Exploring the Versatility of the Amidation of Aryl Acid Fluorides using the Germylamines R3 GeNMe2

The formation of amide bonds is an important process since this linkage is an essential component in proteins, pharmaceuticals, and other medicinally and biologically significant molecules. Recently, it was demonstrated that germylamines R3 GeNR'2 were useful reagents for the conversion of acid fluorides to amides. This transformation occurs readily at room temperature and has a low activation energy. In the present study, the versatility of this amidation reaction with aryl acid fluorides is investigated. A series of thirteen acid fluorides with various substituents on the aromatic ring were reacted with the germylamine Ph3 GeNMe2 and twelve of these were converted to the corresponding amides in high yields, the exception being 1,4-benzenedicarbonyl difluoride. The germylamines Bun 3 GeNMe2 and Pri 3 GeNMe2 also could be used for this interconversion, and both of these species successfully converted 1,4-benzenedicarbonyl difluoride to the corresponding amide. In addition, the crystal structure of Ph3 GeNMe2 is reported. This represents one of only three crystallographically characterized germylamines. The synthesis and 19 F NMR characterization of three fluorogermanes R3 GeF (R=Bun , Pri , and Mes) are also reported herein.

The diagnostic value and cost effectiveness of routine fungal stains in a dermatopathology service of a district general hospital

AIMS

To evaluate the use and effectiveness of fungal stains in a dermatopathology service of a district general hospital.

METHODS

A retrospective analysis of skin biopsies submitted over three years, where fungal stains were used; the results were correlated with clinical history and case notes.

RESULTS

In total, 99 cases were studied for fungi with the periodic acid Schiff stain with diastase. Fungi were present in seven cases; fungi had been suggested in the differential diagnosis of three of these cases but were an unexpected finding in four cases.

CONCLUSION

Non-specific clinical details should prompt early fungal staining and non-specific microscopic findings or inappropriate well recognised skin reaction patterns should warrant the exclusion of fungal infection. The finding of at least one case of unexpected fungal infection is justified financially and for patient best management where clinical and microscopic findings are non-specific or inappropriate.

Regression of primary high-grade gastric B-cell lymphoma following Helicobacter pylori eradication

The causative association between Helicobacter pylori and gastric mucosal inflammation is well established. The inflammatory process leads to the acquisition of mucosa-associated lymphoid tissue (MALT) by the stomach. Evidence links H. pylori gastritis with the development of low-grade primary gastric lymphoma with a phenotype specific for lymphoma of MALT type. It is now accepted that primary low-grade MALT lymphomas regress with H. pylori eradication therapy. However, the response of primary, diffuse, large-cell gastric lymphoma to H. pylori eradication therapy is still not established. We report a case of a primary high-grade gastric lymphoma regressing after H. pylori eradication therapy.

Stress management intervention for primary prevention of hypertension: detailed results from Phase I of Trials of Hypertension Prevention (TOHP-I)

PURPOSE

Stress Management Intervention (SMI) was one of seven nonpharmacologic approaches evaluated in Phase I Trials of Hypertension Prevention (TOHP-I) for efficacy in lowering diastolic blood pressure (BP) in healthy men and women aged 30 to 54 years with diastolic BP 80-89 mm Hg.

METHODS

A total of 242 and 320 participants were randomized to SMI or an "assessment only" SMI Control, respectively, at four clinical centers. The SMI consisted of 37 contact hours in 21 group and two individual meetings over 18 months and included: training in four relaxation methods, techniques to reduce stress reactions, cognitive approaches, communication skills, time management, and anger management within a general problem-solving format. Standardized protocols detailed methods and timing for collecting BP, psychosocial measures, and urinary samples from both SMI and SMI Control participants.

RESULTS

In intention-to-treat analyses, although significant baseline to termination BP reductions were observed in both groups, net differences between the SMI and SMI Control groups' BP changes (mean (95% CI)) were not significant: -0.82 (-1.86, 0.22) for diastolic BP, and -0.47 (-1.96, 1.01) for systolic BP. Extensive adherence sub-group analyses found one effect: a significant 1.36 mm Hg (p = 0.01) reduction in diastolic BP relative to SMI Controls at the end of the trial for SMI participants who completed 61% or more of intervention sessions.

CONCLUSIONS

While the TOHP-I SMI was acceptable to participants as evident from high levels of session completion, the absence of demonstrated BP lowering efficacy in intention-to-treat analyses suggests that the TOHP-I SMI is an unlikely candidate for primary prevention of hypertension in a general population sample similar to study participants. The isolated finding of significant diastolic BP lowering in SMI participants with higher adherence provides very weak evidence of SMI BP lowering efficacy and may be a chance finding. Whether similar or other stress management interventions can produce significant BP lowering in populations selected for higher levels of BP, stress, or intervention adherence remains to be demonstrated.

Bullous pemphigoid complicating human orf

We report five cases of human orf complicated by bullous pemphigoid. This is a previously unrecorded complication of orf. Knowledge of the association allows for better management in the affected patient.

