A psychiatric liaison service in a general hospital. Referrals and their appropriateness

Referrals to a liaison psychiatry service, based in a District General Hospital, were studied over a six month period. 190 [89%] of the 214 referrals were for assessment following an episode of deliberate self harm. An excess of these referrals were male [57%] and a large proportion particularly of the males [36%] were diagnosed as having a significant alcohol problem. Many were felt to have no significant psychiatric problem [31%], and a large proportion were discharged with no psychiatric follow-up [28%]. Patterns of diagnosis and disposal differed between the sexes. Referring junior medical staff when asked to give their opinions on the likely management and overall need for psychiatric referral of patients were found to reach reasonable agreement with the assessing psychiatrist, even without prior training, and to be more cautious in their assessment. In many centres the trend is towards selective referral of deliberate self harm patients, and this appears a safe and appropriate development which can be achieved without intensive training or major alterations to working patterns, and which will result in modest but important reductions in inappropriate referrals.

Transcatheter delivery of c-myc antisense oligomers reduces neointimal formation in a porcine model of coronary artery balloon injury

BACKGROUND

Smooth muscle cell proliferation and extracellular matrix accumulation are the principal mechanisms leading to vascular restenosis. We have previously demonstrated the growth-inhibitory effect of antisense oligomers targeting the c-myc proto-oncogene in human smooth muscle cells. The goal of this study was to investigate whether c-myc antisense oligomers reduce neointimal formation in balloon-denuded porcine coronary arteries.

METHODS AND RESULTS

First, type I collagen synthesis, which reflects synthetic function, was markedly reduced following c-myc antisense oligomers in porcine vascular smooth muscle cells independent of the growth inhibition. These effects in vitro provided the rationale for assessing c-myc antisense oligomers in the prevention of neointima in vivo. Second, the efficiency of single transcatheter delivery of oligomers into denuded porcine coronary arteries was determined. Despite rapid plasma clearance following local delivery, oligomers persisted at the site of injection for at least 3 days, exceeding by severalfold their concentration in peripheral organs. Third, morphometric analyses were carried out in balloon-denuded coronary arteries at 1 month after transcatheter c-myc antisense oligomer administration. Maximal neointimal area was reduced from 0.80 +/- 0.17 mm2 in the control group (n = 12) to 0.24 +/- 0.06 mm2 in the antisense-treated group (n = 13, P < .01). Likewise, a significant reduction in maximal neointimal thickness was observed in the antisense-treated group (P < .01). These changes in vascular remodeling following denuding injury resulted in an increase in residual lumen from 64 +/- 6% in the control group to 81 +/- 5% in the antisense-treated group (P < .05).

CONCLUSIONS

(1) Single transcatheter administration allowed for endoluminal delivery of oligomers to the site of coronary arterial injury. (2) C-myc antisense oligomers reduced the formation of neointima in denuded coronary arteries, implying a therapeutic potential of this approach for the prevention of coronary restenosis. (3) It is postulated that the c-myc proto-oncogene is involved in the process of vascular remodeling, regulating smooth muscle cell proliferation and extracellular matrix synthesis.

Detailed analysis of the basic domain of the E2F1 transcription factor indicates that it is unique among bHLH proteins

The E2F1 transcription factor binds to sites within the promoters of a number of cell cycle regulated genes through a basic-helix-loop-helix motif (bHLH). It is shown here that the basic region of E2F1 is distinct from that of all other bHLH proteins. The center of the basic region contains a helix breaking proline-glycine pair, (P122, G123), implying a turn within this region. This is in contrast to the known bHLH containing proteins where the basic region is alpha-helical. Substitution of P122 and G123 with alanines results in a significant reduction in DNA binding levels, with the predicted formation of an alpha-helix. Also in contrast to other bHLH proteins, mutations generated in conserved basic residues of E2F1 do not effect DNA binding. In addition, a single leucine (191) between helix no. 2 and the leucine zipper is required for DNA binding while the leucine zipper itself is not necessary. Finally, E2F1 interacts with all of the G-residues in the sequence GGCGGGAAA while the A-residues are not required for DNA binding. The uniqueness of the E2F1 DNA binding domain is likely to play a role in its binding a DNA site that is distinct from that of all other bHLH proteins (CACGTG).

Cervical epidural haematoma following minor trauma

Cervical epidural haematoma following minor trauma is unusual in normal adults. It is important that the condition is diagnosed and treated promptly in order to improve the prognosis. Surgery to evacuate the haematoma is the treatment of choice.

Downregulation of c-myc expression by antisense oligonucleotides inhibits proliferation of human smooth muscle cells

BACKGROUND

Proliferation of smooth muscle cells (SMCs) plays an important role in vascular pathobiology, being involved in the development of coronary restenosis and atherosclerosis. The activation of nuclear proto-oncogenes appears to be a final common pathway onto which various mitogenic signals coverage. Accordingly, we attempted to determine whether the activation of the c-myc nuclear proto-oncogene is essential for human SMC proliferation and explored the possibility of inhibiting their growth using antisense oligonucleotides directed against c-myc messenger RNA (mRNA).

