Attitudes of British psychiatrists to the diagnosis of somatisation disorder. A questionnaire survey

A postal questionnaire was sent to 195 senior British psychiatrists who were asked about their attitudes towards the DSM-III-R diagnosis of somatisation disorder (SD) and the ICD-10 diagnosis of multiple somatisation disorder. Of the 148 respondents, 98 (66%) had experience of liaison psychiatry, and these psychiatrists used the diagnosis significantly more often than those without liaison sessions. More than half the respondents perceived SD as both a personality disorder and a mental state disorder, although 27% thought that patients with SD had an undiagnosed physical disease. The marked discrepancy between British and North American psychiatrists in diagnostic practices was perceived to be a consequence of both the difference in health care systems and the interest shown in the disorder by North American psychiatrists, rather than a reflection of genuine differences in prevalence.

Trial of antihypertensive intervention and management: greater efficacy with weight reduction than with a sodium-potassium intervention

The Trial of Antihypertensive Intervention and Management evaluated nine diet-drug combinations in 878 mildly hypertensive, moderately obese participants using a 3 x 3 factorial design. Drugs evaluated were placebo, diuretic (chlorthalidone), and beta-blocker (atenolol); diets were usual (no intervention), weight reduction, and low sodium/high potassium (Na/K). This article reports 6-month dietary changes and the effect of dietary change on blood pressure. Six-month mean weight change was -4.7 kg in the weight reduction group, -0.3 kg in the Na/K group, and -0.5 kg in the usual-diet group. At 6 months, daily electrolyte excretion had changed in the Na/K intervention group. Daily sodium excretion decreased from 138.0 to 112.0 mmol in the Na/K group and increased from 134.1 to 138.4 mmol in the weight reduction group and from 129.1 to 137.0 mmol in the usual-diet group. Daily potassium output increased from 58.7 to 71.4 mmol in the Na/K group, from 57.0 to 60.5 mmol in the weight reduction group, and from 55.3 to 59.1 mmol in the usual diet group. Analysis of 3-day food records indicated that sodium intake decreased from 141.1 to 85.8 mmol and potassium intake increased from 76.4 to 90.5 mmol. Our results indicate that the goal for weight reduction was more easily achieved than the goal for electrolyte modification.

Extracorporeal shock wave lithotripsy for calcified ureteral stent

Calcification of a ureteral stent has been an unusual complication of long-term stent use for bypassing ureteral obstruction or after surgical repair. Open or percutaneous procedures have usually been required to remove the calcification before the stent can be extracted. We report six cases of calcified ureteral stents successfully managed by extracorporeal shock wave lithotripsy (SWL) followed by cystoscopic extraction, thus avoiding open or percutaneous procedures.

Four-year experience in a randomized study of the Gyne T 380 Slimline and the Standard Gyne T 380 intrauterine copper devices

Performance of the Slimline and Standard models of the Gyne T 380 were measured through four years in a comparative study initially involving 996 women, seventy percent of whom were randomized to the Slimline device. Cumulative pregnancy rates of Slimline users were 0.3 +/- 0.2 per 100 both at three and at four years, as compared with rates of 1.5 +/- 0.9 and 3.8 +/- 1.7 at the same intervals for users of the Standard model (P > .05). The four-year explusion rate of the Slimline, 8.6 +/- 1.3 per 100, was significantly higher than the comparable rate of the Standard model, 4.4 +/- 1.6 (P < .05). The two Gyne T* models did not differ in continuation rates. First time IUD users, however, had substantially lower continuation rates than did former users (P < .001), in consequence of their relative youth and desire to have additional children. Other performance measures did not differ importantly by device.

Color Doppler ultrasonography assessment of tubal patency: a comparison study with traditional techniques

OBJECTIVE

To compare the results of color Doppler ultrasonic hysterosalpingography (color US-HSG) and x-ray-HSG with chromoperturbation at the time of laparoscopy.

DESIGN

Open, uncontrolled study of women seeking evaluation for infertility from August 1989 to July 1991.

SETTING

Clinical environment.

PATIENTS

Two hundred thirty-eight infertile women.

