Efficacy of Afternoon Plerixafor Administration for Stem Cell Mobilization

Background:

When used for hematopoietic stem cell mobilization, plerixafor was originally recommended to be administered 11 hours prior to apheresis based on the peak effect of 10 to 14 hours translating into an administration time of 10 to 11 pm. Reports of post-plerixafor anaphylactic reactions mandated labeling change by the Food and Drug Administration with recommendation of monitoring patients after administration. Based on data suggesting sustained plerixafor activity at 18 hours, we changed our administration time to 4 pm at our center.

Objective:

The objective of this study is to compare the stem cell collection efficiency before and after the practice change at our institution.

Methods:

A retrospective chart review for patients with multiple myeloma, Hodgkin lymphoma, and non-Hodgkin lymphoma who received a plerixafor-containing mobilization regimen was conducted. The primary end point was the percentage of patients achieving the minimal CD34⁺ cell goal in ⩽2 apheresis days. The secondary end points included the percentage of patients achieving the preferred CD34⁺ cell goal in ⩽2 apheresis days, days of apheresis, total CD34⁺ cells Collected, and engraftment time.

Results:

A total of 208 patients (4 pm group n = 68, 10 pm group n = 140) with multiple myeloma (n = 112), Hodgkin lymphoma (n = 10), and non-Hodgkin lymphoma (n = 86) were included in the analysis. About 91% and 89% (P = .804) of the patients in the 4 and 10 pm groups, respectively, collected minimum cell dose. Preferred CD34⁺ cell goal was achieved in 57% and 53% of patients in the 4 and 10 pm groups, respectively.

Conclusions:

Late afternoon administration of plerixafor provides efficient stem cell mobilization.

Variations in diet cause alterations in microbiota and metabolites that follow changes in disease severity in a multiple sclerosis model

Multiple sclerosis (MS) is a metabolically demanding disease involving immune-mediated destruction of myelin in the central nervous system. We previously demonstrated a significant alteration in disease course in the experimental autoimmune encephalomyelitis (EAE) preclinical model of MS due to diet. Based on the established crosstalk between metabolism and gut microbiota, we took an unbiased sampling of microbiota, in the stool, and metabolites, in the serum and stool, from mice (Mus musculus) on the two different diets, the Teklad global soy protein-free extruded rodent diet (irradiated diet) and the Teklad sterilisable rodent diet (autoclaved diet). Within the microbiota, the genus Lactobacillus was found to be inversely correlated with EAE severity. Therapeutic treatment with Lactobacillus paracasei resulted in a significant reduction in the incidence of disease, clinical scores and the amount of weight loss in EAE mice. Within the metabolites, we identified shifts in glycolysis and the tricarboxylic acid cycle that may explain the differences in disease severity between the different diets in EAE. This work begins to elucidate the relationship between diet, microbiota and metabolism in the EAE preclinical model of MS and identifies targets for further study with the goal to more specifically probe the complex metabolic interaction at play in EAE that may have translational relevance to MS patients.

Jejunal or portal vein infusions of lipids increase hepatic vagal afferent activity

Jejunal infusions of linoleic acid, corn oil, or caprylic acid significantly increased hepatic vagal afferent activity, whereas saline infusions were ineffective. The magnitude of response was greatest with either linoleic acid or corn oil. Hepatic portal infusions of linoleic acid, Liposyn II, or caprylic acid significantly increased hepatic vagal afferent activity, whereas 5% albumin/phosphate buffer vehicle was ineffective. The magnitude of response was greatest with either linoleic acid or Liposyn II. These data show that either jejunal or portal infusions of lipids increase activity of hepatic vagal afferents and could potentially serve as a complementary and/or alternative substrate to celiac vagal afferents in mediating the effects of jejunal infusions of lipids in suppressing food intake.

Celiac vagotomy reduces suppression of feeding by jejunal fatty acid infusions

We investigated the role of the celiac branch of the vagus nerve in suppression of food intake produced by jejunal fatty acids infusions. Following selective celiac vagotomy or sham surgery, adult, male Sprague-Dawley rats received 7 h infusions of linoleic acid or saline through indwelling jejunal catheters on four consecutive days. Although linoleic acid still produced significant suppression of intake in rats with celiac vagotomy, it was less effective in these animals than in controls. The temporal pattern of results suggested that celiac afferent fibers are involved in mediating both pre- and postabsorptive effects of infused fatty acids.

Changes in plasma gonadotrophin and prolactin concentrations following castration of the pony stallion

Concentrations of gonadotrophins and prolactin were recorded in pony stallions castrated during the early breeding season, to examine the regulatory role of the gonad at a time when testosterone has been postulated to exert positive feedback on LH secretion. Further, gonadotrophin concentrations in geldings are reported to return to values within the normal range of the entire stallion. In an attempt to characterize this species-specific reversal, the gonadotrophin concentrations of 6 male ponies castrated on 25 March were monitored for 4 months, and 4 stallions were used to generate control data. Blood samples were collected daily, from 3 d before to 10 d after castration (Day 0), and weekly thereafter until Day 122. The pituitary response to castration was immediate. Castration resulted in a previously unreported, dramatic (13-fold) but transient (3 d) surge in circulating concentrations of LH. Concentrations of LH and FSH increased in a logarithmically scaled (LH, R2 = 0.77; FSH, R2 = 0.93) manner over the subsequent 5 wk, during which temporal changes in concentrations of both hormones were strongly correlated (R2 = 0.97). The ratio of plasma gonadotrophin concentrations was consistent throughout (LH:FSH, 1.43 +/- 0.04). Maximal concentrations of LH (20.58 +/- 1.97 ng/mL, Day 34.8 +/- 3.2) were attained approximately 2 wk before the peak in FSH (16.99 +/- 1.97 ng/mL, Day 49.7 +/- 3.0). Plasma gonadotrophin concentrations exceeded those of entire stallions throughout the study. The equine testes inhibited LH secretion during the early breeding season, and no chronic decrease in plasma gonadotrophin concentrations was recorded. However, the LH surge evident for 3 d immediately afer castration, may be related to the dynamic seasonal interaction between gonadal steroids and the regulation of pituitary gonadotrophin release.

