Plasma concentrations following oral and sublingual administration of lorazepam

Lorazepam 2.5 mg was given as premedication either orally or sublingually to 20 patients undergoing minor gynaecological surgery. Plasma concentrations were followed for up to 8 h after administration. The time for the maximal plasma concentration (tmax) occurred 40 min after oral administration and 60 min after sublingual administration. No significant differences were found between the two treatments at any time. The plasma concentration after 8 h was high compared to the maximal plasma concentration.

Effects of age and sex on the external induction of scoliosis in rats

To guide inquiries into the mechanisms for progression of mild scoliosis in humans, the authors investigated the effects of age and sex on the response of spines to externally applied deforming moments using a rat model. Groups of male and female rats, with initial ages of 3, 6, or 24 weeks, were held for five weeks in restraints that laterally deformed their trunks. In response to these deforming moments, the spine of every animal studied acquired an at-least-temporarily fixed lateral curve. Without exception, when deforming moments were applied, the rats' spines deformed. Neither age nor sex was an important factor in this response. The implications of these results to possible mechanisms of scoliosis curve progression in humans are discussed.

Back pain and spinal deformity in cystic fibrosis

Back pain is a common complaint of individuals with cystic fibrosis (CF). We studied back pain in our patient population in three ways: a questionnaire, an orthopedic evaluation, and a survey of chest roentgenograms. Forty-seven patients with CF reported back pain as compared with seven controls. Patients with CF showed decreased muscle strength and mobility in the trunk, chest, and shoulders. The incidence of structural kyphosis was only 8.7%, but many had vertebral wedging. Much of the back pain may be due to postural abnormalities or to vertebral wedging, not fixed structural kyphosis.

The production of recombinant HLA-DR beta and invariant chain polypeptides by cDNA expression in E. coli

In this report we describe the production of recombinant fusion proteins of the HLA-DRw6 beta chain and the murine Ia-associated invariant chain. cDNAs encoding the human HLA-DRw6 beta chain and the murine Ia-associated invariant chain were introduced into bacterial expression plasmids. These plasmids direct the synthesis of the respective molecules as fusion proteins of the bacteriophage MS-2 polymerase by E. coli. Fusion proteins purified from crude E. coli lysates were used to raise antisera in rabbits. These antisera were able to immunoprecipitate biosynthetically labelled class II and invariant chain antigens. Additionally, two anti-DR antisera were raised against single domains of the HLA-DR beta chain thus generating reagents with a defined fine specificity. The anti-murine invariant chain serum was shown to cross-react with the human invariant chain and therefore may be useful for studying invariant chain and Ia antigen expression in different species. The method described here permitted us to produce large quantities of immunologically relevant proteins, for use in the production of polyclonal and monoclonal antibodies. Soluble fragments of the fusion proteins representing certain DR domains may also be useful in functional immunological studies.

Capsid protein VP4 of poliovirus is N-myristoylated

Poliovirus was labeled in vivo with [3H]myristic acid. Analysis of the capsid polypeptides revealed that the [3H]myristic acid residues copurified with VP4, the smallest and internal capsid protein of the virion. Evidence is presented showing unambiguously that the N-terminal glycine residue of VP4 is N-myristoylated. A previous analysis of the tryptic peptides of VP4 [Dorner, A. J., Dorner, L. F., Larsen, G. R., Wimmer, E. & Anderson, C. W. (1982) J. Virol. 42, 1017-1028] had shown that the N-terminal blocking group exists on all VP4 molecules as well as on VP0 and P1, two precursor polypeptides to VP4 in poliovirus. The possible function of the myristic acid residue in VP4 and in its precursor in poliovirus proliferation is discussed.

Ureteroscopy: results and complications

The results and complications of 100 consecutive ureteroscopy studies are reported. Introduction through the orifice or the intramural ureter failed in 11 per cent of the patients and in 14 per cent the ureteroscope could not be advanced up to the level of the lesion. Ureteroscopy was successful in 75 per cent of the patients and stone extraction was successful in 69 per cent. Complications occurred in 9 patients: 4 had an uncomplicated urinary tract infection, 4 had a ureteral perforation and 1 presented with ureteral stenosis at the site of the extracted stone a few weeks later. At followup 1 to 3 months after ureteroscopy clinical examination, excretory urography and/or renography revealed no further late sequelae.