INTERVENTION

Saline was administered transcervically during transvaginal color Doppler sonography in 238 women. Traditional x-ray-HSG was performed in 89 women. Laparoscopy with chromoperturbation was done in 121 women. Forty-nine women had all three procedures performed.

MAIN OUTCOME MEASURES

The frequency of diagnosis of bilateral tubal patency, bilateral tubal occlusion, and unilateral tubal patency after color US-HSG and x-ray-HSG was compared with chromoperturbation. The diagnostic efficacy of color US-HSG and x-ray-HSG was compared with chromoperturbation.

RESULTS

Correlation between color US-HSG and x-ray findings with chromoperturbation occurred in 81% versus 60% (P = 0.0008) of all women studied. In 49 women who had all three procedures performed, color US-HSG results correlated with chromoperturbation more often than x-ray-HSG (82% versus 57%, P = 0.0152).

CONCLUSION

Color US-HSG is an alternative technique to x-ray-HSG in diagnosing tubal occlusion as a cause of infertility.

Black lipid membranes of tetraether lipids from Thermoplasma acidophilum

Black lipid membranes were formed of tetraether lipids from Thermoplasma acidophilum and compared to the bilayer forming lipids diphytanoylphosphatidylcholine and diphythanylglucosylglycerol. Bilayer-forming lipids varied in thickness of black lipid membranes due to the organic solvent used. Measurements of the specific membrane capacitance (Cm = 0.744 microF/cm2) showed that the membrane-spanning tetraether lipids from Thermoplasma acidophilum form a monolayer of a constant thickness of 2.5-3.0 nm no matter from which solvent. This finding corresponds to the results of Gliozzi et al. for the lipids of another archaebacterium, Sulfolobus solfataricus. Black lipid membranes were formed at room temperature with a torus from bilayer-forming lipids, however, the torus could also be formed by the tetraether-lipid itself at room temperature and at defined concentration. In these stable black lipid membranes, conductance was measured in the presence of valinomycin, nonactin, and gramicidin. At 10(-7) M concentration, valinomycin mediated higher conductance in membranes from tetraether lipids (200-1200 microS/cm2) than from bilayer-forming lipids (125-480 microS/cm2). Nonactin, at 10(-6) M concentration, mediated a 6-fold higher conductance in a tetraether lipid membrane than in a bilayer, whereas conductance, in the presence of 5 x 10(-11) M gramicidin could reach higher values in bilayers than in tetraether lipid monolayers of comparable thickness. Monensin did not increase the conductance of black lipid membranes from tetraether lipids under all conditions applied in our experiments. Poly(L-lysine) destroyed black lipid membranes. Lipopolysaccharides from Thermoplasma acidophilum were not able to form stable black lipid membranes by themselves. The lipopolysaccharide complexes from Thermoplasma acidophilum and from Escherichia coli decreased the valinomycin-mediated conductance of monolayer and bilayer membranes. This influence was stronger than that of the polysaccharide dextran.

New concepts in ovarian regulation: an immune insight

The purpose of the ovary is to produce eggs. In the human, oocyte production occurs cyclically at monthly intervals. The control of egg production is provided by both the endocrine and immune systems. Successful oocyte production is the result of sophisticated communication between the two systems. These interactions allow adaptive processes necessary for continuation of the species.

Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper TCu 380Ag intrauterine contraceptive devices

OBJECTIVES

The objectives were to measure rates of planned pregnancy and factors affecting these rates after use of very-long-acting contraceptive methods (Norplant or Norplant II implants, a levonorgestrel-releasing intrauterine contraceptive device, or the copper T (model TCu 380Ag) intrauterine contraceptive device.

STUDY DESIGN

The design was a concurrent, multicenter prospective study of 372 women who stopped contraception for planned pregnancy. Analysis was by life-table, log-rank, and standard chi 2 methods.

RESULTS

Pregnancy rates 12 and 24 months after cessation of contraceptive use were 82 and 89 per 100, respectively. Age at removal and family planning intentions at initiation of contraception were both significantly correlated with pregnancy rates (p less than 0.05), but former contraceptive regimen and duration of contraceptive use were not. Pregnancy outcomes did not deviate from normal limits and did not differ by contraceptive formerly used.

