Choroidal thickness in regressed retinopathy of prematurity

PURPOSE

To compare choroidal thickness in patients with regressed retinopathy of prematurity (ROP) with healthy controls using enhanced depth imaging optical coherence tomography (EDI OCT) METHODS: Twenty-four children and young adults (41 eyes) with regressed ROP≥stage 3 had undergone EDI OCT with Spectralis FD-OCT as part of their clinical record. Their refraction, best-corrected visual acuity, and ophthalmoscopic findings were recorded. Corresponding data was collected prospectively from 33 healthy controls (58 eyes) who had been born at term. Choroidal thickness was measured independently by two observers subfoveally and at 1500 μm nasal and temporal to the fovea using EDI OCT.

RESULTS

Mean subfoveal choroidal thickness, adjusted for refraction, was 271.1 μm (95% CI, 247.8-294.5) in the ex-ROP group, which was significantly thinner than 327.4 μm (95% CI, 293.8-360.9) in controls (P=0.008). Similarly, mean adjusted temporal choroidal thickness was 257.2 μm (95% CI, 240.2-274.2) in ex-ROP's vs 320.5 μm (95% CI, 288.6-352.3) in controls (P=0.001). There was no statistically significant difference in the nasal measurement. In the ex-ROP group, there was no significant correlation between subfoveal choroidal thickness and gestational age (r(s)=0.16, P=0.46) or birthweight (r(s)=0.03, P=0.90). In eyes without copathology in addition to regressed ROP (29 eyes, 19 patients), there was no significant correlation between subfoveal choroidal thickness and visual acuity.

CONCLUSIONS

Our findings of thinner subfoveal and temporal macular choroidal thickness in regressed ROP support the case for choroidal involvement in the pathogenesis of this condition.

Peripheral infusion of insulin-like growth factor-I increases the number of newborn oligodendrocytes in the cerebral cortex of adult hypophysectomized rats

We have previously shown that recombinant human (rh) IGF-I induces cell proliferation and neurogenesis in the hippocampus of hypophysectomized rats. In the current investigation, we determined the effects of rhIGF-I on proliferation and differentiation in the cerebral cortex. Adult hypophysectomized rats were injected with bromodeoxyuridine (BrdU) to label newborn cells (once a day for the first 5 d), and rhIGF-I was administered peripherally for 6 or 20 d. In the cerebral cortex, the number of BrdU-labeled cells increased after 20 d but not after 6 d of rhIGF-I infusion. This suggests that rhIGF-I enhances the survival of newborn cells in the cerebral cortex. Using BrdU labeling combined with the oligodendrocyte-specific markers myelin basic protein and 2',3'-cyclic nucleotide 3'-phosphodiesterase, we demonstrated an increase in oligodendrogenesis in the cerebral cortex. The total amount of myelin basic protein and 2',3'-cyclic nucleotide 3'-phosphodiesterase was also increased on Western blots of homogenates of the cerebral cortex, confirming the immunohistochemical findings. Also, we observed an increase in the number of capillary-associated BrdU-positive cells, although total capillary area was not increased. rhIGF-I treatment did not affect cortical astrogliogenesis and neurogenesis was not observed. The ability of rhIGF-I to induce cortical oligodendrogenesis may have implications for the regenerative potential of the cortex.

Human neuroblasts migrate to the olfactory bulb via a lateral ventricular extension

The rostral migratory stream (RMS) is the main pathway by which newly born subventricular zone cells reach the olfactory bulb (OB) in rodents. However, the RMS in the adult human brain has been elusive. We demonstrate the presence of a human RMS, which is unexpectedly organized around a lateral ventricular extension reaching the OB, and illustrate the neuroblasts in it. The RMS ensheathing the lateral olfactory ventricular extension, as seen by magnetic resonance imaging, cell-specific markers, and electron microscopy, contains progenitor cells with migratory characteristics and cells that incorporate 5-bromo-2'-deoxyuridine and become mature neurons in the OB.