Gender and ethnicity in children's cardiovascular reactivity: 7 years of study

A total of 295 children (127 White boys, 15 Black boys, 133 White girls, and 20 Black girls) participated in reactivity examinations in 1987 (all were in 3rd grade; age, M = 9.1 years), 1988, 1989, 1991, 1992 and 1993 (all were in 9th grade; age, M = 15.1 years). An analysis of residualized reactivity change values indicated consistent and significant ethnicity effects (Blacks greater than Whites) for systolic and diastolic blood pressure and for heart rate. Gender effects were also apparent for both systolic and diastolic blood pressure (boys greater than girls). These data suggest that the transition from childhood to adolescence is associated with a significant pattern of ethnic differences in reactivity, although the association of this pattern with the development of cardiovascular risk and disease remains to be ascertained.

Modulation of the alveolar macrophage respiratory burst by hydroperoxides

Exposure of alveolar macrophages to hydroperoxides (ROOH) inhibits subsequent stimulation of O2.- production (the respiratory burst). Previous studies (under nonoxidant stress conditions) have shown that elevation of intracellular free calcium ([Ca2+]i) participates in both initiation and termination of O2.- production. In this investigation, the effects of sublethal ROOH exposure on [Ca2+]i and the respiratory burst of rat alveolar macrophages were compared. Exposure to a sublethal range of H2O2 or tert-butylhydroperoxide (10-100 pmol/10(6) cells; initially 10-100 microM under the experimental conditions) for 15 min resulted in dose-dependent effects on the respiratory burst stimulated by various agents, ADP, ATP, zymosan-activated serum, and phorbol myristate acetate. Low concentrations of the ROOH (10 or 25 pmol/10(6) cells) were found to enhance stimulation, whereas exposure to 75 or 100 pmol/10(6) cells resulted in significant inhibition for all of the stimuli. All concentrations of ROOH caused a rapid elevation in [Ca2+]i. For those concentrations of ROOH that produced enhancement of subsequent stimulation of the respiratory burst, [Ca2+]i returned to near baseline before the end of the 15-min preincubation. The temporal- and concentration-dependent effects of ROOH on [Ca2+]i correlate with subsequent enhancement or inhibition of stimulated O2.- production. Similarities between the ROOH-induced changes in [Ca2+]i and the effect of [Ca2+]i changes in physiological regulation of the respiratory burst suggest a potential relationship.

Gender and ethnicity in children's cardiovascular reactivity: 7 years of study

A total of 295 children (127 White boys, 15 Black boys, 133 White girls, and 20 Black girls) participated in reactivity examinations in 1987 (all were in 3rd grade; age, M = 9.1 years), 1988, 1989, 1991, 1992 and 1993 (all were in 9th grade; age, M = 15.1 years). An analysis of residualized reactivity change values indicated consistent and significant ethnicity effects (Blacks greater than Whites) for systolic and diastolic blood pressure and for heart rate. Gender effects were also apparent for both systolic and diastolic blood pressure (boys greater than girls). These data suggest that the transition from childhood to adolescence is associated with a significant pattern of ethnic differences in reactivity, although the association of this pattern with the development of cardiovascular risk and disease remains to be ascertained.

When to measure resting values in studies of children's cardiovascular reactivity

Investigations suggesting that the order of obtaining resting and cardiovascular reactivity measurements moderates values have provided inconsistent results and have not analyzed data from children; the generalizability of results is uncertain. In this investigation, all children enrolled in the eighth-grade classrooms of the public schools of an entire county (n = 451) participated in standardized reactivity assessments. The order of resting and reactivity measurements was randomized by examination day (a total of 19 days). Analyses indicated that all comparisons of order effects on mean resting blood pressure and heart rate, as well as reactivity (both change from resting and absolute values and both mean and maximal values), were nonsignificant. Results indicate that measurement order is not always a necessary consideration in studies of reactivity; the conditions under which measurement order is a consideration requires clarification.

Modernization in the Samoas and children's reactivity: a pilot study

This investigation studied the potential effects of societal modernization on Samoan children's blood pressure and heart rate reactivity to a standardized television video game procedure. Ethnic Samoan children were sampled from Western Samoa (N = 72), a relatively underdeveloped country with a largely agricultural economy, and American Samoa (N = 70), a territory of the United States that has undergone substantial modernization due to recent economic aid. Results indicated that Western Samoans demonstrated significantly greater systolic blood pressure, diastolic blood pressure, and heart rate reactivity than American Samoans. These data, in conjunction with previous data, suggest that the hemodynamic effects of an acute stressor are inversely associated with societal modernization and an individual's adoption of a lifestyle reflecting integration into a modernized society. Further work is needed to examine the implications of this hypothesis and the associations among concrete measures of modernization and children's cardiovascular risk.

