COVID-19-related changes in outpatient CPAP setup pathways for OSA are linked with decreased 30-day CPAP usage

The COVID-19 pandemic changed continuous positive airway pressure (CPAP) setup pathways. We evaluated patients commenced on CPAP in 2019 (prepandemic) and 2020 (post-first UK wave). Face-to-face (F2F) setup numbers, with CPAP turned on, decreased from 613 patients (98.9%) in 2019, to 6 (1.1%) in 2020. In 2020, setups were F2F without CPAP turned on (403 (71.1%)), or remote (158 (27.9%)). Prepandemic median CPAP usage at first follow-up was 5.4 (2.7-6.9) hours/night and fell by 0.9 hours/night (95% CI 0.5 to 1.2, p<0.0001) in 2020. We found clinically relevant reductions in CPAP usage with pathway changes post-COVID-19.

A review of biocompatibility in hernia repair; considerations in vitro and in vivo for selecting the most appropriate repair material

PURPOSE

Repair of hernia typically makes use of a prosthetic material; synthetic or biologic in nature. Any material which enters the body is subject to interrogation by the inflammation and immune system in addition to numerous other cell families, the outcome of which ultimately determines the success of the repair. In this review, we discuss the fundamental biology which occurs in situ when a biomaterial associates with a tissue, compare and contrast the techniques available to predict this in vitro, and review how features of hernia repair materials specifically may manipulate tissue interrogation and integration. Finally, we conclude our article by examining how biocompatibility impacts surgical practise and how a better understanding of the manner by which materials and tissues interact could benefit hernia repair.

MATERIALS AND METHODS

A review of the literature was conducted using appropriate scientific search engines in addition to inclusion of findings from the groups' primary research.

RESULTS

Using pre-clinical assays to anticipate the biocompatibility of a medical device is critical; however, to maximise the scientific power of in vitro findings, we must carefully consider the in vivo niche of the cells with which we are working. Excessive in vitro culture or contact to non-self materials can add compounding complexity to studies involving leucocytes for instance; therefore, we must ensure careful and stringent assay design when developing techniques for assaying pre-clinical biocompatibility. Furthermore, many of the features associated with hernia repair material design specifically, included to enhance their mechanical or biodegradation characteristics, are inadvertently instructive to cells, and therefore, throughout the prototype stages of a materials development, regular biocompatibility assessment must be performed.

CONCLUSION

The biocompatibility of a material is rate limiting in its ability to function as a medical device. The future of hernia repair materials will rely on close cohesion between the surgical and scientific communities to ensure the most robust biocompatibility assessment techniques, and models are utilised to predict the efficacy of a given material in a particular surgical application.

A scientific evidence for the efficacy of biologic implants for soft tissue reconstruction

The challenges and complications arising from abdominal surgery frequently necessitate soft tissue reconstruction or augmentation. Soft tissue repair generally has been revolutionised by the introduction of synthetic meshes, but their use is contra-indicated in contaminated or infected fields. Biologic materials derived from devitalised allo- or xenogeneic tissues have been proposed as a safer alternative to synthetics and provide an extracellular scaffold necessary for the in-growth of new blood vessels and infiltration of native stromal cells. We review the scientific evidence behind commercially available biologic prostheses in relation to the impact of tissue source, manufacturing processes and supplemental cross-linking on in vitro and in vivo (animal model and clinical) performance. Cross-linked meshes exhibit increased resistance to collagenase activity and degradation whilst still allowing tissue in-growth. Mesh durability may be the most important characteristic in determining optimal clinical outcomes, particularly in the context of the increased collagenase activity seen in contaminated or infected fields. Of all the biologic meshes currently available, HDMI cross-linked acellular porcine dermis has been associated with the best clinical outcomes in contaminated or infected fields.

In vitro activation of human leukocytes in response to contact with synthetic hernia meshes

OBJECTIVES

Evaluation of an in vitro chemiluminescent screen to predict leukocyte ROS in response to surgical materials.

