Multicenter study of the treatment of erectile dysfunction with transurethral alprostadil (MUSE) in Korea

A Korean multicenter study was conducted to assess the effectiveness of transurethral alprostadil with MUSE in 334 subjects with chronic erectile dysfunction (ED) who were enrolled in 21 clinical centers. Patients with psychogenic impotence comprised about 30% of subjects. Intraurethral alprostadil was titrated in a stepwise fashion in the clinics from 250 to 500 or 1000 mcg based on erectile response and tolerability. The erectile responses were evaluated using an erection assessment scale (score of 1-5). The dose that produced a maximal penile response of score 5 (full rigid erection) or 4 (full tumescence, partial rigidity) was selected for home treatment. Patients who showed partial erection (score of 3) with 1000 mcg were also included in the home-treatment group. In-clinic phase: 198 men (59.3%) had maximal penile responses of score 4 or 5. The rate of maximal responses was not related to patient age, etiology or duration of the ED. A total of 228 (68.3%) men progressed to home treatment. The overall level of comfort of the transurethral alprostadil was rated as uncomfortable or very uncomfortable in 12%. Home phase: During the two-month period of home treatment, 178 (78.1%) men had successful sexual intercourse at least once, and 78.2% of administrations (1976) resulted in successful intercourse. The main causes of drop-out were insufficient erectile response in 27 men (11.8%), adverse reactions (mostly penile or urethral pain) in 7 (3.1%) or both in 7 (3.1%). In conclusion, transurethral alprostadil could be a suitable treatment option for patients with ED regardless of age and etiology of ED. Efficacy in an Asian population (Korea) is comparable to that reported previously in Caucasians.

Spontaneous variability of cardiac output in ventilated critically ill patients

OBJECTIVE

To define the magnitude of spontaneous cardiac output variability over time in sedated medical intensive care unit patients attached to a continuous cardiac output monitor, and to determine whether high level positive end-expiratory pressure or inverse inspiratory-to-expiratory (I:E) ratio ventilation resulted in greater variability over time than low positive end-expiratory pressure with conventional I:E ratio ventilation.

DESIGN

Prospective study.

SETTING

Medical intensive care unit in a tertiary medical center.

PATIENTS

A total of 22 hemodynamically stable acute respiratory failure patients with a pulmonary artery catheter inserted for hemodynamic monitoring

INTERVENTIONS

After being sedated, patients were randomized ultimately to receive pressure control ventilation first at setting A (high positive end-expiratory pressure [15 cm H2O] with conventional I:E ratio [1:2]) and then at setting B (low positive end-expiratory pressure [5 cm H2O] with inverse I:E ratio [2:1]), or vice versa, and then at setting C (low positive end-expiratory pressure [5 cm H2O] with conventional I:E ratio [1:2]). Each ventilation setting period lasted 1 hr.

MEASUREMENTS AND MAIN RESULTS

Cardiac output (CO) was measured continuously. The continuous CO value displayed was updated every 30-60 secs. The updated value reflected an average of the previous 3-6 mins. The coefficient of variation (CV) of CO for each setting in each patient was calculated to represent the spontaneous variability. The mean CO+/-SD and CV of each setting was 5.7+/-1.8 L/min and 4.4% for setting A, 5.6+/-1.5 L/min and 4.6% for setting B, and 5.9+/-1.7 L/min and 4.8% for setting C. Analysis of variance revealed no significant differences between the CVs of the three settings. The 95% confidence interval for the COs for each setting was approximately the mean CO+/-0.1 x mean CO measured.

CONCLUSIONS

In critically ill sedated medical intensive care unit patients with stable hemodynamics, the spontaneous variability of cardiac output over time was not significant. High positive end-expiratory pressure (15 cm H2O) and inverse ratio ventilation (2:1) did not contribute to increased spontaneous variability of cardiac output.

