Iatrogenic obstructive jaundice caused by the balloon of a Foley catheter. Case report

A rare kind of obstructive jaundice caused by compression on the common bile duct due to an inflated Foley catheter balloon placed in the duodenum after Suguira surgery for bleeding esophageal vesicles secondary to portal hypertension is presented. After deflating the balloon, the obstruction was relieved. Tc-99m HIDA studies were helpful in the diagnosis of obstruction of the common bile duct and the response following the deflation.

Improvement in allograft survival of islets of Langerhans by pretreatment with deoxyguanosine

In vitro pretreatment of isolated islets of Langerhans prior to transplantation with deoxyguanosine (dGuo) was found to be effective in improving the survival in fully allogeneic diabetic rats (Wistar----PVG). Post transplant immunosuppression was not used. Islets pretreated with various concentrations of dGuo, 1, 1.35, 1.5 and 2 microM dGuo per islet showed a graft survival of 9, 36, 9 and 14% respectively.

Distribution of substance P, GnRH, Met-enkephalin in the central nervous system of the pig

The distribution of substance P (SP), gonadotropin releasing hormone (GnRH) and Met-enkephalin in the brain and spinal cord of the domestic pig is described for the first time. The levels of SP, GnRH and Met-enkephalin were measured by specific radioimmunoassays in various regions of the brain and spinal cord of the pig. Substance P and Met-enkephalin are widely distributed within the central nervous system of the pig. High levels of SP were found in the preoptic area (POA), suprachiasmatic area (SCA), medial basal hypothalamus (MBH) and brain stem while moderate amounts of SP were found in olfactory bulb (OB). High levels of Met-enkephalin were found in POA, SCA and MBH, and moderate levels of Met-enkephalin in OB and brain stem. Both SP and Met-enkephalin levels were higher in the dorsal spinal cord in comparison with the levels of these peptides in the ventral spinal cord. This finding is in agreement with the predominant role played by these neural systems in primary afferent mediation of nociceptive impulses. The POA and SCA contained only low levels of GnRH while the MBH contained high levels of GnRH. Finally, some differences in the quantitative distribution of these peptides in the pig and rat are discussed.

Disulfiram administration affects substance P-like immunoreactive and monoaminergic neural systems in rodent brain

The biosynthetic enzyme peptidylglycine alpha-amidating monooxygenase catalyzes the formation of a variety of biologically active alpha-amidated peptides from respective COOH-terminal glycine-extended peptide precursors. Peptidylglycine alpha-amidating monooxygenase activity is dependent on copper, ascorbate, and molecular oxygen and is inhibited by the relatively selective copper chelator N,N-diethyldithiocarbamate or its disulfide dimer disulfiram (Antabuse). In the present study, chronic disulfiram treatment (100 mg/kg/day, for 12-25 days) resulted in significant changes in several neurochemical parameters in the mouse central nervous system, including levels of substance P-like, unamidated substance P-Gly-like, and protease-generated substance P-Gly-Lys-like immunoreactivities (SP-LI, SP-G-LI, and SP-G-K-LI, respectively). Combined high performance liquid chromatography/radioimmunoassay analyses of the extracted SP-LI, SP-G-LI, and SP-G-K-LI species indicated very similar chromatographic and immunochemical behavior as demonstrated for chemically authentic peptide standards. Additionally, changes in levels of monoamines and their metabolites were observed after drug administration. Complementary immunohistochemical analyses using affinity-purified anti-SP-G sera localized these drug-induced changes in levels of immunoreactive unamidated precursor to neural elements that normally express SP. As a functional corollary to alterations in neurochemical parameters, we observed significant disulfiram-induced increases in pain thresholds, potentiated by capsaicin treatment. Overall, our results indicate that the observed changes in steady state levels of immunoreactive SP and of the immature COOH-terminal extended forms of SP may reflect compensatory biosynthetic and posttranslational processing events in SP-containing neural systems after pharmacological challenge.