DESIGN AND METHODS

6 surgical meshes; manufacture and knitting variations of polypropylene (PP), polyester terephtalate (PET) and polyglycolic acid (PGA) trialled healthy human blood (n=5). Materials and blood were incubated with pholasin. Pholasin emits photons in the presence of reactive oxygen species; secreted by activated leukocytes.

RESULTS

Multifilament-PGA mesh stimulated the greatest ROS response from blood derived human leukocytes. Multifilament-PET light weight and multifilament-PP meshes stimulated similar levels of ROS production which were greater than monofilament-PP light, monofilament-PP and monofilament-PET light meshes. Data demonstrated statistical variations in trans-donor response to the materials.

CONCLUSIONS

An in vitro chemiluminescent assay can be used to assess leukocyte respiratory burst response to biomaterials. PGA mesh elicited the greatest ROS response. PP and PET monofilament meshes induce less ROS than multifilament equivalents. In vitro results correlate with previously published clinical responses to these materials.

Cerebral MRI findings and cognitive functioning: the Atherosclerosis Risk in Communities study

OBJECTIVE

To examine the association between prevalent cerebral abnormalities identified on MRI and cognitive functioning in a predominantly middle-aged, population-based study cohort.

METHODS

Cerebral MRI was performed on 1,538 individuals (aged 55 to 72) from the Atherosclerosis Risk in Communities (ARIC) cohort, with no history of stroke or TIA, at study sites in Forsyth County, NC, and Jackson, MS. White matter hyperintensities (WMHs), ventricular size, and sulcal size were graded by trained neuroradiologists on a semiquantitative, 10-point scale. Cognitive functioning was assessed using the Delayed Word Recall Test (DWRT), Digit Symbol Substitution Test (DSST), and Word Fluency Test (WFT).

RESULTS

High ventricular grade was independently associated with significantly lower scores on the DWRT and DSST and greater risk (odds ratio [OR] 2.32, 95% confidence interval [CI] 1.51 to 3.56) of impaired scores (i.e., < or =10th percentile) on the DWRT. High sulcal grade was associated with a modest decrement in scores on the DWRT. The presence of coexisting high grade WMHs and silent infarcts was independently associated with lower scores on all cognitive tests and greater risk of impaired functioning on the DSST (OR 2.91, 95% CI: 1.23 to 6.89) and WFT (OR 2.28, 95% CI 1.03 to 5.08). The presence of two or more high-grade abnormalities was associated with increased risk of impaired functioning on all cognitive tests (DWRT: OR 2.23, 95% CI 1.40 to 3.55; DSST: OR 2.06, 95% CI 1.13 to 3.76; WFT: OR 2.07, 95% CI 1.23 to 3.49) independent of multiple covariates and silent infarcts.

CONCLUSION

Common changes in brain morphology are associated with diminished cognitive functioning in middle-aged and young-elderly individuals.

Investigation of the permeability of humic molecules using zeta potential measurements

Zeta potential measurements have been performed on colloidal humate in the presence of differing concentrations of sodium ions at pH = 6.0. A series of calculations has been performed in which the radius of the humic colloid was varied until the predicted surface potential was equal to the experimentally determined zeta potential. The results of the calculations showed that as the ionic strength increases, the apparent radius of the colloid decreases. Similar calculations in which a model colloid was treated as a rigid sphere, i.e., the radius of the colloid was kept constant, failed to simulate the observed zeta potential measurements.

Holmium:YAG laser treatment of recurrent superficial bladder carcinoma: initial clinical experience

PURPOSE

To review our initial experience with the holmium laser in patients with recurrent superficial bladder cancer.

PATIENTS AND METHODS

We treated 41 patients having 71 recurrent superficial transitional-cell tumors of the bladder between December 1994 and September 1997 using the holmium:YAG laser under local anesthesia. The laser treatment was carried out as a part of the follow-up flexible cystoscopy protocol, and topical anesthesia was used. The mean follow-up was 14 months (range 3-33 months).