Immunohistochemical distribution of glucose-dependent insulinotropic polypeptide in the adult rat brain

We have previously demonstrated that glucose-dependent insulinotropic polypeptide (GIP; gastric inhibitory polypeptide) is present in the adult rat hippocampus. This finding leads to the conclusion that all members of the secretin-glucagon family of gastrointestinal regulatory polypeptides can be found in the brain. To investigate the localization of GIP-producing cells, we used immunohistochemistry on sections of the adult rat brain. High levels of GIP immunoreactivity were observed in the olfactory bulb, hippocampus, and Purkinje cells in the cerebellum. Moreover, a moderate but distinct GIP immunoreactivity was observed in the cerebral cortex, amygdala, substantia nigra, and lateral septal nucleus as well as in several nuclei in the thalamus, hypothalamus, and brainstem. GIP immunoreactivity was frequently found to colocalize with the neuronal marker NeuN but never with the glial marker glial fibrillary acidic protein. Thus, GIP appears to be mainly neuronal to its distribution. This widespread distribution of GIP-immunoreactive cells suggests the involvement of GIP in various neuronal functions and suggests that GIP may act as a neurotransmitter or neuromodulator. This is the first characterization of the anatomical distribution of GIP-immunoreactive cells in the rat brain providing an anatomical framework for future investigations regarding the functions of GIP in the central nervous system.

Glucose-dependent insulinotropic polypeptide is expressed in adult hippocampus and induces progenitor cell proliferation

The hippocampal dentate gyrus (DG) is an area of active proliferation and neurogenesis within the adult brain. The molecular events controlling adult cell genesis in the hippocampus essentially remain unknown. It has been reported previously that adult male and female rats from the strains Sprague Dawley (SD) and spontaneously hypertensive (SHR) have a marked difference in proliferation rates of cells in the hippocampal DG. To exploit this natural variability and identify potential regulators of cell genesis in the hippocampus, hippocampal gene expression from male SHR as well as male and female SD rats was analyzed using a cDNA array strategy. Hippocampal expression of the gene-encoding glucose-dependent insulinotropic polypeptide (GIP) varied strongly in parallel with cell-proliferation rates in the adult rat DG. Moreover, robust GIP immunoreactivity could be detected in the DG. The GIP receptor is expressed by cultured adult hippocampal progenitors and throughout the granule cell layer of the DG, including progenitor cells. Thus, these cells have the ability to respond to GIP. Indeed, exogenously delivered GIP induced proliferation of adult-derived hippocampal progenitors in vivo as well as in vitro, and adult GIP receptor knock-out mice exhibit a significantly lower number of newborn cells in the hippocampal DG compared with wild-type mice. This investigation demonstrates the presence of GIP in the brain for the first time and provides evidence for a regulatory function for GIP in progenitor cell proliferation.

Hypoxic preconditioning confers long-term reduction of brain injury and improvement of neurological ability in immature rats

Exposure to preconditioning (PC) hypoxia 24 h before a severe hypoxic-ischemic (HI) insult reduces development of injury in the immature brain. Several protective regimens have proved effective in the short-term but not in the long-term perspective. The aim of the present study, therefore, was to evaluate the PC effect on long-term morphologic and neurologic outcome in the developing brain. Six-day-old rats were subjected to hypoxia (36 degrees C, 8.0% O2; PC/HI group) and sham controls to normoxia (36 degrees C; HI group) for 3 h. Twenty-four hours later, all rats were exposed to cerebral HI produced by unilateral carotid artery occlusion combined with 1 h, 15 min of hypoxia (36 degrees C, 7.7% O2). A cylinder test was used to evaluate forelimb asymmetry to determine sensorimotor function at 4, 6, and 8 wk of age. Spatial/cognitive ability was assessed by Morris water maze trials at 7 wk of recovery. Neuropathologic analysis was performed 8 wk after insult. Brain damage was reduced (p<0.0001) in PC/HI (45.0+/-11.1 mm3) in comparison with HI (159.3+/-12.2 mm3) rats. A bias for using the ipsilateral forelimb in wall movements was observed in the cylinder test in HI compared with PC/HI rats at 4 (p<0.001), 6 (p<0.01), and 8 (p<0.0001) wk of age. Results of the Morris water maze test revealed differences (p<0.0001) in average path length between groups on the third and fourth day of trials. Hypoxic PC before HI reduced brain injury by 72% at 8 wk after the insult and provided long-term improvement of sensorimotor and spatial/cognitive functions.