Interleukin 1 stimulation of the hypothalamic-pituitary-adrenal axis

The effect of varying doses of purified human interleukin 1 (IL-1) on rectal temperature (Tr), hypothalamic corticotropin-releasing hormone (CRH), pituitary and plasma adrenocorticotropic hormone (ACTH), and plamsa corticosterone was examined in intact male rats at 24 degrees C; plasma ACTH and corticosterone responses were also studied in hypophysectomized rats. In addition, IL-1-induced changes in corticosterone concentration were investigated by means of adrenal organ cultures. Tr was measured with thermocouples. CRH and ACTH levels were determined by radioimmunoassay, and corticosterone by protein-binding assay. Intravenous administration of IL-1 (0.063-1.0 ng) resulted in hyperthermia, which began 20 min postinjection and continued for an additional 30 min. IL-1 at a dose of 0.5 ng resulted in no change in hypothalamic CRH, pituitary ACTH, or plasma ACTH levels compared with saline-treated rats. Plasma corticosterone was significantly (P less than 0.05) elevated 30 min after IL-1 administration and returned to control levels after 1 h. The higher dose of IL-1 (1.0 ng) did not affect hypothalamic CRH content, but pituitary ACTH began to rise at 15 min and was significantly (P less than 0.05) elevated 30 min after injection. Rats receiving this dose displayed elevated (P less than 0.05) plasma ACTH and corticosterone levels 30 and 60 min postinjection. No change in plasma corticosterone was observed in hypophysectomized rats administered either 1 ng of IL-1 or 1 microgram of recombinant IL-1 beta (rIL-1 beta); adrenal organ cultures treated with IL-1 (10(-11) M) responded similarly.(ABSTRACT TRUNCATED AT 250 WORDS)

Transplantation of islets of Langerhans isolated by Trowell's T8 medium in outbred rats: effect of cyclosporine

This study was carried out to investigate the efficacy of cyclosporine to prolong islets isolated by collagenase in Trowell's T8 medium and Ficoll gradient separation. Our results demonstrate that a short course of cyclosporine is effective in minimizing rejection of transplanted islets in outbred rats.

Spontaneous pneumothorax complicating rheumatoid lung disease

This case report describes the pleuro-pulmonary involvement in a young patient with rheumatoid arthritis (RA) of one and half year duration. The early involvement of lung interstitium in a 27-year-old male and development of pneumothorax were the unusual features. The various aspects of rheumatoid lung disease (RLD) and its clinical significance were briefly discussed.

Analgesia in defeated mice: evidence for mediation via central rather than pituitary or adrenal endogenous opioid peptides

Mice subjected to defeat in a social conflict paradigm display an analgesic response that is apparently mediated by endogenous opioids. It is blocked by naloxone and shows full cross-tolerance to and from morphine. The present study investigated the contribution of sources of endogenous opioids outside of the central nervous system, namely the pituitary and adrenal glands. Treatment known to enhance (metyrapone pretreatment), reduce (2% saline in the drinking water) or block (dexamethasone pretreatment) the release of beta-endorphin from the anterior pituitary did not affect the display of analgesia in defeated mice. Similarly, treatments known to enhance (reserpine pretreatment) or block release of enkephalins (removal of the adrenals or hexamethonium pretreatment) from the adrenal medulla also failed to influence defeat-induced analgesia in the expected manner. If anything, adrenalectomy enhanced and reserpine pretreatment suppressed the analgesic response to defeat. The data are discussed in terms of providing evidence that defeat-induced analgesia is mediated primarily by endogenous opioids released and acting within the central nervous system.

Characterisation of blast cells during blastic phase of chronic myeloid leukaemia by immunophenotyping--experience in 60 patients

The blast cell population of 60 patients with chronic myeloid leukaemia in blast crisis (CML-BC) were analyzed with a panel of monoclonal antibodies to determine the cell surface antigen phenotypes. In addition, cytochemical stains periodic acid Schiff (PAS), myeloperoxidase (MP), Sudan black B (SBB) and terminal deoxynucleotidyl transferase (TdT) were also utilized for subtyping. Nineteen cases (31.6%) expressed lymphoid phenotypes characteristic of common ALL cells and one case with extramedullary lymph node crisis expressed T-cell surface phenotypes. Thirty cases (50%) expressed solely myelomonocytic surface antigens with significant TdT activity in three. Cytochemical stains contributed to recognize only 57% of these myeloid blasts. Seven cases (11.7%) were with a mixture of heterogenous group of cells expressing phenotypic characteristics for various haemopoietic cells of different lineage--five of them from the cells of non-lymphoid series (myelomono-erythromegakaryocytic series) and the other two with cells from both lymphoid and myeloid series. Additionally, in two cases (3.3%), the precursor cells reacted only with the erythroid monoclonals. Finally, in one case, the blast cells remained unclassified due to nonreactivity with any of the monoclonals used but expressed significant TdT positivity. The response to uniform vincristine and prednisolone (V + P) therapy has shown that lymphoid blast crisis cases were highly responsive in contrast to the cases with non-lymphoid blast crisis (complete remission rate 86 vs 21.4%). The results confirm the evidence of multilineage blast crisis involving either single or mixed haemopoietic differentiation pathway and the utility of having phenotypic characterisation for designing protocols for chemotherapy in the CML patients at the time of blast crisis.