RESULTS

There were 13 recurrent tumors in the treated area and 38 recurrences in the untreated areas. Of interest, a subgroup of 10 patients were treated before 1994 with cystodiathermy and later on with the holmium:YAG laser at various times during their follow-up. The local recurrence rate with cystodiathermy was 32% compared with 10% after laser treatment (P = 0.39). A questionnaire study of 33 patients showed complete satisfaction with the treatment. Only 2 (6%) elected to have a further procedure under general anesthesia. In the series, 83% scored their pain as 2 or less of 10 on a visual analog scale.

CONCLUSIONS

The absence of complications, high patient satisfaction, and ability to be used in the outpatient setting make the holmium:YAG laser an attractive alternative in the treatment of recurrent superficial cancer of the bladder.

Depth of lesion model in children and adolescents with moderate to severe traumatic brain injury: use of SPGR MRI to predict severity and outcome

OBJECTIVES

The utility of a depth of lesion classification using an SPGR MRI sequence in children with moderate to severe traumatic brain injury (TBI) was examined. Clinical and depth of lesion classification measures of TBI severity were used to predict neurological and functional outcome after TBI.

METHODS

One hundred and six children, aged 4 to 19, with moderate to severe TBI admitted to a rehabilitation unit had an SPGR MRI sequence obtained 3 months afterTBI. Acquired images were analyzed for location, number, and size of lesions. The Glasgow coma scale (GCS) was the clinical indicator of severity. The deepest lesion present was used for depth of lesion classification. Speed of injury was inferred from the type of injury. The disability rating scale at the time of discharge from the rehabilitation unit (DRS1) and at 1 year follow up (DRS2) were functional outcome measures.

RESULTS

The depth of lesion classification was significantly correlated with GCS severity, number of lesions, and both functional measures, DRS1 and DRS2. This result was more robust for time 1, probably due to the greater number of psychosocial factors impacting on functioning at time 2. Lesion volume was not correlated with the depth of lesion model. In multivariate models, depth of lesion was most predictive of DRS1, whereas GCS was most predictive of DRS2.

CONCLUSIONS

A depth of lesion classification of TBI severity may have clinical utility in predicting functional outcome in children and adolescents with moderate to severe TBI.

Clinical correlates of ventricular and sulcal size on cranial magnetic resonance imaging of 3,301 elderly people. The Cardiovascular Health Study. Collaborative Research Group

To identify potential risk factors for and clinical manifestations of ventricular and sulcal enlargement on cranial magnetic resonance imaging (MRI), 3,301 community-dwelling people 65 years or older without a history of stroke or transient ischemic attack underwent extensive standardized evaluations and MRI. In the multivariate model, increased age and white matter grade on MRI were the dominant risk factors for ventricular and sulcal grade. For ventricular grade, other than race, for which non-Blacks had higher grades, models for men and women shared no other factors. For sulcal grades, models for men and women shared variables reflecting cigarette smoking and diabetes. Clinical features were correlated more strongly with ventricular than sulcal grade and more strongly for women than men. Significant age-adjusted correlations between ventricular grade and the Digit-Symbol Substitution Test were found for men and women. Prospective studies will be needed to extend findings of this cross-sectional analysis.

Lacunar infarcts defined by magnetic resonance imaging of 3660 elderly people: the Cardiovascular Health Study

OBJECTIVE

To identify risk factors for and functional consequences of lacunar infarct in elderly people.

METHODS

The Cardiovascular Health Study (CHS) is a longitudinal study of people 65 years or older, in which 3660 participants underwent cranial magnetic resonance imaging (MRI). Neuroradiologists read scans in a standard fashion without any clinical information. Lacunes were defined as subcortical areas consistent with infarcts measuring 3 to 20 mm. In cross-sectional analyses, clinical correlates were contrasted among groups defined by MRI findings.