METHODS AND RESULTS

Proliferation of human SMCs was associated with an increase in c-myc mRNA expression after growth stimulation. Using 15-mer phosphorothioate oligonucleotides (oligomers), we tested their growth-inhibitory effect in SMCs in vitro. Antisense oligomers directed against the translation initiation region of the human c-myc gene exhibited a significant antiproliferative effect, whereas sense and mismatched oligomers did not inhibit the growth. The growth-inhibitory effect of c-myc antisense oligomers was dose dependent and preventable by an excess of sense oligomers. Furthermore, growth inhibition of SMCs treated with c-myc antisense oligomers was associated with a marked decrease in the c-myc mRNA level. Phosphorothioate oligomers remained stable in medium containing 20% serum and were detectable in SMCs as early as 1 hour after cell exposure. Intact oligomers rapidly accumulated intracellularly and persisted within human SMCs for at least 16 hours.

CONCLUSIONS

c-myc antisense oligomers reduced c-myc expression and produced a significant growth inhibition of human SMCs, indicating an important role of c-myc gene activation in the process of SMC proliferation. Furthermore, extracellular stability and rapid cellular uptake provide the basis for future studies assessing the therapeutic role of the c-myc antisense approach in reducing SMC proliferation in the process of vascular restenosis.

Physical characteristics of a factor related to the c-myc/insulin promoter binding protein ZF87/Pur-1

The ZF87/Pur-1 factor is a zinc finger containing protein that binds to sites within the c-myc and insulin promoters. The open reading frame of the mRNA predicts a 49 kd protein which migrates as a 58 kd protein by SDS-PAGE. Antiserum to ZF87/Pur-1 recognizes the 58 kd protein in western blots of Hela cell nuclear extracts. The antiserum also specifically recognizes an 87 kd protein (p87) that is distributed between cytosolic and nuclear extracts. p87 found in cytosolic extracts sediments faster in a glycerol gradient than that found in nuclear extracts. These data indicate that p87 may associate with specific factors or undergo a post-translational modification that changes its conformation.

The Nithsdale schizophrenia surveys. XI: Relatives' expressed emotion. Stability over five years and its relation to relapse

The level of expressed emotion (EE) in 32 relationships between relatives and schizophrenic patients was assessed on three separate occasions over five years. EE was high on all three occasions in 25% of relatives, low on all three in 38%, and fluctuating in 38%; that is, in the majority of relatives (63%) the level of EE was stable over time. Three relatives who had previously shown high EE had evidence of dementia at the time of the third assessment, and showed low EE. Fourteen patients relapsed at least once over five years; patients who relapsed were evenly spread throughout those living in a home in which EE was consistently high, consistently low, or fluctuating. However, patients living in low-EE homes who did relapse did so significantly less often than those who relapsed and were living in homes in which EE was high or fluctuating. At the time of relapse, EE was not consistently high, and some patients in consistently high-EE homes did not relapse at all over five years.

Successful conservative management of spontaneous spinal extradural haematoma

A 69-year-old man developed severe neck and back pain with paraparesis which resolved within 2 h of onset. A CT myelogram demonstrated an extensive anterior extradural haematoma. This and several other cases from the literature suggest that patients with spontaneous spinal haematomas who rapidly recover from their neurological deficit do not require urgent surgical decompression.

Proteolytic processing of the cardioviral P2 region: primary 2A/2B cleavage in clone-derived precursors

The primary 2A/2B cleavage within cardiovirus polyprotein was examined by construction of cDNA plasmids which linked fragments from the P2 region of encephalomyocarditis virus (EMCV) and Mengovirus genomes to the EMCV 5' nontranslated region. When RNA transcripts from these clones were tested in reticulocyte extracts, the synthesized proteins were cotranslationally processed at the 2A/2B site. No viral segments outside of the P2 region were required for this activity. Engineered deletions which removed the amino-terminal two-thirds of protein 2A or the carboxyl half of protein 2B had no effect on this scission, nor did insertions into a Ser-Ala-Phe sequence (SAF) within 2B, which is conserved in most cardio- and aphthoviruses. In contrast, mutations which disrupted a conserved Asn-Pro-Gly-Pro (NPGP) sequence abolished primary scission. Precursors thus inactivated were unable to serve as substrate when simultaneously expressed with active (wild-type) 2AB sequences. Microsequencing placed the EMCV primary cleavage site between the Gly/Pro pair within the NPGP sequence. It was also determined that endogenous viral protease 3C is the previously unidentified agent responsible for cardiovirus 1D/2A scission, a cleavage that is part of the primary processing reaction in poliovirus.

The Nithsdale schizophrenia surveys. X: Obstetric complications, family history and abnormal movements

Obstetric histories of 54 schizophrenic patients and 114 siblings were obtained from their mothers and scored using the Obstetric Complications Scale. There were no statistically significant difference in the proportion of schizophrenic patients (35%) and siblings (29%) who had at least one definite obstetric complication. There was no evidence that schizophrenic patients with a history of obstetric complications were less likely to have a first-degree relative with a history of psychiatric illness leading to in-patient care. Schizophrenic patients with a history of obstetric complications were more likely to have drug-induced Parkinsonism. There was a trend for tardive dyskinesia to be more common in those schizophrenic patients with no obstetric complications but a family history of schizophrenia.

