Psychiatric aspects of asthma in adults

Asthma is a complex and multifactorial illness. Early theories focused on the psychosomatic aspects of this disease and more work has been done through the years to explore these theories and to further elucidate the variety of psychiatric conflicts, personality traits, and stressors, and the role they play in asthma. More recently, mechanisms have been postulated whereby these conflicts can influence the pathologic process in the lungs causing symptoms of asthma. These seem to act at the level of the limbic system and hypothalamus, the autonomic nervous system, and the immunologic system. Many psychiatric factors play a strong role in maintenance of the asthma. Family interactions, anxiety, depression, panic-fear, and many others can facilitate or impede compliance with an appropriate medical regimen. Although all these variables have yet to be sorted out definitively, asthma is certainly an area where psychiatrists can have a major therapeutic impact.

Individual differences in cerebral blood flow in area 17 predict the time to evaluate visualized letters

Sixteen subjects closed their eyes and visualized uppercase letters of the alphabet at two sizes, as small as possible or as large as possible while remaining "visible." Subjects evaluated a shape characteristic of each letter (e.g., whether it has any curved lines), and responded as quickly as possible. Cerebral blood flow was normalized to the same value for each subject, and relative blood flow was computed for a set of regions of interest. The mean response time for each subject in the task was regressed onto the blood flow values. Blood flow in area 17 was negatively correlated with response time (r = -0.65), as was blood flow in area 19 (r = -0.66), whereas blood flow in the inferior parietal lobe was positively correlated with response time (r = 0.54). The first two effects persisted even when variance due to the other correlations was removed. These findings suggest that individual differences in the activation of specific brain loci are directly related to performance of tasks that rely on processing in those loci.

Neural correlates of different types of deception: an fMRI investigation

Deception is a complex cognitive activity, and different types of lies could arise from different neural systems. We investigated this possibility by first classifying lies according to two dimensions, whether they fit into a coherent story and whether they were previously memorized. fMRI revealed that well-rehearsed lies that fit into a coherent story elicit more activation in right anterior frontal cortices than spontaneous lies that do not fit into a story, whereas the opposite pattern occurs in the anterior cingulate and in posterior visual cortex. Furthermore, both types of lies elicited more activation than telling the truth in anterior prefrontal cortices (bilaterally), the parahippocampal gyrus (bilaterally), the right precuneus, and the left cerebellum. At least in part, distinct neural networks support different types of deception.

Imagining rotation by endogenous versus exogenous forces: distinct neural mechanisms

Previous neuroimaging studies of mental image transformations have sometimes implicated motor processes and sometimes not. In this study, prior to neuroimaging the subjects either viewed an electric motor rotating an angular object, or they rotated the object manually. Following this, they performed the identical mental rotation task in which they compared members of pairs of such figures, but were asked to imagine the figures rotating as they had just seen the model rotate. When results from the two rotation conditions were directly compared, motor cortex (including area M1) was found to be activated only when subjects imagined the rotations as a consequence of manual activity. Thus, there are at least two, qualitatively distinct, ways to imagine objects rotating in images, and these different strategies can be adopted voluntarily.

Mental imagery of high- and low-resolution gratings activates area 17

Some, but not all, previous neuroimaging studies of visual mental imagery have found that Area 17 (primary visual cortex) is activated when people visualize objects. The present study was designed to test the hypothesis that the necessary degree of resolution of the mental image is a determining factor in whether Area 17 is activated during imagery. Eight male subjects visualized and compared sets of stripes that required high or low resolution to resolve, while their brains were scanned using 15O(CO2) positron emission tomography (PET). When imagery in general (visualization of high- and low-resolution gratings stimuli combined) was compared to an auditory baseline condition where subjects did not visualize, Area 17 was activated. However, region of interest (ROI) and statistical parametric mapping (SPM) analyses revealed no difference between imagery conditions using high- and low-resolution stimuli. These results indicate that the resolution of the stimuli alone does not necessarily determine whether Area 17 will be activated during visual mental imagery.

Hypnotic visual illusion alters color processing in the brain

OBJECTIVE

This study was designed to determine whether hypnosis can modulate color perception. Such evidence would provide insight into the nature of hypnosis and its underlying mechanisms.

METHOD

Eight highly hypnotizable subjects were asked to see a color pattern in color, a similar gray-scale pattern in color, the color pattern as gray scale, and the gray-scale pattern as gray scale during positron emission tomography scanning by means of [(15)O]CO(2). The classic color area in the fusiform or lingual region of the brain was first identified by analyzing the results when subjects were asked to perceive color as color versus when they were asked to perceive gray scale as gray scale.

RESULTS

When subjects were hypnotized, color areas of the left and right hemispheres were activated when they were asked to perceive color, whether they were actually shown the color or the gray-scale stimulus. These brain regions had decreased activation when subjects were told to see gray scale, whether they were actually shown the color or gray-scale stimuli. These results were obtained only during hypnosis in the left hemisphere, whereas blood flow changes reflected instructions to perceive color versus gray scale in the right hemisphere, whether or not subjects had been hypnotized.