The utility of screening chest radiographs for flight physicals

Previous studies have shown low efficacy of screening chest radiographs in various populations. Findings of approximately 3,500 screening chest radiographs performed for flight duty were reviewed to determine the rate of detection of significant abnormalities. There were abnormal findings in 107 chest radiographs (3%). Fifty-five of these (1.6% of total), after additional evaluation, were found to be false positive. Only two medically significant conditions were found in the screening population. Based on our data, routine screening of flight duty applicants does not appear to be justified.

The meaning of home: how it shapes the practice of home and hospice care

Nurses often hear clients and their families express a strong desire to "go home" from the hospital or nursing home. The purpose of this article is to explore what they mean when they make this request and how this meaning of home can shape the practice of home and hospice care. To do this, definitions of home and a health-at-home model are described and applied through a case study.

Suppression of food intake, body weight, and body fat by jejunal fatty acid infusions

Three experiments investigated effects of jejunal lipid infusions given on 4 or 21 consecutive days in adult, male Sprague-Dawley rats. In experiment 1, 7-h infusions of linoleic or oleic acid (0.2 ml/h for 7 h; total load = 11.5 kcal) on 4 consecutive days reduced total intake (ad libitum consumption of the liquid diet Boost, Mead Johnson, plus load) by approximately 15% and decreased weight gain compared with 4-day tests with saline administration. In experiment 2, linoleic acid at 0.1 ml/h for 7 h (5.7 kcal) was ineffective, whereas the same load delivered in 3.5 h produced effects similar in magnitude to those in the first experiment. In experiment 3, jejunal infusions of linoleic acid (0.2 ml/h for 7 h) on 21 consecutive days reduced mean total intake by 16%, body weight by 10%, and carcass fat by 48% compared with controls receiving saline. The net decrease in caloric intake may reflect the combined activation of pre- and postabsorptive mechanisms, and it suggests a possible treatment for obesity.

Responses of celiac and cervical vagal afferents to infusions of lipids in the jejunum or ileum of the rat

Multiunit celiac and single-unit cervical recordings of vagal afferents were performed before and during infusions of fatty acids, triglycerides, or saline into either the ileum or jejunum of the rat. In multiunit recordings, lipids increased activity of vagal afferents to a greater extent than saline. The greatest increases in vagal afferent activity resulted from infusions of linoleic acid, conjugated linoleic acid, or oleic acid. The triglycerides, corn oil or Intralipid, were less effective than the fatty acids in affecting vagal afferent activity. Ileal pretreatment with the hydrophobic surfactant Pluronic L-81 significantly attenuated the response of celiac vagal afferents to ileal infusion of linoleic acid. Single-unit recordings of cervical vagal afferents supported the multiunit data in showing lipid-induced increased vagal afferent activity in approximately 50% of ileal units sampled and 100% of a limited number of jejunal units sampled. These data demonstrate that free fatty acids can activate ileal and jejunal vagal afferents in the rat, and this effect can be attenuated by pretreatment with a chylomicron inhibitor. These data are consistent with the view that lipid-induced activation of vagal afferents could be a potential substrate for the inhibitory effects of intestinal lipids on gastrointestinal function, food intake, and body weight gain.

Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax

PURPOSE

To analyze the influence of multiple variables on the rate of pneumothorax and chest tube placement associated with transthoracic needle aspiration biopsy of the lung.

MATERIALS AND METHODS

In 346 patients, 331 computed tomographically (CT) guided and 24 fluoroscopically guided lung biopsies were performed. Variables analyzed were lesion size, depth, and location; number of pleural passes; needle size; presence of emphysema; and training level of the person who performed the biopsy.

RESULTS

Pneumothorax occurred at 144 (40.4%) of 356 biopsies, including 139 (42.0%) CT-guided and five (21%) fluoroscopically guided biopsies. Chest tube placement was needed in 25 (17.4%) of 144 cases of pneumothorax (7% of all biopsies). An increased rate of pneumothorax was correlated with smaller lesion size (P = .001) and presence of emphysema (P = .01). Patients with emphysema were three times as likely to require chest tube placement. The pneumothorax rate was 15% (16 of 105) if no aerated lung was traversed and approximately 50% if aerated lung was penetrated. Lesion location, needle size, number of pleural passes, and level of training were not correlated with pneumothorax rate.

CONCLUSION

Smaller lesion size and emphysema are strongly correlated with occurrence of pneumothorax. Pneumothorax was more than three times less frequent if no aerated lung was traversed. After pneumothorax, chest tube placements were related to the presence of emphysema.

Pulmonary intravascular lymphomatosis: presentation with dyspnea and air trapping

Intravascular lymphomatosis (IVL) is a rare lymphoid neoplasm that is typically of B-cell lineage and characterized by proliferation of malignant cells within small arterioles, capillaries, and venules. We report a patient with pulmonary IVL who presented clinically with progressive dyspnea, fever, and a dry cough. Pulmonary function tests revealed a marked decrease in diffusion capacity with airflow obstruction and severe air trapping. High-resolution CT (HRCT) of the chest with inspiratory and expiratory images revealed mosaic attenuation consistent with air trapping. Transbronchial biopsies revealed the diagnosis of IVL with capillary expansion in the alveolar and peribronchiolar interstitial tissue. IVL should be considered in the differential diagnosis of a patient with an interstitial lung disease, air trapping on pulmonary function tests, and mosaic attenuation on HRCT. Transbronchial biopsies may be the initial diagnostic procedure of choice.

