Retrospective study correlating clinical infectious history and peripheral blood T-cell subpopulations in cancer, GvH and HIV+ patients

The CD4+ CD8- inducer helper cell and the CD4- CD8+ cytotoxic/suppressor cell absolute numbers were measured in the peripheral blood of patients with various pathological conditions: with leukemia-lymphomas or solid tumors, patients with bone marrow grafts suffering from GvH, HIV-1 asymptomatic carriers, ARC and AIDS patients. The study was carried out during observation periods when they were not suffering from opportunistic infections and were untreated. In all the groups a decrease of the CD4+ CD8- cell absolute number was observed. In the leukemia-lymphoma and solid tumor bearing patients the CD4- CD8+ absolute value was lower than normal, while in the GvH- and HIV-infected patients, it was significantly higher. The clinical follow-up of each group indicates that GvH, ARC and AIDS patients developed infection in 40-68% of the cases, ie the only groups at risk of infection are those in which the CD4- CD8+ absolute values are high: we suggest that the balance CD4+ versus CD8+ should be considered rather the absolute CD4+ when discussing appropriate use of immuno-regulators.

The role of personality factors and suggestion in placebo effect during mental stress test

The aims of this study were first of all to document a placebo effect on systolic blood pressure and heart rate during mental arithmetic induced stress and secondly to assess the role of suggestion in producing this effect. Two types of placebo were used, a simple placebo and a placebo with an implied therapeutic action. Both were compared with alprazolam. A placebo response was seen in just over half of the volunteers when the cardiovascular changes to mental arithmetic induced stress in healthy volunteers were measured. This response appeared to be unaffected by the suggested therapeutic effect. Dominant, independent subjects, identified using the Cattell 16 PF personality test were less likely to respond to placebo. Alprazolam (0.5 mg) did not prevent, to a significantly greater degree than placebo, the systolic blood pressure or heart rate increases provoked by the mental stress.

Role of imaging technics in the classification of acute pancreatitis

This paper is a review of some aspects of acute pancreatitis (AP) (definition criteria, outcome, and prognostic factors) and a reminder of the invaluable contribution of computed tomography (CT) in confirming the diagnosis of AP, distinguishing between edematous and necrotizing forms, and in providing prognostic information via detection of possible extrapancreatic spreads (EPS). The Geneva experience (510 cases of AP over a 9-year period) has shown that no fatalities occurred when no EPS were found on CT performed within 48 h of admission; mortality was 1.5% in the case of 1 or 2 EPS and 19% in the case of 3 EPS or more.

[Orthotopic liver transplantation--indications and results]

Indications for and results of orthotopic liver transplantation (OLT) were modified over the past ten years by new immunosuppressive agents, earlier timing of transplantation and better knowledge of potential complications. In 1990, OLT appears justified in the treatment of all liver disease threatening life, in the absence of contraindications and other possible treatments. Between July 1987 and December 1990, 21 patients were transplanted at the Geneva University Hospital. Three children received part of an adult liver (two or three segments), using the reduced-size liver transplantation technique. Four OLTs had to be performed in an emergency situation. Two patients died within six months of transplantation, one after 7.5 months, and the last patient died after one year from cancer recurrence. 17 patients are presently alive (81%) at 4 to 39 months (median 14 months) following OLT. More than the mere survival, however, the quality of life regained after transplantation prompts us to consider transplantation early in the progress of the disease.

Hyperactivation of phospholipase C does not support the enhanced proliferation of aortic smooth muscle cells from spontaneously hypertensive rats