hCds1-mediated phosphorylation of BRCA1 regulates the DNA damage response

Mutations in the BRCA1 (ref. 1) tumour suppressor gene are found in almost all of the families with inherited breast and ovarian cancers and about half of the families with only breast cancer. Although the biochemical function of BRCA1 is not well understood, it is important for DNA damage repair and cell-cycle checkpoint. BRCA1 exists in nuclear foci but is hyperphosphorylated and disperses after DNA damage. It is not known whether BRCA1 phosphorylation and dispersion and its function in DNA damage response are related. In yeast the DNA damage response and the replication-block checkpoint are mediated partly through the Cds1 kinase family. Here we report that the human Cds1 kinase (hCds1/Chk2) regulates BRCA1 function after DNA damage by phosphorylating serine 988 of BRCA1. We show that hCds1 and BRCA1 interact and co-localize within discrete nuclear foci but separate after gamma irradiation. Phosphorylation of BRCA1 at serine 988 is required for the release of BRCA1 from hCds1. This phosphorylation is also important for the ability of BRCA1 to restore survival after DNA damage in the BRCA1-mutated cell line HCC1937.

Asynchronous Ca(2+) waves in intact venous smooth muscle

The rabbit inferior vena cava (IVC) is a large-capacitance vessel that displays typical contractile dose-response curves for caffeine and phenylephrine (PE). Using confocal microscopy on the endothelium-denuded IVC, we undertook experiments to correlate these whole-tissue contractile dose-response curves with changes in subcellular [Ca(2+)](i) signals in the in situ vascular smooth muscle cells (VSMCs). We observed that both caffeine and PE initially elicited Ca(2+) waves in individual VSMCs. The [Ca(2+)](i) in cells challenged with caffeine subsequently returned to baseline whereas the [Ca(2+)](i) in cells challenged with PE exhibited repetitive asynchronous Ca(2+) waves. These [Ca(2+)](i) oscillations were related to Ca(2+) release from the sarcoplasmic reticulum as they were inhibited by ryanodine and caffeine. The lack of synchronicity of the [Ca(2+)](i) oscillations between VSMCs can explain the observed tonic contraction at the whole-tissue level. The nature of these Ca(2+) waves was further characterized. For caffeine, the amplitude was all-or-none in nature, with individual cells differing in sensitivity, leading to their recruitment at different concentrations of the agonist. This concentration dependency of recruitment appears to form the basis for the concentration dependency of caffeine-induced contraction. Furthermore, the speed of the Ca(2+) waves correlated positively with the concentration of caffeine. In the case of PE, we observed the same characteristics with respect to wave speed, amplitude, and recruitment. Increasing concentrations of PE also enhance the frequency of the [Ca(2+)](i) oscillations. We therefore conclude that PE stimulates whole-tissue contractility through differential recruitment of VSMCs and enhancement of the frequency of asynchronous [Ca(2+)](i) oscillations once the cells are recruited.

Differential expression of glycogen synthase kinase 3 genes during zebrafish embryogenesis

Glycogen synthase kinase 3 (GSK-3) belongs to a highly conserved family of protein serine/threonine kinase whose members in high eukaryotes are involved in hormonal regulation, nuclear signaling, and cell fate determination. We have identified two zebrafish homologues related to mammalian GSK-3, ZGSK-3alpha and ZGSK-3beta. ZGSK-3alpha was expressed uniformly from cleavage onward, and later was found in many but not all tissues, especially in the central nervous system, spinal cord, somites and pronephric ducts. ZGSK-3beta was also transcribed maternally but the transcripts were not uniformly distributed during early cleavage stage. Most signals were concentrated in the inner part of the blastomeres. From midblastula stage onward, the ZGSK-3beta transcripts remained confined to inner parts of the deep cell layer. During shield stage, both epiblast and hypoblast expressed the transcripts. After late gastrulation, the signals were detected ubiquitously. During segmentation, prominent ZGSK-3beta signal was detected in head portion of the neural system. In the trunk, the expression was maintained in the neural tube and paraxial mesoderm and then became prominent in adaxial cells, followed by expression at the posterior region of somites. In pharyngula period ZGSK-3beta transcripts were distributed in similar regions as those of ZGSK-3alpha, namely, neural tissues of the head portion, spinal cord and somites.

