Effects of long-term cortisol treatment on growth and osmoregulation of Atlantic salmon and brook trout

Cortisol is the final product of the hypothalamic-pituitary-interrenal (HPI) axis and acts as a gluco- and mineralo-corticoid in fish. Long-term elevations of cortisol have been linked to reduced growth in fishes, but the mechanism(s) and relative sensitivities of species are still unclear. We carried out experiments to examine the relative effects of cortisol on growth and gill NKA activity in two salmonids: Atlantic salmon (Salmo salar) and brook trout (Salvelinus fontinalis). Treatment with intraperitoneal cortisol implants for 30 days resulted in reduced growth in both species, but with greater sensitivity to cortisol in brook trout. Gill NKA activity was strongly upregulated by cortisol in Atlantic salmon, and weakly upregulated in brook trout but with no statistically significant effect. Cortisol treatment resulted in reduced plasma levels of insulin-like growth factor I and increased plasma growth hormone levels in Atlantic salmon. Our results demonstrate that there are species differences in the sensitivity of growth and osmoregulation to cortisol, even among species in the same family (Salmonidae).

EEG and neuroimaging correlations in children with lissencephaly

PURPOSE

To study the usefulness of EEG in the diagnosis of lissencephaly, a rare cortical developmental disorder associated with abnormal cellular proliferation. Currently, the clinical emphasis is placed on the radiological and genetic aspects for the diagnosis of lissencephaly.

METHODS

This is a retrospective review of consecutive EEG recordings and imaging data from 14 children, with the diagnosis of lissencephaly, who were admitted from January 1998 to January 2010. All EEG recordings were performed with the 10-20 system of electrode placement, in both awake and sleep states. All EEG recordings were reviewed using anterior-posterior bipolar and transverse montages and then they were interpreted blindly, with respect to the imaging and genetic investigations for each patient.

RESULTS

All children showed one of the three characteristic EEG patterns reported in the literature of lissencephaly. The EEG pattern I, showed an anterior posterior gradient that corresponded to the severity of the imaging study abnormality. All patients were on two or more AEDs and reported to continue having active epilepsy.

CONCLUSION

In a child with clinical characteristics of lissencephaly, one of these three reported EEG patterns can prove useful in making the diagnosis very probable, preceding imaging and genetic testing.

The ion-binding characteristics of reconstituted collagen

The ion-binding capacity of highly purified reconstituted calf-skin collagen, and the effects of these ions on the precipitation and solubility of the collagen, were studied with a variety of salt solutions at ionic strength 0.16 and pH7.4. Only a small percentage of the total theoretically available anionic and cationic groups was available for ion-binding. In view of this, it appears that most of the ionizable groups of collagen are involved in intramolecular or intermolecular linkages, or both. Nevertheless, marked differences in the binding of the various ions by collagen were observed. Bivalent cations were bound in extremely small but remarkably similar quantities. In contrast, sodium was bound both in much higher and more variable quantities. Of the anions, pyrophosphate and sulphate were bound in the largest quantities, followed by phosphate, fluoride and chloride, in that order. Despite the minimal uptake by collagen of bivalent cations, they prevented the aggregation of tropocollagen into fibrils, and disaggregated fibrillar collagen. In the presence of multivalent anions, tropocollagen aggregated readily and its fibrillar stability was maintained. On the basis of the imbalance in the binding of ion pairs by the sodium pyrophosphate- and sodium phosphate-treated collagens, it was apparent that a reduced number of side-chain carboxyl groups were dissociated in the presence of these salts.

Retinal nerve fiber thickness in inflammatory demyelinating diseases of childhood onset

PURPOSE

To evaluate retinal nerve fiber layer thickness (RNFLT) using optical coherence tomography (OCT) in children with acquired demyelinating diseases.

METHODS

This is a cross-sectional study of patients seen between 2006-2008 at the Pediatric MS Center of the Jacobs Neurological Institute. Consensus definitions for pediatric demyelinating disease were followed. All children received OCT testing and assessment of visual acuity (VA) using Snellen and low contrast letter acuity (LCLA) charts.

