Licorice-induced hypertension: a case of pseudohyperaldosteronism due to jelly bean ingestion

Hypertension is one of the most common problems encountered in the primary care setting. Numerous secondary causes of hypertension exist and are potentially reversible. The ability to screen for such causes and manage them effectively may spare patients from prolonged medical therapy and hypertensive complications. Licorice can cause hypertension and hypokalemia due its effects on cortisol metabolism. We report a case of jelly bean ingestion that highlights the presentation, pathophysiology and management of licorice-induced hypertension.

Functional consequences of S1P receptor modulation in rat oligodendroglial lineage cells

Fingolimod (FTY720) and its phosphorylated form FTY720P are modulators of sphingosine-1-phosphate (S1P) receptors, which are G-protein coupled receptors linked to cell migration and vascular maturation. The efficacy of FTY720 in autoimmune diseases such as multiple sclerosis and its animal models has been attributed to its inhibition of lymphocyte trafficking to target organs. In this study, we examined the role of S1P receptors in cultured rat oligodendrocytes (OLGs) and OLG progenitor cells (OPCs) using the active phosphorylated form of FTY720. We found that (1) FTY720P improves the survival of neonatal rat OLGs during serum withdrawal, which is associated with the phosphorylation of extracellular signal regulated kinases (ERK1/2) and Akt; (2) FTY720P regulates OPC differentiation into OLGs in a concentration-dependent manner; and (3) S1P receptors are differentially modulated by platelet-derived growth factor (PDGF) resulting in downregulation of S1P5 and upregulation of S1P1 in OPCs. In addition, siRNA studies revealed that S1P1 participates in PDGF-induced OPC mitogenesis. We conclude that S1P1 and S1P5 serve different functions during oligodendroglial development, and possibly during remyelination.

Barré-Lieou syndrome and the problem of the obsolete eponym

BACKGROUND

Eponym lists in major sources can give an aura of legitimacy to discredited diagnoses, as exemplified by the case of Barré-Lieou syndrome, a 'rare' vestibular disorder.

METHODS

A literature review for information on the posterior cervical syndrome of Barré-Lieou.

RESULTS

Barré-Lieou syndrome includes very common symptoms--tinnitus, dizziness, and head or neck pain--attributed to ischaemia caused by cervical sympathetic nerve compression. Its original description brings together many unrelated disorders, and its causative mechanism has been discredited. However, it appears credulously in a number of eponym lists, and references to the syndrome are steadily increasing on the internet in general and on alternative medicine and legal profession websites in particular.

CONCLUSION

By inclusion in eponym lists, without a disclaimer, a syndrome can be given legitimacy before the general public. A syndrome, such as Barré-Lieou syndrome, that is useless to the medical profession can unfortunately prove to be very useful for litigants and disability claimants.

Synthesis and evaluation of aza HUN-7293

The aza analogue of the cyclic heptadepsipeptide HUN-7293 (1), which is a potent naturally occurring inhibitor of inducible cell adhesion molecule expression, and its C2(3) (MLEU3 C2) epimer were prepared via solution-phase synthesis. Biological evaluations of these two compounds as inhibitors of cell adhesion molecules expression are detailed.

Commitment, pro-relationship behavior, and trust in close relationships

The present work advances and tests an interdependence-based model of the associations among commitment, pro-relationship behavior, and trust. Findings from two longitudinal studies revealed good support for model predictions. Commitment-inspired acts such as accommodation and willingness to sacrifice provide diagnostic information regarding a partner's pro-relationship motives. Individuals come to trust their partners when they perceive that their partners have enacted pro-relationship behaviors, departing from their direct self-interest for the good of the relationship. The results of mediation analyses are consistent with a model of mutual cyclical growth in which (a) dependence promotes strong commitment, (b) commitment promotes pro-relationship acts, (c) pro-relationship acts are perceived by the partner, (d) the perception of pro-relationship acts enhances the partner's trust, and (e) trust increases the partner's willingness to become dependent on the relationship. Auxiliary analyses revealed that self-reported attachment style does not account for substantial variance beyond the features of interdependence that form the basis for the present model.

Commitment, pro-relationship behavior, and trust in close relationships

The present work advances and tests an interdependence-based model of the associations among commitment, pro-relationship behavior, and trust. Findings from two longitudinal studies revealed good support for model predictions. Commitment-inspired acts such as accommodation and willingness to sacrifice provide diagnostic information regarding a partner's pro-relationship motives. Individuals come to trust their partners when they perceive that their partners have enacted pro-relationship behaviors, departing from their direct self-interest for the good of the relationship. The results of mediation analyses are consistent with a model of mutual cyclical growth in which (a) dependence promotes strong commitment, (b) commitment promotes pro-relationship acts, (c) pro-relationship acts are perceived by the partner, (d) the perception of pro-relationship acts enhances the partner's trust, and (e) trust increases the partner's willingness to become dependent on the relationship. Auxiliary analyses revealed that self-reported attachment style does not account for substantial variance beyond the features of interdependence that form the basis for the present model.

Immobilization of goitred gazelles (Gazella subgutterosa) and Arabian mountain gazelles (Gazella gazella) with xylazine-ketamine

Xylazine combined with ketamine successfully immobilized free-ranging and captive goitred gazelles (Gazella subgutterosa) and Arabian mountain gazelles (Gazella gazella). One hundred thirty immobilizations were performed on 58 individuals. When administered i.m. via dart to free-ranging gazelles, xylazine (125 mg/ml) combined with ketamine (100 mg/ml) produced smooth induction and recovery. Mountain gazelles required higher dosages (11.7-15.2 mg/kg xylazine and 9.3-12.2 mg/kg ketamine) than goitred gazelles (6.8-7.4 mg/kg xylazine and 5.4-5.9 mg/kg ketamine). For manually restrained captive gazelles of both species, i.v. xylazine (11 mg/ml) combined with i.v. ketamine (44 mg/ml) immobilized the gazelles at considerably lower doses (0.4-1.0 mg/kg xylazine and 1.4-3.9 mg/kg ketamine). These anesthetic combinations are useful alternatives to ultrapotent narcotics in these gazelle species.