Purification of membrane-bound lactoferrin from the human milk fat globule membrane

Although lactoferrin is known as a basic soluble glycoprotein, the presence of the membrane-bound form of this protein has also been demonstrated in human milk. Membrane-bound lactoferrin was extracted from the human milk fat globule membrane with a detergent mixture of 1% Tween-20, 0.5% C12E8, and 0.5 M KCl in 20 mM Tris-HCl (pH 7.4). Lactoferrin in the detergent-soluble fraction was purified by affinity chromatography with Concanavalin A and by hydrophobic chromatography with phenyl-Superose. The purified protein gave a single band of 80 kDa by SDS-PAGE. Its N-terminal amino acid sequence was consistent with that of human lactoferrin.

Rapid and sensitive XAFS using a tunable X-ray undulator at BL10XU of SPring-8

The design and performance of the high-brilliance XAFS facility at BL10XU of SPring-8, aimed at rapid and sensitive measurement of X-ray absorption fine structure (XAFS), is reported. Both undulator gap and double-crystal monochromator have been successfully controlled covering a wide energy range (5-30 keV). A versatile goniometer system, consisting of two independent high-precision goniometers, is capable of polarized XAFS in fluorescence mode and surface-sensitive experiments using a grazing-incidence geometry. By sharing major components, i.e. a monolithic Ge 100-pixel array detector and a closed-cycle He cryostat, both polarized XAFS and X-ray standing wave (XSW) experiments can be performed at low temperature (15-300 K). The performance of the spectrometer has been evaluated by recording XAFS spectra in transmission mode.

Synthesis and antibacterial activity of 2alpha-functionalized 1beta-methylcarbapenems related to KR-21012

The 2alpha-functionalized 1beta-methylcarbapenems 3 were synthesized from the 2-formyl 1beta-methylcarbapenem intermediate 5. The best compound in the series of 2alpha-(hydroxy)alkylcarbapenems, KR-21012, displayed well balanced in vitro and in vivo activity as a parent compound of oral carbapenem.

Metabolic acidosis and composite nutritional index (CNI) in CAPD patients

BACKGROUND

Metabolic acidosis (MA) has been recognized as an important stimulus for net protein catabolism. Continuous ambulatory peritoneal dialysis (CAPD) is regarded to have advantage in normalizing the acid-base homeostasis over hemodialysis due to continuous supply of buffer. However, many CAPD patients still remain acidotic and the clinical impact of this MA is uncertain. Recent studies revealed no specific correlation between a certain degree of MA and protein nutritional status while others showed that mild alkalosis is nutritionally beneficial to CAPD patients. A cross-sectional study evaluating acid-base and nutritional status was performed to examine the relationship between acid-base status and overall nutritional status assessed by composite nutritional index (CNI) and to get a basic information about the optimal pH/HCO3 in CAPD patients.

PATIENTS AND METHODS

Total 198 clinically stable patients maintained on CAPD more than 6 months were evaluated. Each of 10 nutritional parameters of CNI consisting of clinical (subjective global assessment), biochemical (total lymphocyte count, albumin, prealbumin, insulin-like growth factor-1, transferrin) and anthropometric parameters (body mass index, % lean body mass, triceps skinfold thickness, midarm muscle circumference) was graded from 0 to 3 point (0; normal, 1; mildly decreased, 2; moderately decreased, 3; severely decreased).

RESULTS

Mean CNI score was 8.2 +/- 5.2 with a range of 0 to 25. CNI was positively correlated with age, duration of peritoneal dialysis, incidence of peritonitis, C-reactive protein (CRP), HCO3 and dialytic protein loss whereas it was inversely correlated with hemoglobin and nPNA. In patients with MA (n = 25, mean arterial HCO3 19.5 +/- 1.9 mM/l), CNI score was significantly lower (6.3 +/- 3.5) compared to patients with normal acid-base status (n = 63, 9.5 +/- 5.9, p < 0.01) or metabolic alkalosis (n = 47, 10.1 +/- 4.6, p < 0.001). Multiple regression analysis revealed that the incidence of peritonitis, duration of dialysis, CRP and dialytic protein loss were the independent predictors of CNI.

CONCLUSIONS

CAPD patients with mild to moderate degree of MA appear to be associated with more favorable overall nutritional status expressed as CNI. Prospective studies evaluating changes in the nutritional parameters with the correction of acid-base abnormality are needed to understand the real impact of acid-base status on nutritional status and to know the optimal pH/HCO3 in CAPD patients.