RESULTS

Thirty-eight children diagnosed with acquired demyelinating disease, 15 healthy controls, and five children with other neurological disorders (OND) were included. Average RNFLT in healthy controls was 107 +/- 12 microm(n = 30) versus 108 +/- 5 microm (n = 10) in OND controls. In children with multiple sclerosis, average RNFLT +/- SD was 99 +/- 14 microm in unaffected (n = 24) versus 83 +/- 12 micromin eyes affected by optic neuritis ("affected eyes") (n = 10). Average RNFLT in children with acute disseminated encephalomyelitis and transverse myelitis was 102 +/- 15 microm in unaffected (n = 18) versus 67 +/- 17 microm in affected eyes (n = 6). In children with optic neuritis (ON), average RNFLT +/- SD was 97 +/- 13 microm in unaffected (n = 5) versus 89 +/- 12 microm in affected eyes (n = 9). Differences between children with demyelinating disease and controls and between ON and nonON eyes were statistically significant (P < 0.001). Bivariate correlations of RNFLT with LCLA (P = 0.002) and VA (P < 0.001) were significant.

CONCLUSIONS

OCT may be a valuable tool for the assessment and monitoring of anterior optic pathway dysfunction in children with demyelinating diseases.

Pattern reversal visual evoked potentials as a measure of visual pathway pathology in multiple sclerosis

BACKGROUND

Pattern reversal visual evoked potentials (PRVEPs) have a well-documented role in diagnosis of multiple sclerosis (MS), but their value as a visual function surrogate remains controversial.

METHODS

We evaluated PRVEP in 37 patients with MS who were participating in a long-term follow-up study following a phase III trial of interferon beta-1a (Avonex). Patients were examined to determine the Kurtzke Extended Disability Status Score (EDSS), multiple sclerosis functional composite (MSFC), contrast letter acuity (CLA), and had cranial MRI scans to determine whole brain atrophy (BPF). PRVEP was evaluated for P100 latency, amplitude, and waveform morphology. Two summary scores were created: for Score A, abnormal latencies, morphologies, and amplitudes of each individual eye were added; for Score B, abnormal latencies, morphologies, and amplitude ratio between eyes was determined. Sixteen patients in this group also had PRVEP at the time they enrolled in the clinical trial, eight years previously.

RESULTS

At the follow-up exam, over 75% of patients had abnormal PVEP parameters while visual acuity (VA) was abnormal only in 59%. Increased PRVEP latency over the eight-year period correlated with deterioration assessed by EDSS (P = 0.006), BPF (P = 0.0001), and MSFC (P = 0.0041). Score A was significantly correlated with EDSS, BPF, CLA, cognitive function, and quality of life assessed with the Sickness Impact profile. No correlation was seen with the MSFC.

CONCLUSIONS

The results indicate that PRVEP measures MS-related pathology, and can provide not only diagnostic but also prognostic information during evaluation of MS patients.

Muromonab-CD3-induced neurotoxicity: report of two siblings, one of whom had subsequent cyclosporin-induced neurotoxicity

Muromonab-CD3 is widely used for immunosuppression in patients undergoing solid organ transplant. We report two siblings with oligomeganephronia and end-stage renal disease who developed encephalopathy and seizures from muromonab-CD3 following renal transplant. The first case is a 13-year-old girl who developed encephalopathy, seizure, and triparesis following renal transplant while muromonab-CD3 was used for immunosuppression. The second case was the 6-year-old sister of the first case, who also developed recurrent focal seizures while she was on muromonab-CD3 for renal transplant immunosuppression. In both cases, a sequential brain magnetic resonance image (MRI) showed progression of abnormalities from the cerebral cortex to the white matter. In the first case, the MRI normalized after muromonab-CD3 was discontinued. In the second case, the patient developed a leukoencephalopathy following cyclosporin administration. The pathophysiology of muromonab-CD3 encephalopathy is believed to be a disturbance to the blood-brain barrier mediated by cytokine release from lymphocyte stimulation by muromonab-CD3. Because the major histocompatibility complex genes are known to regulate cytokine responses, it is possible that the excessive production of cytokines that causes encephalopathy may occur in patients who share close major histocompatibility complex genes. Muromonab-CD3 in a patient whose sibling has developed cerebral complications from its use should be administered with caution. The second case suggests that muromonab-CD3 encephalopathy predisposes patients to develop cyclosporin neurotoxicity. Because the pathogenesis of muromonab-CD3 encephalopathy and cyclosporin-related cerebral complications are both potentially mediated through a disturbance of the blood-brain barrier, it is possible that one agent may predispose a patient to the complication of the other.