CONCLUSION

Contraceptive implants releasing 30 micrograms/day of levonorgestrel or intrauterine contraceptive devices releasing 20 micrograms/day of levonorgestrel or having copper surface areas of 380 mm2 are associated with normal fertility after use for women seeking pregnancy at termination. Durations of use do not affect pregnancy rates.

Influence of serum progesterone levels at the time of hCG on the release of ova during hMG cycles

A study was designed to monitor release of ova by sonography in hMG-treated patients following hCG and to determine if failure to release ova correlates with critically low or high progesterone levels. This was a retrospective study of 292 consecutive patients treated with hMG. The requirement for treatment was that hCG be given when at least one follicle attained a 17-mm diameter with a serum estradiol level of at least 200 pg/mL per mature follicle. If the serum progesterone assay was greater than or equal to 1.8 ng/mL, then hCG would be given as long as there was at least one dominant follicle and a serum estradiol level greater than 200 pg/mL. The patients were divided into four groups for study based on the progesterone level at the time of hCG administration. There were no statistically significant differences in the ability to achieve ova release whether serum progesterone was very low or close to 2 ng/mL when hCG was given. The rise in the progesterone level prior to ovulation has been proposed to enhance egg release. However, the data presented herein do not support the necessity for a critical level of serum progesterone at the time of hCG injection in hMG-treated women.

Lung scintigraphy in pulmonary capillary hemangiomatosis. A rare disorder causing primary pulmonary hypertension

The authors report the results of lung scintigraphy in two patients with primary pulmonary hypertension caused by pulmonary capillary hemangiomatosis, a rare disorder resulting from the proliferation of histologically normal capillaries in the lung. Perfusion studies revealed a nonhomogeneous pattern with some focal defects, similar to that seen with some other histologic types of primary pulmonary hypertension. The mechanisms underlying this perfusion pattern are unknown.

Prolonged intrauterine contraception: a seven-year randomized study of the levonorgestrel 20 mcg/day (LNg 20) and the Copper T380 Ag IUDS

A levonorgestrel-releasing IUD and the Copper T 380Ag IUD were in randomized comparison for seven years in five clinics. In two other clinics the randomized study was truncated at five years, but use of the Copper T continued. No pregnancies occurred to users of either device in years 6 and 7. Cumulative pregnancy rates were 1.1 per 100 at seven years for the steroid-releasing and 1.4 per 100 for the copper-releasing IUDs. Cumulative rates of PID did not differ between devices. Infection rates appeared to be lowest during the sixth and seventh years of the study. Termination attributable to amenorrhea was the principal contributor to differences in cumulative continuation rates between devices. At the five clinics that carried the comparative study to seven years, cumulative continuation rates were 24.9 per 100 for LNg20 IUD users and 29.4 per 100 for TCu 380Ag users. Women who used either method for periods of five to seven years experienced, on average, marked to mild increases in hemoglobin as compared with levels at admission. The Copper T380 family and the LNg20 IUDs represent the most effective reversible contraceptive methods yet studied in long-term randomized trials.

Two-year comparative trial of the Gyne T* 380 Slimline and Gyne T* 380 intrauterine copper devices

In a randomized trial of the Gyne T* 380 Slimline, the-two year pregnancy rate was 0.3 per 100 and the continuation rate was 65 per 100. These rates did not differ statistically from those of the standard Gyne T* 380, nor did other performance parameters differ between devices by the log-rank test. Women under age 30 had lower continuation rates using either device than did women age 30 or older at admission because of removals for planned pregnancy. Conception rates among those who desired pregnancy were 35 per 100 at one month and 86 per 100 at one year.