Glutathione monoethyl ester provides neuroprotection in a rat model of stroke

Oxidative stress plays an important role in the development of tissue damage following transient focal cerebral ischaemia. Glutathione is a central component in the antioxidant defence of cells. We have previously shown a close association between mitochondrial glutathione loss and cell death following middle cerebral artery (MCA) occlusion. Glutathione monoethyl ester increases cellular glutathione and is particularly effective in increasing the mitochondrial pool. In the present investigation, we infused glutathione monoethyl ester into the third ventricle during 2 h of MCA occlusion and 48 h of reperfusion. Infarct size was reduced from 46% of the total ischaemic hemisphere in saline-treated animals to 16% following ester treatment. Thus, glutathione monoethyl ester provides neuroprotection following transient focal cerebral ischaemia.

Glutathione monoethylester prevents mitochondrial glutathione depletion during focal cerebral ischemia

Glutathione is a central component in the antioxidant defences of cells. We have recently reported an early and selective loss of total (reduced plus oxidised) glutathione from mitochondria isolated from rat brain following occlusion of the middle cerebral artery. This mitochondrial glutathione depletion showed an apparent association with the tissue damage that developed during subsequent reperfusion, suggesting that it could be an important determinant of susceptibility to cell loss. In the present study, we have investigated whether in vivo treatment with glutathione ethyl ester can modulate mitochondrial glutathione in the brain and whether this treatment can influence the response to focal ischemia. In further support of our previous findings, middle cerebral artery occlusion caused a duration-dependent partial loss of mitochondrial glutathione. Bilateral injections of glutathione ethyl ester immediately prior to induction of unilateral focal ischemia resulted in a substantial increase in glutathione in mitochondria from the striatum of both the non-ischemic hemisphere (190% of saline-treated controls) and the ischemic hemisphere (240% of controls) at 2h after arterial occlusion. Total tissue glutathione was not affected by the ester treatment at this time. A smaller increase in mitochondrial glutathione was observed at 3h of occlusion in the non-ischemic striatum following ester treatment but at this time point glutathione was not significantly altered in mitochondria from the ischemic hemisphere. Pre-ischemic treatment with glutathione ester did not significantly change the volume of tissue infarction assessed at 48 h following ischemia for 2 or 3h. These studies demonstrate that glutathione ethyl ester is a highly effective modulator of the mitochondrial glutathione pool in the intact brain and provides a useful means for further investigating the role of this antioxidant in the development of tissue damage in ischemia and other brain disorders.

Astrocytes and stroke: networking for survival?

Astrocytes are now known to be involved in the most integrated functions of the central nervous system. These functions are not only necessary for the normally working brain but are also critically involved in many pathological conditions, including stroke. Astrocytes may contribute to damage by propagating spreading depression or by sending proapoptotic signals to otherwise healthy tissue via gap junction channels. Astrocytes may also inhibit regeneration by participating in formation of the glial scar. On the other hand, astrocytes are important in neuronal antioxidant defense and secrete growth factors, which probably provide neuroprotection in the acute phase, as well as promoting neurogenesis and regeneration in the chronic phase after injury. A detailed understanding of the astrocytic response, as well as the timing and location of the changes, is necessary to develop effective treatment strategies for stroke patients.

The effects of focal ischemia and reperfusion on the glutathione content of mitochondria from rat brain subregions

Glutathione is a key cellular antioxidant that is contained in both cytoplasmic and mitochondrial compartments. Previous investigations indicate that depletion of the mitochondrial pool of glutathione can greatly reduce cell viability. In the present investigation, the effect of focal cerebral ischemia on total (reduced plus oxidized) glutathione in mitochondria was assessed using a rat model of middle cerebral artery occlusion. Total glutathione was substantially decreased in mitochondria prepared from severely ischemic focal tissue in both the cerebral cortex and striatum at 2 h of vessel occlusion and persisted for at least the first 3 h of reperfusion. The loss of mitochondrial glutathione was not associated with decreases of the total tissue glutathione content and was not due to the formation of mixed disulfides with mitochondrial proteins. Thus, an imbalance between uptake and release from the mitochondria in the ischemic tissue provides the most likely explanation for the loss. Decreases in glutathione also developed in mitochondria from the moderately ischemic perifocal tissue when the period of arterial occlusion was extended to 3 h. The presence of mitochondrial glutathione depletion during ischemia showed an apparent close association with the subsequent development of tissue infarction. These findings are consistent with a role for the glutathione depletion in determining the susceptibility of brain tissue to focal ischemia.

