxygen desaturation and sleep disruption. Previous investigations of inhaled CO2 in CSR have been uncontrolled and of short duration, sleep has not been monitored electroencephalographically, and most patients studied have had neurological disease with or without cardiac disease. The purpose of our study was to document the effects of inhaled CO2 on CSR in patients with severe stable CHF (left ventricular ejection fraction < 35% and NYHA class 3 or 4 dyspnea) in controlled all-night polysomnographic studies. Six patients were studied for 3 nights and days: adaptation, control and inhalation of CO2. These patients received a constant F1CO2 = 0.03 in air (with a 4-5 mm Hg increase in PaCO2) on night 3. This caused virtual abolition of CSR as reflected by CSR duration/total sleep time (62-2.2%; p = 0.0012) and CSR duration/nonrapid eye movement (NREM) sleep time (73-2.4%; p = 0.00064), and NREM apnea index was reduced from 33.5 to zero (p = 0.026). The apparatus used to accurately control F1CO2, however, was intrusive and some features of sleep structure such as sleep latency were adversely affected. We conclude that inhalation of CO2 with a constant F1CO2 = 0.03 virtually eradicates CSR in all-night polysomnographically monitored studies in patients with severe stable CHF. The clinical significance of these findings remains to be determined.

Extraction of neuropeptides from joint tissue for quantitation by radioimmunoassay. A study in the rat

The feasibility of extracting neuropeptides from rat knee joints for quantitation by radioimmunoassay was tested. The investigation, based on 25 adult Lewis rats, focused on substance P, calcitonin gene-related peptide, neuropeptide Y, and vasoactive intestinal polypeptide. The relative recovery of the peptides in different extraction media was assessed Both knee joints including the articulating epiphysis were dissected and cut into small pieces. The series was divided into five subgroups, 10 joints in each, for extraction in five different media: 1) 1 M acetic acid in 4% EDTA, 2) 2 M acetic acid in 4% EDTA, 3) neutral water in 4% EDTA, 4) 2 M acetic acid in 4% EDTA and 95% alcohol, and 5) 2 M acetic acid without EDTA. Measureable concentrations of the four neuropeptides were reproducibly assessed by RIA. Although all extraction media provided measurable concentrations, 2 M acetic acid in 4% EDTA was found to give the highest overall yield of the four neuropeptides analyzed. Reverse-phase HPLC confirmed that the immunoreactivities assessed by RIA corresponded to the four neuropeptides of interest. Experimental and clinical evidence suggest a neurogenic involvement in the pathophysiology of inflammatory joint disease, e.g., rheumatoid arthritis. The extraction procedure described offers a means of determining neuropeptide concentrations in joint tissue under normal and pathologic conditions by RIA.

A pilot study of flaccid penile blood flow patterns in normal subjects and patients with erectile dysfunction

Dynamic penile scintigraphy was performed using 99Tcm-labelled autologous erythrocytes in five normally potent volunteers and 22 patients with erectile dysfunction including 11 patients with psychogenic and 11 patients with vasculogenic impotence (four arteriogenic, three venogenic, three arteriogenic and venogenic, one arteriogenic and neurogenic). Penile radioactivity changes in the flaccid state were monitored by a gamma camera for 60 min after injection of the radionuclide. The penile time-activity curves of the normal controls characteristically showed secondary pulses of increased activity of variable amplitude, duration and frequency, consistent with phasic increase in penile blood pool. This normal rhythmic pattern was impaired in patients with penile arterial insufficiency whereas a blunted pattern was seen in most patients with functional impotence as well as in patients with nonarteriogenic organic impotence with a psychological overlay. This study provides new insights into the flaccid penile circulatory physiology, which may contribute to our understanding of the pathophysiology of erectile dysfunction. In arteriogenic subjects, the impaired response may be attributable to an inadequacy of penile arterial inflow as well as secondarily due to the resultant sinusoidal dysfunction subsequent to penile ultrastructural damage due to an altered nutritive environment. Increased adrenergic activity in patients with psychogenic impotence may be responsible for the observed deviation from the normal pattern.

