The revival of nitric acid for the treatment of anogenital warts

The destruction of small lesions by tissue denaturation (fixation) rather than erosion (acid hydrolysis) is accomplished by nitric acid of moderate strength in which nitric acid reduction products are generated by nitric acid oxidation of added organic acids. Such solutions show a temperature-dependent increase or loss of nitrite during storage, with loss of therapeutic activity when nitrite levels decrease after storage at cooler temperatures. Use of a preparation technique that completely consumes all the oxidizable organic components added to generate nitrite results in a stable preparation that is effective, well tolerated, and convenient in the treatment of anogenital warts (condylomata acuminata). Of 50 patients monitored after treatment with a 6.6 mol/L nitric acid preparation with no residual oxidizable organic agents, results were good in 39 patients, satisfactory in four patients, and unsatisfactory in seven patients. These observations lead to a simplified stable preparation of modest nitric acid concentration with adequate nitrate reduction products for efficacy in the topical ablation of small skin lesions such as condylomata acuminata.

Oxygen transport in peripheral arterial occlusive disease: effects of calf blood dialysate

The obvious relationship of arterial blood flow to tissue hypoxia has led to the relative neglect of secondary mechanisms that might influence the functional and morphologic consequences of major vessel obstruction. Oxygen diffusion through capillaries, both locally and systemically, may be disturbed in subjects with chronic local ischemia. Follow-up data after a double-blind, placebo-controlled evaluation of the effect of treatment with a calf blood dialysate confirm that such treatment may alleviate the consequences of peripheral arterial obstructive disease even though there is no improvement in blood flow through the arterial system involved.

A mutational analysis of the polypyrimidine tract of introns. Effects of sequence differences in pyrimidine tracts on splicing

The polypyrimidine (py) tract of introns is required for efficient spliceosome assembly and splicing of pre-mRNAs. A detailed mutational analysis of the py tract of an adenovirus 2 intron was carried out. Utilizing a "precursor in pieces" vector system, it was possible to synthesize py tract mutant pre-mRNAs that were otherwise identical. The mutant pre-mRNAs that were otherwise identical. The mutant pre-mRNAs were analyzed for in vitro splicing, for formation of splicing complexes, and for binding to proteins in the HeLa nuclear extract. Chimeric pre-mRNAs that contained the yeast branch point consensus sequence (UAC-UAAC) and altered py tracts were also analyzed. Mutational analysis showed the following. First, any mutation in the py tract that affected splicing did so by interferring with complex A formation in spliceosome assembly. Second, introduction of purines into the py tract is detrimental only if the length of the tract is shortened and if there is a reduction in the number of consecutive uracil residues. Third, uracil and cytosine do not have equivalent functions in the py tract. Our results with chimeric pre-mRNAs also show that a strong py tract can partially replace a weak branch point sequence and a strong branch point sequence can partially replace a weak py tract. Finally, the one surprising finding obtained when examining protein binding was that a mutant pre-mRNA did not bind to heterogeneous nuclear ribonucleoprotein C proteins and yet spliced close to wild type level.

Increased renal drug metabolism in treadmill-exercised Fischer-344 male rats

Renal cytochrome P-450 levels, metabolism of acetaminophen (APAP) and aminopyrine, and activities of several phase II-associated enzymes [UDPGT, beta-glucuronidase, and glutathione-S-transferase (GST)] were determined in sedentary and exercised young and middle-aged Fischer-344 male rats. After an 8-week exercise regimen consisting of treadmill running at a moderate intensity, renal microsomal cytochrome P-450 levels were increased 60% and 37% in young and middle-aged runners, respectively. Exercise was found to increase renal deacetylation of APAP to the nephrotoxic metabolite p-aminophenol by 54% in young and 26% in middle-aged rats. Aminopyrine N-demethylase activity was increased 97% in the young runners only. In contrast, UDPGT, beta-glucuronidase, and GST activities were unchanged by treadmill running. NADPH-cytochrome c reductase activity, determined in young animals only, was also unaltered by exercise. Advanced age decreased renal cortical cytochrome P-450 content by 34% while having no effect on p-aminophenol production. Aminopyrine N-demethylase activity was increased by 130% with increased age. The only phase II-associated enzyme altered by age was GST activity, as sedentary middle-aged animals exhibited a 43% decrease in activity when compared with young rats. Young exercised rats did not gain weight as rapidly as sedentary rats, and middle-aged rats had a slight loss in weight during exercise. Moreover, running resulted in 30-36% less food consumption during the experimental period. In conclusion, this study demonstrated that exercise increased renal phase I drug metabolism without influencing phase II processes; furthermore, a substrate-specific modification of the response to exercise was observed in the aged rats.(ABSTRACT TRUNCATED AT 250 WORDS)