Role of the mesopontine area in the circling behavior induced by apomorphine in rats bearing unilateral lesion of the entopeduncular nucleus

The role of the mesopontine area and superior colliculus in turning behavior induced by systemic administration of apomorphine was studied in rats bearing a unilateral entopeduncular lesion. Bilateral electrolytic damage of the superior colliculus resulted in an enhancement of the ipsilateral circling response to apomorphine, perhaps as a consequence of an increased locomotor drive in such animals. Bilateral electrolytic lesions of the mesopontine area decreased apomorphine-induced turning in entopeduncular rats, while a bilateral kainic acid lesion of the same region was ineffective. It was concluded that the pedunculopontine nucleus and adjacent reticular formation are not an essential link for the striopallidal complex output mediating circling in this model. Fibers running through this region could be implicated in the expression of the behavior under study. Since a unilateral electrolytic lesion of the mesopontine area contralateral to the damaged entopeduncular nucleus reduced drug-induced turning, we propose that an uncrossed pathway from the intact striopallidal complex mediates circling in our rats.

Hypothyroidism following combined treatment for hypopharyngeal and laryngeal carcinoma

The development of hypothyroidism following combined treatment for pharyngeal and laryngeal cancer has received little attention in the literature. We prospectively studied 32 patients over 4 years to determine the incidence of such hypothyroidism and to examine the effect of hemithyroidectomy associated with a combined treatment modality. All patients were men with pharyngeal or laryngeal squamous cell carcinomas and no prior history of thyroid disease. Treatment consisted of radical surgery (30 of 32 patients), followed by postoperative radiotherapy (31 patients). The results of thyroid function tests (free triiodothyronine, free thyroxine, and thyroid-stimulating hormone [TSH]) were all normal preoperatively; tests were repeated every 3 months after treatment. Elevation of TSH values in two successive blood samples was required to make a diagnosis of hypothyroidism. Of 12 patients who underwent hemithyroidectomy as part of total pharyngolaryngectomy and postoperative radiotherapy, 7 became hypothyroid a mean of 6 months after treatment. Twenty patients had similar combined treatment but without thyroid resection. Hypothyroidism developed a mean of 10 months after treatment in only four patients in this group (p less than 0.05). We conclude that hypothyroidism frequently develops following combined treatment for pharyngeal and laryngeal cancer even when thyroid resection has not been performed. Patients should be evaluated postoperatively and carefully monitored by means of serial thyroid function tests.

Reversible lactose malabsorption and intolerance in Graves' disease

Ten patients with untreated Graves' disease underwent tests to determine lactose absorption, liquid gastric emptying, and oral cecal transit time. To determine the influence of thyroid hormone status on lactose absorption, eight of these same patients had repeat studies when rendered euthyroid. Two of these eight patients also underwent studies while transiently hypothyroid. Motility studies were also evaluated in a group of 11 control subjects. Lactose malabsorption occurred in nine patients with Graves' disease. In seven patients who repeated these studies, lactose malabsorption normalized in three, symptoms induced by lactose improved in two and were unchanged in two. However, these latter two patients appeared to have improved symptoms in the transient hypothyroid state. Liquid gastric emptying was significantly faster in untreated patients than controls and treated self-same patients. Transit time was significantly faster in untreated patients than when they were rendered euthyroid. There may be a relationship between altered lactose absorption states and changes in intestinal motility in patients with Graves' disease.

Effect of cyclosporine on ornithine decarboxylase activity in rat submaxillary lymph nodes: modulation by sympathetic nerves

In order to examine whether cyclosporine activity in submaxillary lymph nodes is dependent on sympathetic modulation, rats received a unilateral superior cervical ganglionectomy together with a contralateral sham-operation. Two weeks later, cyclosporine (5 or 20 mg/kg per day s.c.) was injected for five days. Freund's complete adjuvant was injected 1 h before the third injection of cyclosporine and the rats were killed 2 h after the last injection of cyclosporine. A significant increase in ornithine decarboxylase activity in submaxillary lymph nodes was observed two weeks after sympathetic denervation. Cyclosporine decreased enzyme activity in submaxillary lymph nodes on the sham-operated side by 67-77% and by 21-41% on the denervated side (P less than 0.01). The incorporation of [35S]methionine into proteins in ipsilateral submaxillary lymph nodes was increased by unilateral superior cervical ganglionectomy and decreased by cyclosporine to a similar extent in denervated and innervated lymph nodes. Superior cervical ganglionectomy decreased by about 93-95% the norepinephrine content of submaxillary lymph nodes regardless of cyclosporine treatment. The results indicate that an appropriate sympathetic neural environment is needed for cyclosporine to have an effect on ornithine decarboxylase activity in lymphoid tissue.