Outcome of biliary tract surgery in unknown cirrhotics: a case-control study

The substantial risk of biliary surgery in patients with liver cirrhosis may be reduced by preoperative preparation but the problem of the unknown cirrhotic remains. We studied 18 patients found incidentally to have cirrhosis at surgery. The perioperative complications and the outcome in these patients was compared with 18 non-cirrhotic patients, computer matched for age and sex, undergoing the same operations. Mean blood loss at operation was 324 ml (SD 218.1 ml) in the cirrhotic group and 105 ml (SD 74.7 ml) in the control group (P < 0.01). The postoperative complication rate was 38% in cirrhotics, but zero in controls (P < 0.01). The length of hospital stay was significantly increased in the cirrhotic group (P < 0.01). There was no mortality in either group. The incidental finding of cirrhosis at biliary surgery is associated with increased peroperative bleeding and increased morbidity. There is no increase in mortality in such patients.

Sensory and autonomic innervation of the facet joint in the rat lumbar spine

The presence of sensory and autonomic nerves in the synovial membrane of the lumbar facet joint in rats was investigated by immunohistochemistry. Substance P and calcitonin gene-related peptide immunoreactivities, representing sensory nerves, were observed as varicose fibers in the synoviocyte layer. The fibers were predominantly nonvascular. The autonomic innervation was identified by the presence of neuropeptide Y- and tyrosine hydroxylase-positive fibers. Most of these fibers were found adjacent to or within blood vessel walls. Immunoreactivity to vasoactive intestinal polypeptide was seen in varicose nerve terminals in the synoviocyte layer, mostly unrelated to blood vessels. There is accumulating evidence of an involvement of both the sensory and sympathetic nervous systems in inflammatory joint disease. The neuropeptides now identified in lumbar facet joints may prove to play a significant role in the pathogenesis of low-back pain.

Acute and long-term effects of octreotide in patients with ACTH-dependent Cushing's syndrome

PURPOSE

Octreotide is of proven efficacy in the management of patients with acromegaly, thyrotropin-secreting pituitary adenomas, and certain gastrointestinal tumors, but its effect in Cushing's syndrome is less clear.

PATIENTS AND METHODS

We studied 10 patients who presented with adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome, 3 of whom were previously adrenalectomized. Serum cortisol or ACTH levels were measured before and during the administration of octreotide 50 to 500 micrograms every 8 hours for 24 to 72 hours.

RESULTS

Treatment was effective in four patients: serum cortisol levels decreased to within or below the normal range in Patients 1, 2, and 3, and ACTH levels were substantially lowered in Patient 4, who had previously been adrenalectomized for a metastatic islet cell tumor. These responses were sustained during long-term treatment for 2 to 72 weeks. All four patients showed no evidence of a pituitary tumor on computed tomographic or magnetic resonance imaging and had proven (Patients 3 and 4) or presumed ectopic disease. Of the six patients who did not respond, four had pituitary tumors and two had presumed ectopic ACTH production.

CONCLUSION

We conclude that a short trial of octreotide is warranted in patients with ACTH-dependent Cushing's syndrome who have no demonstrable pituitary tumor. A response to treatment should alert the physician to the possibility of an ectopic ACTH source and will identify patients whose disease may be controllable using octreotide.

Respiratory short-term potentiation (after-discharge) in elderly humans

During a ventilatory stimulus, respiratory short-term potentiation (STP, after-discharge) develops, so that ventilation after the stimulus is greater than that before the stimulus. When the stimulus is withdrawn STP gradually decays, tending to prevent hypoventilation and therefore stabilizing breathing pattern. STP has been demonstrated in young humans after brief hypoxic stimuli. Since respiratory arrhythmias increase with age, we examined the decay of STP in normal elderly humans (mean age 62), comparing them with young normals (mean age 27). Resting subjects were exposed to 35-50 sec hypoxia (end-tidal PO2 = 55 Torr) followed by hyperoxia and breathing analyzed during the hyperoxic period, when the subjects were also hypocapnic. With hypoxia, ventilation increased to 152% of control in both the older and younger subjects while end-tidal CO2 fell to 92.0% of control in the older subjects and 94.7% of control in the younger. In both groups the hypoxic increase in ventilation was almost entirely due to an increase of tidal volume. During hyperoxia, ventilation and tidal volume declined over 20-25 sec to control, pre-hypoxic levels, without an apparent undershoot, and there were no consistent differences between the older and younger subjects. Prolonging the hypoxic exposure to 90 sec had no influence on STP in the older subjects. We conclude that neither age nor prolonging the hypoxic stimulus from 50 to 90 sec influenced STP.