Mitochondrial contributions to tissue damage in stroke

Tissue infarction, involving death of essentially all cells within a part of the brain, is a common pathology resulting from stroke and an important determinant of the long-term consequences of this disorder. The cell death that leads to infarct formation is likely to be the result of multiple interacting pathological processes. A range of factors, including the severity of the ischemic insult and whether this is permanent or reversed, determine which mechanisms predominate. Although evaluating mitochondrial properties in intact brain is difficult, evidence for several potentially deleterious responses to cerebral ischemia or post-ischemic reperfusion have been obtained from investigations using animal models of stroke. Marked changes in ATP and related energy metabolites develop quickly in response to occlusion of a cerebral artery, as expected from limitations in the delivery of oxygen and glucose. However, these alterations are often only partially reversed on reperfusion despite improved substrate delivery. Ischemia-induced decreases in the mitochondrial capacity for respiratory activity probably contribute to the ongoing impairment of energy metabolism during reperfusion and possibly also to the magnitude of changes seen during ischemia. Conditions during reperfusion are likely to be conducive to the induction of the permeability transition in mitochondria. There are as yet no well-characterized techniques to identify this change in the intact brain. However, the protective effects of some agents that block formation of the transition pore are consistent with both the induction of the permeability transition during early recirculation and a role for this in the development of tissue damage. Release of cytochrome c into the cytoplasm of cells has been observed with both permanent and reversed ischemia and could trigger the death of some cells by apoptosis, a process which probably contributes to the expansion of the ischemic lesion. Mitochondria are also likely to contribute to the widely-accepted role of nitric oxide in the development of ischemic damage. These organelles are a probable target for the deleterious effects of this substance and can also act as a source of superoxide for reaction with the nitric oxide to produce the damaging species, peroxynitrite. Further characterization of these mitochondrial responses should help to elucidate the mechanisms of cell death due to cerebral ischemia and possibly point to novel sites for therapeutic interventions in stroke.

Insulin-like growth factor-I and neurogenesis in the adult mammalian brain

In most brain regions of highly developed mammals, the majority of neurogenesis is terminated soon after birth. However, new neurons are continually generated throughout life in the subventricular zone and the dentate gyrus of the hippocampus. Insulin-like growth factor-I (IGF-I) is a polypeptide hormone that has demonstrated effects on these progenitor cells. IGF-I induces proliferation of isolated progenitors in culture, as well as affecting various aspects of neuronal induction and maturation. Moreover, systemic infusion of IGF-I increases both proliferation and neurogenesis in the adult rat hippocampus, and uptake of serum IGF-I by the brain parenchyma mediates the increase in neurogenesis induced by exercise. Neurogenesis in the adult brain is regulated by many factors including aging, chronic stress, depression and brain injury. Aging is associated with reductions in both hippocampal neurogenesis and IGF-I levels, and administration of IGF-I to old rats increases neurogenesis and reverses cognitive impairments. Similarly, stress and depression also inhibit neurogenesis, possibly via the associated reductions in serotonin or increases in circulating glucocorticoids. As both of these changes have the potential to down regulate IGF-I production by neural cells, stress may inhibit neurogenesis indirectly via downregulation of IGF-I. In contrast, brain injury stimulates neurogenesis, and is associated with upregulation of IGF-I in the brain. Thus, there is a tight correlation between IGF-I and neurogenesis in the adult brain under different conditions. Further studies are needed to clarify whether IGF-I does indeed mediate neurogenesis in these situations.

Brain mitochondrial responses to postischemic reperfusion: a role for calcium and hydrogen peroxide?