Wild-type murine p53 represses transcription from the murine c-myc promoter in a human glial cell line

Here we analyzed the effect of the suppressor proto-oncogene p53 on transcription from the P2 promoter of the murine c-myc gene. c-myc promoter constructs were coupled to the chloramphenicol acetyl-transferase (CAT) gene and were transiently transfected into a human glial cell along with plasmids overexpressing wild-type or mutant p53. It was found that significant repression of c-myc transcription took place following cotransfection with wild-type but not mutant p53. However wild-type p53 did not suppress transcription from the SV40 early promoter or from the MHC promoter. Promoter-CAT constructs containing only the ME1a2 or E2F elements, from the P2 promoter, were repressed by p53, indicating that p53 may exert its effect at these two sites within the P2 promoter. Finally, when the SV40 T antigen and wild-type p53 were expressed together in glial cells the repressive effect of p53 was abolished.

Isolation of a novel cDNA encoding a zinc-finger protein that binds to two sites within the c-myc promoter

The ME1a1 and ME1a2 elements are cis-acting DNA sequences that exist at positions -46 and -85, respectively, within the P2 promoter of the c-myc gene. These elements are required for optimal transcription initiation from P2. The proteins that bind to these elements are identical or very similar. Here we have isolated a cDNA clone that encodes the carboxy-terminal 494 amino acids of the human ME1a1/ME1a2 factor. This factor is referred to as "ZF87" (zinc-finger protein, 87 kilodaltons). ZF87 specifically binds the ME1a1 element with higher affinity than the ME1a2 element. Western blot analysis indicates that the full-length protein has a relative molecular mass of approximately 87,000 daltons, and Northern blot analysis shows that it is encoded by a 5-kb transcript. ZF87 contains six zinc-finger domains, of the Cys2-His2 type, at the carboxy terminus of the protein. The protein also contains extended tracts of polyalanine.

Three distinct elements within the murine c-myc promoter are required for transcription

We have undertaken a detailed analysis of the cis-acting elements that are required for optimal transcription initiation from P2, the major promoter of the murine c-myc gene. We find that three elements contribute to promoter strength, termed ME1a2, E2F and ME1a1 at positions -85, -64 and -46 respectively (relative to P2). Individually the elements are weak, but combined they contribute to full promoter activity, all acting in a positive fashion. The E2F element is the site at which the SV40 large T antigen transactivates the c-myc promoter. However, transactivation requires the presence of the ME1a2 or ME1a1 elements in addition to E2F. By a number of criteria it appears that the ME1a2 and ME1a1 elements bind the same or a very closely related protein (monomer Mr 94,000). It was found that Hela cells contain a novel factor that is capable of binding to the ME1a1 and ME1a2 elements but only in the presence of the protein-dissociating agents deoxycholate or formamide. Finally, the E2F factor binds DNA both as a monomer and as a multiprotein complex; the latter is cell type specific. Both types of bound E2F factor form less stable protein-DNA complexes than the ME1a2/ME1a1 factor.

Tyrosine phosphorylation of a yeast 40 kDa protein occurs in response to mating pheromone

Tyrosine phosphorylation of proteins in the yeast Saccharomyces cerevisiae has been examined following exposure to the mating pheromone alpha-factor. When a cells are treated with alpha-factor a protein of approximately 40 kDa molecular weight is tyrosine phosphorylated. This tyrosine phosphorylation response requires an intact signal transduction pathway, is not restricted to a short interval of the cell division cycle, and requires protein synthesis for its maximal accumulation. Mating competent fus3 deletion strains fail to elaborate the phosphotyrosine response. The possibility that FUS3 encodes the 40 kDa protein is discussed.

Analysis of the c-myc P2 promoter

The cis-acting elements governing transcription from the murine c-myc P2 promoter have not been well defined. To gain a better understanding of the nature of the protein-DNA interactions that take place on the P2 promoter, protein binding assays were performed. The ME1a2 and E2F factors appear to be the predominant proteins bound to a region spanning positions -140 to -24 relative to the P2 transcription start site. By a number of criteria, these factors appear to be distinct. When c-myc promoter sequences were coupled to the chloramphenicol acetyltransferase gene (CAT) and transiently transfected into tissue culture cells it was found that optimal transcription from P2 was heavily dependent on the ME1a2 element.

Anterior plate fixation in spine tumor surgery. Indications, technique, and results

Anterior decompression by vertebrectomy is now well established as the procedure of choice to optimize neurologic recovery in patients with a deficit due to tumor involvement of the vertebral body. Fifteen patients with tumor involvement of the cervical or thoracic spine and neurologic deficit were treated by single-stage anterior decompression and AO plate stabilization. No patient suffered neurologic deterioration after surgery. All patients with thoracic lesions who were unable to walk on presentation and who managed to survive their primary disease improved to a level that allowed independent ambulation with a frame. There were no problems, such as loss of fixation or deformity. It is concluded that standard AO plates provide adequate stabilization of the cervical and thoracic spine after vertebrectomy for tumor involvement.