Substance P and luteinizing hormone-releasing hormone levels in the brain of the male golden hamster are both altered by castration and testosterone replacement

The effects of castration and testosterone (T) replacement on levels of substance P (SP) and luteinizing hormone-releasing hormone (LHRH) were assessed in discrete areas of the male hamster brain. The animals were either castrated, castrated and given a chronically low or high dose of T by Silastic implant, or sham-operated. Brain tissues and trunk blood were collected 3 weeks after surgery. Plasma T levels were maintained within the normal range by the implants but at significantly lower or higher levels than the mean for sham-operated males. Levels of SP and LHRH were quantified in the olfactory bulbs, rostral basal forebrain, anterior hypothalamic and preoptic area, medial basal hypothalamic area, medial basal hypothalamic area and median eminence, and brain stem. In general, castration and T replacement effected opposite changes in levels of SP and LHRH. In the medial basal hypothalamic area and median eminence SP levels were found to be inversely related to the chronic T levels, whereas the LHRH levels were directly correlated. In the anterior hypothalamic and preoptic area, castration reduced levels of SP. Conversely, castration elevated levels of LHRH in this area. This inverse dynamic relationship between changing peptide levels was also observed in the rostral basal forebrain but not in the olfactory bulbs. In most of these forebrain regions, the dose-response curves for the experimental groups could not incorporate the peptide levels in the sham-operated control group. SP levels in the brain stem showed a monotonic inverse relationship to circulating T levels which did include the control group values.(ABSTRACT TRUNCATED AT 250 WORDS)

Limiting factors in successful preservation of cadaveric kidneys with ischemia time exceeding 50 hours

The results of 61 cadaveric allografts preserved for 30 to 76 hours were analyzed to determine the effect of cold ischemia time, the method of preservation, and the type of immunosuppression on early graft viability and long-term graft survival. Preservation in cold storage up to 50 hours gave a low incidence of nonfunction (4%) and of posttransplant dialysis (20%) and a high rate of function both at 1 month (96%) and at 2 years (60%). Cold ischemia time greater than 50 hours caused a significantly increased need for dialysis (58%) but without appreciable difference in graft function at 1 month or at 2 years. Preservation by machine had no advantage over preservation by simple cold storage when the cold ischemia time was less than 50 hours. When cold ischemia time exceeded 50 hours, machine preservation was associated with a significantly reduced incidence of posttransplant dialysis but without significant differences in long-term function at 2 years. With up to 50 hours of cold ischemia and providing there was no ATN, CsA had little nephrotoxicity and gave excellent graft function at 1 month and at 2 years. However, the nephrotoxicity of CsA was markedly increased when the preservation interval exceeded 50 hours, resulting in a significantly increased rate of primary nonfunction and the need for dialysis with a significant decrease in graft function at 1 month and at 2 years. The nephrotoxicity of CsA was considerably decreased or eliminated without affecting its powerful immunosuppressive property when initial immunosuppression was begun with azathioprine with sequential conversion to CsA when graft function was fully established. It is recommended that when cold ischemia is long or when there is ATN, CsA should be used as a sequential therapy to azathioprine after graft diuresis or, alternatively, in much smaller doses as part of a combination therapy with azathioprine.

HLA, MLR, P and Lewis antigens and living donor renal transplantation in a single centre in the Middle East

One hundred and fifty-one living donor renal transplants performed in a single centre in Kuwait were analysed for graft survival in relation to HLA matching, mixed lymphocyte reaction (MLR), P and Lewis antigens. There was a significant difference in graft survival (P = .05) but only at 3, 4 and 5 years between HLA identical (97%, 94%, 94%) and haploidentical combinations (83%, 81% and 79%), respectively. The zero haplotype matched combinations were not significantly different in graft survival from the identical or haploidentical groups. Compatibility or incompatibility for P or Lewis antigens did not influence graft survival. The MLR was significant (P = .05) with the MLR negative recipients having 100% graft survival at 4 years compared to 84% in the MLR positive group. In conclusion with an overall actuarial graft survival of 84% at 6 years none of the factors examined 'dramatically' influenced graft survival. The 'Centre Effect' is the main factor influencing graft survival in our Centre.