Ciprofloxacin-induced oral facial dyskinesia in a patient with normal liver and renal function

A 49-year-old Chinese woman with good past health presented to a general practitioner with fever, chills, dysuria, and loin pain. Urinary tract infection was diagnosed and she was treated with oral ciprofloxacin. She was hospitalized because of persistent chills and fever. Physical examination showed hyperpyrexia of 38.6°C, together with suprapubic and bilateral loin tenderness. White cell count was 11.2×109/litre. Ultrasonogram of kidneys showed no structural abnormality. She was treated as having acute pyelonephritis with ciprofloxacin 200 mg intravenously twice daily. Her symptoms improved. Urine and blood culture yielded negative results.

She developed involuntary facial grimacing 2 days after starting ciprofloxacin treatment. Neurological examination did not reveal other abnormal findings. Her only other medication was paracetamol 500 mg orally four times a day. She had no prior history of similar involuntary movements. The oral facial dyskinesia occurred intermittently every 4–6 hours, with each attack lasting about an hour. She maintained a clear sensorium during the involuntary movements. Computed tomography and magnetic resonance imaging of the brain, as well as lumbar puncture, yielded normal results. Electroencephalogram showed normal wave form. The levels of liver transaminases were raised transiently after starting ciprofloxacin treatment, with aspartate aminotransferase 82 U/litre (normal 12–28 U/litre) and alanine aminotransferase 176 U/litre (normal 5–31 U/litre). Serum albumin, bilirubin, prothrombin time and creatinine levels were normal. The involuntary movements improved slightly with clonazepam therapy, but did not subside completely. In view of the possibility of ciprofloxacin-induced neurotoxicity, ciprofloxacin was stopped and substituted with netromycin. Her oral facial dyskinesia stopped and did not recur. The patient had an uneventful recovery.

Chinese food cooking and lung cancer in women nonsmokers

Cigarette smoking cannot fully explain the epidemiologic characteristics of lung cancer in Taiwanese women, who smoke rarely but have lung cancer relatively often. In a previous study, the authors suspected that exposure to fumes from cooking oils was an important risk factor for lung cancer in Taiwanese women nonsmokers in the Republic of China. In a new case-control study conducted in 1993-1996, they further explored the association of oil fumes with lung cancer in women. Two sets of controls were used concurrently. The subjects were 131 nonsmoking incident cases with newly diagnosed and histologically confirmed primary carcinoma of the lung, 252 hospital controls hospitalized for causes unrelated to diseases of smoking, and 262 community controls; all controls were women nonsmokers matched by age and date of interview. Details on cooking conditions and habits were collected, in addition to other epidemiologic data. Lung cancer risk increased with the number of meals per day to about threefold for women who cooked these meals each day. The risk was also greater if women usually waited until fumes were emitted from the cooking oil before they began cooking (adjusted odds ratios = 2.0-2.6) and if they did not use a fume extractor (adjusted odds ratios = 3.2-12.2). These results suggest that a proportion of lung cancer may be attributable to the habit of waiting until the cooking oil has been heated to a high temperature before cooking the food.

Electron contamination from the lead cutout used in kilovoltage radiotherapy

In kilovoltage radiotherapy, low-energy electrons are generated on the lead cutout plate frequently used to shape the x-ray field. They can cause surface dose enhancement and affect the percentage depth dose (PDD) and cutout factor when these parameters are measured with a parallel plate chamber. Although many previous studies concerning a similar surface dose enhancement have suggested using a thin electron filter to eliminate the effect of these low-energy electrons, no details have been given regarding the adequacy of the filter. This paper describes the procedures required to test an electron filter for our Darpec 2000 superficial x-ray machine. A piece of plain paper was found to be an adequate electron filter, which could block all the low-energy electrons without affecting the PDD and cutout factor measurement. The surface dose enhancement caused by the presence of the cutout plate was studied with such a filter. The enhancement was found to increase with x-ray energy and decrease with cutout size as well as applicator size. At the highest x-ray energy in this study (120 kV, HVL 8.6 mmAl), the enhancement ranges from less than 1% for a 8 cm diameter cutout to a maximum of 14% for a 2 cm diameter cutout with a 10 cm applicator. For a 5 cm diameter applicator it ranges from about 1% to about 11%. The difference between the measured and predicted cutout factor displays similar characteristics. Since the low-energy electrons do not generate any useful treatment dose but their presence can lead to potential dosimetry problems, we suggest that a filter tested with the procedure described in this paper should be used when percentage depth dose and cutout factor for kilovoltage x-ray are measured with a parallel-plate chamber.