During early recirculation following global brain ischemia, mitochondria are exposed to markedly elevated Ca(2+) concentrations and a short-lived production of reactive oxygen species, including hydrogen peroxide (H(2)O(2)). A brief increase in mitochondrial Ca(2+) and a subsequent increase in mitochondrial glutathione content have been observed. In the present study, we have confirmed the increase in mitochondrial glutathione in a rat model of global forebrain ischemia. This change was not inhibited by treatment of the rats with FK506, contrasting with our previous finding that cyclosporin A partially blocked the increase. These results suggest that induction of the mitochondrial permeability transition may be necessary for the increase in glutathione content in these organelles. To further investigate possible mitochondrial responses during early postischemic reperfusion, mitochondria isolated from normal brain were exposed to Ca(2+) and H(2)O(2), under conditions similar to those in intact cells. Respiratory activity was substantially modified when the mitochondria were exposed to Ca(2+) and H(2)O(2) together. Two distinct and largely noninteracting mechanisms apparently accounted for the responses to these agents. The effects of Ca(2+), but not H(2)O(2), were inhibited by cyclosporin A, again implicating the permeability transition in some of the mitochondrial changes.

Impairment of brain mitochondrial function by hydrogen peroxide

Hydrogen peroxide, at concentrations comparable to those observed under some pathological conditions, produced a concentration-dependent inhibition of state 3 (ADP-stimulated) and uncoupled mitochondrial respiratory activity. The ADP:O ratio was also substantially reduced. In contrast, the organic peroxide, t-butylhydroperoxide at the same concentrations produced no significant changes in respiratory activity. Intramitochondrial glutathione was oxidised to a similar extent in the presence of hydrogen peroxide or t-butylhydroperoxide. Thus, changes in this endogenous antioxidant apparently did not underlie the different responses to these peroxides. The effects of hydrogen peroxide were not altered by deferoxamine indicating that the extramitochondrial generation of hydroxyl radicals was not likely to be involved. However, modifications arising from the generation of hydroxyl radicals within the mitochondria remain a likely contributor to the observed deleterious effects on respiratory function. The inhibitory effects of hydrogen peroxide were greatest when pyruvate plus malate were present as respiratory substrates. Lesser inhibition was seen with glutamate plus malate and no significant inhibitory effects were detected in the presence of succinate. The findings suggest that mitochondrial components involved in pyruvate oxidation were particularly sensitive to the hydrogen peroxide treatment. However, no significant change was seen in activity of either the pyruvate dehydrogenase complex or NADH-ubiquinone oxidoreductase (complex I) when measured directly following treatment of the mitochondria with hydrogen peroxide.

Improved recovery of highly enriched mitochondrial fractions from small brain tissue samples

The investigation of mitochondrial abnormalities in brain commonly requires isolation of these organelles from small tissue samples. We have modified a mitochondrial isolation procedure based on Percoll density gradient centrifugation to increase the proportion of the total mitochondrial pool recovered while reducing contamination with synaptosomes and related structures containing cytoplasm. Initially, myelin was removed by centrifugation in 12% Percoll in isotonic buffer. The pellet was resuspended, treated with digitonin to break up synaptosomes and similar structures and subjected to discontinuous Percoll density gradient centrifugation. The mitochondrial fraction obtained from this procedure was highly metabolically active and well coupled, exhibiting respiratory control ratios above 5. The recovery of mitochondrial markers using a single rat forebrain as starting material was approximately 18% to 21%. When small tissue samples (approximately 50 mg wet weight) were used as starting material the recovery of the mitochondrial marker was approximately 16%. The ratio of recovery of a mitochondrial marker to the cytoplasmic marker lactate dehydrogenase exceeded 200 in preparations from a single rat forebrain. This is substantially greater than values reported for previously published procedures reflecting both an improved yield of mitochondria and a reduction in cytoplasmic contamination.

Mitochondrial respiratory function and cell death in focal cerebral ischemia

Pyruvate-supported oxygen uptake was determined as a measure of the functional capacity of mitochondria obtained from rat brain during unilateral middle cerebral artery occlusion and reperfusion. During ischemia, substantial reductions developed in both ADP-stimulated and uncoupled respiration in tissue from the focus of the affected area in the striatum and cortex. A similar pattern of change but with lesser reductions was seen in the adjacent perifocal tissue. Succinate-supported respiration was more affected than that with pyruvate in perifocal tissue at 2 h of ischemia, suggesting additional alterations to mitochondrial components in this tissue. Mitochondrial respiratory activity recovered fully in samples from the cortex, but not the striatum, within the first hour of reperfusion following 2 h of ischemia and remained similar to control values at 3 h of reperfusion. In contrast, impairment of the functional capacity of mitochondria from all three regions was seen in the first 3 h of reperfusion following 3 h of ischemia. Extensive infarction generally affecting the cortical focal tissue with more variable involvement of the perifocal tissue developed following 2 h of focal ischemia. Thus, mitochondrial impairment during the first 3 h of reperfusion was apparently not essential for tissue infarction to develop. Nonetheless, the observed mitochondrial changes could contribute to the damage produced by permanent focal ischemia as well as the larger infarcts produced when reperfusion was initiated following 3 h of ischemia.