[Unusual treatment for myasthenia gravis associated with asthma]

Abnormal antibody production is now recognized as the basis of many diseases, among them myasthenia gravis (MG) and a variant of bronchial asthma. It is not unusual to find 2 or even more of these diseases in the same patient. A patient in whom both MG and bronchial asthma were diagnosed is presented. In both diseases the respiratory muscles are mechanically disadvantaged, which may result in severe dyspnea. In our case, despite specific treatment for both diseases severe attacks of dyspnea still occurred. Specific inspiratory muscle training was followed by significant clinical improvement. There was indirect evidence that respiratory muscles can be trained in patients with MG. Thus, patients with MG with respiratory muscle involvement may benefit from respiratory muscle training.

Requirement of cellular uptake for adenosine inhibition of p-nitrophenol glucuronidation in isolated rat hepatocytes

Adenosine (ADO) has been shown previously to inhibit p-nitrophenol glucuronidation in a concentration-dependent manner when concurrently incubated in isolated rat hepatocytes for 30-60 min. In the current study, preincubation of ADO (500 microM) in isolated hepatocytes for 30 min prior to addition of 100 microM p-nitrophenol resulted in a greater inhibition of glucuronidation when compared to that without preincubation (80 vs 50% inhibition). The inhibitory effect of 250 microM ADO on glucuronidation was decreased from 60 to 10% in the presence of the ADO transport inhibitor nitrobenzyl thioinosine during the 30-min preincubation period. Without prior incubation, 100 microM dibutyryl cyclic AMP (DBcAMP) produced an inhibition of glucuronidation similar to that of 500 microM ADO. In contrast to ADO, there was no significant difference in the inhibitory effect of DBcAMP on p-nitrophenol glucuronidation with or without a 30-min preincubation. Thus, DBcAMP and ADO appear to inhibit glucuronidation through different mechanisms. Furthermore, these results indicate that the inhibitory effect of ADO on p-nitrophenol glucuronidation is dependent to a large degree on the cellular uptake of ADO into hepatocytes, while a portion of the inhibitory effect may arise from the generation of intracellular cyclic AMP.

[Inspiratory muscle training combined with general exercise reconditioning in chronic obstructive pulmonary disease]

In a controlled clinical trial, we compared the effect of 6 months of specific inspiratory muscle training combined with general exercise reconditioning, with that of general exercise reconditioning alone. We measured the effects of the 2 regimens on inspiratory muscle strength, endurance, and exercise performance in patients with chronic obstructive pulmonary disease (COPD), 2 groups of 10 patients each. Inspiratory muscle strength (expressed as the PImax at RV) increased significantly from 43.2 +/- 3.0 to 67.8 +/- 2.9 cm H2O (p < 0.0001) and respiratory muscle endurance (expressed as the relationship between PmPeak, the pressure achieved with the heaviest load tolerated for at least 60 sec, and PI max) increased significantly from 60.2 +/- 2.5 to 85.6 +/- 2.8% (p < 0.001) in the first group (combined treatment). After the 6-month training period, in both groups there were significant increases in 12-minute walk and endurance work time at 2/3 of Wmax (maximal work each subject achieved on a progressive bicycle exercise test of maximum work load). However, those in the first group showed significantly greater improvement in distance walked and endurance time than the others. We conclude that specific inspiratory muscle training for 6 months improves inspiratory muscle strength and endurance in patients with COPD. This training, combined with general exercise reconditioning, also results in improvement in exercise tolerance significantly greater than that of general exercise reconditioning alone.