Typing of Histoplasma capsulatum isolates based on nucleotide sequence variation in the internal transcribed spacer regions of rRNA genes

The nucleotide sequences of internal transcribed spacer (ITS) regions of rRNA genes of 24 isolates of Histoplasma capsulatum were examined. The results indicate that the sequences of ITS regions in different isolates are not identical. Sequence variations were found at 20 positions in the 496 bp that were sequenced. Ten different sequence patterns, designated types A through H, were observed when the sequences from the 24 isolates were aligned. Twelve isolates from Indianapolis were classified into four different types. Two isolates from New York belonged to type G. Three isolates from different cities were type F. The remaining six isolates were of different types.

Ruptured giant intrathoracic lipoblastoma in a 4-month-old infant: CT and MR findings

BACKGROUND

We describe a 4-month-old infant with a ruptured intrathoracic lipoblastoma arising from the parietal pleura and associated with a pleural effusion.

OBJECTIVE

The clinical presentation was rapidly evolving respiratory distress. The chest radiograph showed a large mass and a pleural effusion in the right thoracic cavity. CT demonstrated an inhomogeneous low-attenuation mass which was 7 cm in diameter and which showed areas of enhancement after intravenous contrast medium. MRI showed a fatty intrathoracic mass with intratumoral streaks and whorls, which were attributed to loose fibrovascular connective tissue on pathological examination.

RESULTS

Thoracotomy and pathological examination revealed a ruptured intrathoracic lipoblastoma arising from the parietal pleura.

CONCLUSION

The pleural effusion might have suggested rupture of the tumour.

Diagnosis of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients with polymerase chain reaction: a blinded comparison to standard methods

Pneumocystis carinii pneumonia (PCP) is an important cause of morbidity and death among persons with human immunodeficiency virus (HIV) infection. Polymerase chain reaction (PCR) analysis of respiratory specimens has been investigated as a rapid diagnostic method. We have previously reported on the utility of this technique for diagnosing PCP in HIV-infected patients. In this report we evaluate PCR used in a blinded study design to avoid biases inherent to retrospective and nonblinded studies. The diagnosis of PCP was established on the basis of clinical findings and morphological studies of bronchoalveolar lavage (BAL) and/or lung biopsy specimens before PCR testing. PCR was performed without knowledge of the diagnosis. PCR results were graded from "negative" to 3+ on the basis of intensity of the banding pattern. Forty-seven patients were enrolled in the study, including 18 with proven PCP and 29 with other conditions. PCR was positive at grade 1 or higher for all 18 patients with PCP (100% sensitivity), at grade 2 or higher for 13 patients (72.2% sensitivity), and at grade 1 or higher for 4 of the 29 control patients (specificity of 86.2%). If a grade 2 or higher was required for diagnosis, the specificity improved to 100%. Results were reproducible with testing of a second aliquot for 46 of 47 patients (97.8%). Our findings confirm that PCR is a sensitive and reproducible test for detection of P. carinii in BAL specimens. Problems with false-positive results for control patients, however, limit the applicability of this method.

The production of nitric oxide and TNF-alpha in peritoneal macrophages is inhibited by Dichroa febrifuga Lour

Nitric oxide (NO) and tumor necrosis factor-alpha (TNF-alpha) have been suggested to play an important role in endotoxin-mediated shock and inflammation. In this study, we investigated the effect of aqueous extract of Dichroa febrifuga Lour. (Saxifragaceae) roots, a traditional antimalarial drug, on the production of NO and TNF-alpha. The aqueous extract of D. febrifuga roots (AEDF) inhibited the secretion of NO and TNF-alpha in lipopolysaccharide (LPS) and/or interferon-gamma (IFN-gamma)-stimulated mouse peritoneal macrophages, without affecting cell viability. The protein level of inducible nitric oxide synthase (iNOS) in peritoneal macrophages was also decreased by AEDF. In addition, the serum level of NO was reduced by i.p. administration of AEDF. These results suggest that AEDF suppresses the endotoxin-induced inflammatory responses through inhibiting the production of NO and TNF-alpha, and could be used as an anti-inflammatory drug.