Primary lymphoma of bone

A survey of the 2075 cases in the Leeds Bone Tumour Registry showed that 54 cases of Primary Lymphoma of Bone that had been registered since data collection began in 1958 (2.6% of primary bone tumours). The overall sex ratio was 1.5 males: 1 female, largely due to the preponderance of males in the under 40 age group. The age distribution was bimodal, the second peak of incidence demonstrating a significant reversal of the sex ratio with females being more commonly affected in the older group. The clinical features and radiological findings were non-specific, diagnosis relying principally on tissue histology. The overall survival at five years was 46% and was not affected by the interval from the onset of symptoms until the final diagnosis.

Pressor reactivity, ethnicity, and 24-hour ambulatory monitoring in children from hypertensive families

We assessed blood pressure responses of a multiethnic (Black and White) sample of 120 children of hypertensive families to orthostasis, video game, forehead cold, and dynamic exercise, and monitored the children's ambulatory pressure 24 hours later. Thirteen children were studied twice (1-year stability). The Black children exhibited higher 24-hour ambulatory systolic and diastolic pressures than the White children. Regardless of ethnicity, peak and mean systolic pressures during each task were generally positively correlated with mean systolic pressure while the children were awake and asleep. Associations between diastolic pressor responses and ambulatory measurements were somewhat dependent upon ethnicity and task. Relatively few reactivity-ambulatory correlations were significant, using pressor reactivity change scores. The children who participated twice exhibited significant 1-year stability for most ambulatory and pressor measurements. Children's pressor responses to laboratory tasks may generalize to the natural environment.

Consistency of ethnic differences in children's pressor reactivity. 1987 to 1992

In this prospective investigation, all children enrolled in the public third-grade classrooms of an entire county (n = 474) had blood pressure measured both at rest and during a stressful television video game. Examinations were repeated in 4 subsequent years when cohort children as well as newly enrolled children were in grades 4, 5, 7, and 8. Both cross-sectional and longitudinal analyses indicated that black children demonstrated significantly greater systolic and diastolic pressor reactivity than white children. These data suggest that ethnic differences in children's pressor reactivity presage ethnic differences in adulthood hypertension.

Stimulation of the rat alveolar macrophage respiratory burst by extracellular adenine nucleotides

Exogenous nucleotides can serve as extracellular factors that cause significant functional changes in numerous cells, including phagocytes. In the current study, addition of ATP, ADP, and ATP gamma S directly stimulated the respiratory burst (superoxide production) by rat alveolar macrophages, whereas adenosine and AMP did not. The relative potency of these nucleotides at saturating concentration was ADP > or = ATP gamma S >> ATP; however, simultaneous addition of maximally stimulatory concentrations of ADP and ATP (100 microM of each) produced an additive effect suggesting involvement of two P2 receptors. Following addition of the nucleotides, an elevation of intracellular Ca2+ ([Ca2+]i) occurred within seconds, followed by a decline within 1 min but with a prolonged elevation above baseline for at least 5 min. Removal of extracellular Ca2+ only slightly attenuated the initial elevation, indicating that adenine nucleotides stimulate the rapid release of intracellular Ca2+ stores. Removal of extracellular Ca2+ also eliminated the sustained elevation in [Ca2+]i and markedly suppressed the respiratory burst. Incubation with verapamil, a Ca2+ channel blocker, also significantly inhibited the respiratory burst stimulated by ATP. These studies demonstrate that adenine nucleotides stimulate a Ca(2+)-dependent respiratory burst by rat alveolar macrophages, probably through purinergic receptors.

Effects of sodium and proton pump activity on respiratory burst and pH regulation of rat alveolar macrophages

At pH 7.4, extracellular Na+ removal inhibited the rat alveolar macrophage respiratory burst (RB) stimulated by phorbol 12-myristate 13-acetate (PMA) or zymosan-activated serum (ZAS). At pH 6.8, the RB was lower and decreased the Na+ effect. Amiloride inhibited the ZAS RB independently of effects on Na(+)-H+ exchange, but did not affect PMA stimulation. NBD-Cl, an H(+)-ATPase inhibitor, significantly inhibited the PMA or ZAS RB. Na+ removal caused sustained elevation of intracellular free [Ca2+], which previous studies suggested inhibits the RB. Intracellular pH (pHi) was lower at pHo 6.8 compared with pHo 7.4, but not altered by Na+ removal. PMA stimulation resulted in acidification corresponding with onset of superoxide production. At pHo 7.4, recovery to baseline pHi occurred that was not inhibited by amiloride or Na+ removal. In contrast, amiloride slowed pHi recovery after an exogenous acid load. Addition of H(+)-ATPase inhibitors, NBD-Cl or bafilomycin, following PMA stimulation or acid loading, inhibited pHi restoration. These studies suggest that pHi regulation following stimulation was mainly through a proton pump, whereas Na(+)-H+ exchange occurred only after greater acid loading. Nevertheless, Na+ and pH interacted to modulate the RB independent of Na(+)-H+ exchange.