Cholecystokinin satiety involves CCKA receptors perfused by the superior pancreaticoduodenal artery

Three experiments compared the potency of the type A cholecystokinin (CCKA)-receptor antagonist devazepide for increasing intake of 30% sucrose when injected into the superior pancreaticoduodenal (SPD) artery (SPD group) or jugular vein (IV group). In experiment 1, 15 min of sucrose intake in adult, male Sprague-Dawley rats after 6 h of food deprivation was increased by devazepide (20 micrograms/kg) administered into the SPD artery whether given alone or in conjunction with cholecystokinin octapeptide (CCK-8, 2 micrograms/kg ip). Devazepide had no effect in the IV group. In experiment 2, injection of 8, 20, and 50 micrograms/kg of devazepide into the SPD artery increased sucrose intake of nondeprived rats. Only the highest dose was effective in the IV group. On subsequent tests, administration of 1 microgram/kg of CCK-8 significantly suppressed intake only in the SPD group. In experiment 3, nondeprived rats with SPD artery and jugular vein catheters were tested in a within-subjects design. Devazepide (20 micrograms/kg) increased sucrose intake after injection into the SPD artery, but not into the jugular vein. In experiment 4, intraduodenal devazepide (8, 20, and 50 micrograms/kg) had no effect. These results indicate that CCKA receptors within the SPD arterial bed mediate the satiating action of CCK, consistent with local action of duodenal CCK.

CCK-8 activates hepatic vagal C-fiber afferents

Intravenous administration of 2 micrograms/kg CCK-8 increased the single unit activity of 54% of hepatic vagal afferent fibers. Conduction velocity tests indicated that all of these units were C fibers. The increase in hepatic vagal activity produced by CCK-8 was significantly reduced by i.v. administration of 200 micrograms/kg of the CCKA receptor antagonist devazepide. Control comparisons indicated that this reduction was not an artifact of tachyphylaxis resulting from repeated administration of CCK-8. Further, the inability of pretreatment with atropine and hexamethonium to reduce the increases in hepatic vagal activity produced by CCK-8 suggests that the latter effect was not secondary to changes in gastrointestinal motor function. These outcomes demonstrate that activation of CCKA receptors by CCK-8 increases hepatic vagal afferent activity and support the view that the duodenal satiety action of CCK is mediated by the hepatic branch.

Pulmonary artery sarcomas: a review of clinical and radiologic features

Primary pulmonary artery sarcomas are rare tumors that are frequently misdiagnosed as chronic pulmonary emboli. We present classic imaging findings and review data from 136 previously reported sarcomas. We believe that the imaging findings can be quite specific, especially when the disease is advanced. Despite a recent increase in antemortem diagnosis, the prognosis remains poor. Surgery prolongs survival time and is potentially curative. Experience with adjuvant chemotherapy and radiotherapy is limited.

Sand aspiration with near-drowning. Radiographic and bronchoscopic findings

Sand and foreign-body aspiration may accompany drowning and near-drowning, but few details regarding such patients are available in the literature. We report a 26-yr-old woman who suffered near-drowning after a motor-vehicle accident. Initial attempts at ventilation were compromised by increased peak airway pressures, which decreased following the removal of large amounts of sand from the patient's endotracheal tube. Chest radiographs and computed tomographic (CT) scans of the patient obtained upon her arrival in the emergency department demonstrated sand bronchograms within the lower lobes of both lungs, and sand within the maxillary sinuses and stomach. We present the radiographic, bronchoscopic, and microbiologic findings within hours after this patient's accident, with a review of the literature and provisional recommendations for the management of such patients.

Identification of tobacco-specific carcinogen in the cervical mucus of smokers and nonsmokers

BACKGROUND

In 1996, an estimated 15,700 new cases of cancer of the uterine cervix and 4,900 deaths from this disease were expected to occur in the United States. In a recent international study, human papillomavirus DNA was found in more than 90% of cervical tumor specimens examined, irrespective of the nationality of the patients from whom the samples were obtained. Although infection with human papillomavirus is the major known risk factor for the development of cervical cancer, it alone is not sufficient. Other etiologic factors that have been associated with this disease include deficiencies in micronutrients, lower socioeconomic status, oral contraceptive use, and cigarette smoking. Several compounds from cigarette smoke (nicotine and its major metabolite, cotinine) have been identified in cervical mucus, and the occurrence of smoking-related DNA damage in the cervical epithelium has been documented.

PURPOSE

This investigation was conducted to determine for the first time whether carcinogenic tobacco-specific N-nitrosamines are present in the cervical mucus of cigarette smokers and of nonsmokers (most likely as a result of environmental exposure).

METHODS

Cervical mucus specimens from 15 smokers and 10 nonsmokers were subjected to supercritical fluid extraction with the use of carbon dioxide that contained 10% methanol, and the resultant extracts were analyzed for tobacco-specific nitrosamines by use of a very sensitive method that involved gas chromatography and mass spectroscopy analyses.

RESULTS

In a total of 16 samples obtained from 15 women who were current smokers (two samples from the same woman), we detected the tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) at concentrations that ranged from 11.9 to 115.0 ng/g of mucus. Only one of a total of 10 cervical mucus specimens obtained from 10 women who claimed to be nonsmokers did not contain detectable NNK, and NNK concentrations ranged from 4.1 to 30.8 ng/g of mucus in the specimens from the remaining nine women. The concentrations of NNK in specimens from cigarette smokers were significantly higher than those from nonsmokers (mean +/- standard deviation: 46.9 +/- 32.5 ng/g of mucus versus 13.0 +/- 9.3 ng/g of mucus; two-tailed Student's t test, P = .004).

CONCLUSION

The cervical mucus of cigarette smokers contains measurable amounts of the potent carcinogen NNK. This compound represents the first tobacco-specific carcinogen identified in this physiologic fluid of women who smoke cigarettes. The presence of NNK in the cervical mucus of nonsmokers is likely due to environmental exposure or to the fact that some of the subjects in this study may not have revealed that they occasionally smoked cigarettes.