When cultured in the presence of fetal calf serum, arterial smooth muscle cells from spontaneously hypertensive rats (SHR) proliferate more rapidly and are more numerous at confluency than cells from normotensive Wistar-Kyoto (WKY) animals. The phenomenon has been demonstrated in several laboratories but its molecular origin remains unclear. On the other hand phospholipase C activation and c-fos transcription are early events able to trigger cell mitosis. Therefore, the enhancement of inositol phosphates formation induced in SHR cells by various vasoactive agents and growth factors suggests that this enzyme might be implicated in the abnormal proliferation triggered by serum. In this case a unique molecular abnormality would be responsible for both arterial hypercontractility and dystrophy encountered in hypertension. In order to test this hypothesis we have compared DNA replication, phospholipase C activation, and c-jun and c-fos nuclear protooncogene transcriptions stimulated by fetal calf serum (FCS), vasoactive agents (angiotensin II and vasopressin), and epithelial growth factor (EGF) in SHR and WKY rat cells. The results obtained with these various agonists tested under the same experimental conditions confirm that the classical pathogenic diagram: (PLC hyperactivation----increase in c-fos transcription----enhanced cell proliferation) may apply to the action of vasoactive agents which are only slightly mitogenic on SHR cells, but not to the very important effect of fetal calf serum. Indeed, FCS stimulated inositol phosphate formation and c-jun and c-fos transcription, but none of these parameters was enhanced in SHR cells. Phospholipase C activation may exert some control upon DNA replication, as its partial inhibition by pertussis toxin coincided with an equivalent decrease in thymidine incorporation. It is, however, not absolutely required for the onset of DNA replication in aortic smooth muscle cells, as shown by the results obtained with EGF under the same experimental conditions. An abnormal molecular reaction different from PLC activation is therefore responsible for the enhanced proliferation of cultured SHR aortic smooth muscle cells, and several cell alterations may concur to the formation of the hypertensive arteriopathy.

Panel sees high demand for diverse CFO skills

A more sophisticated healthcare industry, challenged by competition and payer demands, also looks for sophistication when filling its senior financial positions. Individuals with experience in managed care contract negotiations, knowledge of hospital-physician ventures, and superior planning and treasury management skills are increasingly sought by hospitals. Some organizations also may single out chief financial officers able to assume broader administrative duties, including chief executive officer positions. These are among the observations of a panel convened by HFMA to discuss recent trends in healthcare executive recruiting. Highlights of the session, moderated by HFMA President Richard L. Clarke, FHFMA, follow.

[Oculocerebral malignant non-Hodgkin lymphoma. A report of 5 cases]

Five patients, age 35 to 77, with histologically proven malignent ocular non-Hodgkin's lymphoma (previously known as reticulum cell sarkoma) are presented. The clinical ocular findings (vitreous infiltrates, retinal infiltrates, anterior uveitis) were initially misinterpreted as "panuveitis". The usual antiinflammatory therapie a temporary diminution of the "uveitis" could be observed. Four cases showed a histologically proven CNS involvement. All the patients (except the one in whom the correct diagnosis was made post mortem) received cerebral radiation therapie, including the eyes. Under the radiation therapy the ocular findings disappeared within a few weeks. The longtime prognosis for the eye and quoad vitam is unfortunately not promissing.

Conservative treatment of acute pancreatitis

Most attacks of acute pancreatitis) have a favorable course and can thus be treated by conservative measures. The purpose of this review is: a) to present techniques (prognostic scores, computerized axial tomography, etc.) which can assist in the early identification of those cases of acute pancreatitis which can reasonably be submitted to non-surgical treatment; b) to summarize and discuss the main results of recent pharmaceutical research, and various conservative measures which have proven helpful in the treatment of this difficult disease.

Enhanced response to growth factors and to angiotensin II of spontaneously hypertensive rat skin fibroblasts in culture

Skin fibroblasts from newborn spontaneously hypertensive rats (SHR) and Wistar-Kyoto (WKY) rats were cultured to study their growth rate and their reactivity to various agonists in terms of mitogenic potency and inositol phosphate production. A marked enhancement of nuclear 3H-thymidine incorporation, occurring after stimulation of quiescent fibroblasts by fetal calf serum, correlated with the increased growth rate of these cells with regard to WKY ones. Insulin (1 microgram/ml) and epidermal growth factor (10 ng/ml) induced two and four times greater DNA synthesis in SHR fibroblasts compared to WKY cells, without activating the phospholipase C pathway. In contrast, angiotensin II, bradykinin, vasopressin which stimulated inositol phosphate production, and phorbol-12 myristate 13-acetate were unable to stimulate DNA synthesis. Higher levels of tritiated inositol phosphates were produced in SHR cells after serum, bradykinin and angiotensin II stimulation, but not in WKY cells after vasopressin. This enhanced mitogenic response of SHR skin fibroblasts is probably due to a genomic alteration and appears to be independent of the hyperactivation of the phospholipase C to some vasoactive agonists.