Symptoms and signs predictive of the voiding pattern after acute urinary retention in men

Over a 9-month period 228 men were admitted for acute urinary retention to six different casualty wards in the Copenhagen area. The patients were followed in the corresponding urological departments for one year. Twenty-seven variables were registered for each patient. The cumulative rate of recurrent retention was 56% after one week and 68% after one year. Factors predictive of preserved voiding ability were a retained volume less than 500 ml, a known event provocative of acute retention, and a maximum flow rate of more than 5 ml/s after the retention. The maximum flow rate measured within the first week after the retention was reliable within the follow-up period if the voided volume was 150 ml or more. The etiology of the acute retention was infravesical obstruction in 90% of the patients, and 85% required subsequent surgical treatment. Predictive of surgical treatment for infravesical obstruction were recurrent urinary retention within one week, a volume of retention of more than 500 ml, the absence of a provocative situation prior to the retention episode and nocturia twice or more.

Urinary undiversion with implantation of an artificial urethral sphincter

Urinary undiversion was performed in a 21-year-old man with a contracted flaccid bladder. The steps of the procedure were: bladder dilatation; antireflux implantation of an ileal conduit into the bladder; external sphincterotomy, and implantation of an artificial urethral sphincter. The patient is continent and has a good bladder capacity and emptying. In many patients with urinary ileal conduit diversion, upper urinary tract and stomal problems develop after some years. In these patients urinary undiversion must be considered but, so far, evaluation showing a high risk of postoperative incontinence has been regarded as a contraindication to urinary undiversion. However, the introduction of artificial urethral sphincters has made it possible to perform undiversion procedures in many of these patients in whom the bladder capacity and bladder emptying is acceptable, if a nonobstructed outlet is secured. We describe the findings and procedures in a patient undergoing urinary undiversion with implantation of an artificial sphincter 8 years after urinary diversion due to neurological disorders caused by a myelomeningocele.

Lumbar trunk muscle use in standing isometric heavy exertions

A study was conducted to see whether a biomechanical model previously validated for predicting the lumbar spine internal loads imposed by the performance of easy and moderately strenuous physical tasks was also adequate for predicting loads imposed by heavy exertions. Lumbar trunk muscle myoelectric activities were measured in 10 healthy young adult men performing a variety of less strenuous and more strenuous tasks while standing upright, and these were compared to the lumbar muscle contraction magnitudes predicted by the model. For the less strenuous tasks, measured activities and predicted forces showed strong linear correlations, confirming the validity of the model at those load levels. Model predictions for the more strenuous tasks were often found to be inadequate. Contrary to model-incorporated assumptions, substantial antagonistic muscle contractions sometimes occurred, intraabdominal pressurization may sometimes have contributed substantially to the maintenance of structural equilibrium, and the ligamentous tissues of the trunk seemed sometimes to develop substantial passive resistances to bending and twisting moments.

Acute urinary retention in women: a prospective study of 18 consecutive cases

Over a 9 month period 18 women were admitted for acute urinary retention to six different Copenhagen hospitals, serving a population of approximately 700,000 people. Urodynamically 9 patients had underactive detrusor function, 2 had infravesical obstruction and 3 had both underactive detrusor function and infravesical obstruction. In 4 patients bladder and urethral function were not classified. In 10 patients a provocative event preceded the retention episode. Eleven patients developed recurrent retention within 3 months and 7 patients had persistent severe obstructive voiding problems. Best prognosis was found for patients with correctable infravesical obstruction and for patients with minimal symptoms prior to the retention episode.

Thiazides in the prophylactic treatment of recurrent idiopathic kidney stones

In a double-blind prospective clinical study patients with at least two verified episodes of urolithiasis, but stone-free at the time of inclusion in the study, were subjected to prophylactic treatment with either bendroflumethiazide (2.5 mg) + 573 mg potassium chloride 3 times a day, or placebo. The material included a total of 22 patients, all males, aged 20-49 years. We found a clear tendency to reduced stone formation in the group treated with the active drug (P less than 0.01). Calcium excretion was reduced by 25-50% in 7 of 12 patients treated with thiazide.