Deficits of gaze stability in multiple axes following unilateral vestibular lesions

Abnormalities in the vestibulo-ocular reflex (VOR) after unilateral vestibular injury may cause symptomatic gaze instability. We compared five subjects who had unilateral vestibular lesions with normal control subjects. Gaze stability and VOR gain were measured in three axes using scleral magnetic search coils, in light and darkness, testing different planes of rotation (yaw and pitch), types of stimulus (sinusoids from 0.8 to 2.4 Hz, and transient accelerations) and methods of rotation (active and passive). Eye velocity during horizontal tests reached saturation during high-velocity/acceleration ipsilesional rotation. Rapid vertical head movements triggered anomalous torsional rotation of the eyes. Gaze instability was present even during active rotation in the light, resulting in oscillopsia. These abnormal VOR responses are a consequence of saturating nonlinearities, which limit the usefulness of frequency-domain analysis of rotational test data in describing these lesions.

Detection of serologic neutralizing antibodies against HPV-11 in patients with condyloma acuminata and cervical dysplasia using an in vitro assay

This study was designed to investigate if neutralizing antibodies against HPV-11 are detectable in the serum of patients with condyloma acuminata (CA) or cervical intraepithelial neoplasia (CIN) using an in vitro infectivity assay for HPV-11. Purified HPV-11 virions were extracted from xenografted condyloma tissues implanted into athymic mice and used to infect cultured neonatal human foreskin keratinocytes (HFK) and an immortalized adult skin cell line (HaCaT). The presence of HPV-11-specific E1--E4 mRNA as detected by reverse transcriptase-polymerase chain reaction was indicative of early infection. Sera previously characterized for reactivity to HPV-11 and HPV-11 VLP (virus-like particles) by ELISA were tested for the ability to prevent HPV-11 in vitro infectivity. Neutralizing antibodies against HPV-11 were demonstrated when monoclonal antibodies or patient serum preincubated with HPV-11 virions prevented the infection of either of the two cell cultures, as shown by the absence of the E1--E4 mRNA transcript. Eleven (of 20) patients with CA were strongly ELISA reactive against HPV-11 virus-like particles. Five of these 11 patients also had detectable levels of neutralizing antibodies in their serum. It was also demonstrated that the neutralizing properties of the serum were titratable by endpoint dilution. None of 15 patients with CIN had detectable neutralizing antibodies against HPV-11. Neutralizing antibodies against HPV-11 can be detected in some patients with CA and the neutralizing effects of the patient sera can be titrated by endpoint dilution. The in vitro assay for the detection of neutralizing antibodies against HPV-11 may have utility for investigating the natural history of HPV infection and resolution, as well as assessing the efficacy of any putative HPV vaccine.

VCAM-1/alpha 4-integrin adhesion pathway: therapeutic target for allergic inflammatory disorders

Lymphocyte recirculation and leukocyte extravasation involve a multistep process that is central to immune surveillance and the rapid response of white blood cells to sites of injury or infection. Interaction of vascular adhesion molecules (VCAM-1, ICAM-1, and selectins) with ligands on the leukocyte surface (integrins, carbohydrates, and mucin-like molecules) regulate diapedesis. The nature of an inflammatory stimulus ultimately determines the pattern of endothelial adhesion molecule expression and the avidity state of their counterreceptors, thus dictating to a large extent whether a subclass of leukocytes will play a dominant role in the immune response. Immunoglobulin superfamily member VCAM-1 recognizes alpha 4 beta 1 integrin, expressed on all leukocytes except neutrophils. Blockade or inhibition of VCAM-1/alpha 4 beta 1 interaction is expected to have therapeutic potential in treating various inflammatory disorders and autoimmune diseases since this adhesion pathway has a major influence on eosinophil, lymphocyte, and monocyte trafficking. This review summarizes some of the strategies that are currently used to selectively inhibit the VCAM-1/alpha 4 integrin pathway, including soluble VCAM-Ig fusion protein, peptide antagonists, antisense oligonucleotides, natural products, and neutralizing antibodies to VCAM-1 or alpha 4 integrin.

T-cell receptor alpha beta and gamma delta T cells in rat and human skin--are they equivalent?

In the not-so-distant past the skin was generally viewed as a passive target for immune-mediated injury. Over the last decade, however, concepts of a previously unrecognized role for the skin have unfolded, whereby resident bone marrow-derived leukocytes (e.g. Langerhans cells and T cells) initiate and regulate the immune responses that protect it. Their combination with other immunomodulatory resident cells (e.g. keratinocytes, melanocytes, endothelial cells, fibroblasts) led to the idea that the skin may function as a self-sustaining lymphoid tissue. Although T lymphocytes or, at least, certain subpopulations thereof have the general propensity to populate epithelial tissues, there exist major species differences regarding the phenotype of intraepidermal T cells. The purpose of this review is to fill gaps in our understanding of the relationship of rodent skin T cells to T cells identified in human skin and the normal physiologic and pathologic role(s) of these cells.