Guinea pig cochlear blood flow under definite sound exposure-hydrogen clearance measurement

Blood flow measurements were carried out on 18 coloured guinea pigs (8 animals served as control group) before and during definite sound exposure (12 kHz, 110 dB SPL). The exposure time amounted to 60 min. The anaesthesia was carried out according to the following schedule: a mixture consisting of 70 mg alpha-chloralose/kg b.w. and 400 mg urethane/kg b.w. was injected intraperitoneally. The relaxation was performed by means of i.p. application of 3 mg Tricuran/kg b.w./h. The hydrogen clearance measurements (HCM) were carried out under artificial respiration with control of arterial pH, endexpiratory CO2 content, as well as blood pressure and body temperature. After a duration of noise exposure of 30-45 min the cochlear blood flow reached an average level of 80% of the initial point. This level remained mainly unchanged until the end of noise exposure (60 min). Our HMC's confirm Laser Doppler flowmetry findings.

Protein kinase C and platelet reactivity in spontaneously hypertensive rats

Since protein kinase C (PKC) plays an important role in the control of platelet biological responses, we investigated whether it can be involved in the enhanced platelet reactivity to thrombin which is observed in spontaneously hypertensive rats (SHR) in comparison to that observed in controls (WKY). PKC activity was determined by measuring the phosphorylation of P47 protein (the endogenous substrate of PKC in the platelet). Mean effective concentration (EC50) values for phorbol ester and synthetic diacylglycerol (direct activators of PKC) were similar in SHR and WKY, thus revealing similar intrinsic activity of PKC in both rat strains. EC50 values for thrombin were approximately 30% lower in SHR v WKY. Enhanced PKC activity in SHR is likely the result of an increased diacylglycerol formation and release of Ca2+ from intracellular pools, consequent to an increased thrombin-induced phospholipase C activity.

Radical splenopancreatectomy with duodenal loop conservation in rats

In an attempt to find a reproducible method of total splenopancreatectomy (TSP) with duodenal loop conservation in rats, we used the technique recently described by S. Houry and M. Huguier (Eur. Surg. Res. 15: 328, 1983) but were not able to induce a true diabetes. We therefore developed a more radical splenopancreatectomy (RSP) in rats and compared this technique with the TSP. RSP involves a more extensive dissection of the common bile duct, a short choledocoduodenal anastomosis, and total excision of the retroportal pancreatic lobules with the aid of a dissecting microscope. In rats who had undergone the TSP technique, blood glucose levels were maximal 8 hr after operation (270 +/- 16 mg/dl), and thereafter recovered baseline values. In contrast, after the RSP technique all the rats became diabetic as documented by persistent hyperglycemia (347 +/- 20 mg/dl at 8 hr, P = 0.01 compared to TSP; 500 +/- 20 mg/dl at 8 hr, P less than 0.0001). Eight hours after the operation, blood lipase levels increased more significantly after TSP than after RSP (847 +/- 247 IU/liter and 130 +/- 37 IU/liter, respectively, P = 0.01), and then decreased to 92 +/- 19 IU/liter at 24 hr in the TSP group and less than or equal to 30 IU/liter in the RSP group (P = 0.003), suggesting a more radical dissection of pancreatic tissue with the RSP technique. At sacrifice at 48 hr, no complications were found with either technique on macroscopic and microscopic examination, except for marked gastric distension with RSP. A third group of rats underwent RSP and were followed until natural death.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma levels of digitalis-like substance in pregnancy-induced hypertension in Nigeria

Digitalis-like substance or plasma inhibitor factor was measured by a competitive binding method in 56 subjects comprising: (1) 12 normotensive normally menstruating non-pregnant women without a family history of hypertension; (2) 13 normotensive normally menstruating non-pregnant women with a family history of hypertension; (3) 15 normotensive pregnant subjects without a family history of hypertension; and (4) 16 subjects with clinical features of pregnancy-induced hypertension. Even though the mean value (1.14 +/- 0.12) of the inhibitor factor (expressed as KD ratios) in the non-pregnant women with family history was slightly higher than the mean value (0.95 +/- 0.12) in the non-pregnant women without a family history, the difference did not attain statistical significance. The mean value (1.25 +/- 0.24) of the inhibitor factor in the pregnant subjects without family history was, however, significantly elevated when compared with the non-pregnant subject without family history (P less than 0.05). The inhibitor factor levels in the subjects with pregnancy-induced hypertension were generally lower than those of the normotensive pregnant subjects, although the difference was not statistically significant. The relevance of these results to the understanding of the pathophysiology of pregnancy-induced hypertension is discussed.