Burkitt's lymphoma--a study of 50 consecutive cases

A retrospective study of Burkitt's lymphoma done over a period of 7 years is presented. The relative frequency of Burkitt's lymphoma as compared to other non-Hodgkin's lymphomas was 6.35%. Although Pakistan is non-endemic for Burkitt's lymphoma, but the frequency of the disease is higher than other non-endemic countries. There was male predominance (M:F 2.3:1). Majority of the cases were in pediatric age group and 12% were older than 35 years. The main clinical presentation was abdominal (42%), either in the intestinal tract (22%) or retroperitoneal (18%) region (American mode of presentation). Jaw tumour (4%) (African mode) was rare. Sporadic cases at almost all sites were also encountered. Burkitt's lymphoma presenting as primary nodal disease was seen in 36% cases. Fifty-four percent showed bone marrow infiltration. The stage of the disease at diagnosis was advance in 54% cases. Follow-up of ten cases revealed poor survival inspite of treatment.

Mutants of the Bacillus subtilis multidrug transporter Bmr with altered sensitivity to the antihypertensive alkaloid reserpine

The Bacillus subtilis multidrug transporter Bmr effluxes structurally diverse toxic compounds out of bacterial cells. Antihypertensive alkaloid reserpine reverses Bmr-mediated multidrug resistance by inhibiting drug transport. We have obtained a mutant of the bmr gene that provides a normal level of multidrug resistance, which can, however, only be reversed by very high concentrations of reserpine. Reduction of Bmr sensitivity to reserpine has been caused by the substitution of Leu for Val286 in the Bmr molecule. This mutation also led to a dramatic decrease of [3H]reserpine binding to membrane vesicles prepared from the Bmr-overexpressing bacteria. Leucine is larger than valine by one methylene group. Substitution of Val286 with a smaller residue, glycine, had an opposite effect. It led to increased sensitivity of Bmr to reserpine and increased affinity of reserpine binding to the membranes prepared from Bmr-overexpressing bacteria. Neither of the mutations significantly changed the sensitivity of Bmr to rescinnamine, a structural analog of reserpine. The results suggest that Val286 is involved in the formation of the reserpine-binding site of the Bmr molecule.

Neuropeptide Y, tyrosine hydroxylase and vasoactive intestinal polypeptide-immunoreactive nerve fibers in the vertebral bodies, discs, dura mater, and spinal ligaments of the rat lumbar spine

The occurrence of autonomic nerves in the lumbar spine of rats was investigated by immunohistochemical technique. Both peptidergic nerves, represented by immunoreactivity to neuropeptide Y (NPY), vasoactive intestinal polypeptide (VIP), and noradrenergic nerves as reflected by tyrosine hydroxylase (TH) immunoreactivity, were identified. NPY- and TH-positive nerves were predominantly found in the blood vessels walls. They occurred in the bone and periosteum of the vertebral body, disc, dura mater, and in the spinal ligaments. They were particularly numerous along the growth plate and in the outer layers of the intervertebral discs. VIP-positive fibers were predominantly nonvascular. They occurred in all tissues analyzed, but were most abundant in the vertebral bone marrow and periosteum. The VIP-immunoreactive fibers in the outer fibrous layers of the disc and the spinal ligaments were occasionally observed in blood vessel walls. No immunoreactivity could be detected in the nucleus pulposus. In the dura mater, NPY-, TH- and VIP-positive fibers were found both in the ventral and dorsal portion. In view of the vasoconstrictive properties of both NPY and noradrenaline, it may be assumed that the abundance of NPY- and TH-immunoreactive nerves fibers in blood vessel walls reflects a vasoregulatory activity. The predominance of nonvascular VIP-positive fibers in the vertebral bone marrow and periosteum may represent an involvement in local bone physiology.