Depression of stimulated arachidonate metabolism and superoxide production in rat alveolar macrophages following in vivo exposure to 0.5 ppm NO2

Alveolar macrophages (AM) have been found to suffer significant functional deficits in response to nitrogen dioxide (NO2) exposure. The present investigation examined changes in the activation of AM arachidonate metabolism and superoxide production in response to an environmentally relevant level of NO2. Rats were exposed to 0.5 ppm NO2 for periods of 0.5-10 d and AM were obtained by bronchoalveolar lavage (BAL). NO2 exposure produced complex effects upon both unstimulated and stimulated AM arachidonate metabolism. Unstimulated AM synthesis of leukotriene B4 (LTB4) was depressed rapidly within 1 d of exposure, and depressed again at 5 d. Alveolar macrophage production of thromboxane B2 (TxB2), LTB4, and 5-hydroxyeicosatetraenoate (5-HETE) in response to stimulation with the calcium ionophore, A23187, were acutely depressed within 1 d of exposure; however, generation of these compounds recovered to air-control levels with longer exposure, while 5-HETE was increased at 10 d. In contrast, AM production of LTB4 in response to another stimulus, zymosan-activated rat serum (ZAS), was not depressed until following 5 d of exposure and remained slightly lower than air-control levels at 10 d. Levels of TxB2, LTB4, prostaglandin E2 (PGE2), and prostaglandin F2 alpha (PGF2 alpha) measured in BAL fluid (BALF) were found to be depressed within 4 h of exposure, suggesting an acute decrease in the in vivo pulmonary arachidonate metabolism; however, production of these compounds generally recovered to air-control levels with longer exposure. The AM superoxide production stimulated by phorbol myristate acetate (PMA) was decreased rapidly and continuously throughout the study. Thus, exposure to a low concentration of NO2 acutely depresses activation of AM arachidonate metabolism and superoxide production in response to external stimuli, and may impede defense against pulmonary infection.

Ethnicity, pressor reactivity, and children's blood pressure. Five years of observations

During the 5 years of this investigation, resting blood pressure and pressor reactivity were measured in 292 white children and 46 black children in 1987, 1988, 1989, and 1991. In 1987, all children were in the third grade; in 1991, the children were in the seventh grade. Reactivity was assessed with a standardized psychological stressor, a television video game. Children displayed significant stability of absolute blood pressure and heart rate reactivity between grades 3 and 7. At all examinations, black children demonstrated blood pressure reactivity that was significantly greater in magnitude (both absolute level and change from resting measurements) than that of white children. Black children exhibited significantly greater heart rate reactivity only when defined as change from the resting measurements; absolute levels of heart rate reactivity were comparable for blacks and whites. For black children, blood pressure reactivity in 1987 was the strongest predictor of resting blood pressure (both systolic and diastolic) in 1991. Among white children, resting blood pressure was the strongest predictor of future resting blood pressure. Further research is needed to determine if ethnic differences in children's pressor reactivity are associated with ethnic differences in the prevalence of hypertension.

Subacute cutaneous lupus erythematosus--the annular variant. A histological and ultrastructural study of five cases

Subacute cutaneous lupus erythematosus is an uncommon, non-scarring variant of lupus erythematosus which has received scant attention in the pathology literature. Its recognition as a distinct entity is important, as, although mild systemic features may be associated, there is characteristically a relative absence of life-threatening renal or central nervous systemic involvement. Subacute cutaneous lupus erythematosus may be clinically sub-divided into the more common annular and the rarer papulosquamous (psoriasiform) variants. A clinicopathological study of five cases of the annular variant is presented with a review of the literature. We highlight the histological and ultrastructural appearances. Discriminatory features from the other variants of lupus erythematosus and additional conditions with which it may be confused, including lichen planus and acute graft-versus-host disease, are discussed.

Whether to measure change from baseline or absolute level in studies of children's cardiovascular reactivity: a two-year follow-up

Blood pressure and heart rate were measured at rest and during a television video game in 399 healthy children. At the first assessment, children were in third grade and at the 2-year follow-up, they were in fifth grade. Children were classified according to race (black/white), gender (boy/girl), body mass index (light/heavy), and video game performance (low score/high score). Correlational analysis indicated that irrespective of the classification variable, absolute reactivity values, e.g., a heart rate of 110 bpm, tended to be more stable than change reactivity values, e.g., a heart rate change of 10 bpm. The greater stability of absolute values was most pronounced with systolic blood pressure. Absolute values were at least as stable as resting values and frequently demonstrated greater stability. Mean and maximal reactivities were correlated comparably. We conclude that children's reactivity is a stable characteristic and that, unless indicated by a priori hypotheses, the use of absolute values is preferable to the use of change values.