Carbamate poisoning: high resolution CT and pathologic findings

Carbamate insecticides are commonly used agricultural insecticides. The major cause of morbidity and mortality in acute carbamate poisoning is respiratory failure associated with pulmonary edema. Although carbamate poisoning is well recognized in the clinical literature, the findings of high resolution CT (HRCT) with carbamate have not been reported. We report the radiographic and HRCT findings of a patient with acute carbamate poisoning who had pathologically proven interstitial pneumonitis after resolution of initial pulmonary edema.

Levothyroxine suppression of thyroglobulin in patients with differentiated thyroid carcinoma

For patients with differentiated thyroid carcinoma, the appropriate degree of TSH suppression by levothyroxine (L-T4) is still unknown. To find the target level of TSH suppression, we analyzed the relationship between the degree of TSH suppression determined by third generation assay and thyroglobulin (Tg) response during the titration of the dosage of L-T4. Ninety-two patients with differentiated thyroid carcinoma (19 males and 73 females; age, 40.5+/-13.5, mean +/- SD) were included. All of the recruited patients had near-total thyroidectomy, 30-150 mCi 131I thyroid ablation, and negative Tg autoantibodies. They were classified into 3 groups. Group A was composed of 25 patients with local or distant relapse. Group B was composed of 12 patients without clinically detectable relapse, but Tg levels either above 2 ng/mL under L-T4 suppression or above 3 ng/mL off L-T4 therapy. Group C included 55 patients who had no active disease and Tg levels below 2 and 3 ng/mL during and off L-T4 suppression, respectively. Serum TSH and Tg were measured simultaneously at the end of 8-12 weeks of a certain dose of L-T4 therapy during dosage titration and also after withdrawal of L-T4 for 4-6 weeks for the total body scan. Wilcoxon signed ranks test was used to compare paired samples of Tg, and Spearman rank correlation was used to determine the correlation of relative changes in TSH to changes in Tg calculated by individual. The results showed that 1) Tg levels were significantly higher during the period off L-T4 therapy than on L-T4, therapy in all 3 groups (P < 0.01); 2) during L-T4, therapy, within the same treatment course, mean Tg levels were higher when TSH levels were normal than when TSH levels were suppressed, statistically significant in group A (P = 0.001), nonsignificant in group B (P = 0.09), and nonsignificant in group C (P = 0.30); and 3) when TSH was suppressed below normal, there was no correlation between the relative changes in TSH and Tg by individual in all 3 groups (P > 0.05). The data suggest a stratified postoperative thyroid hormone management of patients with differentiated thyroid carcinoma. TSH should be lowered to below normal in patients with active disease. If patients are clinically disease free with Tg levels below 2 ng/mL, TSH can be kept within the normal range. For the most controversial group B patients, it is recommended that the TSH be suppressed and be closely followed up.

ERK/MAPK pathway is required for changes of cyclin D1 and B1 during phorbol 12-myristate 13-acetate-induced differentiation of K562 cells

Phorbol 12-myristate 13-acetate (PMA)-induced differentiation of human erythroleukemic K562 cells is characterized by growth arrest, morphological change, and expression of megakaryocyte-specific proteins. We examined the possible involvement of cell cycle regulators with PMA-induced growth arrest and megakaryocytic differentiation of K562 cells. The concentrations of cyclin D1 and p21Waf1/Cip1 were dramatically increased, whereas those of cyclin B1 and cdc2 were decreased, by PMA treatment. The concentrations of most cyclin-dependent kinases (Cdk2, Cdk4, and Cdk6), however, were unchanged by PMA treatment. PD98059, a specific inhibitor of MEK1, partially prevented the increase in cyclin D1 caused by PMA and fully reversed the down-regulation of cyclin B1 protein seen in response to PMA treatment. Thus, it is demonstrated here that the PMA-mediated changes of cyclin D1 and B1 are the result of a persistent increase in extracellular signal-regulated kinase/mitogen-activated protein kinase (ERK/MAPK) activity.