Maturation of murine leukemia virus env proteins in the absence of other viral proteins

A mutant of Akv which produces env but no detectable gag or pol products (A. Rein, D. R. Lowy, B. I. Gerwin, S. K. Ruscetti, and R. H. Bassin, J. Virol. 41, 626-634 (1982] was examined for maturation of env gene protein products. In comparison with wild-type Akv, the mutant AK 71 synthesizes gPr85env and produces gp70 and Prp15E in normal amounts and with normal kinetics. Cell surface gp70 was found alike in the mutant and wild type. However, cleavage of Pr15E to p15E did not occur in the mutant. This final cleavage step of AK 71 Prp15E could be made to occur by superinfecting cells containing the mutant with baboon endogenous virus. Thus, unlike earlier steps, this final step in maturation of the env gene product appears to require gag or pol gene products. It is proposed that the virus-encoded protease is required for this last step.

Standing and supine Cobb measures in girls with idiopathic scoliosis

The standing Cobb measure in a group of 287 girls with idiopathic scoliosis at the start of treatment was in the mean approximately 9 degrees larger than the supine Cobb measure. This mean standing-supine difference was essentially independent of curve severity expressed by the supine Cobb measure. Because of this, when the difference was expressed as a percentage of the supine Cobb measure, the mean values of this ratio decreased substantially with increasing curve severity. The mean difference decreased only slightly with age through adolescence, indicating that spine lateral curves stiffen little as patients mature. The standard deviations in the standing minus supine Cobb differences were approximately 6 degrees in the majority of the age and severity groupings studied. Ninety-three percent of these patients had standing-supine Cobb measure differences that were between 0 degrees and 20 degrees.

Fibrin adhesive sealing of ureter after ureteral stone surgery. A controlled clinical trial

In a prospective randomized study 8 patients were peroperatively allocated to closure of ureterotomies with a fibrin adhesive (Tisseel) and 8 patients to closure with Dexon sutures to evaluate whether the duration of postoperative urinary leakage could be diminished by the use of fibrin adhesive. The median drainage period was 6.5 days (range 3-15 days) and 5.5 days (2-16 days), respectively. Closure of ureterotomies with a fibrin adhesive cannot be recommended.

Different recombinant murine leukemia viruses use different cell surface receptors

Retroviruses can be grouped by viral interference measurements into classes which use common cell surface receptors. We previously tested a large number of isolates of mink cell focus-inducing (MCF) murine leukemia viruses (MuLVs), and reported that all of them share a distinct receptor on NIH/3T3 cells (A. Rein, Virology 120, 251, 1982). We now extend this generalization to several additional recombinant isolates, including two (SL3-2 and GPA-V2) which would not be considered MCFs on the basis of host-range data. We note the superiority of interference tests, based on positive, unambiguous data, over host-range tests for virus classification. We also show that in contrast to the MCFs, which are all derived from ecotropic MuLVs, a recombinant derived from wild mouse amphotropic MuLV (S. Rasheed et al., Int. J. Cancer 29, 345, 1982) uses a unique receptor on NIH/3T3 cells. This suggests that (a) mouse cells contain more than one type of endogenous env sequence; and (b) there is some specificity in the generation of recombinants, since ecotropic MuLVs appear to give rise only to MCFs, while amphotropic MuLV has generated a distinct type of recombinant. It also represents a second case (in addition to the MCFs) in which an env gene recombinant is more pathogenic than its exogenous parent. We also show that xenotropic MuLV does not interfere with MCFs in NZB mouse cells; thus, despite the close homology between MCF and xenotropic env sequences, the gp70 of xenotropic MuLV appears to have no detectable affinity for the MCF receptor.

Direct Vision Internal Urethrotamy. A Critical Review of 365 Operations

Internal urethrotomy under direct vision for urethral strictures in the male was employed on 369 occasions in 225 patients during a 4-year period. A retrospective review of results showed an overall cure rate of 77% but the cure rate after each individual operation was less than 50%. Operations for recurrence carried a significantly lower cure rate than initial operations but even after several recurrences there were reasonably good results considering the relatively minor procedure. An active post-operative follow-up employing routine urethroscopy showed significantly better results than mictiographic follow-up. The post-operative period of catheterisation and positive urine culture at the time of follow-up had no significant influence on the results.