Regulation of c-myc transcription in vitro: dependence on the guanine-rich promoter element ME1a1

P2 is the major promoter for the murine c-myc proto-oncogene. The cis-acting elements that are required for initiation of transcription from P2 have not been well defined. In this report elements involved in initiating transcription from P2 were analysed in an in vitro system. In addition to a consensus TATA element at position -28, a guanine-rich element exists at position -48. This element, termed ME1a1, increases transcription initiation when inserted into a deletion mutant that lacks it. When mutations are engineered into ME1a1 it no longer acts to increase the level of initiation. Gel-shift and DNAase I footprinting analysis indicate that Me1a1 binds a protein. ME1a1 does not show any striking similarity to other promoter elements and therefore may be a novel cis-acting element.

The metabolism of nafimidone hydrochloride in the dog, primates and man

1. The biotransformation of nafimidone, an imidazole-substituted anticonvulsant, has been studied by characterization of urinary metabolites in dogs, cynomolgus monkeys, baboons and man. 2. The biotransformation of nafimidone in these laboratory animals and man is initially very similar, in each case proceeding by reduction to the aliphatic alcohol metabolite, nafimidone alcohol or 1-[2-hydroxy-2-(2-naphthyl)ethyl]imidazole. 3. Further transformation of this metabolite involves oxidation in the naphthyl and imidazole functions, and/or conjugation. 4. The dog differs from the higher primates in that no metabolic modification of the naphthyl group takes place, the major metabolite in the dog being the O-beta-glucuronide of nafimidone alcohol. 5. In higher primates and man two isomers involving dihydroxylation in the naphthyl ring--1-[2-hydroxy-2-(5,6- or 7,8-dihydroxydihydro-2-naphthyl)ethyl]imidazole--were tentatively identified. These species alone showed evidence of an imidazole linked N-glucuronide of nafimidone alcohol. 6. The possible occurrence of stereoselective metabolism by the introduction of a chiral centre at C-9 in nafimidone alcohol was indicated in human urine by the presence of both epimers of the O-beta-glucuronide of nafimidone alcohol in a 2:1 ratio.

Paraplegia following surgery of the descending thoracic aorta

Paraplegia remains an uncontrollable complication of aortic reconstructive surgery. Twenty-one consecutive patients undergoing surgery at the Royal Adelaide Hospital for lesions of the descending thoracic aorta were reviewed. Those patients suffering an acute traumatic transection had a much higher rate of postoperative paraplegia (40%) than those undergoing elective reconstruction of chronic aneurysms (10%). The incidence of paraplegia after surgery for an acute transection when bypass was not employed was greater than 50%. In contrast, the outcome was successful in all patients who underwent reconstruction using left heart extracorporeal bypass. Based on these findings, the routine use of bypass during reconstruction of the thoracic aorta is recommended, particularly for acute traumatic transection.

Interleukin-1 is a potent regulator of JE and KC gene expression in quiescent BALB/c fibroblasts

Interleukin-1 alpha and beta are polypeptide hormones with a broad range of biological activities. Both interleukins are recognized by a receptor that has been characterized as a member of the immunoglobin superfamily. The interleukin-1 receptor does not appear to be a tyrosine protein kinase. Moreover, the intracellular events that mediate the multiple interleukin-1 responses are poorly understood. Here we show that the JE and KC genes, first isolated and characterized as platelet-derived growth factor inducible in quiescent BALB/c-3T3 fibroblasts, are induced by femtomolar concentrations of recombinant interleukin-1 alpha (rIL-1). The response of JE and KC to IL-1 occurs at the transcriptional level. These observations suggest that an analysis of the JE and KC transcriptional response to rIL-1 may aid in identifying elements involved in interleukin-1-mediated signal transduction

The role of arthroscopy in children and adolescents

A retrospective review of the first 5 years' experience with arthroscopy at the Adelaide Children's Hospital was conducted. Two hundred and twelve arthroscopies were performed in 192 patients. The average period of follow-up was 5.9 months. The most common arthroscopic finding was anterior cruciate ligament (ACL) injury, followed by meniscal lesions, chondromalacia patellae, patellar dislocations, and osteochondritis dissecans. There was a high rate of associated lesions with ACL tears and acute patellar dislocation. Septic arthritis responded well to arthroscopic drainage and lavage. We concluded that arthroscopy is a safe and accurate diagnostic and therapeutic tool in childhood and adolescence. Arthroscopy is recommended when a joint is too painful to allow adequate clinical examination, in hemarthroses, for ACL injury, after acute patellar dislocation, and to treat septic arthritis. There is only a 56% chance of making a correct diagnosis on clinical grounds, which contrasts with an accuracy in excess of 99% with arthroscopy.