IMPLICATIONS

The presence of NNK in human cervical mucus further strengthens the association between cervical cancer and tobacco smoking.

Localized benign fibrous tumors of the pleura: MR appearance

PURPOSE

Our goal is to describe the MR findings in benign localized fibrous tumors of the pleura.

METHOD

Chest radiographs, CT scans, and MR images of four patients with localized benign fibrous tumors of the pleura were retrospectively reviewed and correlated with the pathologic findings.

RESULTS

Tumors ranged from 4 to 18 cm in their largest diameter. Three tumors were located in the diaphragmatic region, and one was within the left major fissure. All tumors were round to ovoid, pedunculated, and well delineated. On T1-weighted SE MR images, tumors showed low signal intensity. All tumors had heterogeneous but predominantly low signal intensity on proton-density-weighted images and lower signal intensity on T2-weighted images.

CONCLUSION

Localized benign fibrous tumors of the pleura were characterized by low signal intensity on all MR sequences that is explained by high collagen content within the tumors' stroma and should suggest the diagnosis preoperatively.

Effect of pyloric cuffs on cholecystokinin satiety

Because inflation of a pyloric cuff during feeding blocks gastric emptying and increases gastric distention, this device was used to test the hypothesis of synergism between gastric distention and cholecystokinin octapeptide (CCK-8) in reducing intake. Adult, male Sprague-Dawley rat were allowed 20-min access to 30% sucrose, with or without inflation of pyloric cuffs, after intraperitoneal injection of saline or 1, 2, or 4 micrograms/kg CCK-8. Cuff inflation resulted in large increases in gastric volume at the end of feeding tests. However, this manipulation failed to enhance the effectiveness of any dose of CCK-8. In fact, data analyses revealed trends suggestive of decreased effectiveness of the two lowest doses under these conditions. The effect of 4 micrograms/kg CCK-8 was almost identical in tests with and without cuff inflation. These results are contrary to the prediction of greater potency of CCK-8 resulting from increased gastric distention.

Case report. Chemical-shift MRI of exogenous lipoid pneumonia

Exogenous lipoid pneumonia results from the aspiration or inhalation of fatty substances, such as mineral oil found in laxatives or nasal medications containing liquid paraffin. We present standard and lipid-sensitive (Chemical-shift) MR findings in a patient with histologically confirmed lipoid pneumonia. The loss of signal intensity in an area of airspace disease on opposed-phase imaging was considered specific for the presence of lipid.

Effects of dietary 1,4-phenylenebis(methylene)selenocyanate on 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone-induced DNA adduct formation in lung and liver of A/J mice and F344 rats

1,4-Phenylenebis(methylene)selenocyanate (p-XSC) was tested for its ability to inhibit DNA adduct formation induced by the tobacco-specific N-nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) in the liver and lung of A/J mice and F344 rats. Dietary p-XSC, providing a dose of 5 p.p.m. selenium, significantly inhibited the formation of 7-methylguanine (7-mGua) induced by a single i.p. injection of 10 mumol of NNK(12.8% inhibition at 4 h and 19.9% at 96 h) and O6-methylguanine (O6-mGua) (16.5% at 4 h and 34.8% at 96 h) in the liver of A/J mice. Dietary supplements of p-XSC providing 15 p.p.m. of selenium reduced the levels of 7-mGua by 17.3% (4 h) and 33.6% (96 h). The formation of O6-mGua was inhibited by 69.5% (4th) and 73.8 (96h). In A/J mouse lung DNA the most significant reduction was observed in levels of O6-mGua. Dietary p-XSC at 5 p.p.m. as selenium inhibited the formation of this adduct by 73.1% (4 h). Ninety-six hours after NNK injection, and at both time points with p-XSC providing 15 p.p.m. selenium, O6-mGua was not detected. Although levels of 7- mGua in mouse lung DNA were also reduced, this was significant only 4 h after carcinogen administration. In general, selenite at a5 p.p.m. as selenium had no significant effect on the levels of these lesions; however, it inhibited O6-mGua in the liver only 4 h after NNK administration. These effects may explain why there is chemopreventive activity for p-XSC, but not for selenite, in NNK-induced lung carcinogenesis in A/J mice. Moreover, these findings raised our interest in determining the potential chemopreventive activity of p-XSC against NNK-induced lung adenocarcinomas in male F344 rats by first determining its effects on NNK-induced DNA methylation in the lungs of rats. Diet supplemented with 10 p.p.m. selenium as p-XSC did indeed inhibit the formation of adducts in pulmonary DNA of F344 rats treated with four consecutive injections of 81 mg/kg of NNK. Statistically significant inhibition of O6-mGua formation was observed 4 h after carcinogen treatment in both pulmonary (49.1% inhibition) and hepatic (39.8%) DNA. Statistically significant inhibition of 7-mGua formation was also measured in lung DNA isolated 24 h after the last NNK injection (45.0%) and in liver DNA 4 h after carcinogen treatment (31.8%). These results suggest that p-XSC would also inhibit induction of lung adenocarcinoma in male F344 rats by NNK.

Inhibition of sucrose intake by continuous celiac, superior mesenteric, and intravenous CCK-8 infusions

Two experiments compared the potency of continuous infusions of cholecystokinin octapeptide (CCK-8) for reducing sucrose intake when administered into abdominal arteries or the jugular vein. Adult, male Sprague-Dawley rats received 22-min infusions of saline or several doses of CCK-8. Sucrose was available for 20 min, beginning 2 min after onset of infusions. In the first experiment, intraceliac CCK-8 in doses of 50, 125, and 312 ng produced significant reductions in intake, but no dose affected intake when administered into the jugular vein. In experiment 2, only the highest dose, 312 ng, suppressed intake when infused into the superior mesenteric artery, and jugular infusions were again ineffective. Behavioral observations indicated that intra-arterial CCK-8 had no affect on feeding within the first several minutes of test meals but accelerated the subsequent decline in incidence of feeding. These results suggest that receptors involved in cholecystokinin satiety are widely distributed within the gastrointestinal tract.