Efficacy of the ketogenic diet in focal versus generalized seizures

Most reports of the ketogenic diet have focused on its efficacy for generalized seizures. Few data are available regarding its effect on focal seizures. We retrospectively studied patients (mean = 7.5 years of age) with medically intractable epilepsy treated by the ketogenic diet. The predominant seizure types in each patient were classified as generalized (100 patients) or focal (34 patients) based on ictal electroencephalograms (EEGs) or seizure semiology and interictal EEG. A seizure reduction of more than 50% compared with baseline was seen in nine patients (27%) with focal seizures and 46 patients (46%) with generalized seizures at 3 months, in 10 patients (30%) with focal seizures and 46 patients (46%) with generalized seizures at 6 months, and in eight patients (24%) with focal seizures and 42 patients (42%) with generalized seizures at 12 months. Differences were not significant. Outcome tended to be better in patients younger than 12 years of age compared with the older age group, but the difference was significant at 6 months only. Our results suggest that some patients with intractable focal epilepsy may respond favorably to the ketogenic diet and that this option should be considered if epilepsy surgery is not possible.

An immediate-extraction anterior single-tooth replacement utilizing a fiber-reinforced dual-component bridge

Replacement of a single anterior tooth is an extremely challenging procedure. Numerous objective and subjective factors must be evaluated by the interdisciplinary team in the determination of the appropriate restorative method. This article reviews the restorative options and describes an emerging treatment modality--the fiber-reinforced dual-component bridge--as the option selected in a case requiring an immediate extraction of the maxillary right central incisor. The pertinent technology, indications, contraindications, and current clinical technique of dual-component nonmetallic prostheses are examined.

Challenges in health development

Health development projects in Bolivia and Zimbabwe are described in order to illustrate that, in economically depressed areas, the integration of services within the health sector alone is not sufficient to obtain the desired results. Significant barriers to sustainable progress are inevitable unless there is functional coordination with other sectors.

Tethered cord syndrome presenting as a nonhealing cutaneous ulcer

The usual clinical presentations of tethered cord syndrome include pain in the lumbosacral region, gait difficulty, weakness, and bladder abnormalities. We describe an unusual presentation of tethered cord - a nonhealing gluteal ulcer in an anesthetic cutaneous territory supplied by the S2-4 segments. Unexplained cutaneous lesions may be the presenting sign of an underlying neurological condition.

Pleomorphic carcinoma (spindle and giant cell) of the lung

Pleomorphic carcinoma is a rare, very aggressive subtype of lung cancer that follows the clinical pattern of carcinosarcoma. The tumors tend to present as a peripheral mass frequently showing a mixture of spindle and giant cell features and often are associated with other, more common histologic subtypes of lung carcinoma. Clinical outcome is poor, with median survival of ten months. This article describes an unusual lung tumor (pleomorphic carcinoma) in a patient presenting with explosive symptoms suggesting an infection.

The use of imipenem-cilastatin in neonatal meningitis caused by Citrobacter diversus

Citrobacter diversus is a cause of severe meningitis in neonates and infants. It is unique in its propensity to produce brain abscesses that play an important role in the poor prognosis associated with this condition. The recommended therapeutic regimen of third-generation cephalosporines, aminoglycosides and trimethoprim-sulfamethoxazole is usually disappointing. We describe the use of imipenemcilastatin in successfully treating Citrobacter diversus meningitis complicated by brain abscesses.