Myristylation of gag-onc fusion proteins in mammalian transforming retroviruses

Four cell lines producing transforming proteins encoded by three mammalian oncogenes (fes, abl, and ras) were investigated for incorporation of [3H]myristate into gag-onc fusion proteins. Using 5-min pulse-labelings, fusion proteins of Abelson murine leukemia virus, Gardner-Arnstein strain of feline sarcoma virus (FeSV), and Snyder-Theilen strain of FeSV were shown to be myristylated. In a 4-hr pulse, p29gag-ras of rat sarcoma virus (RaSV) was also shown to incorporate radiolabel. The fatty acid was recovered from this labeled protein by acid hydrolysis, and identified by reverse-phase thin-layer chromatography to be [3H]myristic acid. The results indicate that substitution of viral gag sequences by cellular oncogene sequences does not abolish their ability to become post-translationally modified by this long chain fatty acid (A. Schultz and S. Oroszlan, J. Virol. 46, 355-361). It is assumed that in the fusion proteins the myristyl moiety is linked through an amide linkage to the amino-terminal glycine as previously found for several retroviral gag precursor polyproteins (L. E. Henderson, H. C. Krutzsch, and S. Oroszlan, Proc. Natl. Acad. Sci. USA 80, 339-343). The possible role of myristylation of transforming proteins is discussed.

Trunk muscle myoelectric activities in idiopathic scoliosis

Twenty adolescent girls with mild-to-moderate cases of idiopathic scoliosis and twelve adolescent girls with structurally normal spines performed 15 exercises isometrically while standing. The exercises included resisting flexion, extension, and lateral bending moments imposed on the trunk. Myoelectric activities in 12 trunk muscle groups were measured during these performances, using surface electrodes. For one set of comparisons, the patients were divided into those whose clinical records documented curve progression and those with no documented progression. No significant differences were noted in mean myoelectric activities between these two patient groups. For a second set of comparisons, the subjects were divided into patients with curves of more than 25 degrees, patients with curves of 25 or fewer degrees and normals. No significant differences in mean myoelectric activities were noted between the patients with the smaller curves, while the patients with the larger curves had significantly larger convex side myoelectric activities in their anterior, lateral and posterior muscles at lumbar levels compared to the normal girls. The findings of this study, along with biomechanical model analyses, suggest that the asymmetries in muscle actions evidenced by myoelectric measurements result from scoliosis. Scoliosis progression seems not to be caused by asymmetry in muscle contractions; rather it may be caused by a lack of adequate asymmetry.

Biological, chemical, and immunological studies of Rauscher ecotropic and mink cell focus-forming viruses from JLS-V9 cells

Two murine leukemia viruses were isolated from JLS-V9 cells which had been infected with Rauscher plasma virus. One virus was XC positive and failed to grow on mink or cat cells and thus was an ecotropic virus. The other virus formed cytopathic foci on mink cells, was XC negative, and fell into the mink cell focus-forming (MCF) viral interference group and was thus an MCF virus. The glycoproteins of the two viruses could be distinguished immunologically, by peptide mapping, and by size in sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The MCF virus produced gp69, and the ecotropic virus produced gp71, explaining the origin of the heterogeneous glycoprotein (gp69 and gp71) of Rauscher leukemia virus. Amino-terminal sequences of gp69 and gp71 were determined. The MCF sequence was distinct from the ecotropic sequence, but retained partial homology to it. The data show that the glycoproteins are encoded by related yet distinct genes. The protein structural data support the proposal that MCF virus gp70 molecules have nonecotropic sequences at the amino terminus, with ecotropic sequences occurring at the 3' end of the gene. The Rauscher MCF virus glycoprotein lacks a glycosylation site found at position 12 of the ecotropic sequence.

Joint flexibilities in structurally normal girls and girls with idiopathic scoliosis

Seven clinical measurements of joint flexibilities were made in 51 girls with untreated mild idiopathic scoliosis and 65 girls with structurally normal spines. Subject ages ranged from 10 to 16 years. Abilities to have the index finger passively extended, the wrist bent, and the elbow and the knee hyperextended, along with abilities to bend the trunk voluntarily forward and to the right and left sides, were measured. The girls with scoliosis in the mean either had the same flexibilities or were less flexible than the normal girls. The study provided no evidence that untreated mild idiopathic scoliosis occurs or progresses because of increased joint flexibilities.

Use of lumbar trunk muscles in isometric performance of mechanically complex standing tasks

Ten subjects performed 25 tasks isometrically while standing. Those tasks imposed substantial extension, lateral bending, and twisting moments on the lumbar spine. Mechanically complex trunk muscle actions were called for to resist those moments. Biomechanical model analyses were used to predict the trunk muscle contraction forces needed to perform those tasks, and surface myoelectric activities were measured to validate those predictions. Predictions and measurements were linearly well correlated.