Seizure-induced transient hippocampal abnormalities on MR: correlation with positron emission tomography and electroencephalography

We report transient focal abnormalities on MR in a patient having frequent electrographic seizures that were not obvious clinically. Marked mass effect (confirmed with volumetric studies) and abnormal T2 signal intensity in the right hippocampal region correlated with electroencephalographic ictal activity and with increased positron-emitting radiotracer uptake in the medial temporal lobe. The follow-up MR 2 months later, after electroencephalography findings normalized, revealed no hippocampal abnormalities.

Fathers of children born to adolescent mothers. Predictors of contact with their children at 2 years

OBJECTIVE

To examine factors associated with long-term involvement of the fathers of children born to adolescent mothers receiving health care in a teen-tot clinic.

DESIGN

Ninety-three first-time adolescent mothers younger than 18 years receiving care in a hospital-based teen-tot clinic participated in standardized structured interviews at 2 weeks and 24 months post partum. Data were obtained on demographic factors, the father's prenatal and delivery involvement, frequency of the father's contact with his child, and his participation in child care and financial support of the child.

RESULTS

Factors associated with at least monthly contact between father and child during the first 24 months of the child's life were attending at least one prenatal visit, seeing the newborn in the hospital, and a reported supportive relationship between the young mother's family and the father at the 2-week interview. Age of the father and his education, work, or living arrangement did not predict involvement at 24 months.

CONCLUSIONS

Our study suggests an association between a father's active participation in both the prenatal and neonatal periods and later contacts between children of adolescent mothers and their fathers. Since other studies indicate that paternal involvement results in more effective maternal parenting and satisfaction, interventions that encourage fathers' participation in both prenatal and intrapartum care should be developed and rigorously evaluated.

Scintigraphic findings in renal malakoplakia

The scintigraphic findings in a rare case of bilateral renal malakoplakia are presented. Markedly increased Ga-67 activity was present in both kidneys in sites corresponding to focal cortical defects on Tc-99m gluceptate (glucoheptonate) imaging. Interestingly, there was no abnormal renal activity with In-111 leukocyte scanning.

Suppression of sucrose intake by continuous near-celiac and intravenous cholecystokinin infusions in rats

We compared suppression of intake of 30% sucrose produced by continuous aortal (near celiac) and intravenous infusions of cholecystokinin octapeptide (CCK-8). Adult, male Sprague-Dawley rats received 21-min infusions of saline or 100-1,600 ng CCK-8. Sucrose was available for 20 min, beginning 1 min after onset of infusions. Significant reductions in intake were produced by near-celiac infusions of 400, 800, and 1,600 ng CCK-8, but only the two highest doses affected intake when infused intravenously. In a second experiment, which replicated previous observations, near-celiac bolus infusions of 70 ng CCK-8 significantly reduced sucrose intake but intravenous infusions did not. Behavioral observations indicated that although bolus infusions produced immediate disruption of feeding, suggesting an aversive effect, effects of continuous CCK-8 infusions on temporal intake patterns were consistent with enhancement of satiety. These data provide further evidence that CCK-8 acts on a site within the upper gastrointestinal tract to produce satiety.

Gastric adenocarcinoma in a patient with common variable immunodeficiency

We describe a 46-year-old man with a 20-year history of common variable immunodeficiency (CVID) who developed adenocarcinoma of the stomach. Although the mechanism is still debated, there is an increased frequency of gastric adenocarcinoma of the stomach in patients with CVID. Consequently, gastric complaints in patients with CVID should be pursued aggressively.

Duodenal sucrose and glucose infusions enhance suppression by cholecystokinin of sham feeding

In two experiments I examined whether intraduodenal sucrose and glucose would enhance inhibition of sham feeding by cholecystokinin-8 (CCK-8). In the first experiment, adult male Sprague-Dawley rats received infusions of 0.88 M (30%, wt/vol) sucrose or normal saline at 0.51 ml/min for the first 7.67 min of 30-min sham-feeding tests. Tests began 10 min after intraperitoneal injections of saline or 0.5, 1, or 2 micrograms/kg CCK-8. When sucrose was infused, all doses of CCK-8 reduced sham feeding of 0.88 M sucrose by 60% or more, but with saline infusions, only the highest dose was effective. In the second experiment, rats received 30-min infusions of 0.3 M (5.4%) or 0.6 M (10.8%) glucose or equimolar saline at 0.388 ml/min. Although 1 microgram/kg CCK-8 was ineffective in the absence of infusions, it significantly reduced intake in combination with both concentrations of glucose and hypertonic (0.6 M) saline. Behavioral observations indicated that reductions in intake were attributable primarily to decreased meal length and slower intake. These results suggest that an intestinal signal may contribute to the previously reported ability of preloads to potentiate CCK satiety.

Analysis of tobacco-specific N-nitrosamines in indoor air

A method was developed and applied for the assessment of tobacco-specific N-nitrosamines (TSNA) in indoor air polluted with tobacco smoke. Air samples were collected on Cambridge filters treated with 0.01 M potassium bisulfate, extracted with dichloromethane and enriched by column chromatography. The fraction containing the TSNA was concentrated and placed on a thermal desorption cartridge packed with Tenax GR. The sample was thermally desorbed and analyzed by capillary GC using a thermal energy analyzer. When the method was applied in a test laboratory in which one, two and four cigarettes were smoked during 30 min, linearity was observed. Field studies included sampling in bars, restaurants and trains. The concentration of N'-nitrosonornicotine (NNN) ranged from not detected to 23 pg/l, that of N'-nitrosoanatabine ranged from not detected to 9 pg/l, while 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) was detected in concentrations ranging from 1 to 29 pg/l. This means an exposure to NNN and NNK of 0.1-0.3 cigarette equivalents. Thus, non-smokers can be exposed to highly carcinogenic TSNA.