Transcriptional role of a conserved GATA-1 site in the human epsilon-globin gene promoter

The epsilon-globin gene is the first of the human beta-like globin genes to be expressed during development. We have analyzed protein-DNA interactions in the epsilon-globin promoter region by DNase I footprinting and electrophoretic mobility shift experiments using nuclear extracts from K562 human erythroid cells and from nonerythroid HeLa cells. A restricted set of ubiquitous proteins, including Sp1, bound to regions of the promoter including the CACCC and CCAAT sites. Three interactions, at positions -213, -165, and +3 relative to the transcription start site, were erythroid specific and corresponded to binding of GATA-1, a transcription factor highly restricted to the erythroid lineage. Interestingly, the GATA-1 site at -165 has been conserved in the promoters of 10 mammalian embryonic globin genes. Point mutations demonstrate that GATA-1 binding to this site is necessary for interaction with an erythroid-specific enhancer but that in the absence of an enhancer, GATA-1 does not increase transcription.

Chronic tophaceous gout. A case report

A review of gout is presented, followed by a discussion of the current medical literature on diagnosis, differential diagnosis, staging, and treatment. Chronic tophaceous gout is not as prevalent as it once was because of early diagnosis and treatment, but it is still encountered in the podiatric practice. A severe case of chronic tophaceous gout is presented. The patient was successfully treated by surgical intervention. Although surgery may be avoided in most cases, it is indicated when intractable pain, loss of motion, and massive joint destruction are present.

[Psychotherapy of loss and grief]

For many years, survivors of the Holocaust in Israel and elsewhere have made little space in their lives for past memories. Indeed, they feared being overcome by them and influencing their children negatively as a result. When these people reach the age of putting their whole life into perspective, the mourning and loss processes are reactivated by the need to hold testimony. Also, they seek to be part of the continuity of crucial events that marked their past, particularly concerning the separation from their family of origin, network of friends and cultural community. Furthermore, since people belonging to the second generation grew up with this separation from family roots, they would develop fantasies often linked to a somewhat guilty complex. The authors present two clinical cases to illustrate each of the two themes in the article.

Effects of prolonged mental work on functional brain topography

Topographic patterns of event-related covariance between electrodes were measured from subjects performing a difficult memory and fine-motor control task for 10-14 h. Striking changes occurred in the patterns after subjects performed the task for an average of 7-9 h, but before performance deteriorated. Pattern strength was reduced in a fraction-of-a-second-long response preparation interval over midline precentral areas and over the entire left hemisphere. By contrast, pattern strength in a succeeding response inhibition interval was reduced over all areas. The pattern changed least in an intervening interval associated with visual-stimulus processing. This suggests that, in addition to the well-known global reduction in neuroelectric signal strength, functional neural networks are selectively affected by sustained mental work in specific fraction-of-a-second task intervals.

N-(3,5-dichlorophenyl)succinimide nephrotoxicity in streptozotocin-induced diabetic rats

N-(3,5-Dichlorophenyl)succinimide (NDPS) is an experimental fungicide which induces renal toxicity. The following study examined the nephrotoxicity induced by NDPS in streptozotocin (STZ) diabetic rats. Male Fischer 344 (F344) rats were injected with 35 mg/kg STZ (i.p.) or citrate buffer. Fourteen days after STZ or citrate buffer injection, the rats (4-6 rats/group) were injected with (0.4 or 1.0 mmol/kg) NDPS or vehicle (sesame oil, 2.5 ml/kg). Kidney weight, blood urea nitrogen (BUN) levels, morphology and renal cortical slice uptake of organic ions was quantitated 48 h after NDPS administration. A 0.4 mmol/kg dose of NDPS induced diuresis, increased kidney weight and a moderate elevation in BUN levels in the normoglycemic group. The 1.0 mmol/kg dose of NDPS produced diuresis, proteinuria, increased kidney weight and a marked increase in BUN levels in the normoglycemic group. The renal cortical slice uptake of p-aminohippurate (PAH) and tetraethylammonium (TEA) was also decreased 48 h after NDPS injection in the normoglycemic group. No alterations in kidney weight, BUN levels, morphology or renal cortical slice uptake of organic ions was observed in the diabetic animals treated with (0.4 or 1.0 mmol/kg) NDPS. The results of this study indicate that the renal toxicity of NDPS was reduced in the diabetic rat.