Familial migraine with vertigo and essential tremor

We report a family with dominantly inherited migraine headaches, episodic vertigo, and essential tremor. All symptoms improved with the use of acetazolamide. Linkage analysis ruled out linkage to markers on chromosome 19p, known to be linked to the genetic defect in families with the clinically similar syndromes of hemiplegic migraine and periodic ataxia. This genetic heterogeneity of migraine syndromes could result from defects in a family of genes coding proteins with similar properties.

The 3D-structure of a natural inhibitor of cell adhesion molecule expression

The three-dimensional structure of cyclopeptolide HUN-7293, a naturally-occurring inhibitor of cell adhesion molecule expression, has been determined from nuclear magnetic resonance data recorded in solution and from X-ray diffraction analysis of single crystals. The backbone conformation of HUN-7293 is characterized by two cis-peptide bonds in both the solution and crystalline state. Differences between the solution and crystal structure are visible for the orientation of some side chains and the strength of two transannular hydrogen bonds. Such structural information helps to provide insight into the molecular architecture of HUN-7293 on the atomic level and opens the way for structure-based modifications of this novel inhibitor of cell adhesion molecule expression.

Nicotinic agonists administered into the fourth ventricle stimulate norepinephrine secretion in the hypothalamic paraventricular nucleus: an in vivo microdialysis study

Nicotinic cholinergic agonists stimulate ACTH secretion by a central mechanism involving brainstem catecholamines. In vivo microdialysis studies were conducted to measure the release of norepinephrine (NE) in the hypothalamic paraventricular nucleus (PVN) in response to the administration of nicotine (Nic) or another nicotinic cholinergic (NAch) agonist, cytisine (Cyt), directly into the IVth ventricle. Alert, freely mobile rats, equipped 24 h previously with a chronic guide cannula in the IVth ventricle and microdialysis probe in the PVN, were injected with artificial cerebrospinal fluid (CSF, 500 nl/60 s), Nic (1-5 micrograms), or Cyt (1-25 micrograms) after three 20-min baseline samples had been taken. Analysis of the dialysates by HPLC with electrochemical detection demonstrated the dose-dependent secretion of PVN NE to Nic or Cyt with ED50s of approximately 1 or 6 micrograms, respectively; these were completely blocked by prior IVth ventricular injection of the NAch antagonist, mecamylamine (4 micrograms). In contrast, alpha-bungarotoxin, which antagonizes the action of NAch agonists by acting through the alpha 7 bungarotoxin-type NAchR, failed to reduce the NE response to Nic. Partial, but significant desensitization of NE secretion in response to a second injection of Nic (2.5 or 5 micrograms) 100 min after the first was seen, whereas NE responses to the second injection of Cyt (5 or 25 micrograms) were completely desensitized. However, cross-desensitization of each agonist to the other did not occur. This may reflect heterogeneity of the NAch receptor subtypes involved. The results of this study establish a correlation between the action of nicotine on brainstem norepinephrinergic regions and the resultant release of NE in the PVN, which would lead to the release of ACTH secretagogues.

Paroxetine in the treatment of chronic daily headache

Forty-eight patients with chronic daily headache, unresponsive to several combinations of pharmacological treatments, were selected for an open-label study using paroxetine. Patients were given 10 mg to 50 mg of paroxetine for a period of 3 to 9 months. Ninety-two percent of the patients improved significantly, based on the patients' percent of the reduction in number of headache days per month. The common side effects were fatigue, insomnia, and urogenital disturbances. The possible mechanism of action of paroxetine in the treatment of chronic daily headache is discussed. Paroxetine appears to be effective in the treatment of chronic daily headache; however, double blind studies are needed to confirm these preliminary findings.

Vestibular rehabilitation

Vestibular rehabilitation is a physical therapy programme for persons with symptomatic lesions of the vestibular system. When applied early in the course of recovery, it can hasten compensation. It can also reduce symptoms resulting from permanent deficits caused by vestibular injury. It has been shown to be effective when applied to patients with unilateral or bilateral losses, and reduces both dizziness and imbalance. Compensation occurs through tonic re-balancing at the level of the vestibular nuclei; by substitution of vision, proprioception and peripheral sensation for the missing vestibular input; and by the use of behavioural strategies to deal with residual deficits. The latter two mechanisms can be facilitated with rehabilitation exercises. Treatment methods must be varied, based on the patient's underlying disorder. The best prognosis for full recovery is for individuals with acute, unilateral vestibular injury. Patients with bilateral lesions will show improvement, but will have permanent deficits. Persons with progressive vestibular disorders, those having central involvement and persons with visual or somatosensory impairments may require more prolonged courses of treatment or demonstrate incomplete recovery. Patients with a previous history of vestibular loss with recent decompensation require a thorough re-evaluation to rule out these more complex problems. Rehabilitation includes vestibular exercises, management of vestibular suppressant medications, general conditioning and patient instruction. Exercises should be directed at static and active posture and balance, eye-head co-ordination and symptomatic dizziness. Balance exercises include practice with standing, walking and turning. Eye-head co-ordination exercises require head movement during visual fixation or visual target changes. Treatment of symptomatic dizziness is based upon habituation to the provoking stimulus, usually head or eye movement. Home exercises are combined with formal physical therapy sessions and patient education to complete the process of rehabilitation.