gli, a zinc finger transcription factor and oncogene, is expressed during normal mouse development

The oncogene GLI is amplified and expressed in some cases of human malignant glioma and undifferentiated childhood sarcoma and is the prototype for a gene family characterized by a highly conserved set of five tandem zinc fingers and a consensus cysteine-histidine link. This zinc finger motif has been shown to bind DNA with sequence specificity and may mediate transcriptional regulation. Since GLI is expressed in embryonal carcinoma cell lines but not in most normal adult tissues and shows significant sequence similarity within its zinc finger domain to cubitus interruptus dominant (ciD), a Drosophila segmentation gene known to be important in the morphogenesis of the posterior portion of each larval segment, we established the temporal and tissue expression patterns of the mouse homologue of human GLI in day 10 through 18 mouse embryos with Northern blotting, reverse transcriptase coupled PCR, and in situ hybridization. gli transcripts were demonstrated on days 10 through 18 of mouse embryonic development as well as in normal adult uterus, brain, testis, and limb. Tissue expression of gli during gestation was demonstrated in Meckel's precartilage mesenchyme, the basis occipitus, rib mesenchymal condensations, primordial vertebral bodies, digital mesenchymal condensations in forefoot and hindfoot plates, the ependymal layer of the spinal cord, and the mesoderm of the gastrointestinal tract. Expression persisted throughout gestation in developing bone and cartilage of the extremities, the ribs, and the vertebral bodies, as well as the gastrointestinal tract mesoderm. These findings support a role for gli family genes in normal craniofacial and digital development in mammals first suggested by the demonstration of translocation breakpoints within the GLI3 gene in families with the Greig cephalopolysyndactylyl syndrome and subsequently by reduced gli3 expression in the mouse mutant extra toes. It is surprising that a single gene would be expressed in such a wide range of mesenchymal structures.

Systemic manifestations of invasive amebiasis

Eighty-four patients with serious infection due to Entamoeba histolytica were evaluated for systemic complications by objective criteria for dysfunction of the organ systems normally assessed in surgical sepsis. Of 71 patients with amebic liver abscess (ALA), 41% had systemic complications and 13% had more than one organ system involved. Patients > or = 40 years of age and those being treated with steroids were at significantly increased risk of developing complications (P < or = .05). The erythrocyte sedimentation rate and the levels of the acute-phase markers C-reactive protein (CRP) and serum amyloid A (SAA) were significantly elevated in patients with ALA over values in those without ALA (P < or = .05). ALA patients with complications had lower CRP and SAA concentrations than those without complications (P < or = .05). Blood and liver aspirates in ALA patients were usually bacteriologically sterile. The pathogenesis of systemic complications and the associated acute-phase response requires further study, and ways of predicting disease severity and intervening therapeutically must be devised.

Volume-dependent intracavernous hemodilution during pharmacologically induced penile erections

The change in the cavernous hematocrit following induction of pharmacological erection by an intracavernous injection of papaverine hydrochloride was documented in normal controls and patients with impotence. Blood samples taken from the penile cavernosa showed a significantly lower hematocrit compared to the systemic venous blood in all normal subjects. The decrease in the cavernous hematocrit was attributable to dilution of the cavernous blood pool by the injected volume of the drug, since this was not observed in erections produced by visual sexual stimulation. It appears that a restriction of the cavernous venous outflow in response to papaverine injection causes sequestration of the diluted blood in the cavernous compartment. The degree of cavernous hemodilution was found to aid in the differential diagnosis and was especially valuable in differentiating patients with arteriogenic impotence from those with venous leakage.

Macroprolactinomas with suprasellar extension: effect of bromocriptine withdrawal during one or more pregnancies

OBJECTIVE

To investigate the effects of bromocriptine withdrawal during one or more pregnancies in patients who presented with pituitary macroprolactinomas with suprasellar extension.

DESIGN

Four infertile patients presenting with a macroprolactinoma with suprasellar extension conceived during treatment with bromocriptine on 10 occasions resulting in eight full-term normal deliveries. Treatment was withheld shortly after conception in each pregnancy.