Anterior cruciate ligament injury in children and adolescents

Although the natural history of anterior cruciate ligament (ACL) injuries in the adult is well documented, the natural history of ACL injury in children and adolescents has not previously been reported. A case note review revealed 31 cases with ACL pathology out of 212 arthroscopies performed in the Adelaide Children's Hospital from November 1980 until June 1986. Partial tears were more common than complete midsubstance tears. In 27 cases there was no bony involvement. All 27 patients were available for analysis. The average age was 14.3 years, with a range of 8-18 years. Twelve of the 27 patients were younger than 14 years old. All patients completed a questionnaire and were interviewed. The average follow-up was 51 months (range 26-87 months). At the time of initial injury, 11 of the 27 patients (41%) had associated pathology. Subsequently, four patients have undergone further arthroscopic surgery, four patients have had a reconstruction of the ACL, and a further three have had reconstruction recommended. We conclude that this is not as benign an injury as was previously believed.

Evidence for a novel signal transduction pathway activated by platelet-derived growth factor and by double-stranded RNA

Platelet-derived growth factor (PDGF) and the synthetic double-stranded RNA poly(I).poly(C) [poly(I.C)] stimulate transcription of the JE gene in BALB/c-3T3 fibroblasts. The response of JE to poly(I.C) does not appear to be channeled through any known component of the PDGF receptor signal transduction apparatus. In addition, JE sequences upstream of the transcription start site are devoid of previously identified poly(I.C)-responsive elements, such as those found in the beta-interferon gene. These data suggest that a novel signal transduction pathway regulates the JE response to PDGF and double-stranded RNA. The c-myc and c-fos proto-oncogenes also respond to this pathway but with poor efficiency. However, this pathway operates very efficiently on other PDGF-inducible genes that encode the secretory proteins KC and M-CSF.

Platelet-derived growth factor generates at least two distinct intracellular signals that modulate gene expression

Regulation of the genes by PDGF has some common features. All are primary response genes, and they can still be expressed in the presence of cycloheximide (Cochran et al. 1983; Kelly et al. 1983; Kruijer et al. 1984; Lau and Nathans 1985). In fact, many of the genes are superinduced when cells are treated with growth factors plus cycloheximide (Greenberg et al. 1986). The genes that have been characterized all contain a sequence motif in their 3'-noncoding sequences that appears to make the message labile (Meijlink et al. 1985; Treisman 1985; Shaw and Kamen 1986). All competence genes so far examined are controlled at least in part at the level of transcription (Cochran et al. 1983; Edwards et al. 1985; Almendral et al. 1988). Differences in regulation of the genes include variations in the time course of induction, ranging from 10 minutes to over 4 hours, and differences in the persistence of the mRNAs after their synthesis (Cochran et al. 1983; Muller et al. 1984; Lau and Nathans 1987). The data presented in this paper strongly suggest that multiple, distinct intracellular signals that lead to the expression of multiple genes are generated when cells are treated with growth factors such as PDGF. The variation in the time course of induction of PDGF-inducible genes suggests several models of signal transduction. Four such models are presented in Figure 5. One possibility (Fig. 5A) is that one signal is generated by the interaction of PDGF with its receptor and that this signal activates the very early genes, such as c-fos.(ABSTRACT TRUNCATED AT 250 WORDS)

Platelet-derived growth factor-inducible genes respond differentially to at least two distinct intracellular second messengers

Platelet-derived growth factor (PDGF) stimulates expression of the c-myc, c-fos, JE, and KC genes in BALB/c/3T3 cells. Here we show that these genes respond differentially to at least two distinct intracellular second messengers generated by PDGF. A broad body of data support the view that response of the c-myc and c-fos genes to PDGF is channeled, at least in part, through activation of protein kinase C. Both PDGF and protein kinase C agonists stimulate transcription of c-myc and c-fos. Down regulation of protein kinase C inhibits the transcriptional induction of c-fos and c-myc by PDGF. In contrast, protein kinase C agonists do not stimulate transcription of JE and KC. Down regulation of protein kinase C does not inhibit the ability of PDGF to stimulate transcription of JE and KC. The differential response of these four genes to PDGF and 12-O-tetradecanoylphorbol-13-acetate correlates with differential phosphorylation of specific intracellular proteins. PDGF treatment stimulates phosphorylation of intracellular proteins at 31, 32, and 80 kilodaltons. Down regulation of protein kinase C prevents phosphorylation of the 80-kDa protein in response to PDGF, but phosphorylation of the smaller proteins is not affected. Finally, PDGF which induces all four genes (and stimulates phosphorylation of three proteins) is a much more potent mitogen than protein kinase C agonists which regulate only some of these events.