Pharmacological modulation of endothelial cell-associated adhesion molecule expression: implications for future treatment of dermatological diseases

Skin diseases with an inflammatory component, regardless of their etiology, are characterized at some point by the extravasation and subsequent infiltration of leukocytes into the dermal and/or epidermal compartments. This trafficking pattern is determined by a complex series of events whereby the leukocytes interact with cell adhesion molecules (CAM), particularly those induced on endothelial cells following activation with various inflammatory mediators. Vascular CAMs belonging to the selectin family (i.e., P-selectin and E-selectin) are thought to mediate early and reversible events involving leukocyte rolling and margination along the lumenal surface of microvascular cells (post-capillary venules). Certain members of the immunoglobulin supergene family (i.e., VCAM-1 and ICAM-1) regulate later and irreversible steps which lead to firm attachment and subsequent diapedesis of leukocytes. Accumulating evidence suggests that if one blocks the ligand-binding sites between leukocytes and endothelial cells, or inhibits vascular CAM expression, hematopoietic cell extravasation and progressive inflammatory events can be greatly diminished. To identify such inhibitors we developed a cell-based Elisa using the human microvascular cell line HMEC-1. As reported in the present paper, this approach yielded a naturally-occurring, low molecular weight compound which potently inhibits cytokine-induced adhesion molecule expression on cultured endothelial cells, without modulating "house-keeping" proteins.

Functional loss of the horizontal doll's eye reflex following unilateral vestibular lesions

The doll's eye reflex represents the vestibulo-ocular reflex (VOR) elicited by high-acceleration head rotation. After complete unilateral vestibular lesions, the ipsilateral, horizontal doll's eye reflex is replaced by a series of "catch-up" saccades. These cause permanent symptoms of blurred vision and dizziness during ipsilateral turns. We compared normal controls and patients with complete surgical lesions or canal paresis of up to 9 years duration via electronystagmography (ENG) to determine the usefulness of the doll's eye test as a diagnostic test for complete vestibular lesions. This test was found to be more sensitive in diagnosis of such lesions than head-shaking nystagmus, rotatory directional preponderance, and spontaneous nystagmus. It is also useful to document VOR function in patients in whom caloric irrigation is contraindicated.

Selective administration of nicotine into catecholaminergic regions of rat brainstem stimulates adrenocorticotropin secretion

Nicotine (Nic) is a potent stimulus for ACTH secretion, and this response appears to be mediated by central catecholamine secretion. We have previously shown that fourth ventricular administration of Nic rapidly elevated plasma ACTH levels, that a nicotinic cholinergic antagonist, mecamylamine, instilled into the fourth ventricle inhibited the ACTH response to iv Nic, and that Nic stimulated norepinephrine secretion in the hypothalamic paraventricular nucleus. Thus, the present investigations sought to identify Nic-responsive regions in the brainstem that give rise to ascending catecholaminergic afferents resulting in ACTH secretion. Chronic brain and jugular cannulae were implanted, and Nic (50 nl over 30 sec) was infused into the locus coeruleus (LC), nucleus of the solitary tract (NTS -C2 or -A2 regions), C1, or A1 cell regions of freely moving, adult male rats. Injection of Nic (free base, 0.25-10 micrograms) into either the C2 or A2 region of NTS resulted in a dose-dependent increase in plasma ACTH. In contrast, C1 was unresponsive and A1 only showed responses to the highest doses of Nic (5 or 10 micrograms). In LC, Nic in doses of 2.5 micrograms or higher was required to elevate plasma ACTH. This dose is approximately 10-fold greater than that required in NTS-A2. Finally, mecamylamine (0.25 mg/kg body wt, iv), administered 2 min before Nic, abolished the ACTH responses in both C2 and A2 and significantly reduced the 7-min peak ACTH response in LC (P < 0.05). In summary, microinjection of Nic selectively activated the brainstem regions under investigation, with a rank order of sensitivity to Nic that was NTS-A2 > NTS-C2 > LC > A1 > C1 = cerebrospinal fluid. Therefore, systemically administered Nic appears to activate multiple catecholaminergic brainstem regions that are involved in mediating ACTH secretion.

Nicotine stimulates the expression of cFos protein in the parvocellular paraventricular nucleus and brainstem catecholaminergic regions

The rapid secretion of ACTH in response to nicotine is mediated by a central mechanism involving brainstem catecholaminergic regions. To identify specific brainstem regions involved in activating the hypothalamo-pituitary-adrenal axis and other areas of the brain by iv nicotine, immunocytochemical detection of cFos protein was used as a marker for neuronal activation. Nicotine (0.05 mg/kg) stimulated cFos expression in the parvocellular paraventricular nucleus (pcPVN; containing CRH-positive neurons mediating ACTH secretion); this correlated with the expression of cFos in the A2 (norepinephrinergic) and C2 (epinephrinergic) regions of the brainstem nucleus tractus solitarius, which project directly to the pcPVN. The selectivity of this brainstem activation was shown by the absence of responses in the locus coeruleus (LC), A1, and C1 catecholaminergic regions to this low dose of nicotine. In contrast, a high dose of nicotine (0.1 mg/kg), which produced a brief episode of tremor, was required for expression of cFos in the LC. This was associated with a further increase in the number of cFos-positive cells in the PVN, primarily through recruitment in the magnocellular region, a known projection field of LC. The higher dose of nicotine also induced cFos in the vasopressinergic region of the supraoptic nucleus (SON), whereas the lower dose of nicotine exclusively induced cFos in the oxytocinergic region of the SON. Limbic regions that receive catecholaminergic inputs, such as the the central nucleus of the amygdala (involved in PVN regulation) and the cingulate gyrus of the cortex, showed a dose-dependent increase in the number of cFos-positive cells after nicotine, whereas the dentate gyrus of the hippocampus only responded to the high dose. Thus, nicotine is a potent and selective stimulus for neuronal activation in brainstem catecholaminergic regions and their projection fields in the pcPVN and SON, which regulate the hypothalamo-pituitary-adrenal axis and vasopressin/oxytocin secretion, respectively.