[Hemodynamics and sleep structure in attempted weaning after nCPAP ventilation therapy of obstructive sleep apnea syndrome]

nCPAP (continuous positive airway pressure) treatment is presently the standard therapy in marked obstructive sleep apnoea syndrome. Fundamentally, this is a long-term treatment. Various authors have been making different recommendations in respect of the frequency of application, based partly only on the patient's individual pattern of complaints and symptoms. Our study aimed at examining the short-term nocturnal effects of discontinuing the treatment course in 12 patients, using polysomnography as a diagnostic tool. Results showed that directly after discontinuation of therapy the sleep structure, respiration during sleep and the nocturnal blood pressure pattern returned to baseline findings. It is concluded from this that nCPAP treatment should be strictly adhered to every night to minimise the risk of cardiovascular complications in the patients concerned.

Thermal effects on horseradish peroxidase uptake in laser nerve transections

The authors previously reported that rat tibial nerves transected with CO2 or KTP/532 laser transmit less horseradish peroxidase (HRP) than those transected with a scalpel. This may be due to laser-specific effects or to thermal phenomena that are laser-independent. This study investigated potential thermal effects on the transmission of HRP through the tibial branch of the sciatic nerve in rats. Bilateral nerve transections were performed on 18 animals using a scalpel (control) or an electrocautery device, which simulated the thermal effects produced by lasers. HRP retrograde transport and deposition in the rat spinal cord were analyzed. Thirteen of 15 animals showed a higher number of HRP-labelled neurons on the scalpel side compared to the electrocautery side; a paired student's t test showed a significant difference (P = .028) in the numbers of HRP-stained cell bodies between the control group (x = 687.13 +/- 119.3) and the electrocautery group (x = 388.1 +/- 111.2). In conclusion, reduced HRP uptake in tibial nerves transected with lasers may be in part due to thermal effects produced by the lasers.

Inspiratory muscle training in patients with bronchial asthma

In patients with asthma, the respiratory muscles have to overcome the increased resistance while they become progressively disadvantaged by hyperinflation. We hypothesized that increasing respiratory muscle strength and endurance with specific inspiratory muscle training (SIMT) would result in improvement in asthma symptoms in patients with asthma. Thirty patients with moderate to severe asthma were recruited into 2 groups; 15 patients received SIMT (group A) and 15 patients were assigned to the control group (group B) and got sham training in a double-blind group-comparative trial. The training was performed using a threshold inspiratory muscle trainer. Subjects of both groups trained five times a week, each session consisted of 1/2-h training, for six months. Inspiratory muscle strength, as expressed by the PImax at RV, increased significantly, from 84.0 +/- 4.3 to 107.0 +/- 4.8 cm H2O (p < 0.0001) and the respiratory muscle endurance, as expressed by the relationship between Pmpeak and PImax from 67.5 +/- 3.1 percent to 93.1 +/- 1.2 percent (p < 0.0001), in patients of group A, but not in patients of group B. This improvement was associated with significant improvements compared with baseline for asthma symptoms (nighttime asthma, p < 0.05; morning tightness, p < 0.05; daytime asthma, p < 0.01; cough, p < 0.005), inhaled B2 usage (p < 0.05), and the number of hospital (p < 0.05) and sick-leave (p < 0.05) days due to asthma. Five patients were able to stop taking oral/IM corticosteroids while on training and one in the placebo group. We conclude that SIMT, for six months, improves the inspiratory muscle strength and endurance, and results in improvement in asthma symptoms, hospitalizations for asthma, emergency department contact, absence from school or work, and medication consumption in patients with asthma.