Disposition of nafimidone in rats

The absorption, distribution, excretion, and metabolism of 14C-nafimidone, a novel anticonvulsant, have been studied in rats. Nafimidone was completely absorbed following single oral doses of 10 and 100 mg/kg. After both iv and oral administration, nafimidone was rapidly eliminated from plasma (t 1/2 about 5 min), with concomitant formation of a pharmacologically active, nonconjugated metabolite, nafimidone alcohol. Systemic clearance of nafimidone from plasma after iv administration was approximately 2 times higher than hepatic blood flow in rats, and the oral bioavailability was 15%. However, the AUC of nafimidone alcohol was 30% higher after oral administration of nafimidone than that after iv administration of nafimidone. It is likely that, given its pharmacological activity, nafimidone alcohol is the more important species pharmacologically. Distribution of nafimidone-related radioactivity was widespread with highest concentrations associated with liver, kidney, adrenals, and the gastrointestinal tract. Elimination of radioactivity from tissues was rapid and complete, except that retention was noted in arterial vessels and in the ocular melanin of pigmented rats. Determination of hepatic and brain levels of nafimidone and nafimidone alcohol showed no detectable levels of nafimidone in either tissue. However, levels of nafimidone alcohol in liver and brain were as much as 13-fold and 2-fold, respectively, higher than levels in plasma. After either iv or oral administration of 14C-nafimidone, approximately two-thirds of the radioactivity was recovered in urine. The major urinary metabolites of nafimidone after a 100 mg/kg dose were characterized and shown to be dihydroxydihydronaphthalene, substituted nafimidone alcohol, and the 1-beta-glucuronide of nafimidone alcohol.

Iatrogenic superior vena cava syndrome treated with streptokinase

The development of an iatrogenic superior vena cava syndrome secondary to a thrombosis from an indwelling Hickman catheter in a patient with ovarian carcinoma is presented. The patient was treated with a combination of streptokinase and heparin with successful and dramatic results. Streptokinase appears to be highly effective in the treatment of iatrogenic superior vena cava syndrome from Hickman catheters. It appears that the Hickman catheter may be safely left in situ post-treatment.

Genetic aspects of Perthes' disease. A critical review

Contradictory theories of the mode of inheritance of Perthes' disease have been largely due to sampling error, which is revealed by comparison of four series. Confusion also has been caused by the unequal sex incidence of the disease. Family data from a series of 87 boys and 58 girls with Perthes' disease were combined with those of Gray et al. (223 boys and 44 girls) to provide the largest possible group for analysis. Proportions of first-, second-, and third-degree relatives affected were recorded separately for each sex of index cases and each sex of relatives. Comparison of the incidence of Perthes' disease in relatives with that in the general population of the same sex revealed features of multifactorial inheritance, and a gradient of 35:4:4:1 from first:second:third-degree relatives to the general population. Equal estimates of heritability (h2) from first cousin and sib data suggest that environmental factors are of relatively little importance in etiology. Heritability from sib data was 84 +/- 4%, giving a recurrence risk of 2.6% for sibs and offspring, which agrees with the empirical figure of 2.4%. It is argued that the concentration of cases in certain families is not inconsistent with multifactorial inheritance.

A longitudinal study of carpal bone development in Perthes' disease: its significance for both radiologic standstill and bilateral disease

This paper reports a longitudinal study of carpal bone development in 125 children (98 boys, 27 girls) attending a clinic for Perthes' disease. The age at appearance of ossification in each carpal bone was estimated by studying consecutive radiographs obtained at six-months intervals. The results were compared with the findings for normal children published by Stuart et al. Three radiologic groups of carpal bone maturation are defined: not delayed (capitate and hamate); markedly delayed (triquetral and lunate); and slightly delayed (scaphoid, trapezium, and trapezoid). Overall, the bone age delay is severely abnormal at three to five years of chronologic age and indicates the time in development when general abnormalities occur. The mean age at diagnosis (and standard deviation) for 34 boys with skeletal standstill was 4.49 +/- 1.07 years, compared with 7.28 +/- 2.40 years for 51 boys without such standstill; the mean age at appearance of carpal bones was not significantly different between these two groups, suggesting an equally profound delay of carpal maturation in the group of later-diagnosed boys. Boys with bilateral hip disease show a significant delay in age at ossification of the trapezoid compared with boys who have unilateral disease. The immaturity of bone age may be present during a latent period and be of etiologic significance in the onset of the hip disease, but at present the evidence links it only with bilateral disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Parental involvement in the lives of children in hospital

A care by parent scheme was established in the children's department of a university hospital. It was seen as the natural extension of the increased involvement of parents in the care of their children in hospital. A structured observational study was carried out to monitor its effect on the lives of child patients. Children in the scheme spent far less time awake alone, cried less, and slept less than those nursed unaccompanied. They had far more social interaction with a smaller number of adults, most of their contacts being with family members rather than hospital staff. Children with a resident parent but outside the scheme were generally in an intermediate position on these factors.

An assessment of endocrine function in boys with Perthes' disease

The frequent association of short stature and retardation of skeletal maturation in Perthes' disease has prompted an investigation of growth-related hormones in this condition. A group of 18 prepubertal boys, aged five to 11 years, who either had a bone age two years or more less than their chronologic age or whose heights were less than the third centile, were studied. Their serum growth hormone (Se GH) response to insulin-induced hypoglycemia was significantly reduced, compared with a control group of short boys. They also demonstrated a tendency to elevated levels of somatomedin activity, measured by chick cartilage bioassay. Thyroid function was normal. These findings suggest a defect in the pituitary-somatomedin-target tissue axis in Perthes' disease.