Isolation of human immunodeficiency virus type 1 from human epidermis: virus replication and transmission studies

For a better understanding of the pathogenetic events operative in the cutaneous manifestations of human immunodeficiency virus type 1 (HIV-1) disease, we investigated whether epidermal cells (EC) from HIV-1-seronegative persons can be infected with HIV-1 and, vice versa, whether HIV-1 can be rescued from the epidermis of HIV-1-infected individuals. In a series of three experiments, we consistently found that exposure of EC from HIV-1-seronegative donors to HIV-1 led to viral replication in these cells as evidenced by the detection of HIV-1 p24 in culture fluids. Because EC had been substantially enriched for Langerhans cells (LC) before being exposed to HIV-1, it is reasonable to assume that these CD1a+/CD4+/MHC class II+ antigen-presenting cells of the epidermis represented the actual targets of infection. This assumption is further strengthened by the observation that T cell-depleted cell suspensions from Langerhans cell histiocytosis (LCH) lesions could be productively infected with HIV-1. Conversely, co-culture of epidermal sheets from HIV-1-seropositive individuals with mononuclear phagocytes (MNP) from HIV-1-seronegative donors resulted, after 3 to 5 weeks, in the detection of HIV-1 p24 in 12 of 23 cases. Immunocytochemical analysis, using a monoclonal antibody specific for p24, revealed the presence of HIV-1 in adherent MNP in three cocultures tested. In addition, cellular DNA from these cultures showed strong signals when hybridized to a HIV-1-specific DNA probe. The further finding that two isolates examined exhibited different restriction enzyme patterns indicates that they are separate entities rather than contaminants. Transmission of these isolates to MNP, B- or T-cell lines resulted in cultures strongly positive for p24 and, in the case of H9 cells, for viral particles as detected by electron microscopy. Our results therefore strongly suggest that EC not only can serve as targets for HIV-1, but also can allow efficient virus replication and transmit HIV-1 to various cell types of the hematopoietic lineage.

ICAM-1 Expression in a Spontaneously Transformed Human Keratinocyte Cell Line: Characterization by a Simple Cell-ELISA Assay

Interferon gamma (IFN-gamma) is known to induce ICAM-1 on keratinocytes (KC) in vitro, and its expression in vivo is correlated with epidermal T-cell infiltration in various dermatoses. However, the mechanisms for this cytokine-mediated ICAM-1 expression are essentially unknown. We investigated the induction of ICAM-1 by IFN-gamma in HaCaT cells, a spontaneously transformed human KC cell line, using an immunoperoxidase-ELISA with the monoclonal antibody (MoAb) R6.5. HaCaT cells constitutively expressed low levels of ICAM-1, which were upregulated by IFN-gamma. The kinetics and dose response were similar to those published for primary KC, regardless of whether the HaCaT cells were cultured in low- or high-calcium medium. ICAM-1 expression was increased significantly at 4 h with 500 U/ml IFN-gamma, and reached a plateau (approximately 5 x greater than constitutive) by 24 h. At concentrations greater than 10 U/ml for 24 h, IFN-gamma induced ICAM-1 expression in a dose-dependent fashion (half maximal at 100 U/ml). TNF-alpha alone, and in synergistic combination with IFN-gamma, also upregulated the expression of HaCaT ICAM-1. IFN-gamma treatment of HaCaT cells increased the level of ICAM-1 mRNA and enhanced (approximately 3x) the adherence of fluorescently labeled (calcein) human T lymphoblasts, as determined by Northern blotting and an in vitro adhesion assay, respectively. Our findings suggest that HaCaT cells, in conjunction with a simple immunoperoxidase cell-ELISA, provide a reliable system for studying pharmacologic modulation of ICAM-1 on KC.

Calcitonin gene-related peptide is chemotactic for human T lymphocytes

Certain neuropeptides, such as CGRP, are associated with C-type nerve fibers in the skin and are known to be proinflammatory mediators. Because of their probable role in various cutaneous diseases, we investigated the effect of alpha- and beta-CGRP on human leukocyte migration in a 48-well microchemotaxis chamber using a 5-microns-pore filter. Elutriated peripheral blood leukocytes (enriched 80-90% for CD3+ and 10-20% for CD20+ lymphocytes) were added to the upper wells, and CGRP to the lower ones in a dose range of 10(-19)-10(-5) M; both were diluted in RPMI medium containing 0.05% fetal calf serum. The chamber was incubated at 37 degrees C for 2.5 hours, and the filter was washed and stained. The mean number of cells migrating through the filter was calculated for quadruplicate wells in each treatment group. Chemotactic activity was expressed as a migration index (MI = number of cells responding to CGRP/media control). Both alpha- and beta-CGRP were optimally chemotactic for leukocytes at approximately 50 pM, with a mean migration index of 11.5 for filter-adherent cells (n = 13 experiments); migration due to chemokinesis was minimal, as measured by checkerboard analysis. Almost all leukocytes that responded to CGRP were T cells (TCs), and the CD4 to CD8 ratio was similar to that of the input population; B cells were not observed. CGRP-induced migration appears to be a specific receptor-mediated event, as pretreating the cells with CGRP resulted in significant down-regulation of their chemotactic response to CGRP, but not to interleukin-1 alpha. Our data suggest that the release of CGRP from free nerve endings near the dermal-epidermal junction could influence cutaneous TC trafficking. As neuropeptides exacerbate (possibly initiate) the inflammatory process, they are likely to be important pharmacological targets in dermatological disorders.