Effects of acute and subchronic delta 9-tetrahydrocannabinol administration on the plasma catecholamine, beta-endorphin, and corticosterone levels and splenic natural killer cell activity in rats

The effect of acute (1 day) or subchronic (25 days) treatment with delta 9-tetrahydrocannabinol (THC), the major psychoactive constituent of marihuana, on plasma norepinephrine (NE), epinephrine (E), corticosterone, beta-endorphin (beta-end), and splenic natural killer (NK) cell activity of the rat was studied. Groups of animals received subcutaneously, either THC in corn oil + saline (3 mg THC/kg); oil + saline; or THC + naloxone (2 mg naloxone/kg and 3 mg THC/kg). Acute injection of THC with or without naloxone did not significantly change plasma levels of NE, E corticosterone, beta-end, or the NK cell activity. However, subchronic treatment with THC significantly reduced plasma levels of NE, E, corticosterone, and NK cell activity, compared to controls. The plasma beta-end levels were significantly elevated in the THC-treated animals. In the THC + naloxone group of animals, the plasma hormone levels (corticosterone and beta-end) were similar to control levels and the NK cell activity was significantly higher than in THC-treated animals. These results indicate that subchronic exposure to THC results in suppression of splenic NK cell activity. The interaction of THC with the endogenous opiate system appears to be a contributing factor leading to the NK cell suppression in rats. A direct suppressive action of THC or its metabolites on the NK cell is not ruled out by this study.

Effect of delta 9-THC on brain and plasma catecholamine levels as measured by HPLC

The effects of chronic administration of delta 9-tetrahydrocannabinol (delta 9-THC) on the plasma and brain catecholamine (CA) levels were measured using high performance liquid chromatography-electrochemical detection (LC-EC) system. Intact male rats were injected daily with vehicle (50 microliter oil) or with delta 9-THC (3 mg/kg body wt) over a period of 25 days. Trunk plasma and tissue from preoptic area (POA) and mediobasal hypothalamus (MBH) were collected and catecholamine levels were detected by LC-EC system coupled to an electronic integrator. Alumina extract of tissue and plasma samples, spiked with the internal standard (dihydroxybenzylamine), were injected into the LC-EC system; the CA were chromatographed and eluted within 12 minutes using sodium phosphate buffer as the mobile phase. delta 9-THC treatment resulted in a significant decrease in plasma and MBH levels of norepinephrine (NE), epinephrine (E), POA levels of NE; and significant increases in MBH levels of dopamine (DA) and dihydroxyphenylacetic acid (DOPAC). Our study indicates for the first time that delta 9-THC treatment significantly alters not only the POA and MBH CA levels, but also the plasma CA levels.

Changing patterns of admission in a state mental hospital

The patterns of admission in a State Mental Hospital during the past decade (1st January 1973 to 31st December 1932) was studied. It was observed that voluntary admissions gradually increased whereas certified admissions declined over the decade. The certified cases from Madras City showed a decline in the recent years after some fluctuations and the certified cases from Districts of Tamil Nadu remained almost constant throughout the decade. The admissions from Madras City increased whereas the admissions from the Districts of Tamil Nadu showed a tendency to decline. The reasons for the above observations are discussed.

Behaviour charateristics of the mentally retarted in a state mental hospital-a comparative study

30 institutionalised severely subnormal (SSN) subjects and 30 matched severely subnormal individuals attending the outpatient services of the Institute of Mental Health, Madras were evaluated for their behaviour characteristics using a schedule containing two scales,the social and physical incapacity (SPI) scale and the speech, self help and literacy (SSL) scale. Destructive behaviour, self injury, overall poor speech, self help and literacy ability, overall social and physical incapacity, poor speech ability, poor speech comprehensibility, poor self help and poor literacy were the discriminating factors much more common for the institutionalised subjects than for the outpatient individuals. The usefulness of this informations in the planning and implementation of services for the institutionalised mentally retarded is discussed.