Glutathione turnover in cultured astrocytes: studies with [15N]glutamate

The incorporation of [15N]glutamic acid into glutathione was studied in primary cultures of astrocytes. Turnover of the intracellular glutathione pool was rapid, attaining a steady state value of 30.0 atom% excess in 180 min. The intracellular glutathione concentration was high (20-40 nmol/mg protein) and the tripeptide was released rapidly into the incubation medium. Although labeling of glutathione (atom% excess) with [15N]glutamate occurred rapidly, little accumulation of 15N in glutathione was noted during the incubation compared with 15N in aspartate, glutamine, and alanine. Glutathione turnover was stimulated by incubating the astrocytes with diethylmaleate, an electrophile that caused a partial depletion of the glutathione pool(s). Diethylmaleate treatment also was associated with significant reductions of intraastrocytic glutamate, glycine, and cysteine, i.e., the constituents of glutathione. Glutathione synthesis could be stimulated by supplementing the steady-state incubation medium with 0.05 mM L-cysteine, such treatment again partially depleting intraastrocytic glutamate and causing significant reductions of 15N labeling of both alanine and glutamine, suggesting that glutamate had been diverted from the synthesis of these amino acids and toward the formation of glutathione. The current study underscores both the intensity of glutathione turnover in astrocytes and the relationship of this turnover to the metabolism of glutamate and other amino acids.

Clinical assessment of treatments for prolonged bleeding in users of Norplant implants

The effectiveness of three drugs in controlling prolonged bleeding in the first year of NORPLANT implants use was tested. The drugs were levonorgestrel (L-Ng, 0.03 mg twice a day for 20 days), ethinylestradiol (EE, 0.05 mg per day for 20 days) and ibuprofen (Ib, 800 mg three times a day for 5 days) and were given orally. A control group received a placebo (PL, one pill of lactose for 20 days). Treatment should start each time a woman experienced eight consecutive days of bleeding or spotting. The 183 volunteers were not aware of the drug administered. A daily record of bleeding and spotting and of treatment intake was maintained. One-hundred-forty women completed the study period; 60 never used the prescribed treatment. Women treated with the three test drugs had significantly fewer bleeding and spotting days during the treated month and also throughout the study year than women using the placebo. The mean number of bleeding plus spotting days per actually treated subject in the first year was 77, 94, 101 and 129 days for the EE, Ib, L-Ng and PL groups, respectively. The administration of EE might help in the management of prolonged bleeding during the first year of NORPLANT implants use.

Pelvic sonography can predict ovum release in gonadotrophin-treated patients as determined by pregnancy rate

Ultrasonographic monitoring of ovum release was performed in two consecutive cycles in each of 220 patients treated with gonadotrophin. Definite release occurred in 69% of cycles, indeterminate in 24% and non-release in 7%. Support for the accuracy of sonography in diagnosing the luteinized unruptured follicle (LUF) was demonstrated by a much higher pregnancy rate in those patients showing ovum release. There was a definite tendency for non-release to recur in the next cycle. Thus, the data support the routine use of sonography 2-3 days after human chorionic gonadotrophin (HCG) injection to monitor ovum release in gonadotrophin-treated patients (HMG).

Synthesis of positively charged phthalocyanines and their activity in the photodynamic therapy of cancer cells

Positively charged zinc containing or metal free phthalocyanines 6a-c and 7a-c were prepared via a three step procedure starting from 4-nitrophthalonitrile. The phthalocyanines contain alkyl chains of different length in order to influence the hydrophilic vs lipophilic character of the compounds. The partition between a hydrophilic (water) and lipophilic (octanol-1) phase was determined, and the photoredox activities were investigated. Initial results on the photodynamic activity of these compounds were compared with those of Dougherty's Photofrin II on different malignant and non-malignant cell lines (XP 29MAmal, CX1, HeLa, S180 and NO17). Positively charged phthalocyanines in vitro showed a higher photodynamic activity than Photofrin II.