Once daily cefixime compared with twice daily trimethoprim/sulfamethoxazole for treatment of urinary tract infection in infants and children

We conducted a randomized prospective multicenter study to compare the safety and efficacy of once daily oral cefixime (8 mg/kg) to twice daily oral trimethoprim/sulfamethoxazole (TMP/SMX) (8/40 mg/kg/day) for the treatment of acute urinary tract infection in children ages 6 months to 13 years. Seventy-six patients (38 in each group) were studied. Thirty-seven percent were younger than 3 years of age. Escherichia coli was the most common isolate in both groups (85%). Eighty-five percent of all Gram-negative organisms were susceptible to TMP/SMX and all were susceptible to cefixime. Seventy-two percent of all patients were febrile at the time of diagnosis. Both groups were treated for 7 to 10 days. Peripheral white blood cell counts, erythrocyte sedimentation rate, body temperature and urinalysis returned to normal at the same rate in both groups. No failures were observed and relapse occurred in 3 cases within the 4 weeks after treatment (2 in the cefixime group and one in the TMP/SMX group). Side effects were observed in 14% of the cefixime group and 16% of the TMP/SMX group and were all mild enough not to necessitate discontinuation of therapy. We conclude that the efficacy and safety of cefixime administered once daily compared favorably with TMP/SMX administered twice daily for acute uncomplicated urinary tract infection.

An evaluation of morphine and oxymorphone administered via patient-controlled analgesia (PCA) or PCA plus basal infusion in postcesarean-delivery patients

The analgesic efficacy and adverse effects of morphine and oxymorphone in 32 patients who received traditional patient-controlled analgesia (PCA) following cesarean delivery were compared with those in 32 other patients receiving the same agents via PCA plus basal opioid infusion (PCA + BI). All patients were operated upon during epidural anesthesia with 2% lidocaine and 1:200,000 epinephrine to achieve a T4 sensory level. Upon first complaint of pain in the recovery room, patients were given a titrated iv loading dose of the assigned opioid until comfortable and were then provided with a programmable PCA device. Group I (PCA) consisted of two subsets in which incremental boluses of morphine (1.8 mg, n = 16) or oxymorphone (0.3 mg, n = 16) could be self-administered via conventional PCA. Patients in group II (PCA + BI) received a basal infusion of morphine (0.6 mg/hour, n = 16) or oxymorphone (0.1 mg/hour, n = 16) in addition to self-administered boluses of 1.8 and 0.3 mg, respectively. Patients were evaluated for 24 h following initiation of analgesic therapy, and 10-cm visual analog scales (VAS) were utilized at selected intervals to assess pain at rest, pain during movement, and satisfaction with therapy. The level of sedation and incidence of nausea/vomiting and pruritus were also recorded. Patients utilizing PCA + BI noted significant reductions in resting pain scores with oxymorphone and decreased pain during movement with both opioids when compared with individuals using PCA alone (P less than 0.05). There were no significant differences between treatment groups in 24-h dose requirements or patient satisfaction with therapy (P = ns).(ABSTRACT TRUNCATED AT 250 WORDS)

Alterations of creatine kinase isoenzymes in colon washings from patients with colonic and rectal diseases

Mucus samples obtained from 61 patients with different types of colon and rectal disease were assayed for CK isoenzyme fractionation. Twelve additional patients without evidence of such diseases were used as reference subjects. The diseases surveyed were hemorrhoids, proctocolitis, polyps, and cancer of the colon and rectum. The CK BB fraction was predominant in the mucus of the reference subjects and in mild cases of hemorrhoids and polyps. With inflammation of degeneration of the colonic mucosa, the present CK BB decreased and the percent of CK MM increased. It is speculated that the increased CK MM possibly derives from increased permeability of degeneration of the colonic wall, permitting plasma CK MM to admix with the mucus. Mucin CK isoenzyme fractionation may be useful in assessing the pathogenesis of colonic and rectal diseases, as a marker to monitor the efficacy of the therapeutic regimen, and as a technique for monitoring conversion of a premalignant process into a malignant one.

Stress inoculation and interinstitutional transfer of mentally retarded individuals

Forty-four mentally retarded individuals were studied to determine if relocation syndrome can be averted in interinstitutional transfer. Twenty-two persons who were transferred on a voluntary basis to a small, new, highly staffed facility and given individualized attention in preparation for the move were compared to a group of nontransferred matched control persons on the Progress Assessment Chart and the Maladaptive section of the Adaptive Behavior Scale, Which were administered prior to transfer and 1, 2, and 4 weeks after. The transferred group displayed no lowered functioning in adaptive behavior and no increase in maladaptive behavior. No relocation syndrome was evidenced as prerelocation preparation appears to have averted the deleterious effects of transfer.