Bioavailability of tobacco-specific N-nitrosamines to the snuff dipper

Use of supercritical carbon dioxide extraction in the analysis of smokeless tobacco for tobacco-specific N-nitrosamines revealed the presence of higher levels of 4-(methylnitros-amino)-1-(3-pyridyl)-1-butanone (NNK) than had been determined with conventional methods. Whether human saliva may be similarly capable of releasing apparently bound NNK during chewing or snuff dipping was tested by incubating smokeless tobacco with enzymatically active saliva and with heat-treated saliva respectively. Enzymatically active human saliva was found to liberate up to twice the amount of the highly carcinogenic NNK than did heat-treated saliva. This is of major consequence for the cancer risk assessment of snuff dippers and tobacco chewers.

Supercritical fluid extraction in the determination of tobacco-specific N-nitrosamines in smokeless tobacco

A new approach to the analysis of the carcinogenic, tobacco-specific N-nitrosamines (TSNA) in moist snuff tobacco is based on the extraction of tobacco with methanol-modified supercritical carbon dioxide. Extracted TSNA are trapped across a glass cartridge filled with Tenax GR, from which they are subsequently released by thermal desorption and analyzed by capillary gas chromatography with a thermal energy analyzer. The analytical recoveries for the major TSNA range from 83 to 98%; the detection limits are below 2 ng/g. The methodology is fast, reproducible, highly selective, and sensitive. The supercritical fluid extraction (SFE) releases up to 7 times more of the highly carcinogenic 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) from tobacco than has been determined after conventional solvent extraction. Studies have confirmed that this is not an artifact. In contrast, the cyclic N-nitrosamines, N'-nitrosonornicotine, N'-nitrosoanabasine, and N'-nitrosoanatabine, showed no significant quantitative differences whether determined by the SFE method or the conventional solvent extraction method.

Analysis of 1,3-butadiene and other selected gas-phase components in cigarette mainstream and sidestream smoke by gas chromatography-mass selective detection

An analytical procedure was developed for the analysis of 1,3-butadiene, acrolein, isoprene, benzene and toluene in the gas phase of cigarette smoke and environmental tobacco smoke (ETS) utilizing cryogenic gas chromatography-mass selective detection (GC-MSD). The MSD was operated in the selective ion monitoring (SIM) mode. The compounds of interest eluted in less than 15 min. The gas phase of freshly generated mainstream smoke was introduced into the GC-MSD via a 10-port gas sampling valve on a puff-by-puff basis. This method minimizes the ageing of tobacco smoke. The levels of 1,3-butadiene in the mainstream smoke ranged from 16 to 75 micrograms/cigarette. The gas phase of sidestream smoke was trapped in methanol using three midget impingers at -78 degrees C. The amount of 1,3-butadiene in the sidestream smoke ranged from 205-361 micrograms/cigarette. The concentration of 1,3-butadiene in ETS in a smoke-filled bar amounted to 2.7-4.5 micrograms/m3.

Inhibitory effects of cholecystokinin develop through interaction with duodenal signals

I previously reported that cholecystokinin octapeptide (CCK-8) had little effect on feeding motivation as indexed by runway performance, but that substantial impairment resulted from the interaction of CCK-8 and prefeeding of sucrose. If the sucrose was sham-fed, potentiation of the effect of CCK-8 was seen only after large doses. The current experiments examined whether synergy between 1 microgram/kg CCK-8 and prefeeding could be reproduced using gastric, duodenal, or hepatic-portal infusions. Gastric and duodenal infusions of 30% sucrose were effective; in conjunction with CCK-8 they decreased running speed as substantially as prefeeding did. The duodenal effect was specific. Glucose appeared to be as effective as sucrose, whereas equi-osmotic saline and mannitol were not. Intraportal glucose was relatively ineffective; interaction with CCK-8 was seen only after very large infusions, and the resulting running speeds did not approach those seen after prefeeding or gastrointestinal infusions. These results suggest that decreased feeding motivation after 1 microgram/kg CCK-8 develops through synergy between this peptide and a carbohydrate-sensitive signal generated within the small intestine.

Prolonged effect of a single injection of human chorionic gonadotrophin on plasma testosterone and oestrone sulphate concentrations in mature stallions

The long term effect of a single injection of 6,000 iu of human chorionic gonadotrophin (hCG) was studied in two pony stallions. Peripheral plasma samples were analysed for testosterone and oestrone sulphate. Testosterone concentrations were markedly elevated for five days after injection in both stallions. No adverse effects of these high concentrations were observed on concentrations later in the experiment. There was an initial increase in oestrone sulphate in one stallion, after which concentrations decreased to below pre-injection levels. The other stallion (whose initial oestrone sulphate concentrations were somewhat higher) showed no rise in response to hCG but did show a significant decline from five days after injection. Whether this suppression is an effect of the high testosterone concentrations remains to be determined.

Monorchidism in the horse

Six horses with monorchidism, identified at surgery for cryptorchidectomy, are reported. All six presented with a single scrotal testis. Following surgical removal of one testis, they were either hormonally, anatomically or behaviourally determined to be geldings. Three other horses reported in the literature are reviewed. Of these nine cases of monorchidism, eight were thought to be caused by testicular degeneration and one by testicular agenesis. The vaginal process was present in all of the former and absent in the latter. The left side was involved in five of these eight horses. In seven, the epididymis was absent and, in the remaining two, only the epididymal tail was present. The condition was thought to be congenital in the six horses in this series. A surgical approach to identify accurately monorchid horses is described.