A clinical evaluation of the effect of calf blood dialysate on the course of acute myocardial infarction

The effect of daily intravenous treatment for 3 weeks with a calf blood dialysate presumed to improve disturbed oxidative metabolism was compared with placebo in a randomized double-blind study of 60 subjects with a first acute transmural myocardial infarction. Overall clinical evaluation of initial severity and clinical course suggested a better response of borderline significance in the dialysate-treated group. Blood enzyme elevations were statistically significantly less for that group on day 4 post-infarction for creatine kinase (CK) and aspartate aminotransferase (AspAT) but not for lactate dehydrogenase (LDH). ST segment elevations in the 36 lead ECG developing after admission were fewer in the verum treated than in the placebo group. Results by each of three criteria (clinical evaluation, enzyme elevations, and electrocardiographic changes) suggest a more favorable response to treatment with the calf blood dialysate as compared to placebo.

Differential effects of swimming and running on microsomal metabolism in middle-aged and aged Fischer 344 rats

Cytochrome P-450 (P-450) content as well as p-nitroanisole (pNA) O-demethylase and UDP-glucuronyltransferase (UDPGT) activities were determined in livers of middle-aged (MA; 12 or 18 months) and aged (24-26 months) rats exercised by either treadmill running or swimming. In addition, aniline hydroxylase activity was measured in MA runners and aged swimmers and compared to respective sham and non-handled controls. Treadmill exercise consisted of running aged and MA rats on a motorized treadmill for 16 and 20 m/min respectively, 60 min/day and 4 times per week, for 8 weeks. Sham rats were placed on the treadmill twice per week for 5 min at 8 m/min. No differences were found in any parameter comparing sham rats to non-handled controls. Running did not affect body weight or hepatic microsomal protein during the 8-week study. A 33-35% decline in microsomal P-450 content in treadmill exercised MA and aged rats was found. PNA O-demethylase activity was decreased 30% in MA and 45% in aged runners and aniline metabolism was inhibited 21% in MA rats. UDPGT activity was not affected by running in MA or aged rats. Swimming exercise was accomplished by placing the rats in a tank of water (32-33 degrees C) filled to a depth of 2 ft. Swim time was 60 min twice daily, 5 times per week. The aged and MA rats were trained for 6 months and 1 year, respectively. Two control groups, non-swimming sedentary (dry control) and 1 min swim/day sham (wet control), were utilized. MA and aged wet controls and swimmers weighted 8% and 15% less respectively, than MA and aged sedentary rats. Microsomal protein was significantly increased in MA swimmers compared to sedentary (20%) and wet control (35%) but no change was found with swimming in the aged rats. The results of the enzymatic studies were variable in the MA rats. Increases in P-450 content were found in wet controls (16%) and swimmers (27%) of the MA group, but only the swimming change was significant. No significant change was determined for pNA metabolism between swimmers and wet (22%) or dry (17%) controls. Aged swimmers and wet controls were more consistent, with no change in any of the parameters except aniline metabolism which was significantly increased in wet controls (25%) and swimmers (28%) as compared to dry controls. No significant change in UDPGT activity was measured in either age group of swimmers.(ABSTRACT TRUNCATED AT 400 WORDS)

Sickle cells modified by an osmotic pulse in the presence of inositol hexaphosphate have decreased intracellular hemoglobin concentration and decreased in vitro sickling without prolonged in vivo survival

An osmotic pulse was used to modify red blood cells (RBC) from two patients with sickle cell disease, resulting in an increased volume and decreased hemoglobin content. This treatment yielded cells which were divided into two populations, one in which RBC had markedly decreased hemoglobin concentration and another in which the cells appeared to be unmodified. Morphological sickling at low oxygen partial pressure was markedly decreased. However, there was no evidence for increased RBC lifespan when the 51Cr-labeled, modified cells were reinfused.