The role of the Internet in medical decision making

The Internet has dramatically changed the means by which information is obtained. Accurate, up-to-date information is vital to maintain the quality of healthcare, especially as US healthcare delivery changes to a primary care-based system. The availability of this new and potentially vast source of information also affects strategies for medical decision making. In this article, use of online information in our medical center is discussed, together with the impact of a locally-developed decision support system. This system first contained components for differential diagnosis as well as computer-assisted instruction. Initially, online searching was limited to Medline literature searches. This component has now been expanded to include important new tools for accessing medical information on the Internet.

Properties of peripherally induced persistent hindlimb flexion in rat: involvement of N-methyl-D-aspartate receptors and capsaicin-sensitive afferents

In the sodium pentobarbital anesthetized rat, percutaneous electrical stimulation (2 mA, 7 ms, 100 Hz, 60 min) across the upper hindlimb produces an ipsilateral hindlimb flexion that persists following spinal transection. Using this preparation, the following were found. (1) Flexion was observed in both the intact and acutely spinalized (T7) rat 10 hours to two weeks following induction, but was negligible at six weeks. (2) Pretreatment of intact rats with the non-competitive N-methyl-D-aspartate (NMDA) receptor antagonists, ketamine HCl and MK-801, reduced persistent hindlimb flexion in a dose-dependent manner. (3) Pretreatment of spinalized rats with MK-801 reduced the amount of flexion, observed at 30 min following stimulation. However at 72 hrs following stimulation, administration of MK-801 to acutely spinalized rats had no effect on flexion. (4) Capsaicin pretreatment, of either neonates or adults, reduced the amount of flexion observed at 30 min following stimulation, but only adult capsaicin pretreatment reduced flexion at 72 h. (5) At 72 h following induction, bilateral dorsal rhizotomy (T11-L6) of acutely spinalized rats had no significant effect on flexion when compared to pre-rhizotomy levels. However, the subsequent removal of the hindlimb skin produced a significant reduction in flexion, and the remaining flexion was eliminated by the removal of the thoracolumbar spinal cord and cauda equina. These combined results suggest that prolonged activation of C-afferents and NMDA receptors induce a persistent hindlimb flexion in rat that is maintained at the level of the spinal cord.

Inhibition of chronic hindlimb flexion in rat: evidence for mediation by 5-hydroxytryptamine

Prolonged high-intensity stimulation of the rat hindlimb produces a persistent unilateral flexion. 5-Hydroxytryptamine (5-HT) has been implicated in the modulation of spinal cord mechanisms. Electrical stimulation across the upper hindlimb was used to induce a persistent hindlimb flexion. The flexion was measured after stimulation and at 72 h, both before and after spinal transection at T7. Transection of the spinal cord typically resulted in an increase in flexion of 3-5 g (rebound). Pretreatment with para-chlorophenylalanine (pCPA) to deplete 5-HT, or the administration of metergoline, a non-specific 5-HT antagonist, had no significant effect on flexion at 72 h in the intact rat but abolished rebound. The 5-HT1A agonist, (+-)-8-hydroxy-2-(di-N-propylamino)tetralin hydrobromide (8-OH-DPAT) and 5-HT1B agonist, m-trifluoromethylphenylpiperazine-HCl (TFMPP), had no effect on flexion at 72 h in the intact rat but reduced rebound. The 5-HT2 agonist, 1-(2.5-dimethoxy-4-iodophenyl)-2-aminopropane-HCl (DOI), suppressed post-stimulation flexion and flexion subsequent to spinal section. Furthermore, ketanserin, a 5-HT2 antagonist, restored flexion suppressed by DOI in the acutely spinalized rat. These results suggest that chronic hindlimb flexion is suppressed in the intact rat by descending, serotonergic fibers which exert an effect through spinal 5-HT2 receptors. Moreover, 5-HT1 agonist suppression of rebound implicates these receptors as well in the modulation of chronic hindlimb flexion.