RESULTS

Serum prolactin (PRL) levels fell initially from a mean of 2,776 (range 1,682 to 4,515) to 27 micrograms/L (range 1 to 71) with the development of a partially empty sella in all patients. Recovery of visual field defects occurred in the only affected individual. In case 1, PRL levels remained within the normal range, after bromocriptine withdrawal in the first pregnancy, with the development of an empty sella. Prolactin levels, however, increased substantially in cases 2 to 4. An asymptomatic suprasellar tumor extension returned in cases 2 and 3. After two or more pregnancies (cases 1, 3, and 4), there was a progressive decline in the serum PRL levels. Although still elevated in cases 3 and 4, the PRL levels were considerably below those obtained at presentation or in the first pregnancy. Tumor regression with the development of an empty sella was observed in both these patients as well in their pregnancy or postpartum period.

CONCLUSIONS

Bromocriptine may be safely withdrawn during pregnancy in patients presenting with a macroprolactinoma. With multiple bromocriptine induced pregnancies, PRL levels and tumor size may progressively decrease with the eventual development of an empty sella.

Case report: amoebic liver abscess complicated by a hepatoduodenal fistula

Amoebic liver abscess (ALA) is a common extra-intestinal presentation of amoebiasis caused by Entamoeba histolytica. The liver abscess may be complicated by rupture into adjacent structures. Common organs involved include thorax, peritoneum and pericardium. Rupture into the gastrointestinal tract is extremely rare. We report a patient who developed a hepatoduodenal fistula complicating an amoebic liver abscess. Suspicions were raised on finding air in the liver abscess on ultrasound scanning. Diagnosis was confirmed on a water-soluble (Gastrografin) swallow (Fig. 1 a,b). Complications of ALA are associated with a high morbidity and mortality and early diagnosis is important. To our knowledge only one previous case of a hepatoduodenal fistula complicating an ALA with radiological confirmation has been reported.

Hodgkin's disease in children

This study provides information about histological types of Hodgkin's disease (HD) among children of Pakistan. Hodgkins disease constitutes 12 per cent of all pediatric malignant tumours. The peak incidence is between 6 and 10 years. The male to female ratio is 5.25:1. The majority (78 per cent) present with cervical lymphadenopathy. Mixed cellularity (MC) is the commonest histological type. In the developed countries nodular sclerosis (NS) and lymphocyte predominant (LP) subtypes are more common, and which have better prognosis. The developing countries have a higher incidence of poor prognostic subtypes. Our study indicates a situation intermediate between the two.

Analysis of adenoid cystic carcinoma treated by radiotherapy

The records of 41 patients with adenoid cystic carcinoma of the head and neck region who had been treated with radiotherapy were reviewed. Local control was achieved in 72.3% in the cases with primary lesions at 5 years. The prognosis for tumors that arose in the major salivary glands was better than that for tumors that arose in the minor salivary glands; however, the difference was not statistically significant. In the minor salivary glands, early-stage tumors were well controlled with the use of radiation therapy alone. In spite of the high local control rate, the disease-free survival rate of the patients at 10 years was only 20.8%. Lung metastasis determined the prognosis.

The effect of intracavernosal haemodilution on the radionuclide quantification of penile vascular changes during pharmacologically induced penile erections

Radionuclide phallography was performed using 99Tcm-labelled red blood cells in conjunction with pharmacologically induced penile erections. The radioactivity content of aliquots of systemic venous blood taken from the antecubital vein was compared with aliquots of blood withdrawn from the penile cavernosa 20 min after an intracavernosal injection of 10 micrograms prostaglandin E1. The cavernosal samples showed significantly lower counts per unit of blood compared to the systemic venous blood indicating a comparatively lower concentration of tagged red blood cells. On haematological analysis, a significant difference in the haematocrit of the two samples was also established. The fall in the cavernosal haematocrit was found to result from dilution of the cavernosal blood pool by the injected volume of the drug since larger volumes of injection produced a greater fall in the haematocrit. Restriction of the cavernosal venous outflow in response to the injection of the vasoactive drug causes sequestration of the diluted blood in the cavernosal compartment. This factor might affect the quantification of penile blood volume using radiotracer methods.

'Spontaneous' rectus sheath haematoma: a rare cause of abdominal pain

Images