Gallium-67 scans as an adjunct to computed tomography scans for the assessment of a residual mediastinal mass in pediatric patients with Hodgkin's disease. A Pediatric Oncology Group study

This study determines the utility of gallium-67 (Ga-67) scintigraphs as an adjunct to computed tomography (CT) scans for the assessment of residual mediastinal masses in children and adolescents with advanced-stage Hodgkin's disease. At diagnosis 42 patients with CT scan-documented mediastinal disease had a Ga-67 scan performed. Thirty-four of 42 patients (81%) had gallium-avid mediastinal lesions, whereas in eight (19%), the Ga-67 scan was negative. At the completion of eight cycles of therapy of Mustargen (mechlorethamine), Oncovin (vincristine), procarbazine, prednisone (MOPP) alternating with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD), 21 of 34 patients with initially positive Ga-67 scans had them repeated; 18 of 21 converted to negative results, and three remained positive. In 11 of 18 patients, the loss of gallium avidity was consistent with a negative mediastinal CT scan. In seven, although the gallium scan was negative, the CT scan remained positive; all seven patients had a mediastinal biopsy of suspected residual disease and in all seven the biopsy results were negative for Hodgkin's disease. These preliminary results in a small cohort of patients demonstrate that Ga-67 scans may be of benefit in evaluating residual mediastinal masses in patients with Hodgkin's disease.

M.H2I, a multispecific 5C-DNA methyltransferase encoded by Bacillus amyloliquefaciens phage H2

Bacillus amyloliquefaciens phage H2 codes for a multispecific cytosine-5-DNA- methyltransferase (MTase), M.H2I, which methylates GGCC, GCNGC and [sequence: see text] target sequences. The gene coding for M.H2I was cloned in Escherichia coli and its nucleotide (nt) sequence was determined. It consists of 1509 bp, corresponding to a protein of 503 amino acids (aa) with a calculated Mr of 57,166. A comparison of the aa sequence of M.H2I with those of the multispecific MTases encoded by Bacillus subtilis phages SPR, phi 3T and rho 11S, revealed that M.H2I is closely related to these enzymes. A very high degree of homology was observed between M.H2I and M.rho 11SI, with 96.2% aa identity and 97.8% nt identity of the corresponding genes.

Chemotherapy of metastatic Merkel cell cancer

Out of 16 cases of Merkel cell cancer identified in the records of the Mt. Sinai Medical Center or affiliates, 11 patients developed systemic metastases. Literature review confirms the substantial possibility of dissemination. Both in our series and in the literature, cytotoxic chemotherapy produced a high rate of usually short-lived response, although one of our patients with disseminated metastases achieved complete remission for two years.

Nature of enhanced mitochondrial oxidative metabolism by a calf blood extract

The effect of calf blood extract (Solcoseryl, SS) on mitochondrial oxidative function in various states was studied polarographically in vitro. 1) Mitochondrial respiration in all 4 conventional study states (Estabrook, 1967) was enhanced by the addition of SS, including states 1 and 2 (endogenous substrates only). 2) The effect of SS on mitochondrial oxygen consumption was concentration dependent, while ADP/O ratio remained constant. The effect of added respiratory substrates varied with the particular substrate at optimally active concentrations. With suboptimal substrate levels, ADP/O ratios were concentration dependent, in contrast to the SS effect. Under oligomycin ATPase inhibition, SS was no longer active, in contrast to DNP, which remained active. 3) In states 3 (added ADP) and 4 (ADP exhausted), oxygen consumption and oxidative phosphorylation were enhanced by SS in the presence or absence of citrate, glutamate, pyruvate, lactate, or ascorbate. However, in the presence of succinate, SS had no effect. 4) ADP/O ratio was decreased by SS in the presence of added substrate, suggesting that SS activation of H(+)-ATPase enhances ATP hydrolysis as well as oxidative phosphorylation and ATP synthesis. 5) The enhancing effect of SS on mitochondrial function is due to hydrophilic components of SS. The lipidic components obtained by Folch fraction of SS have no effect. It is concluded that the effects of SS respiratory substrates and uncouplers on mitochondrial function are essentially different. SS enhances both ATP synthesis and oxygen consumption by mitochondria.