RESULTS

Of the 3660 subjects who underwent MRI, 2529 (69%) were free of infarcts of any kind and 841 (23%) had 1 or more lacunes without other types present, totaling 1270 lacunes. For most of these 841 subjects, their lacunes were single (66%) and silent (89%), namely without a history of transient ischemic attack or stroke. In multivariate analyses, factors independently associated with lacunes were increased age, diastolic blood pressure, creatinine, and pack-years of smoking (listed in descending order of strength of association; for all, P < .005), as well as maximum internal carotid artery stenosis of more than 50% (odds ratio [OR], 1.81; P < .005), male sex (OR, 0.74; P < .005), and history of diabetes at entrance into the study (OR, 1.33; P < .05). Models for subgroups of single, multiple, silent, and symptomatic lacunes differed only minimally. Those with silent lacunes had more cognitive, upper extremity, and lower extremity dysfunction not recognized as stroke than those whose MRIs were free of infarcts.

CONCLUSIONS

In this group of older adults, lacunes defined by MRI are common and associated with factors that likely promote or reflect small-vessel disease. Silent lacunes are also associated with neurologic dysfunction.

Relationship between ApoE, MRI findings, and cognitive function in the Cardiovascular Health Study

BACKGROUND AND PURPOSE

We determined the relationship between apolipoprotein (Apo)E, MRI, and low cognitive scores.

METHODS

The relationship between age, education, ApoE genotype, MRI examination of the brain, subclinical and clinical cardiovascular disease, and low (<80) score on the Modified Mini-Mental State Examination (3MSE, as modified by Teng and Chui) was evaluated for 3469 black and white participants in the Cardiovascular Health Study (CHS) in years 5 and 6 of the study. The participants were followed for up to 3 years.

RESULTS

The prevalence of scores <80 in years 5 and 6 of the CHS was 8.2% for participants without and 20.4% for those with prior history of stroke. Age, race, and education were important determinants of low 3MSE scores. The prevalence of ApoE-4 (odds ratio [OR], 1.6 [1.1 to 2.1]) was directly related to scores <80, as was high ventricular volume (OR, 1.6 [1.2 to 2.3]), high white matter grade (OR, 1.4 [1.1 to 1.9]), and infarctlike lesions (OR, 1.6 [1.2 to 2.1]) on the MRI in the multivariate analysis. A five-point or greater decline in scores over up to 3 years was more often observed for participants with low 3MSE scores at year 5, at older ages, with lower education, and experiencing incident stroke (OR, 3.6 [1.2 to 10.6]), ApoE-4 genotype (OR, 1.8 [1.4 to 2.3]), and with MRI findings of high ventricular volume (OR, 2.0 [1.5 to 2.7]), and infarctlike lesions (OR, 1.2 [0.9 to 1.5]).

CONCLUSIONS

These results demonstrate that vascular changes on MRI, measures of brain atrophy, ApoE-4, and age, education, and race are associated with low cognitive scores among older individuals. The MRI of the brain provides valuable information related to cognitive tests and decline over time. The potential exists for using MRI measurements to identify high-risk individuals for dementia and to test potential interventions to reduce the risk of dementia.

Interactions of recombinant hemoglobin (rHb1.1) and endotoxin in vivo: effects on systemic tumor necrosis factor and interleukin-6 levels in lethal and sublethal murine models of endotoxemia