Trunk strengths in structurally normal girls and girls with idiopathic scoliosis

Maximum voluntary isometric strengths of the trunk were measured in 93 girls who had mild idiopathic scoliosis and 109 girls who had structurally normal spines. Subject ages ranged from 10 to 16 years, and the mean Cobb measurement in the girls with scoliosis was approximately 22 degrees. Strengths were measured in attempted trunk flexion, attempted extension, ad attempted left and right lateral bending. No consistent differences appeared in performance between the girls with scoliosis and the structurally normal girls.

Bulging of lumbar intervertebral disks

Lateral, posterolateral, posterior, and end plate bulges in the intervertebral disks of 14 fresh human cadaver lumbar motion segments were measured. Loads were applied in compression of up to 800 N; and in right lateral bending, extension, flexion, and torsion of up to 12 Nm. Mean disk bulges up to 2.7 mm were found. Disk bulges differed little after fluid injection or after posterior element removal.

Analysis and quantitative myoelectric measurements of loads on the lumbar spine when holding weights in standing postures

Ten subjects executed a number of weight-holding and force-resisting work tasks while standing either upright or with their trunks in 30 degrees of forward flexion. All tasks involved sagitally symmetric body configurations and were performed isometrically. A simple calculation scheme was devised to predict the lumbar trunk muscle contraction forces and the lumbar spine compression forces required for execution of each task. The myoelectric activity was recorded quantitatively at eight sites over the lumbar trunk muscles and at four sites over the abdominal muscles. Good correlation was found between the predicted muscle contraction forces and the myoelectric activities.

Loads on the lumbar spine. Validation of a biomechanical analysis by measurements of intradiscal pressures and myoelectric signals

We studied the validity of predictions of compressive loads on the lumbar spine and contraction forces in lumbar trunk muscles based on a biomechanical model. The predictions were validated by quantitative measurements of myoelectric activities at twelve locations on the trunk and of the pressure in the third lumbar disc. Twenty-five tasks were performed isometrically by four healthy volunteers. The model predicted that the tasks imposed mean compressive loads on the spine of as much as 2400 newtons and required contraction forces of the posterior muscles of the back of as much as 1800 newtons. Intradiscal pressures of as much as 1600 kilopascals were measured. The predicted and measured quantities were well correlated. It appears that the model adequately predicted the compressive loads on the lumbar spine and the tensions in the back muscles.

CLINICAL RELEVANCE

Patients with low-back disorders limit their physical activities, which indicates that loading on the spine must be a factor in those disorders. This study shows that the loads imposed on the spine by physical activities need not be measured. They can easily be calculated. This will significantly accelerate biomechanics research on low-back disorders. The calculation techniques that we validated for predicting loads on the spine can be used to calculate the loads on any skeletal structure. Those loads are largely determined not by the externally applied loads, but by the moments of those applied loads and by the moments of the weights of the body segments that the structure must support.

Correction of scoliosis by muscle stimulation: biomechanical analyses

Quantitative theoretical analyses of the ability of trunk muscle contraction forces to reduce lateral curves in the spine are presented. The effects of contraction of each of 68 muscle slips on each of 13 configurations of scoliosis were examined using biomechanical models of the trunk. The lateral curve, sagittal curve, and longitudinal axis rotation changes that resulted from contraction of these muscles were determined in each case. The muscles best able, from a biomechanical viewpoint, to reduce different lateral curves are listed. Effects of initial postural configurations and the consequences of reflex attempts to right the trunk after contracting a trunk muscle are described. Substantial changes in spine configuration can result from trunk muscle contractions of even modest intensity.

Infusion of vasoactive intestinal polypeptide in man: pharmacokinetics and effect on gastric acid secretion

Elimination and effect on acid secretion of vasoactive intestinal polypeptide (VIP) were studied in six healthy volunteers. On a background infusion of pentagastrin, 100 ng/kg-h, VIP was administered as stepwise intravenous infusions in doses of 0.5, 0.9, and 2.7 micro/g/kg-h, each dose being give for 1 h. Mean plasma VIP concentrations rose from 5.7 pmol/l to 28, 106 and 336 pmol/l during the VIP infusions. No significant changes in acid secretion occurred during VIP infusion as compared to infusion of pentagastrin alone, and no duodeno-gastric reflux was registered. Serum gastrin concentrations were unaltered during VIP infusion. Elimination of VIP was bi-exponential with half-lives of 2 and 21 min, respectively. Metabolic clearance rate was 42 ml/kg-min and the estimated volume of distribution 135 ml/kg.