Sodium channel kinetics in normal and denervated rabbit muscle membrane

The effects of chronic denervation on sodium (Na) channels in rabbit muscle membrane were determined using intracellular microelectrodes and Vaseline gap voltage clamp techniques. The Hodgkin-Huxley model was used to describe the kinetic and steady-state parameters of channel activation and fast inactivation. Chronic (7-10 days) denervation was found to cause a decreased resting potential, lowered action potential peak, and fibrillation potentials in rabbit extensor digitorum longus (EDL) muscles. Under voltage clamp conditions, no differences were observed between denervated and normal fibers in the voltage dependence of the steady-state Na channel activation and fast inactivation curves, or in the time course of development of fast inactivation. However, in denervated fibers, the time course of recovery from fast inactivation was approximately half that measured in normal fibers. Also, whereas depolarizing holding potentials induced a long-term inactivation to varying degrees in normal EDL fibers, denervated EDL fibers and normal soleus fibers were uniformly resistant to prolonged depolarization. These results suggest that the denervation-induced development of spontaneous activity may be due in part to changes in the mechanisms that control the refractoriness of Na channels.

Inhibition of thrombus formation on intravascular sensors by electrical polarization

Implantable biomedical sensors built on a silicon substrate capped with glass are currently being developed for intravascular applications. Electrical techniques for inhibiting thrombus formation on the surface of a proposed optical sensor in direct contact with blood have been investigated. Glass-on-silicon specimens (4 X 1.2 X 0.4 mm3) were coated with indium-tin oxide, a transparent conductor, and implanted in the vena cava and iliac veins of three dogs for 10, 20, or 33 days. The equilibrium surface-blood interface potentials of the specimens were modified by implanted current sources which supplied either direct current (8-15 microA) or 100 KHz alternating current (5 microA, root mean square). Light-microscopic and scanning electron-microscopic analyses showed each of the DC-polarized specimens to be free of thrombus, in contrast to nonpolarized (control) specimens on which varying amounts of adsorbed protein and thrombus deposits were found. Like the control specimens, the AC-polarized specimens formed thrombus, but the appearance of the deposits differed. These findings support the view that the polarity, magnitude and time dependence of the potential across conducting surface-blood interface significantly influence thrombogenicity. Further work is necessary to determine the roles of electrochemical and electrostatic factors in preventing thrombus formation on foreign materials.

Small-bowel lymphoma and regional enteritis: radiographic similarities

Lymphoma and regional enteritis may demonstrate strikingly similar patterns in the small bowel. Fifty cases of regional enteritis and small-bowel lymphoma were reviewed. Of these, there were 12 cases of both diseases in which a confident radiographic distinction could not be made. Both diseases may narrow the terminal ileum, present as inflammatory processes, and demonstrate nodular patterns. Other similarities include aneurysmal dilatation, several types of ulceration, fistula formation, mesenteric masses, and involvement of the terminal ileum either alone or in association with skip areas. Clinical implications and the pathologic processes responsible for the radiographic similarity between these entities are discussed.

"Is this the liberry?"

The importance of a library in the hospital setting is discussed. Suggestions on how to start a library, build library holdings, develop a story hour, and promote a library are provided.

Cytologic bile examination in the diagnosis of biliary duct neoplastic strictures

Cytodiagnosis of the bile is not frequently thought of as a method of obtaining a histopathologic diagnosis of the cause of a neoplastic biliary duct stricture. However, cells surrounding the biliary ducts are continuously exfoliated into bile and become available for cytologic examination whenever bile is collected. Nineteen patients with obstructive jaundice are reported. In seven of 15 with neoplastic biliary duct strictures, cytodiagnostic examination showed tumor cells. There were no false-positive results. The sensitivity of bile cytodiagnosis in this series was 47%, its specificity was 100%, and its accuracy was 58%.