The effects of acellular hemoglobin-based oxygen carriers in preclinical models of sepsis and endotoxemia have been inconclusive with regard to outcomes reported for survival. In the present study, mice were infused with 1 gm/kg of recombinant human hemoglobin, rHb1.1, and the effects on mortality and systemic tumor necrosis factor (TNF) and interleukin-6 (IL-6) levels were determined by using both lethal and sublethal bolus endotoxin challenge. Pretreatment of mice with rHb1.1 and challenge with 20 mg/kg of lipopolysaccharide (LPS) at an LD100 resulted in a 100% mortality rate by 20 hours, whereas the same mortality rate with the vehicle or 5% albumin groups occurred at 50 hours. Mice challenged with lower LPS concentrations of 10 and 2.5 mg/kg, corresponding to LD15 and LD0, respectively, had 100% and 17% mortality rates in the rHb group and 17% and 0% mortality rates in the vehicle-treated animals. These doses of LPS resulted in maximal increases in systemic TNF, and there were only modest differences between the rHb and the vehicle groups at LPS challenge doses of 2.5 and 20 mg/kg, whereas no difference was observed at the 10 mg/kg concentration. At LPS concentrations below 10 microg/kg, the increases in circulating TNF were dose dependent and no differences were observed in serum TNF levels between the rHb1.1 and vehicle groups. In addition, there were generally no differences in IL-6 levels between the experimental groups, although at 10 mg/kg LPS, a twofold increase in plasma IL-6 levels over those in the controls was observed in the rHb1.1-treated animals. Infusion of rHb1.1 alone did not induce any increase in circulating IL-6 or TNF. These data demonstrate that endotoxin exacerbation, although apparent, was observed only at the highest doses of LPS and that at lower concentrations, there were no differences in the extent of cytokine elevation or in survival rate when rHb1.1-, albumin-, or vehicle-pretreated animals were compared.

Chronic administration of dexamethasone results in Fc receptor up-regulation and inhibition of class I antigen expression on macrophages from MRL/lpr autoimmune mice

The MRL/lpr mouse develops, after approximately 8 weeks of age, a severe autoimmune syndrome with many features resembling human systemic lupus erythematosus, including autoantibodies against DNA and basement membranes resulting in immune complexes, vasculitis, and multiorgan disease. While this murine model of lupus has been used for the identification of therapeutics with potential efficacy in human autoimmune disease, the long-term impact of chronic immunosuppressive therapy on macrophage function in this paradigm is not understood. To this end, MRL/lpr mice were treated prophylactically with dexamethasone at 0.01, 0.1, and 1 mg/kg of body weight for 20 weeks or were allowed to develop autoimmune disease and, at 15 weeks of age, treated therapeutically with 1-mg/kg dexamethasone for 8 additional weeks. Analysis of surface antigens on resident peritoneal macrophages demonstrated a progressive loss in class I expression with a concomitant increase in Fc receptor expression. Neither phagocytosis nor CD11b expression was modulated with chronic steroid treatment. Furthermore, dexamethasone treatment was associated with a reduction in anti-DNA antibodies and total immunoglobulin G and yet an elevation in serum cholesterol due to an increase in high-density lipoproteins. Therefore, the MRL/lpr mouse serves not only as a small-animal model of autoimmune disease but also as one in which the negative and positive sequelae associated with chronic immunosuppression can be further understood.

The prevalence and severity of white matter lesions, their relationship with age, ethnicity, gender, and cardiovascular disease risk factors: the ARIC Study

White matter lesions (WMLs) detected by cerebral magnetic resonance imaging (MRI) are putatively a consequence of cerebral hypoperfusion or ischemia. We investigated the prevalence, severity and correlates of WMLs in a population-based sample of 1,920 African-American and European-American men and women aged 55-72 years, during the second follow-up examination of the Atherosclerosis Risk in Communities Study. The spin density images from 1.5-tesla MRI scans were used to define WMLs using a 0-9 scale with 0 for normal and 9 for most severe WMLs. Age was positively associated with the prevalence (percent) and severity of WMLs. African-Americans had lower overall prevalence of WMLs, but a higher prevalence of relatively more severe WMLs, than European-Americans. After adjusting for age, sex, and ethnicity, WMLs were significantly associated with smoking, lower education, hypertension, systolic blood pressure, and pulse pressure, and weakly associated with diastolic blood pressure. The associations of smoking, alcohol intake, systolic and diastolic blood pressure, pulse, pressure, and hypertension were stronger in African-Americans than in European-Americans (p < 0.15 for interactions by ethnicity). This population-based MRI study documents significant relationships between several cardiovascular disease risk factors and WMLs. The findings suggest that such factors play a role in the pathogenesis of WMLs, an elements linked to hypoperfusion and/or fluid accumulation, which presumably lead to WMLs. African-Americans exhibited both a higher proportion of normal white matter and a higher proportion of relatively more severe WMLs than European-Americans.