Deconvolution of local surface response from topography in nanometer profilometry with a dual-scan method

In profilometric measurements, by scanning the sample twice with a fixed vertical offset, one can separate the signal that comes from surface heterogeneity from the topographic signal. Using differential confocal microscopy, a newly developed open-loop nanometer profilometric technique, we demonstrated this dual-scan method on composite samples and obtained 10-nm depth resolution. This technique can also be applied to other profilometric techniques such as atomic force microscopy and scanning tunneling microscopy.

Case report: Clostridium septicum infection presenting as liver abscess in a case of choriocarcinoma with liver metastasis

Clostridium septicum is an anaerobic, gram-positive bacillus. Infection with this organism has a known association with malignant diseases, especially colon and haematological cancers. Clostridium septicum is rarely found to be a pathogen of liver abscess. Herein, we report the case of a female choriocarcinoma patient with liver metastasis in which C. septicum infection presented as a gas-forming liver abscess. This case and previous reports indicate that once C. septicum is identified as a pathogen in liver abscess, metastatic liver tumours should be highly suspected.

Modification of cardiovascular responses to spinal GABA(B) receptor stimulation by cAMP and by K(ATP) channel blockade in anaesthetized rats

1. Intrathecal (i.t.) injection of baclofen (30, 60 and 100 nmol), a GABA(B) receptor agonist, produced a dose-dependent decrease in blood pressure (BP) and heart rate (HR). 2. Pretreatment with 5-aminovaleric acid (50 nmol), a GABA(B) receptor antagonist, blocked the depressor and bradycardic effects of baclofen (100 nmol). 3. Pretreatment with 8-bromo-cAMP (10 nmol), a cAMP analogue, attenuated the depressor and bradycardic effects of baclofen (100 nmol), but not with 8-bromo-cGMP (10 nmol), a cGMP analogue. 4. In addition, pretreatment with glipizide (20 nmol), an ATP-sensitive K+ channel (K(ATP)) blocker, attenuated the depressor and bradycardic effects of baclofen (100 nmol). These results suggest that GABA(B) receptors in the spinal cord have an inhibitory role in the central cardiovascular regulation and that these depressive and bradycardic actions are modified by cAMP and by K(ATP) channel blockade.

Early onset of hypernatraemic dehydration and fever in exclusively breast-fed infants

Five cases of moderately severe hypernatraemic dehydration were identified within a 5-month period between two regional hospitals in Hong Kong. Unlike previous reported cases, these exclusively breast-fed infants presented with the unusual triad of fever, absence of overt signs of dehydration and within the first week of life. Three of the cases also had high serum bilirubin concentrations at presentation. The fever subsided quickly and the serum bilirubin concentration fell rapidly within a few hours of rehydration. All infants made an uneventful recovery without permanent neurological sequelae. Fever, presumably secondary to dehydration, is an useful early warning sign. These cases emphasize the importance of early and regular measurement of bodyweight in exclusively breast-fed infants so that prompt identification of affected cases may prevent potentially detrimental complications.

Chronic exposure to antibodies directed against anti-opiate peptides alter delta-opioid receptor levels

The development of addictive states in response to chronic opioid use may be regulated partially by the release of endogenous peptides. These anti-opiate peptides (AOP) are secreted or released into the CNS and produce diverse actions that counterbalance the effects of prolonged opiate exposure. Though the mechanism(s) by which these peptides exert their physiological properties remain largely unknown, there is some indication that AOP's modulate opioid receptor levels. In this study, we investigated the effects of chronically infused alpha-melanocyte stimulating hormone (alpha-MSH), dynorphin(1-8) (DYN(1-8)), dynorphin A (DYNA), and NPFF antibodies on delta-opioid receptor expression in rat brains. Quantitative autoradiographic experiments revealed that antibodies directed against alpha-MSH and DYNA produced significant increases in delta receptor levels in the caudate, claustrum, and cingulate cortex of the rat brain. Conversely, NPFF monoclonal antibodies caused significant decreases in the caudate, nucleus accumbens, olfactory tubercle, and cingulate cortex. These results suggest that the density of delta-opioid receptors is affected by changes in the levels of the anti-opioid peptides in the extracelluar fluid in the rat brain.