Raised somatomedin activity in the serum of young boys with Perthes' disease revealed by bioassay. A disease of growth transition?

This paper reports a study of the serum somatomedin activity in 67 boys with Perthes' disease and in 43 control boys aged three to 11 years. It was undertaken to evaluate some abnormalities of growth in children with Perthes' disease that have been previously reported. A brief account is given of knowledge relating to somatomedins in postnatal and fetal life. Serum somatomedin activity was measured using a bioassay based on the principle that somatomedins stimulate the synthesis of both DNA and proteoglycans in porcine costal cartilage. In control boys, the serum somatomedin activity increased with age, which is consistent with previous reports for normal children. In affected boys, the normal increase in serum somatomedin activity with age did not occur. The somatomedin activity in affected boys is higher than in control boys at three to five years but not at six to 11 years of age. Findings support the hypothesis that some children with Perthes' disease have an abnormality of the growth hormone-dependent somatomedins. The serum findings together with those of both skeletal age delay and impaired skeletal growth distally in the limbs are consistent with the view that the general disorder of some children with Perthes' disease results from an imbalance in mechanisms that determine the postnatal transition from the "fetal" to the "basic" component of the normal human growth curve.

The metabolism of nicardipine hydrochloride in healthy male volunteers

Four human volunteers given a 30 mg oral dose of nicardipine hydrochloride containing 40 microCi of the 14C-labelled material achieved peak plasma levels of compound-related radioactivity within one hour of dosing. Parent compound comprised only a minor fraction of the circulating radioactivity indicating rapid first-pass metabolism. Plasma radioactivity declined to background levels within 96 h and was excreted both in the urine and faeces. Urinary excretion was the favoured route comprising about 60% of the dosed radioactivity. Mean total recovered radioactivity amounted to 94.8%. Both 1,4-dihydropyridine and pyridine metabolites of nicardipine hydrochloride were excreted in the urine. The major urinary metabolites, comprising some 36% of the radioactivity excreted in the 0-8 h post-dose period, were the glucuronide conjugates of +/- 2-hydroxyethyl methyl-1,4-dihydro-2,6-dimethyl-4(m-nitrophenyl)-3,5-pyridine dicarboxylate and its pyridine from 2-hydroxyethyl methyl-2,6-dimethyl-4-(m-nitrophenyl)-3,5-pyridine dicarboxylate.

Ovarian cancer complicated by cerebellar degeneration: a paraneoplastic syndrome

A patient with ovarian carcinoma who subsequently developed the paraneoplastic syndrome of cerebellar degeneration is presented. The literature is reviewed and possible explanations of the phenomenon are discussed.

Breast feeding: differences in prevalence between caucasian and negroid women resident in Paddington and North Kensington, London, England

Three hundred and thirty-seven caucasian women and 150 negroid women who were resident in an inner London health district, who gave birth in the district's maternity unit and who were transferred home before 6 days after delivery were studied in respect of their intentions and practices for feeding their babies. Differences in the numbers breast feeding within and between various sub-groups of the two racial groups were compared and inferences drawn in respect of to which group effort in promoting breast feeding should be directed.

The metabolism and pharmacokinetics of nicardipine hydrochloride in man

Studies have been carried out to investigate the disposition of nicardipine hydrochloride following intravenous and oral administration to male volunteers. Following oral administration of a radiolabelled dose, nicardipine was shown to be rapidly and extensively metabolised and to be rapidly eliminated from plasma. After intravenous infusion of nicardipine at 5 mg-1 for 3 h, plasma levels declined biexponentially, and clearance values were of the same order as hepatic blood flow. With repeated oral administration, 20 mg three times daily for 28 days, plasma levels rose over the first 3 days of administration and then declined to some extent. Possible reasons for this decline are discussed. Steady-state plasma levels and bioavailability show a nonlinear relationship with doses over the range 10-40 mg three times daily. Food consumption has been shown to reduce the bioavailability of nicardipine when the food is taken before or at the same time as nicardipine administration.

Early synthesis of specific cytoplasm proteins is correlated with the rate of exit of lymphocytes from the resting state

We investigated the initiation of synthesis of proteins in human lymphocytes exposed to the mitogen phytohemagglutinin (PHA) for 6 h. Radiolabeled proteins in three subcellular fractions, cytoplasmic, nuclear salt wash, and nuclear, were separated on polyacrylamide gels. Compared with cells incubated for the same time in the absence of PHA only two cytoplasmic proteins of Mr 51 and 60 kd showed increased synthesis in a dose-dependent fashion. Synthesis of the 60-kd protein shows the strongest correlation with rate of entry into the first S phase and with rate of cellular aggregation. Thus, the 60-kd protein appears to be a major early response-associated protein for entry of lymphocytes into the first S phase after PHA stimulation.