The effect of a selective estrogen receptor modulator on the progression of spontaneous autoimmune disease in MRL lpr/lpr mice

The MRL lpr/lpr mouse strain is an animal model for the autoimmune disorder systemic lupus erythematosus (SLE). Pathologic changes in the mice include a severe proliferative glomerulonephritis, lymph node and spleen enlargement, increase in autoantibody titers, and shortened life spans. In the present investigation, female MRL lpr/lpr mice have been dosed po daily for 7 months with the selective estrogen receptor modulator (SERM) LY139478 (4 mg/kg) or 17alpha-ethinylestradiol (EE2, 1 mg/kg) and compared to vehicle control animals. The LY139478 group had an increase in survival (73% survival at 7 months, P = 0.02) but the EE2-treated animals did not (53% survival at 7 months, P = 0.4) when compared to the control group (32% survival at 7 months). Although there were no reductions in autoantibody levels as determined by anti-DNA antibody ELISA, histological analysis of kidney tissue indicated that both LY139478 and EE2 mitigated the progression of glomerular nephritis which was evident in the controls. In contrast, there were no significant differences in lymph node size although the LY139478 and EE2 groups retained a well-defined sinusoidal region. Finally, flow cytometric analysis documented that thymuses from animals treated for 7 months with LY139478 but not with EE2 contained predominantly CD4+/CD+ T cells consistent with a normal thymic phenotype observed in non-MRL lpr/lpr mouse strains. These studies demonstrate that SERMs may be potentially useful for the treatment of autoimmune disorders.

Inhibition of LDL oxidation and myeloperoxidase dependent tyrosyl radical formation by the selective estrogen receptor modulator raloxifene (LY139481 HCL)

Cellular oxidation of protein and lipoproteins is believed to contribute to the pathology associated with both acute and chronic inflammatory processes. Enzymatic, myeloperoxidase and lipoxygenase, and non- enzymatic oxidation of low density lipoprotein, LDL, has been implicated in foam cell formation and the progression of atherosclerotic changes within the arterial wall. In the present study, the in vitro protective role of the selective estrogen receptor modulator, raloxifene, in these oxidant triggered processes has been investigated. Raloxifene, as with estrogen was observed to inhibit both copper mediated LDL oxidation as well as the cellular modification of LDL by murine peritoneal macrophages. Raloxifene was, however, a more potent inhibitor of LDL oxidation than 17 beta-estradiol. The inhibition of macrophage LDL modification by raloxifene was not due to a non-specific effect on all effector functions as phagocytosis of opsonized yeast was comparable with control macrophage cultures. In addition to the protective effects on LDL oxidation, raloxifene also inhibited tyrosyl radical formation catalyzed by myeloperoxidase. The inhibition of myeloperoxidase activity was observed for both the isolated enzyme and in phorbol ester stimulated murine peritoneal neutrophils. In contrast, raloxifene was a weaker inhibitor of horseradish peroxidase. These results demonstrate a potential protective role for raloxifene as an anti-oxidant in in vitro assays designed to evaluate oxidant mediated radical formation and tissue damage.

Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study

BACKGROUND AND PURPOSE

Our aim was to identify potential risk factors for and clinical manifestations of white matter findings on cranial MRI in elderly people.

METHODS

Medicare eligibility lists were used to obtain a representative sample of 5888 community-dwelling people aged 65 years or older. Correlates of white matter findings were sought among 3301 participants who underwent MRI scanning and denied a history of stroke or transient ischemic attack. Participants underwent extensive standardized evaluations at baseline and on follow-up, including standard questionnaires, physical examination, multiple blood tests, electrocardiogram, pulmonary function tests, carotid sonography, and M-mode echocardiography. Neuroradiologists graded white matter findings from 0 (none) to 9 (maximal) without clinical information.