Human monoclonal antibody recognizing an antigen associatedwith ovarian and other adenocarcinomas

MS2B6, a human monoclonal antibody derived from a patient with advanced ovarian cancer, has been used to study the distribution and characteristics of its target antigen. The MS2B6 antigen was detected by immunoperoxidase studies in 41 of 41 epithelial ovarian cancers and in the majority of nonovarian adenocarcinomas. Among normal tissues the MS2B6 antigen was found in the adult epithelia of the fallopian tube, endometrium, endocervix, colon, bronchus, breast, sweat duct, and large renal ducts. No detectable antigen was found in peritoneal epithelia, tissue stromal cells, spleen, thymus, or blood-borne cells. Immunoblotting analysis showed that the MS2B6 epitope resides on polypeptides of 38, 44, and 60 kd. The cellular location of the MS2B6 antigen was studied with immunoperoxidase and immunofluorescent staining and immunoelectronmicroscopy of ovarian cancer ascites tumor cells. The results suggest that in ascites tumor cells the MS2B6 antigen is located in a layer of the peripheral cytoplasm beginning just below the cell membrane. MS2B6 may be useful as an imaging or therapeutic agent.

Prefrontal sonic treatment: MR findings

The authors describe the use of MR in a patient who underwent prefrontal sonic treatment for relief of intractable headaches. MR demonstrated well-demarcated regions of encephalomalacia within the white matter of the frontal lobe (with relative sparing of cortex) in a characteristic conical volume that corresponded to the insonified regions.

First clinical study of the selective 5-HT3 antagonist, granisetron (BRL 43694), in the acute treatment of migraine headache

Granisetron (BRL 43694), a selective 5-HT3 receptor antagonist, was assessed as acute therapy for the first time in migraine patients. In an open pilot study 7 migraine attacks were treated in 6 patients. All but 1 patient experienced marked and rapid relief from the headache, and nausea and vomiting were rapidly resolved in the 6 cases where these symptoms accompanied the attack. No side effects were recorded. Development of granisetron for migraine was suspended during the study for extraneous reasons.

Human epidermal T cells predominantly belong to the lineage expressing alpha/beta T cell receptor

The epidermis of clinically normal-appearing human skin harbors a phenotypically heterogeneous population of T lymphocytes (TCs), the majority of which are CD2+/CD3+/CD5+ "memory" cells, but in an unactivated state, and express the TCR-alpha/beta. In contrast to murine skin, only a very minor subpopulation of CD3+ cells in the human epidermis bears the TCR-gamma/delta. Epidermal TCs primarily are distributed along the rete ridges in the basal keratinocyte layer and are often in close apposition to Langerhans cells (LCs). These TCs were propagated from epidermal cell suspensions after stimulation with TC activating agents (Con A, rIL-1, rIL-2), then evaluated for phenotypic features and TCR diversity. Similar to the in situ situation, most were CD4-/CD8+/TCR-alpha/beta+. In addition, two cultures contained TCR-gamma/delta+ cells; one of these determined to be an adherent CD4-/CD8+ population. Epidermal TCs were significantly (p less than 0.0001) more abundant in the sole than in the other body regions examined (i.e., 40 vs. 7 CD3+ cells/linear centimeter of epidermis) and seemed to have a particular affinity for the acrosyringial epithelium of eccrine sweat ducts. Moreover, the sole usually contained a greater number of CD8+ relative to CD4+ TCs, whereas the epidermal CD4/CD8 ratio in the trunk and extremities was quite variable, although the trend also was towards a slightly larger percentage of CD8+ cells. Collectively, our data suggest that the volar epidermis has a unique microenvironment which is responsible for both the higher density of TCs, preferentially CD8+, and lower number of LCs. This study has not only provided evidence for significant regional variability in the human epidermal TC population of normal skin, but also strengthens the concept for skin-associated lymphoid tissues (SALT), whereby memory TCs recirculate back to the epidermis and interact with resident antigen-presenting cells (i.e., LC).

Ontogeny of Langerhans cells in human embryonic and fetal skin: cell densities and phenotypic expression relative to epidermal growth

Langerhans cells (LCs) positive for HLA-DR antigens were present in developing human epidermis by at least 7 weeks estimated gestational age (EGA). Most were negative for CD1 (T6) until 12-13 weeks EGA when they underwent a dramatic increase in CD1 reactivity. To gain insight into the density of LCs during ontogeny and to assess whether their distribution was coordinated with epidermal growth, the number of cells positive for both HLA-DR and CD1 antigens was determined relative to surface area and to volume of developing, interfollicular epidermis. LCs differed in their phenotype, distribution (follicular vs. interfollicular), size, and shape between 7 and 21 weeks EGA; however, during this period they maintained a statistically equivalent (P greater than .25) density (65 cells/mm2 and 1,750/mm3) even though the epidermis increased in thickness and the fetus rapidly expanded its surface area. While LCs were evenly distributed within the epidermal sheets at all gestational ages, those in embryonic skin were much smaller and less dendritic than the older cells. The density, size, and shape of LCs in developing skin seemed to be independent of epidermal status (e.g., thickness of keratinization, and number of cell layers) but rather were correlated with gestational age. The number of fetal LCs, through at least 23 weeks EGA, was only 10-20% of the adult LC density. Thus, we can conclude that the increase in LC density to adult levels must occur either during the third trimester or after birth.