Effects of temperature on aggregation and the mitogen-induced exit of lymphocytes from the resting state

We have determined the temperature dependence of the kinetics of entry into the first S phase of phytohemagglutinin-stimulated lymphocytes under conditions varying the stability of substrata over which the cells have settled. An exponential model was used to characterize entry into S phase. This model yields as parameters duration of lag period, t0, apparent first order rate constant for entry, k, and the number of cells committed to enter the first S phase, NA(t0). Values of t0 and NA(t0) show a 1.5-fold and 2.0-fold decrease and increase, respectively, over a 4 degrees C temperature range and are independent of variation in substrate stability. The temperature dependence of the apparent first-order rate constant, k, however, is strongly influenced by stability. The observed activation energy increases from 3.0 kcal to 37 kcal when the substratum is agitated. This correlates well with reduced adherence of multicellular aggregates in agitated samples. The temperature dependencies for these three parameters are all numerically different, indicating that these parameters are determined by different rate-limiting processes. We propose that the mechanism mirrored by k is linked to the adherence of multicellular aggregates to the substratum.

Coxa plana--the fate of the physis

Eighty patients who had unilateral coxa plana and who had been treated conservatively were followed to a mean age of sixteen and one-quarter years, and their cases were reviewed for radiographic evidence of a disturbance of the femoral capital growth plate. This physeal involvement was inferred by the presence of one or more of five findings: premature physeal closure, overgrowth of the greater trochanter, change in physeal shape, lateral protrusion of the capital nucleus, and medial bowing of the femoral neck. Premature physeal closure, which was more common in the girls than in the boys, occurred in 25 per cent of the affected femoral heads, and 90 per cent of the patients showed some interference with normal physeal growth in the affected femoral head. A direct correlation was found between the severity of the physeal involvement and the ultimate deformity of the femoral head. The possible causes of interference with physeal growth and damage are discussed.

First year of an inner city general practitioner community hospital

The first inner city general practitioner community hospital opened on 4 January 1982. This paper describes the operation of the hospital over the first 12 months. There were 316 admissions, with an average length of stay of 13 days. The average age of the patients was 73 and the most common reason for admission was disease of the respiratory system. Thirty five per cent of patients were admitted because of an acute illness and 37% were admitted on the same day as the request for admission. The policies of intermittent or phased care allowed for the admission of patients at regular intervals to relieve carers, and the assessment of the home circumstances of all patients allowed for planning the patient's return home.

Alterations in nasal airway resistance following superior repositioning of the maxilla

Superior repositioning of the maxilla is a contemporary surgical procedure used to correct a variety of dentofacial deformities, including vertical maxillary excess. Concern for the effect of this procedure on nasal respiration is warranted, since superior repositioning of the maxilla may decrease the volume of the nasal cavity. In this study pre- and postoperative nasal-resistance values were obtained for 52 patients who underwent superior repositioning of the maxilla by the LeFort I downfracture procedure. Of these 52 patients, 24 underwent segmental osteotomies and 28 underwent one-piece superior repositioning. Results indicate that the long-faced persons for whom superior repositioning of the maxilla is recommended usually have pretreatment nasal-resistance values within previously reported normal ranges. Superior repositioning of the maxilla, with or without involvement of the nasal floor, usually results in decreased nasal resistance.

Lesions of the vulva

Lesions of the vulva are common and are often associated with unnecessary and sometimes harmful delays in diagnosis and definitive therapy. Simple office biopsies, performed prior to treatment, permit histologic classification of the lesion and provide a basis for therapeutic recommendations.

Bleomycin-mitomycin C in advanced squamous cell carcinoma of the female genital tract

Bleomycin and mitomycin C have been reported to be active against advanced squamous cell carcinoma of the uterine cervix. Miyamoto et al reported a total response rate of 93% and complete response in 80% of the first 15 patients treated by sequential combination of bleomycin and mitomycin C. Updated results by Miyamoto reveal an 88.3% total response rate with a 65.3% complete response. However, others have reported poor results using the protocol outlined by Miyamoto. Using this protocol, 11 patients with advanced squamous cell carcinoma were treated at the authors' institution. There were no complete responses: one patient with partial response (9%), four with stable disease (36%), and six (55%) with progressive disease.

Surgical-orthodontic treatment planning for simultaneous mobilization of the maxilla and mandible in the correction of dentofacial deformities

Simultaneous mobilization of the maxilla and mandible is indicated for the optimal correction of specific dentofacial deformities, as discussed in the preceding publication. Because of the added complexity of this type of surgical-orthodontic treatment, it is important to determine the absolute need for surgery and to construct a detailed blueprint of the specific changes to take place at the time of surgical intervention as well as those to be made by the orthodontist prior to initiation of any treatment. The intent of this article is to describe a technique of treatment planning which includes cephalometric prediction tracings, model surgery, determination of orthodontic-surgical sequencing, splint construction, and specific sequencing of surgery. When followed, these guidelines will enable the surgeon and the orthodontist to accurately determine the need for simultaneous mobilization of both the maxilla and the mandible and provide more predictable and stable results when it is performed.