RESULTS

Many potential risk factors were related to the white matter grade, but in the multivariate model the factors significantly (all P < .01) and independently associated with increased grade were greater age, clinically silent stroke on MRI, higher systolic blood pressure, lower forced expiratory volume in 1 second (FEV1), and income less than $50,000 per year. If excluded, FEV1 was replaced in the model by female sex, history of smoking, and history of physician-diagnosed hypertension at the baseline examination. Many clinical features were correlated with the white matter grade, especially those indicating impaired cognitive and lower extremity function.

CONCLUSIONS

White matter findings were significantly associated with age, silent stroke, hypertension, FEV1, and income. The white matter findings may not be considered benign because they are associated with impaired cognitive and lower extremity function.

Using a deformable surface model to obtain a shape representation of the cortex

This paper examines the problem of obtaining a mathematical representation of the outer cortex of the human brain, which is a key problem in several applications, including morphological analysis of the brain, and spatial normalization and registration of brain images. A parameterization of the outer cortex is first obtained using a deformable surface algorithm which, motivated by the structure of the cortex, is constructed to find the central layer of thick surfaces. Based on this parameterization, a hierarchical representation of the outer cortical structure is proposed through its depth map and its curvature maps at various scales. Various experiments on magnetic resonance data are presented.

Back school programs. The ballet dancer

This article discusses factors influencing back injury in ballet dancers and describes a back rehabilitation program. This program, which applies principles of motor skill acquisition in a progressive manner, has been modified for the young ballet dancer to incorporate aspects of dance class.

Hyperglycemic activity in dogs of recombinant DNA-derived 20,000 dalton variant of methionyl human growth hormone

The recombinant DNA-derived 20,000-dalton variant of N-terminal methionyl human growth hormone (20K-Met-hGH) had a hyperglycemic effect in fasted dogs when injected 11 hours prior to an oral glucose tolerance test (OGTT). These results reported here suggest that 20K-Met-hGH can induce glucose intolerance in dogs similar to that produced by recombinant DNA-derived 22,000 dalton N-terminal methionyl human growth hormone (22K-Met-hGH) and the normal pituitary-source human growth hormone (22K-hGH).

Pergolide for the treatment of pituitary tumors secreting prolactin or growth hormone

We gave pergolide mesylate, a new long-acting ergot derivative with dopaminergic properties, to 47 patients with hypersecretion of prolactin or growth hormone. Single doses produced long-lasting reductions of serum prolactin levels; after 24 hours, the values remained depressed at a mean of 28.8 per cent of the base-line value. Among 41 patients (22 women and 19 men) with hyperprolactinemia who took pergolide for three months or more, prolactin levels fell to normal in 37 and remained slightly elevated in 2. In the two patients in whom the levels fell to only 38 to 52 per cent of base line, treatment was regarded as a failure. The level of growth hormone fell to a mean of 52.8 per cent of base line in patients with acromegaly who were taking 100 micrograms of pergolide per day. Among patients for whom adequate CT scans were available, definite tumor shrinkage occurred in 10 of 13 with macroadenomas and definite or probable shrinkage in 5 of 9 with microadenomas. Menses returned in 76 per cent of treated women and testosterone levels rose in 10 of 14 men. We conclude that pergolide reduces hypersecretion and shrinks most prolactin-secreting macroadenomas. In some patients long-term pergolide therapy may be superior to surgery and x-ray treatment.

Persistent hypoglossal artery and persistent trigeminal artery presenting with posterior fossa transient ischemic attacks. Report of two cases

Two patients, one with a persistent hypoglossal artery and the other with a persistent trigeminal artery, presented with transient ischemic attacks in the distribution of the posterior fossa. Both had stenosis and ulcerative plaques at the carotid bifurcation. Their symptoms were successfully relieved after carotid endarterectomy.