Electrolytes and reproductive hormone concentrations in maternal plasma and fetal fluids of dairy cows with hydrops

Electrolytes, metabolites, cortisol and reproductive hormones were measured in maternal plasma taken at least twice daily from three cases of bovine hydrops before, during and after parturition induced by dexamethasone or prostaglandin. Caesarean operations were required for two of the cases. Maternal plasma electrolytes remained within the normal range, but average potassium and creatinine concentrations were higher (9.2 and 0.68 mmol/litre, respectively) than normal (4.7 and 0.42 mmol/litre) in samples of amniotic fluid obtained at calving. Sodium (100 mmol/litre) and chloride (67 mmol/litre) in allantoic fluid were also higher than normal (53 and 20 mmol/litre, respectively). Conversely, creatinine concentrations were lower than normal in allantoic fluid (2.2 vs 13.8 mmol/litre). Oestradiol concentrations were lower than normal in maternal plasma (ranges: less than 20 to 140 pg/ml vs 30 to 440 pg/ml); maximum prostaglandin F metabolite (PGFM) concentrations were slightly elevated (ranges 1.1 to 2.0 ng/ml vs 0.4 to 0.9 ng/ml). Progesterone and cortisol concentrations remained within the normal range; the latter hormone increased markedly in parallel with raised PGFM concentrations. In two cases, the concentrations of reproductive hormones tended to be lower in the amniotic fluid than in the allantoic fluid. For example, progesterone concentrations were 42.8 and 14.9 ng/ml in the amniotic fluids vs 64.2 and 29.8 ng/ml in the allantoic fluids of the two cows; PGFM concentrations were 27.7 and 4.3 ng/ml vs 34.6 and 5.0 ng/ml, and oestradiol concentrations were 1.5 and 3.5 ng/ml vs 1.1 and 6.4 ng/ml in the two fluids, respectively.

Determination of benzene, toluene and 1,3-butadiene in cigarette smoke by GC-MDS

An analytical procedure was devised for the determination of selected gas phase constituents in cigarette smoke utilizing capillary gas chromatography and mass selective detection (GC-MSD); the MSD was used in the selective ion monitoring mode (SIM). The gas of freshly generated mainstream smoke was analyzed via a 10-port gas sampling valve on a puff-by-puff basis. Benzene, toluene, and 1,3-butadiene were found in the range of 6-73, 5-88, and 16-75 micrograms/cigarette, respectively. The gas phase of sidestream smoke was trapped in methanol using 3 midget impingers at -78 degrees C. Benzene in sidestream smoke was found in the range of 490-840 micrograms/cigarette; toluene and 1,3-butadiene levels were 1,090-1,690 and 300-470 micrograms/cigarette, respectively. Environmental tobacco smoke (ETS), sampled in a smoke-filled bar, was analyzed using the cold trap method. The concentrations of benzene and toluene in this indoor air were found to be 26-36 and 41-80 micrograms/m3, respectively, while 1,3-butadiene was present at 3.3-4.5 micrograms/m3.

The effect of artificial photoperiod at the end of the breeding season on plasma testosterone concentrations in stallions

Testosterone concentrations in stallions showed a seasonal trend with peak concentrations in the spring (April and May in Britain) and lowest concentrations in the period from December to February. The effect on this pattern of changing the length of the photoperiod at the end of the normal breeding season (mid-summer's day) was studied in 2 experiments. In the first experiment artificial illumination was organised from 21 June to mimic the effect of transfer to a southern hemisphere spring and summer, that is short days becoming longer. The stallions had low concentrations of testosterone in February and high concentrations in April. Concentrations in July, August and September were extremely low with a return to high values in late November/early December. In the second experiment, illumination was maintained at the equivalent of a 16 1/2-hour day from 21 June to mid December. These stallions had high testosterone concentrations in April, after which they fell until August, later rising to a maximum in October. These results are discussed in relation to transfer of stallions between the northern and southern hemispheres.

Ventromedial hypothalamic and paraventricular nucleus lesions damage a common system to produce hyperphagia

We investigated the anatomical basis of paraventricular (PVN) and ventromedial (VMH) hypothalamic hyperphagia. Asymmetrical electrolytic lesions, damaging the VMH and PVN contralaterally, produced significant hyperphagia and weight gains (mean = 257.2 g) almost three times those of controls (89.8 g) during 56 postsurgical days. Weight gain in these rats was not significantly different from that in rats with bilateral lesions of the VMH (277.2 g) or PVN (188.2 g). Combined bilateral destruction of the PVN and VMH produced weight gain (272.8 g) almost identical to that seen after bilateral VMH lesions alone. The lack of additivity of these combined lesions and the effectiveness of the asymmetrical lesions are consistent with the hypothesis that lesions of either of these two regions damage a longitudinally running system to produce elevated food intake and body weight. Cell bodies of this system may lie within the PVN and send efferent projections through the VMH. Hyperinsulinemia developed only in rats with bilateral damage in the VMH. Thus, hypothalamic hyperphagia and hyperinsulinemia appear to be dissociable, reflecting damage to separate neural systems.

Studies of pituitary-adrenal-testis interaction in sheep. II. The effects of repeated injections of adrenocorticotrophic hormone outside the breeding season

The administration of 0.5 mg of long-acting adrenocorticotrophic hormone (ACTH, Synacthen-Depot) twice daily for 5.5 d to four rams outside the breeding season caused marked rises in plasma cortisol without any evidence of adrenal depletion. This treatment also caused marked rises in basal plasma follicle stimulating hormone (FSH) concentrations which remained high even after cessation of treatment. Plasma FSH responses to 5 ug of gonadotrophin releasing hormone (GnRH) were consistently observed and ACTH treatment increased the FSH response to GnRH. In contrast, spontaneous fluctuations in the plasma luteinizing hormone (LH) and testosterone concentrations were abolished by ACTH treatment. The quantity of testosterone released after GnRH (estimated by the maximum values reached and by the area under the response curve) was also suppressed while that of LH was only slightly lower. A comparison of the results of this experiment with those obtained in rams during the breeding season showed that the effects of ACTH on LH and testosterone were more marked during the breeding season. In contrast, the effect of ACTH on FSH is to increase the latter during the nonbreeding season, whereas no effect was observed during the breeding season.