Intact parathyroid hormone in primary hyperparathyroidism

In 49 patients with primary hyperparathyroidism, intact parathyroid hormone (PTH) was measured with a recently developed immunoradiometric assay, and midregional PTH fragments (sequence 44-68) were measured with an established radioimmunoassay technique. In 47 normal subjects, the concentration of intact PTH ranged from 2.0 to 6.8 pmol/l, and in 49 patients with primary hyperparathyroidism it ranged from 6.4 to 80.0 pmol/l. In contrast, midregional PTH fragments were normal in seven of 49 patients with primary hyperparathyroidism. In five healthy controls and in 12 patients with surgically confirmed primary hyperparathyroidism and serum calcium levels below 3.0 mmol/l, a rapid calcium loading test was performed. In healthy controls, intact PTH was in the low normal to subnormal range within 2.5-5.0 min, and had recovered within 15 min of calcium infusion. In patients with primary hyperparathyroidism, the calcium infusion also led to a 30-50 per cent decrease in intact PTH levels within 5.0-7.5 min after injection, with a slow recovery after 10-15 min. In six of the patients with only slightly elevated basal intact PTH, a suppression to the normal range was observed. In 24 patients (16 patients with a solitary adenoma and eight patients with four-gland hyperplasia) the intact PTH levels were followed intraoperatively during parathyroidectomy, revealing a significantly different rate of decline for single adenomas compared with hyperplasia during the first 15 min after removal of the primary enlarged gland. Intact PTH values remained constantly elevated in one patient with primary hyperparathyroidism and an unsuccessful neck exploration. These results confirm that (a) the measurement of intact PTH in patients with primary hyperparathyroidism is superior to the measurement of midregional fragments; (b) PTH secretion in primary hyperparathyroidism is not totally autonomous; and (c) intraoperative monitoring of intact PTH values could be used to monitor the success of surgery.

Regional differences in norepinephrine and dopamine concentration and effect on serotonin uptake and release in bovine pineal gland

In order to analyze whether the bovine pineal gland is a homogeneous or a heterogeneous structure as far as monoamine content, the regional differences in norepinephrine (NE), dopamine (DA), serotonin (5HT), and 5-hydroxyindoleacetic acid (5HIAA) contents were assessed by high-pressure liquid chromatography. NE content was maximal in the proximal (close to the recessus pinealis) region and decreased in a rostral-caudal direction to achieve minimal values at the distal region. DA exhibited an opposite trend to NE, NE/DA ratios varying from 3.2 (proximal region) to 1.4 (distal region). Significantly lower NE content was found at the inferior as compared to the superior pineal region, and at the cortex as compared to the medulla. No significant differences were detected in DA concentration of these latter pineal regions, or in 5HT or 5HIAA concentration as a function of the region examined. 3H-5HT and 3H-NE uptake were maximal at the proximal zone in a rostral-caudal direction, at the superior as compared to the inferior region, and at the medulla as compared to the cortex. Unlabeled NE was equally effective to compete with 3H-5HT uptake in the several pineal regions studied. While NE increased maximally 3H-5HT release in a rostral-caudal direction, DA exhibited an opposite trend, displaying maximal 5HT release activity at the distal pineal region. DA and NE 5HT-releasing activity were greater in the pineal medulla than in the cortex, and did not exhibit differences in the superior as compared to the inferior pineal aspects. Excess (55 mM) K+ released 3H-5HT to a similar extent regardless of the pineal region examined.