Children's cardiovascular reactivity: stability of racial differences and relation to subsequent blood pressure over a one-year period

After measuring blood pressure and heart rate at rest and during a video game procedure in 477 children enrolled in 3rd grade, 434 (91%) children had these measurements repeated a year later in 4th grade. Black children demonstrated greater blood pressure and heart rate reactivity than White children in both years, and an increase in heart rate reactivity from 3rd to 4th grade. Gender effects were inconsistent. Systolic and diastolic blood pressures during the video game were more highly correlated from year-to-year than were the resting measures. Regression analysis indicated that systolic reactivity was significantly related to subsequent systolic pressure at rest, particularly among Black girls. Diastolic reactivity was associated with subsequent resting diastolic pressure only among White children. Associations between reactivity and future blood pressure were independent of initial resting blood pressure. This study suggests that cardiovascular reactivity to psychological stress may be one important factor in future level of blood pressure and that the increased heart rate reactivity of Black children may be associated with the prevalence of hypertension among Black adults.

Stability of ethnic differences in children's pressor responses during three annual examinations

In this study, 395 healthy children had blood pressure and heart rate measured both at rest and during a stressful video game. Identical measurement procedures were used for three annual examinations. Consistently, black children demonstrated significantly greater pressor responses than white children. In view of the greater prevalence of hypertension among black adults than white adults, these data suggest that blacks exhibit hemodynamic irregularities well before the onset or diagnosis of hypertension.

Investigation and characterization of receptors for pituitary adenylate cyclase-activating polypeptide in human brain by radioligand binding and chemical cross-linking

Pituitary adenylate cyclase-activating polypeptide (PACAP) is a novel peptide of hypothalamic origin which increases adenylate cyclase activity in rat anterior pituitary cell cultures. The 38-amino acid peptide shows a close sequence homology to vasoactive intestinal peptide (VIP). Binding sites for PACAP in membranes from postmortem human brain tissue were studied using [125I]PACAP27 as the radioligand. High specific binding sites (amount of specific binding measured at 0.25 nM [125I]PACAP27 in femtomoles per mg protein +/- SEM; n = 4) were present in hypothalamus (344.5 +/- 13.0), brain stem (343.0 +/- 29.3), cerebellum (292.0 +/- 21.1), cortex (259.6 +/- 19.8), and basal ganglia (259.2 +/- 50.3). Specific binding sites in pituitary, although present, were less abundant (35.0 +/- 8.9). Binding of [125I]PACAP27 was reversible and time, pH, and temperature dependent. Despite the homology with VIP, VIP was a poor inhibitor of [125I]PACAP27 binding (IC50, greater than 1 microM) compared with PACAP27 (IC50, 0.5-1.3 nM) and PACAP38 (IC50, 0.2-1.3 nM). Scatchard plots of [125I]PACAP27 binding showed the presence of both high and lower affinity sites. Chemical cross-linking of PACAP-binding sites revealed that [125I]PACAP27 was bound to polypeptide chains of 67,000 and 48,000 mol wt. Thus, we have demonstrated the presence of PACAP-specific receptors in human brain which are not VIP receptors. This opens the possibility of PACAP functioning as a novel neurotransmitter/neuromodulator in human brain.

Polycythaemia and neuroblastoma

The treatment of primary proliferative polycythaemia (polycythaemia rubra vera) may include radioactive phosphorus (P32) in conjunction with venesection. Acute leukaemia or carcinoma can be associated with the use of P32. We present a case of primary proliferative polycythaemia treated by repeat venesection together with P32 whose follow-up was complicated by the development of malignant neuroblastoma.

Endothelin in human brain and pituitary gland: presence of immunoreactive endothelin, endothelin messenger ribonucleic acid, and endothelin receptors

The presence of immunoreactive (IR) endothelin, endothelin mRNA, and endothelin receptors in human brain and pituitary gland has been studied by RIA, Northern blot hybridization, and receptor assay. IR endothelin was detected in all five brain regions examined (cerebral cortex, cerebellum, brain stem, basal ganglia, and hypothalamus) (6-10 fmol/g wet wt) and spinal cord (22 +/- 6 fmol/g wet wt, n = 7, mean +/- SEM). Higher concentrations of IR endothelin were found in the pituitary gland (147 +/- 30 fmol/g wet wt). Fast protein liquid chromatographic analysis of the IR endothelin in pituitary gland showed a large IR peak in the position of endothelin-3 and a smaller peak in the position of endothelin-1, whereas IR endothelin in the hypothalamus and brain stem was mainly endothelin-1. Endothelin messenger RNA was detected by Northern blot hybridization in the pituitary but not in hypothalamus. The receptor assay showed that 125I-endothelin-1 binding sites were present in large numbers in all five brain regions but were much less abundant in the pituitary gland. Binding capacity and dissociation constant were 5052 +/- 740 fmol/mg protein and 0.045 +/- 0.007 nM in brain stem and 963 +/- 181 fmol/mg protein and 0.034 +/- 0.009 nM in hypothalamus. In the pituitary gland, there were two classes of binding sites for endothelin with dissociation constants of 0.059 +/- 0.002 nM (binding capacity = 418 +/- 63 fmol/mg protein) and 0.652 +/- 0.103 nM (binding capacity = 1717 +/- 200 fmol/mg protein). Endothelin-1, -2 and -3 were almost equipotent in displacing the binding (IC50 approximately 0.04 nM). These findings are in accord with the possibility that endothelin acts as a neurotransmitter, neuromodulator or neurohormone in man.