Morphometric and statistical analyses describing the in utero growth of human epidermis

Epidermal development of human embryonic and fetal skin from the lower limb was studied using morphometric and statistical methods. Epidermal growth, as defined by an increase in epidermal thickness and the number of cell layers, occurred in three distinct stages during the first and second trimesters. The first growth spurt occurred between 5 and 13 weeks estimated gestational age (EGA) and was followed by a plateau phase with little change in epidermal thickness from 14 to 21 weeks, after which the epidermis began to increase in height again. The periderm reached its maximal height by approximately 13 weeks EGA, and by 25 weeks was shed into the amniotic fluid. Thus, within a five-month period (5 to 25 weeks EGA) the epidermis changed from a single cell layer less than 10 micron thick to a 10 to 12-cell layer, keratinized epithelium greater than 60 micron thick. In contrast, epidermis from adult lower limb consisted of about 25 cell layers and was almost 75 micron in thickness. The age-related differences in epidermal thickness probably reflect changes in cell size and shape more than changes in the directional movement (apically vs. laterally) of proliferating keratinocytes, because the addition of cell layers throughout development was relatively constant. During the plateau phase, when there is a rapid increase in fetal growth rate, the suprabasal keratinocytes become more flattened, thereby allowing for the addition of new cell layers while maintaining a relatively constant epidermal thickness.(ABSTRACT TRUNCATED AT 250 WORDS)

Repair of nasal septal perforation utilizing the midface degloving technique

A technique utilizing the midfacial degloving approach in the repair of nasal septal perforations in 24 patients is reported. The midface degloving approach was limited to patients with septal perforations greater than 3 cm and failed prior attempts at surgical closure. Bilateral posteriorly based unipedicled flaps were utilized in the septal closure. Complete closure was accomplished in 75% (18/24) of cases, with a follow-up of one to three years. Complications included reperforation in 25% (6/24) of cases and partial vestibular stenosis in 20% (5/24) of cases. A modification of our technique, relining the nasal floor with postauricular full-thickness skin grafts, has alleviated vestibular stenosis.

Heterosexual spread of human immunodeficiency virus in Edinburgh

Heterosexual transmission of human immunodeficiency virus (HIV) was investigated in 123 subjects with no apparent risk factor for infection other than having had heterosexual intercourse with a person who was either infected with HIV or at high risk of being infected with it. Seven subjects were found to be infected with the virus. Risk factors for transmission included being the regular sexual partner of an abuser of intravenous drugs and having a sexual relationship of more than 18 months' duration. Anal intercourse was not a risk factor in the three subjects who admitted to it. There were 41 regular partnerships with abusers of intravenous drugs in which the antibody state and history were fully known for both partners. In these partnerships male to female transmission of the virus occurred in five out of 34 (15%) and female to male in one out of seven. In 30 couples in whom one partner was known to be positive for HIV and an abuser of intravenous drugs four female partners were found to be seropositive at first testing, but there were no new positive results on subsequent serial testing. In six of these 30 couples both partners abused intravenous drugs but the partner who was negative for HIV remained so. Few of the partnerships always practised safe sexual techniques, even after a partner was known to be positive for HIV. Heterosexual transmission of HIV occurred but was incomplete and may be related to the timing of the relationship with the infection.

Differential effects of tissue processing on human embryonic and fetal skin

To most accurately evaluate quantitative data from studies of developing epidermis, the effects of tissue processing on human embryonic and fetal skin (8-20 weeks gestational age) were examined using two different techniques: 1) EDTA-separated epidermal sheets that were briefly fixed in 2% paraformaldehyde, processed through Permount infiltration, and prepared as whole mounts on glass slides, and 2) skin that was fixed in Karnovsky's fixative and embedded in Epon. Based on en face measurements of surface area before and after tissue processing, both procedures caused differential, age-dependent shrinkage. However, the trend of increasing shrinkage was inversely related to increasing age in the paraformaldehyde-fixed epidermal sheets (y = 57.14 + 1.26x, where x = gestational age in weeks and y = % of original surface area), but directly correlated with aging in the Karnovsky-fixed skin (y = 955.62 - 232.77x + 20.38x2). Shrinkage of epidermal sheets occurred during the dehydration and clearing steps, whereas most of the dimensional changes in whole skin took place during fixation in Karnovsky's. These differences are probably due to greater cross-linking of proteins and longer fixation time in the more concentrated and fast-acting Karnovsky's, as well as the influence of increasing quantities of fibrous proteins in the dermis of whole skin.

Ontogeny of Langerhans cells in human embryonic and fetal skin: expression of HLA-DR and OKT-6 determinants

Langerhans cells (LCs) have been identified in human skin by 10 weeks estimated gestational age (EGA), but it was not known when they first enter the epidermis or acquire HLA-DR, OKT-6, and ATPase reactivity. We assayed for LCs in human embryonic and fetal skin by using immunolabeling and histochemical techniques on epidermal sheets. HLA-DR+ and ATPase+ LCs were present in the epidermis by 6-7 weeks EGA, the youngest tissue examined. Most LCs were OKT-6- until about 12 weeks EGA when they underwent a dramatic increase in OKT-6 reactivity. Although LC densities between 50-100 days were statistically similar (100 cells/mm2 of epidermis), LCs early in development were smaller, less dendritic, and phenotypically heterogeneous. We conclude that LCs migrate into the epidermis during the first trimester and resemble the adult phenotype by the second trimester, long before the immune system is fully activated.

Propranolol-epinephrine interaction: a potential disaster

Presented here are six examples of potentially life-threatening propranolol-epinephrine interactions. The only report found that warns of a deleterious clinical interaction between propranolol and epinephrine appeared in 1980. With widespread use of propranolol for approved and unapproved conditions, the population at risk is significant. All physicians and dentists using local anesthetic with epinephrine should be aware of this interaction.