Effect of short photoperiod on hypothalamic methionine-enkephalin and LHRH content and serum beta-endorphin-like immunoreactivity (beta-end LI) levels in golden hamsters

Adult female golden hamsters were used to study the effect of short photoperiod on the endogenous opioid system and the effect of pinealectomy on the serum beta-endorphin-like immunoreactivity (beta-end LI) levels. Hamsters were housed under either long photoperiod (14L:10D) or short photoperiod (2L:22D) and the regularity of the estrous cycles was determined by daily vaginal exfoliative cytology. Hamsters under short photoperiod became acyclic after about 7 wk. At the end of 8 wk, all the hamsters were decapitated and medial basal hypothalamic (MBH) content of LHRH and methionine-enkephalin (met-enkephalin) were measured by specific radioimmunoassays (RIA). Both LHRH and met-enkephalin levels of the MBH were significantly elevated in the short-photoperiod hamsters as compared to the normally cycling control animals under long photoperiod. In a second experiment, the effect of pinealectomy (PNX) on the serum levels of beta-end LI in the short-photoperiod hamsters was determined. The serum beta-end LI levels were increased approximately threefold in the noncyclic hamsters housed under 8 wk of short-photoperiod conditions. Pinealectomized hamsters kept under 8 wk of short-photoperiod exhibited lower serum beta-end LI levels similar to those of normally cycling hamsters kept under long photoperiod. These results indicate a possible functional relationship between increased pineal activity (as a result of short photoperiod) and increased MBH met-enkephalin, LHRH, and serum beta-end LI levels.

Institutionalised mentally retarded in a state mental hospital

298 institutionalised mentally retarded patients in Institute of Mental Health, Madras were studied for the aetiological factors, levels of intelligence, associated disorders and family structure and compared with 163 matched group of mentally retarded attending the outpatient services of the Institute of Mental Health. In 41% of the institutionalised the cause was unknown, 29.3% had infective aetiology, 18% formed the primary group and 6.4% were due to genetic and chromosomal factors. Statistically significant number of institutionalised were severely subnormal, had more associated disorders and poor family structure. The need for the development of exclusive residential services for the mentally retarded and community oriented approach are discussed.

Diurnal fluctuations in methionine-enkephalin levels in the hypothalamus and preoptic area of the male rat: effects of pinealectomy

Methionine-enkephalin (met-enk) levels were measured at 09.30-10.30, 16.30-17.30 and 23.30-00.30 h in the anterior hypothalamus-preoptic area (AHPOA), medial basal hypothalamus (MBH), anterior, intermediate and posterior lobe of the pituitary gland of male rats. Met-enk levels in the AHPOA and MBH fluctuated significantly through a 24-hour period; from low levels at 09.30-10.30 h, met-enk in the AHPOA and MBH rose slowly in the afternoon to reach peak concentrations at 23.30-00.30 h. Pinealectomy appears to depress or shift the normally occurring increments in met-enk levels at 23.30-00.30 h in the AHPOA only. Serum testosterone (T) levels displayed an inverse relationship with the met-enk rhythm; high concentrations during the day were associated with low met-enk levels and as T levels decreased to a nadir at 23.30-00.30 h, the met-enk in the MBH and AHPOA attained peak concentrations. Daily changes in serum T levels were not affected by pinealectomy.

Altered hypothalamic dopamine depletion rate and LHRH content in noncyclic hamsters

Effect of light deprivation on hypothalamic dopamine (DA) depletion rate and luteinizing hormone releasing hormone (LHRH) content was evaluated in golden hamsters. Hamsters maintained in continuous darkness (CD) became acyclic after about 6 weeks while another group of hamsters maintained vaginal cyclicity under 20 lux light intensity for 14 hours a day. All hamsters were ovariectomized subsequently. Luteinizing hormone releasing hormone levels were significantly higher in the medial basal hypothalamus (MBH) and the serum gonadotropin levels were significantly lower in CD hamsters when compared with 20 lux group. However, gonadotropin release in response to exogenous LHRH was not significantly different in CD or 20 lux group of hamsters. Examination of hypothalamic catecholamine levels one hour after alpha-methyl-p-tyrosine injection indicated that the DA depletion was higher in CD animals. Results indicate that light deprivation probably enhances DA depletion rate in the MBH, suggesting that increased activity in dopaminergic neurons may inhibit the release of MBH LHRH in hamsters kept in continuous darkness.