Clinical, blood gas, and lactate changes in the course of the treatment of peripheral vascular disease with a hemodialysate

In a double-blind comparison with placebo, treatment with a hemodialysate (Solcoseryl) in severe peripheral vascular disease (PVD) resulted in a distinct improvement in symptomatology and clinically observed pathology. Initially depressed ApO2 was normalized with a corresponding increase in AO2 saturation, an increase in A-V pO2 difference, and reduction of elevated blood lactate levels. Correction of disturbed O2 diffusion is postulated to explain these observations. The mechanism proposed may be operative in lung-to-blood, blood-to-tissue, within-tissue and within-cell aspects of oxygen transport under pathologic conditions.

Age-related changes in biotransformation of azoxymethane and methylazoxymethanol in vitro

1. Age-related changes in hepatic hydroxylation of azoxymethane (AZO) to methylazoxymethanol (MAM), as well as colonic phase I metabolism of MAM by alcohol dehydrogenase (ADH) were examined in young (2-4 months), middle-aged (12-14 months), and old (22-24 months) male Fischer 344 rats. In addition, the possibility that colonic glucuronyltransferase might be involved in the biotransformation of MAM was also investigated. 2. A significant decrease in hepatic conversion of AZO to MAM was found in old vs young rats, concomitant with a decrease in hepatic cytochrome P-450 content, while no age-related difference was found in the colonic metabolism of MAM by ADH. MAM inhibition of colonic 4-methylumbelliferone glucuronyltransferase was non-competitive, suggesting indirectly that colonic glucuronyltransferase is not involved in conjugation of MAM. 3. It is concluded that ageing in the male Fischer 344 rat results in alternations of AZO and MAM biotransformation which indicate that AZO may be less carcinogenic in older rats.

Evaluation of analgesic agents in recurring headache compared with other clinical pain models

The efficacy of three preparations (placebo, analgesic agent, and analgesic plus antihistaminic agent) were compared in a double-blind crossover study in subjects with recurring headaches. It was confirmed that headache as a pain model does not show the usual return of pain with as the effects of a single analgesic dose wear off. Consequently, there is no "peak effect," and the rationale for comparing treatments by "area under the curve" calculations is weakened. Greater efficacy was demonstrated for the analgesic over the placebo and for the analgesic and antihistaminic combined over the analgesic alone in several parameters. Slopes of straight lines derived as a quadratic function of pain versus time data proved to be a more effective discriminator between treatments than area under the curve calculations from the same data.

The in vivo survival of human red cells with low oxygen affinity prepared by the osmotic pulse method of inositol hexaphosphate incorporation

The purpose of this study was to determine the posttransfusion survival of low-affinity red cells (RBCs) containing the hemoglobin modifier, inositol hexaphosphate (IHP). An osmotic pulse technique was used to incorporate IHP, a compound that normally does not cross the RBC membrane. Two groups of six volunteers were studied. RBCs were treated under conditions that resulted in a relatively large increase in mean corpuscular volume (delta MCV = 11.8 +/- 4.0, 1 SD) in Group I, but a relatively small increase (delta MCV = 5.5 +/- 1.9) in Group II. The groups had a similar decrease in mean corpuscular hemoglobin (delta MCH = -3.8 +/- 0.9 for Group I and -3.1 +/- 1.1 for Group II). The 24-hour posttransfusion RBC survival, measured with 3 mL of 51Cr-labeled autologous RBCs, correlated with the induced change in oxygen affinity, and larger shifts were associated with poorer survival. An acceptable 75-percent 24-hour posttransfusion survival was achieved for p50 increases up to approximately 15 torr. Cells that survived 24 hours appeared to have a normal lifespan. This study is the first demonstration of adequate survival for human RBCs with a potentially long-lasting decrease in oxygen affinity.