Tracheal tube forces on the posterior larynx: index of laryngeal loading

Most tracheal tubes sold today are arcuate in shape while the human airway is S-shaped. In situ, the tubes exert different forces on the posterior larynx, depending on their stiffness. Laryngeal damage after prolonged intubation is recognized as the result of these forces. The authors tested 8 types of size 8.0 tracheal tubes to determine the magnitude of laryngeal loading in a model approximating the geometry of the human airway. The force each tube exerted on the posterior larynx was measured in conditions simulating both, immediately after intubation and after prolonged intubation of 24 h. The force was converted into an integer number, an index of laryngeal loading, that can be used to compare various types of tracheal tubes. The airway model and test procedure can be utilized by manufactures, designers, and others to provide valuable information on tracheal tube performance and to develop improved tracheal tubes in the future. The results indicate that the polyvinylchloride tubes (PVC) and the silicone rubber tubes had the lowest index of laryngeal loading after long-term conditioning and would be preferable for prolonged intubation. The red rubber tube had the highest index of laryngeal loading after long-term conditioning, yet its stiffness would facilitate intubation.

Stomach cancer following gastric surgery for benign disease

The records of 1,079 patients with gastric carcinoma were reviewed. Of these, only 21 (about 2%) had had previous gastric surgery for benign disease, usually peptic ulcer. The average interval between the original gastric surgery and the discovery of stomach cancer was 26.9 years. The symptoms of cancer presentation were not distinguishable from other forms of the postgastrectomy syndrome. Gastric cancer tended to develop in these patients during the sixth decade of life, irrespective of when they had had their original gastric surgery, strongly suggesting an age-related factor. Although it would appear that previous gastric surgery for benign disease is not a major risk factor for the subsequent development of gastric cancer, such a relationship may exist. Patients who have undergone gastrectomy should be followed up carefully for the recurrence of symptoms.

Chronic osteomyelitis following mandibular fractures and its treatment

In a review of 350 patients with mandibular fractures between 1976 and 1978, eight cases of chronic mandibular osteomyelitis were found. Treatment in all cases consisted of intravenous antibiotics and debridement. In addition, in some cases a suction-irrigation system was used after debridement. From this study, the following can be stated: (1) Osteomyelitis following mandibular fractures is uncommon. (2) Once chronic osteomyelitis has developed, aggressive antibiotic and surgical treatment is needed. (3) The use of the suction-irrigation system after debridement is an effective adjunctive aid in treating osteomyelitis. Cosmesis is superior to that obtained with older techniques because wounds are closed primarily.

Otitis media, cleft palate, and middle ear ventilation

Chinchillas with unilateral tympanostomy tubes in place underwent palate-clefting in an effort to determine the histologic and bacteriologic effects of using tympanostomy tubes in the treatment of otitis media. The tympanostomy tube appeared to almost totally eliminate the occurrence of middle ear effusion but had much less, if any, effect on eliminating the middle ear inflammation which occurs in the clefted chinchilla.

Medial canthoplasty: early and delayed repair

Naso-orbital trauma can cause medial orbital wall disruption and detachment of the medial canthal ligament. Damage to the nasolacrimal drainage apparatus, cerebrospinal fluid rhinorrhea and frontal sinusitis can occur. Twelve cases of naso-orbital trauma have been reviewed. There is a high incidence of associated injury to adjacent structures. Medial canthal ligament separation was missed acutely in a number of cases leading to the necessity of delayed repair. Important diagnostic and therapeutic points are stressed in the acute and delayed management, particularly medial canthal ligament separation. A wire to intranasal button technique for the delayed repair of traumatic telecanthus is presented.

Prismatic cristae and paracrystalline inclusions in mitochondria of myocardial cells of the oyster Crassostrea virginica Gmelin

Several types of unusual mitochondrial configurations were found in myocardial cells of the oyster Crassostrea virginica Gmelin. These mitochondria include, in order of frequency, prismatic cristae, filamentous paracrystals in honeycomb and herringbone configurations, and paracrystals composed of rows of electron dense particles. The long, parallel, evenly spaced prismatic cristae are square or rhomboidal in cross section. In the space between the prismatic cristae are rodlike structures (4--6 nm in diameter) that are regularly spaced about 12 nm apart and appear to pass between adjacent cristae. Filamentous paracrystals observed in slender, elongated mitochondria. The filament spacing and form of these paracrystals suggest that they are composed of the intercristal rods. Alternatively, filamentous paracrystals might be tangential sections of prismatic cristae and intercristal rods. Particulate paracrystals which consist of dense lines or rows of particles are the least frequent type of unusual configuration. The particles are triangular, possibly pyramidal, in shape; their bases are 10-12 nm thick and repeat in rows every 17-18 nm. There is a close association between particulate paracrystals and prismatic cristae plus intercristal rods. Although similar mitochondrial configurations have been associated with disease or altered metabolism in a number of species, we have found so such association in the oyster as yet.

Pneumatic hydrogen pellet injection system for the ISX tokamak

We describe the design and operation of the solid hydrogen pellet injection system used in plasma refueling experiments on the ISX tokamak. The gun-type injector operates on the principle of gas dynamic acceleration of cold pellets confined laterally in a tube. The device is cooled by flowing liquid helium refrigerant, and pellets are formed in situ. Room temperature helium gas at moderate pressure is used as the propellant. The prototype device injected single hydrogen pellets into the tokamak discharge at a nominal 330 m/s. The tokamak plasma fuel content was observed to increase by (0.5-1.2) x10(19) particles subsequent to pellet injection. A simple modification to the existing design has extended the performance to 1000 m/s. At higher propellant operating pressures (28 bars), the muzzle velocity is 20% less than predicted by an idealized constant area expansion process.