Maternal brown fat metabolism returns to control level by four weeks postweaning in rats

We studied body composition, white and brown adipose tissue cellularity, lipoprotein lipase activity and metabolic enzyme activity in three groups of rats: nonpregnant controls, lactating dams and nonlactating dams (i.e., dams not permitted to suckle their young). Nine to 11 rats in each group were killed on d 12 postpartum (study d 34) and on d 40 postpartum (study d 62). During lactation, brown fat citrate synthase, beta-hydroxyacylCoA dehydrogenase (HOAD) and lipoprotein lipase activities were significantly lower in the lactating than in the nonlactating dams or virgin controls. Although the nonlactating dams had their pups removed within 24 h after delivery, by d 12 postpartum citrate synthase and HOAD activities were significantly lower than those of nonpregnant controls. By the end of the study there were no differences among the three groups except in the case of HOAD. HOAD activity in the lactation group was significantly lower than in the nonlactation group. White fat cell number in the parametrial depot was significantly increased in the nonlactation groups by d 12 postpartum. In the lactation group, increased white fat cell number in this depot was detectable at d 40 postpartum, when carcass fat stores and fat cells had been repleted. These results demonstrate that both lactating and nonlactating dams undergo cellular hyperplasia, at least in the parametrial depot. This may predispose them to obesity. Also, decreased brown fat metabolism in the nonlactating dams may be contributing to their significantly greater carcass fat content at d 12 postpartum.

Prediction of the left ventricular ejection fraction response to doxorubicin using a multiple linear regression model

The aim of this study was to develop a model for predicting clinically significant deterioration in the left ventricular ejection fraction due to chronic doxorubicin administration. Twenty-six patients were monitored during their courses of doxorubicin chemotherapy with serial gated equilibrium radionuclide angiography. Multiple linear regression analysis was used to derived the best combination of clinical and radionuclide angiographic predictors of resting left ventricular ejection fraction at any point during the course of chemotherapy. The final model consisted of five variables: left ventricular ejection fraction at the previous monitoring point; cumulative dose of doxorubicin achieved at the previous monitoring point; increment in dose from the previous monitoring point; age of the patient; and time to peak left ventricular emptying at the previous monitoring point. The cumulative dose, the ejection fraction at the previous monitoring point and the final model, respectively, explained 11%, 33% and 53% of the variability in ejection fraction determinations during the 26 patient courses. The final model also forecast a potentially very low resting left ventricular ejection fraction (less than 35%) at the cumulative doses of doxorubicin which provoked serious clinical cardiotoxicity in two patients. A multivariate model is a useful aid in timing discontinuation of doxorubicin prior to the development of a clinically significant deterioration in left ventricular ejection fraction.

Telephone versus face to face interviewing as a means of collecting data relevant to the management of diabetes among general practitioners in France: a randomized design

Successful patient education requires planed programs with specific target populations. As general practitioners see 85% of noninsulin-dependent diabetics in France, this study was designed to test the feasibility of the telephone as a method for data collection within the context of a random sample of general practitioners in the Paris region. In addition, data were collected assessing physician's perceptions of various barriers and facilitators to the management of this illness. The study demonstrated the feasibility of phone interviews among general practitioners, as no significant differences were found in response rates or for any single variable collected on the telephone versus "face-to-face". Treatment patterns were described and results indicated that 77% of general practitioners agreed to participate in a subsequent study and, of these 93% agreed to the participation of their noninsulin-dependent patients.

Effects of palmitate on astrocyte amino acid contents

The effects of palmitate on intracellular and extracellular amino acid concentrations of cultured astrocytes was studied. Exposure of astrocytes to either 0.72 mM or 0.36 mM palmitate was associated with a significant reduction in the intracellular pool of glutamine and taurine. In contrast, the intracellular concentration of histidine, glycine, citrulline, isoleucine and leucine were increased in the presence of 0.72 mM palmitate. Comparable changes in the extracellular amino acid pool were not observed. The data suggest that palmitic acid, which accumulates in the brain during periods of anoxia, alters the metabolism of several amino acids in cultured astrocytes. These changes may be of significance in terms of the pathophysiology of a stress such as anoxia.

[Small intestine pouches as a therapeutic principle in stomach and large intestine replacement]

Small bowel pouches are being utilized in several versions as substitute reservoirs after total gastrectomy and after continence preserving proctocolectomy. Throughout the world, most frequently the pouch is formed by simple duplication of the gut. The principles of reservoir formation, the special functional requirement in the upper and lower GI-tract are delineated. Follow-up studies prove the successful use of gastric and ileoanal pouches.