Endothelin in human brain and pituitary gland: comparison with rat

To investigate the physiological roles of endothelin (ET) in the brain and pituitary gland, the presence of immunoreactive (ir) ET and ET receptors was studied by radioimmunoassay and receptor assay in humans and rats. ir-ET concentrations in human brain (6-10 fmol/g of wet weight) were comparable with the levels in the rat brain (5-9 fmol/g of wet weight). Higher concentrations of ir-ET were found in human pituitary glands (147 +/- 30 fmol/g of wet weight, mean +/- SEM) and rat posterior pituitary lobes (88 +/- 26 fmol/g of wet weight). Fast protein liquid chromatography (FPLC) showed that the ir-ET in human hypothalamus and brainstem was mainly ET-1, while the ir-ET in human pituitary was mainly ET-3. FPLC of the whole rat brain extract showed a larger peak in the position of ET-3 and a smaller peak in the position of ET-1. Receptor assay showed that [125I]ET-1 binding sites were present in very large numbers in all five human brain regions and four rat brain regions examined but were much less abundant in the human pituitary. ET mRNA was detected by Northern blot hybridization in human pituitary but not in human hypothalamus. These findings are in accord with the possibility that ET acts as a neurotransmitter, neuromodulator, or neurohormone.

Effects of doxepin on withdrawal symptoms in smoking cessation

In a double-blind study, 15 cigarette smokers self-monitored 10 withdrawal symptoms. For the first 21 days (baseline), subjects received doxepin hydrochloride, up to 150 mg/day, or inert medication while continuing to smoke. On day 22, they were instructed to stop smoking; medication was continued. Withdrawal symptoms on the first 28 days of treatment (baseline and 7 days of attempted cessation) were analyzed. During cessation, subjects taking doxepin reported significantly less craving for cigarettes. Results from this study and others suggest that antidepressants may attenuate the severity of symptoms during withdrawal from addictive substances.

A comparison of two automated monitors in the measurement of blood pressure reactivity. Trials of Hypertension Prevention Collaborative Research Group

Cardiovascular reactivity is the change in blood pressure, pulse, and other parameters of cardiovascular function in response to a challenging task. During the conduct of cardiovascular reactivity protocols, researchers frequently use automated blood pressure devices to measure blood pressure reactivity. However, the accuracy of automated devices in measuring blood pressure reactivity is unknown. To investigate the accuracy and precision of the Dinamap 1846 SXP and the VitaStat 2600B in the measurement of blood pressure reactivity, we compared blood pressure reactivity recorded by the VitaStat and Dinamap with that obtained by observers using a conventional mercury sphygmomanometer. At three sites, 159 normotensive subjects performed the same task twice, once with blood pressure reactivity measured by the manual observers and once by the VitaStat (n = 79) or Dinamap (n = 80), with the order determined at random. Ratios (VitaStat/Dinamap) of aggregate within-person variance for baseline and task, systolic and diastolic blood pressures ranged from 1.53 to 4.93 (all P < 0.01), suggesting that the Dinamap has better precision than the VitaStat. For both diastolic and systolic blood pressure reactivity and for both types of automated devices, the mean differences in blood pressure reactivity between manual and automated measurements were small (range, -1.8 to 0.8 mm Hg). However, the VitaStat versus manual scatter plot of diastolic blood pressure reactivity showed greater dispersion (correlation coefficient r = 0.16, P = 0.15) than the Dinamap versus manual scatter plot (r = 0.36, P = 0.001). For systolic blood pressure reactivity, the VitaStat versus manual and Dinamap versus manual scatter plots were similar. Our data indicate that the Dinamap is superior to the VitaStat in the measurement of blood pressure reactivity. The substantial performance differences between the VitaStat and Dinamap suggest that other automated blood pressure monitors must be evaluated prior to use in cardiovascular reactivity studies.