Significance of gamma-glutamyl transferase (GGT) activity measurements in alcohol-induced hepatic injury

Experimental evidence is presented that the determination of gamma-glutamyl transferase (GGT) activity in serum is useful in the assessment of alcohol-induced liver disease and for demonstrating to patients the toxic effects of their drinking habits on the liver. Serial measurements of GGT activity in serum have also proved valuable in monitoring the progress of therapy as well as alleged abstention from alcohol in the known alcoholic.

Procollagen assembly and secretion in embryonic chick bone

Chick embryo skull bones incorporated radioactive proline and cystein into procollagen in short term organ culture. Pulse-chase experiments showed that individual precursor chains (pro-alpha1 and pro-alpha2) were formed first and that these were subsequently linked by disulfide bounds into trimers. Radioautography showed that labeled material was secreted 30 min after adding label to the cells, and electrophoretic analyses showed that after this time completed labeled collagen molecules appeared. Conversion from disulfide-linked procollagen to collagen proceeded in more than one step. An intermediate form consisting of shorter chains, which were still trimerically linked, was found.

Elaboration of the matrix glycoprotein of enamel by the secretory ameloblasts of the rat incisor as revealed by radioautography after galactose- 3 H injection

The elaboration of enamel matrix glycoprotein was investigated in secretory ameloblasts of incisor teeth in 30-40-g rats. To this end, the distribution of glycoprotein was examined histochemically by the use of phosphotungstic acid at low pH, while the formation of glycoprotein was traced radioautographically in animals sacrificed 2.5-30 min after galactose-(3)H injection. Histochemically, the presence of glycoprotein is observed in ameloblasts as well as in the enamel matrix; in ameloblasts glycoprotein occurs within the Golgi apparatus in amounts increasing from the outer to the inner face of the stacks of saccules, and is concentrated in condensing vacuoles and secretory granules; in the enamel matrix, glycoprotein is observed within linear subunits. Radioautographs at 2.5 min after injection demonstrate the uptake of galactose-(3)H label by Golgi saccules, indicating that galactose-(3)H is incorporated into glycoprotein within this organelle. After 5-10 min, the label collects in the condensing vacuoles and secretory granules of the Golgi region. By 20-30 min, the label appears in the secretory granules of the apical (Tomes') processes, as well as in the enamel matrix (next to the distal end of the apical processes, and at the tips of matrix prongs). In conclusion, galactose contributes to the formation of glycoprotein within the Golgi apparatus. The innermost saccules then distribute the completed glycoprotein to condensing vacuoles, which later evolve into secretory granules. These granules rapidly migrate to the apical processes, where they discharge their glycoprotein content to the developing enamel.

Cytotoxic effects of puromycin on the Golgi apparatus of pancreatic acinar cells, hepatocytes and ameloblasts

A single injection of puromycin was given to rats in a dose sufficient to produce almost total inhibition of protein synthesis in pancreas and liver. By 10 min after injection, Golgi saccules in pancreatic acinar cells, hepatocytes and ameloblasts appeared grossly and irregularly distended, and almost devoid of content. In pancreas the condensing vacuoles near the inner face of the Golgi were often altered, and those normally present in ameloblasts were lacking. Between 2 and 3 hr after injection, protein synthesis had started anew. At this time, granules without limiting membranes appeared within cisternae of the rough endoplasmic reticulum in acinar cells and ameloblasts. These intracisternal granules are believed to consist of newly synthesized secretory protein which could not be transported through the disrupted Golgi apparatus to be packaged into secretory granules. Indeed, by 3 hr postinjection the secretory granules which normally abound in the apical processes of ameloblasts were sparce or absent. Thus, while biochemical evidence indicates that puromycin blocks protein synthesis on the ribosomes, the use of this antibiotic in vivo results in alterations in the Golgi apparatus and interruption of the packaging of protein into secretory granules.