Studies of pituitary-adrenal-testis interaction in sheep. III. The effects of repeated injections of adrenocorticotrophic hormone in recently castrated rams

Twice daily for 5.5 d, 0.5 ug of long-acting adrenocorticotrophic hormone (ACTH, Synacthen-Depot) was administered to four rams castrated 17 d earlier. There was a progressive diminution in basal plasma follicle stimulating hormone (FSH) during and after treatment. ACTH also suppressed basal plasma luteinizing hormone (LH) concentrations and the maximum LH values reached and the quantity of LH released in response to the injection of 5 ug of gonadotrophin releasing hormone (GnRH). There was, however, evidence that the LH concentrations returned to pretreatment levels after ACTH treatment ceased. This experiment demonstrated that the effects of ACTH on LH are modulated by castration, but throughout this series of experiments ACTH always depressed LH activity. In contrast, FSH is affected by ACTH in different ways, depending on the season and the presence or absence of a testis.

Studies of pituitary-adrenal-testis interaction in sheep. I. The effects of repeated injections of adrenocorticotrophic hormone during the breeding season

The administration of 0.5 mg of long-acting adrenocorticotrophic hormone (ACTH, Synacthen-Depot) twice daily for 5.5 d to four adult rams during the breeding season had no consistent effect on plasma follicle stimulating hormone (FSH) concentrations. In contrast, it suppressed both plasma luteinizing hormone (LH) and testosterone concentrations. The responses to injections of 5 ug of gonadotrophin releasing hormone (GnRH), as measured by maximum concentrations reached and areas under the response curves, were also suppressed. These findings suggest that ACTH exerts its suppressive efects on LH at the pituitary level.

Dose-dependent interaction between cholecystokinin and sham feeding

Previous work in this laboratory indicated that decreases in feeding motivation produced by cholecystokinin octapeptide (CCK-8) develop through synergism with signals generated by feeding. In these experiments, we used a runway paradigm to assess the contribution of signals from the oral cavity to this interaction. In contrast to the substantial (44%) impairment in runway performance produced by the combination of 1 microgram/kg CCK-8 and 5 min normal prefeeding, 5 min sham feeding failed to potentiate the effect of 1 microgram/kg CCK-8. Sham feeding in conjunction with this dose of CCK-8 reduced running speed by no more (2%) than CCK-8 alone (9%). Similar results were obtained whether rats were allowed a longer sham feeding interval (12 min) or the prefeeding interval was shifted in time so that it ended only 3 min before the start of the runway test. By contrast, larger doses of CCK-8 interacted with 5 min sham feeding to substantially impair runway performance; significant decreases in speed of 29% and 41% were observed after 2 and 4 micrograms/kg CCK-8, respectively. Results with these doses indicate that synergy between CCK-8 and signals from the oral cavity can contribute to the inhibitory effects of this agent. However, the failure of the combination of the 1 microgram/kg dose and sham feeding to replicate the interaction seen with normal prefeeding indicates the additional involvement of signals arising from food stimulation distal to the oropharynx.

Effect of the surface geometry of smooth and porous-coated titanium alloy on the orientation of fibroblasts in vitro

The migration and orientation of human gingival fibroblasts in relation to the rim of smooth-surfaced and porous-coated titanium discs placed on multilayers in vitro was investigated. Samples were examined after 6 h, 24 h, 3 days, and 7 days of culture using phase-contrast and scanning electron microscopy. The cells migrated from the multilayer onto the smooth-surfaced discs forming bridges between them, and orientated along parallel circumferential grooves in the rim of the discs. This resulted in the cellular bridges orientating at an acute angle to the rim of the disc, and adjacent cells in the multilayer orientating parallel to the rim. Cellular bridges were also formed between the porous-coated discs and the multilayer but, because the cells that migrated onto, and between, the spheres of the porous-coat showed no preferred orientation, the bridges retained their orientation at right angles to the surface of the rim. This in turn resulted in the cells of the adjacent multilayer becoming similarly orientated. These observations suggest that the geometrical configuration of the surface of implants could influence whether a capsule or an orientated fibrous attachment is developed in relation to implants in vivo.

Cholecystokinin interacts with prefeeding to impair runway performance

Previous experiments demonstrated the ineffectiveness of the C-terminal octapeptide of cholecystokinin (CCK-8) for impairing runway performance by food-deprived rats. These results were consistent with the proposal that CCK-8 does not reduce food intake by inhibiting appetitive motivation but instead acts late in the meal to prematurely trigger satiety. For further evaluation of this hypothesis, the effect of CCK-8 on runway performance was assessed after 21 h food-deprived rats consumed a partial meal of 30% sucrose. Injection of 1.0 micrograms/kg CCK-8 after rats were allowed 3 min (6.2 ml consumed) or 5 min (9.7 ml) access to 30% sucrose produced significant reductions in running speed of 43% and 70%, respectively. After 5 min prefeeding, 0.25 and 0.50 micrograms/kg CCK-8 also produced significant decreases in speed of 20% and 59%, respectively. By contrast, CCK-8 had little or no effect without prefeeding. Doses of 0.25 and 0.50 micrograms/kg failed to affect running speed on these tests and 1.0 micrograms/kg produced a small (7%) though significant decrease. These results suggest that inhibition of feeding motivation after CCK-8 administration develops during the course of the meal through interaction with signals generated by the ingestion of food.