Aerobic fitness and the diurnal rhythm of blood pressure in adolescents

We examined the effects of aerobic fitness and race on the diurnal rhythm of blood pressure of 175 healthy adolescents who performed a cycle ergometer maximal exercise test while oxygen consumption was measured. A median split of maximum oxygen consumption for boys and girls separately classified them as either "more-fit" or "less-fit" subjects. Ambulatory blood pressure recordings were also performed, and the data were analyzed for means while subjects were awake and asleep. Less-fit black boys had higher systolic pressures than more-fit black boys while awake (124 vs. 115 mm Hg; p less than 0.009) and asleep (117 vs. 108; p less than 0.001). Less-fit black boys also had higher systolic pressures than less-fit white boys while awake (114; p less than 0.002) and asleep (105; p less than 0.001), and they had higher systolic pressures than more-fit white boys while asleep (105; p less than 0.01). Less-fit black girls had higher systolic pressures than more-fit black girls while awake (116 vs. 109; p less than 0.004) and asleep (109 vs. 100; p less than 0.001). Less-fit black girls also had higher diastolic pressures than more-fit black girls while awake (71 vs. 66; p less than 0.002) and asleep (66 vs. 61; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

The validity of children's self-reports of physical activity: a preliminary study

Ninety-two healthy children provided self-reports of their physical activity. Self-reports were based upon posters depicting children performing typical childhood activities and were validated by measured oxygen uptake during maximal cycle ergometry. Results indicated that when children were classified as sedentary or active by their poster selection, active children had significantly greater oxygen uptake than sedentary children. These results, while preliminary, are the first to indicate that children's self-reports can provide a valid index of maximal oxygen uptake, the 'gold standard' of aerobic fitness.

Demonstration of Epstein-Barr virus in primary brain lymphoma by in situ DNA hybridisation in paraffin wax embedded tissue

Tumour tissue from 29 patients with primary brain lymphoma was reviewed to determine if there was an aetiological association between Epstein-Barr virus and polyclonal and monoclonal lymphoproliferations. The morphology and immunophenotype in 24 patients for whom paraffin wax embedded tissue was available were studied. A high grade pleomorphic tumour morphology with plasmacytoid features was seen in 13 tumours. Because of the large number of pleomorphic lymphomas, all tumours were examined for the presence of the Epstein-Barr virus genome using in situ DNA hybridisation. A panel of three biotinylated probes to different sequences in the Epstein-Barr virus genome was used. Positive hybridisation with one or more probes was shown in tumours from 11 patients. The remaining tumours gave no hybridisation signal. There was no correlation between positive hybridisation and morphological subtype or clinical outcome.

Primary lymphoma of the bladder: a clinicopathological study of 3 cases

Primary involvement of the bladder by lymphoma is rare but is associated with a favourable prognosis if diagnosed early and treated appropriately. The clinicopathological features of 3 cases of primary, non-Hodgkin's lymphoma of the bladder are described. This small study suggests a better prognosis with a favourable histological grade and an uncomplicated lymphoma confined to the bladder. We emphasise the value of aggressive treatment of the tumour.

Race and gender influence ambulatory blood pressure patterns of adolescents

The purpose of this study was to examine ambulatory blood pressure and heart rate patterns in healthy, normotensive adolescents and to determine the influence of race and gender on these patterns. Ambulatory blood pressure recordings were performed on 199 adolescents; 42 were black males, 55 were white males, 65 were black females, and 37 were white females. The mean age (+/- SD) was 13 +/- 2 years. Blood pressure readings were obtained with an automatic, noninvasive recorder. Black adolescents and white adolescents had similar blood pressures while awake (116/69 vs. 116/69 mm Hg), with boys having higher levels of systolic blood pressure (118 vs. 114 mm Hg) and comparable levels of diastolic blood pressure (69 vs. 69 mm Hg) relative to girls. The patterns while the adolescents were asleep, however, were different. White boys (106 mm Hg), white girls (105 mm Hg), and black girls (105 mm Hg) had similar systolic blood pressures during sleep. Black boys (112 mm Hg), however, had significantly higher systolic blood pressures while asleep. Black adolescents, as a group, had significantly higher diastolic blood pressures than white adolescents while asleep (64 vs. 61 mm Hg). Changes in blood pressure from awake to asleep were not related to changes in heart rate. Results of this study indicate that both race and gender are important determinants of the diurnal pattern of blood pressure and heart rate in adolescents.

Morphologic and immunophenotypic characterization of primary brain lymphomas using paraffin-embedded tissue

Primary lymphomas of the brain constitute about 1% of all primary intracranial neoplasms, but recent studies suggest an increasing incidence. Most cases are associated with an immunosuppressed state. We reviewed 29 cases of primary brain lymphoma from the Yorkshire Health Authority Region between 1970 and 1988 and found a striking increase in incidence over this period. No overt evidence of immunosuppression was found in any case. All were non-Hodgkin's in type and were classified morphologically using Kiel criteria and immunophenotypically using a panel of antibodies. Cryo-preserved tissue was available in five cases for parallel immunophenotyping. The majority of tumours were high-grade lymphomas together with three of lymphoplasmacytoid type. Thirteen tumours showed a striking pleomorphic morphology with plasmacytoid features. A reactive, predominantly perivascular monomorphic T-cell population was seen in all tumours. Most tumours were of B-cell lineage. No cases of Hodgkin's disease, T-cell or histiocytic lymphoma were present. Light chain restriction was present in only 46% of cases. The results of tumour immunophenotyping on cryostat sections were comparable with those from paraffin blocks. Our study emphasizes the value of a panel of antibodies reactive in paraffin-embedded tissue, allowing simultaneous evaluation of morphology and immunophenotype, and suitable for small biopsies received from stereotactic procedures.