Double-contrast esophagrams. The prone technique

The authors describe a simple method for obtaining double-contrast images of the lower esophagus with the patient in a prone position. This technique has a high success rate, allows repeated imaging, and is easily incorporated into routine upper gastrointestinal studies. Diagnostic double-contrast studies were obtained in 78% of 28 patients. Ten abnormalities, including a Mallory-Weiss tear, were demonstrated. Single-contrast esophagrams, performed immediately afterwards, demonstrated only six abnormalities.

Secondary esophageal tumors

Secondary esophageal carcinoma usually originates from a primary site in either the lung or breast and produces obstruction and symptoms that frequently mimic a benign esophageal stricture or primary esophageal carcinoma. Esophagoscopy shows a smooth identation, usually covered with normal mucosa; the appearance resembles a benign esophageal stricture. Esophageal biopsy in patients with secondary tumors is often negative for carcinoma. The radiologist plays a significant diagnostic role by his ability to show that the cause of the stricture is extramucosal and may be due to a secondary carcinoma involving the esophagus.

Pseudotumor caused by gastric varices

On upper-gastrointestinal examination a patient with cirrhosis of the liver was found to have prominent gastric varices presenting as a pseudotumor near the cardia. The diagnosis of varices was confirmed by gastroscopy and angiography. A correct diagnosis is necessary to avoid an ill-advised biopsy or unwarranted surgery.

Direct calibration of a totally implantable pulsed Doppler ultrasonic blood flowmeter

A totally implantable pulsed Doppler ultrasonic blood flowmeter has recently been developed to provide information on the velocity-flow profile in a vessel as well as its diameter. Volume flow can be indirectly obtained according to the formula: Q = (phi/4)(diam)2-v. In order to determine the accuracy of this estimate, in vivo direct bleedout measurements were performed on the abdominal aorta of six dogs with an overall accuracy in 77 trials of +2.0 +/- 8.7% (mean +/- 1 SD). The best-fit mean linear regression line was found to be: flowmeter output = 1.013-true flow + 5.1 ml/min. The scatter in the flowmeter's accuracy is thought to be due to small variations in the angle of the transducer. The source of the 2% overestimation in the mean accuracy could not be directly attributed to any one condition; the error is sufficiently small that in many cases it can be neglected.

Endometrial stromal sarcoma of the broad ligament arising in an area of endometriosis in a paramesonephric cyst. Case report

A 63-year-old Jamaican negress had an endometrial stromal sarcoma arising in a paramesonephric cyst of the broad ligament. Morphological evidence is presented to show that the tumour arose from an area of endometriosis within the cyst wall. Subsequent metastases responded for a few months to cyclophosphamide therapy and the patient died 14 months after the onset of symptoms.

Sequential feline esophageal nutrient blood flow: perfusion measurements in vivo

The utilization of a catheter semiconductor beta detector (CASRAD) to perform in vivo, sequential, esophageal nutrient blood flow distribution studies in cats is described. A diffusable radioisotope, Rubidium 86 (86Rb), was injected intravenously and the CASRAD placed within the esophageal lumen. The distribution of 86Rb remained stable within the feline esophagus for sufficient time to allow for counting at 1.5 cm levels in the esophagus. The accuracy limitations of the CASRAD system were assessed by comparing the in vivo, recorded distribution of 86Rb with the esophageal distribution of 86Rb as determined by a well-type scintillation counter. The distribution throughout most of the esophagus was similar by both techniques. Sequential esophageal studies performed with the CASRAD showed less variability than existed in the biological differences between cats and the methodology of obtaining and counting tissue by well-type scintillation counter (mean coefficient of variation 11.6% versus coefficient of variation 23.1%).

Plasma insulin in pancreatic disease

Pancreatic exocrine function tests and plasma insulin curves after a glucose load have been performed in 74 patients, 32 with no significant pancreatic disease, 31 with various disorders of the pancreas, and 11 with postmature diabetes mellitus. Exocrine function was impaired in all patients with chronic pancreatitis and chronic relapsing pancreatitis, whereas insulin production was defective in seven of 10 of those with chronic pancreatitis, and in one of seven with chronic relapsing pancreatitis. The findings in other examples of pancreatic disease are mentioned. Two out of four patients presenting with diabetes mellitus, who were found to have a flat plasma insulin curve, proved on investigation to have chronic pancreatitis. The results of plasma insulin response curves in this series are discussed in relation to pancreatic disease and their possible value in diagnosis.