Doxepin as an adjunct to smoking cessation: a double-blind pilot study

In a double-blind study, 19 adults received bedtime doses of either 150 mg of doxepin hydrochloride (N = 9) or placebo (N = 10). After 3 weeks the subjects were instructed to stop smoking and continue taking medication for 4 additional weeks. Cessation was reported by all nine doxepin subjects 1 week after cessation and by seven doxepin subjects 9 weeks after cessation. One placebo subject reported cessation. Cotinine assays generally confirmed cessation but were subject to interpretation. Doxepin assays suggested that the precessation level was associated with cessation. Further studies with larger samples and extended follow-up are needed to determine the reliability of these results.

Physical fitness in children: a survey method based on parental report

In the present study of 213 healthy children, the relation between parental reports of activity level and laboratory-determined physical fitness was examined. Results indicated that parental reports of activity level were associated with fitness for the entire sample. The association was most consistent among White children who resided in a household that was headed by their father.

Race and cardiovascular reactivity. A replication

In a previous study, we reported that black children demonstrated greater cardiovascular reactivity than did white children to the psychological stress of a television video game. Reliance on urban volunteers and the wide age range of the children may have limited conclusions concerning the generalizability of those results. In the present study, 481 of 484 children enrolled in the third grade of the public schools of an entire rural county in Tennessee were examined with the same video game procedure used previously. Results indicated greater heart rate and blood pressure reactivity among black children than among white children. Thus, the previous results were replicated. The greater prevalence of hypertension among black adults may relate to the greater reactivity among black children; reactivity may be either a marker or a mechanism in the development of hypertension.

Race and cardiovascular reactivity. A neglected relationship

The magnitude of the cardiovascular response to stress has been implicated in the pathogenesis of cardiovascular disease. Psychological stress procedures have received increased usage as an alternative to expensive physical (exercise) stress procedures. In the present investigation, 213 healthy, black or white, male or female children between the ages of 6 and 18 years were exposed to the psychological stress of a video game. The video game challenge was administered by a black or a white experimenter and was played under three levels of increasing stress, 1) personal challenge, 2) experimenter's challenge, and 3) experimenter's challenge accompanied by a financial incentive, while blood pressure and heart rate were monitored. Results indicated that the video games provoked significant and incremental cardiovascular reactivity across the games. Black children demonstrated significantly greater reactivity than white children; the racial difference was more reliably observed for systolic and diastolic blood pressure than for heart rate. Furthermore, the race of the experimenter exerted a significant effect and often interacted with the race of the child, such that greater reactivity occurred in same-race pairings than in mixed-race pairings. These results suggest that reactivity is affected by an individual's race and social milieu and that reactivity may be one mechanism responsible for the greater prevalence of hypertension among blacks.

Chronic pain: an investigation of assessment instruments

The present study investigated professional perceptions of utility and the actual predictive validity of the MMPI and the Millon Behavioral Health Inventory (MBHI) in a sample of chronic pain patients. Overall results indicated statistical preference for the MBHI on nine of the ten dimensions of clinical utility. In addition, patient prognosis was rated as more favorable based upon the MBHI report. The differences noted between raters of different professional capacities were hypothesized to reflect differences in familiarity with assessing pain patients from a psychological perspective. However, over the course of a one year follow-up, neither instrument significantly predicted such behaviors as hospital usage, medication usage or general status. Rather, the psychologists who wrote the original consultations (which were not rated for utility) were more accurate than either the MMPI or the MBHI in predicting these health related behaviors.

A case study reportedly involving possession

The following case report documents the efficacy of a behavioral intervention in the case of a reportedly possessed adolescent female. The intervention used was the differential reinforcement of other behavior which involved monetary and social reinforcement for appropriate behaviors and inattention to inappropriate and unusual behaviors, i.e. the incidents of possession behavior. The procedure was formalized in a contingency contract. The entire intervention was successfully implemented by the subject's great-grandmother.

Effect of surveillance on the number of hysterectomies in the province of Saskatchewan

In 1972 the College of Physicians and Surgeons of Saskatchewan appointed a committee to study hysterectomies because the Saskatchewan Department of Health had data showing that the annual number of hysterectomies carried out in the province had increased by 72.1 per cent between 1964 and 1971, whereas the number of women over 15 years of age had increased by 7.6 per cent. The committee compiled a list of indications for hysterectomy. Any hysterectomy carried out for one of these reasons was classified as justified, and the remainder as unjustified. Five hospitals were reviewed in 1970 and a further two in 1973. In 1974, all seven hospitals were reviewed again. In these hospitals, the average proportion of unjustified hysterectomies had dropped from 23.7 per cent at the time of the first review to 7.8 per cent in 1974. The total number of hysterectomies in the province dropped by 32.8 per cent between 1970 and 1974.