CONCLUSIONS

Among highly hypnotizable subjects, observed changes in subjective experience achieved during hypnosis were reflected by changes in brain function similar to those that occur in perception. These findings support the claim that hypnosis is a psychological state with distinct neural correlates and is not just the result of adopting a role.

The role of area 17 in visual imagery: convergent evidence from PET and rTMS

Visual imagery is used in a wide range of mental activities, ranging from memory to reasoning, and also plays a role in perception proper. The contribution of early visual cortex, specifically Area 17, to visual mental imagery was examined by the use of two convergent techniques. In one, subjects closed their eyes during positron emission tomography (PET) while they visualized and compared properties (for example, relative length) of sets of stripes. The results showed that when people perform this task, Area 17 is activated. In the other, repetitive transcranial magnetic stimulation (rTMS) was applied to medial occipital cortex before presentation of the same task. Performance was impaired after rTMS compared with a sham control condition; similar results were obtained when the subjects performed the task by actually looking at the stimuli. In sum, the PET results showed that when patterns of stripes are visualized, Area 17 is activated, and the rTMS results showed that such activation underlies information processing.

Regional cerebral blood flow during script-driven imagery in childhood sexual abuse-related PTSD: A PET investigation

OBJECTIVE

The purpose of this study was to determine whether anterior limbic and paralimbic regions of the brain are differentially activated during the recollection and imagery of traumatic events in trauma-exposed individuals with and without posttraumatic stress disorder (PTSD).

METHOD

Positron emission tomography (PET) was used to measure normalized regional cerebral blood flow (CBF) in 16 women with histories of childhood sexual abuse: eight with current PTSD and eight without current PTSD. In separate script-driven imagery conditions, participants recalled and imagined traumatic and neutral autobiographical events. Psychophysiologic responses and subjective ratings of emotional state were measured for each condition.

RESULTS

In the traumatic condition versus the neutral control conditions, both groups exhibited regional CBF increases in orbitofrontal cortex and anterior temporal poles; however, these increases were greater in the PTSD group than in the comparison group. The comparison group exhibited regional CBF increases in insular cortex and anterior cingulate gyrus; increases in anterior cingulate gyrus were greater in the comparison group than in the PTSD group. Regional CBF decreases in bilateral anterior frontal regions were greater in the PTSD group than in the comparison group, and only the PTSD group exhibited regional CBF decreases in left inferior frontal gyrus.

CONCLUSIONS

The recollection and imagery of traumatic events versus neutral events was accompanied by regional CBF increases in anterior paralimbic regions of the brain in trauma-exposed individuals with and without PTSD. However, the PTSD group had greater increases in orbitofrontal cortex and anterior temporal pole, whereas the comparison group had greater increases in anterior cingulate gyrus.

Mental rotation of objects versus hands: neural mechanisms revealed by positron emission tomography

Twelve right-handed men participated in two mental rotation tasks as their regional cerebral blood flow (rCBF) was monitored using positron emission tomography. In one task, participants mentally rotated and compared figures composed of angular branching forms; in the other task, participants mentally rotated and compared drawings of human hands. In both cases, rCBF was compared with a baseline condition that used identical stimuli and required the same comparison, but in which rotation was not required. Mental rotation of branching objects engendered activation in the parietal lobe and Area 19. In contrast, mental rotation of hands engendered activation in the precentral gyrus (M1), superior and inferior parietal lobes, primary visual cortex, insula, and frontal Areas 6 and 9. The results suggest that at least two different mechanisms can be used in mental rotation, one mechanism that recruits processes that prepare motor movements and another mechanism that does not.

Neural systems shared by visual imagery and visual perception: a positron emission tomography study

Subjects participated in perceptual and imagery tasks while their brains were scanned using positron emission tomography. In the perceptual conditions, subjects judged whether names were appropriate for pictures. In one condition, the objects were pictured from canonical perspectives and could be recognized at first glance; in the other, the objects were pictured from noncanonical perspectives and were not immediately recognizable. In this second condition, we assume that top-down processing is used to evaluate the names. In the imagery conditions, subjects saw a grid with a single X mark; a lowercase letter was presented before the grid. In the baseline condition, they simply responded when they saw the stimulus, whereas in the imagery condition they visualized the corresponding block letter in the grid and decided whether it would have covered the X if it were physically present. Fourteen areas were activated in common by both tasks, only 1 of which may not be involved in visual processing (the precentral gyrus); in addition, 2 were activated in perception but not imagery, and 5 were activated in imagery but not perception. Thus, two-thirds of the activated areas were activated in common.

Visual imagery and perception in posttraumatic stress disorder. A positron emission tomographic investigation

BACKGROUND

Relative regional cerebral blood flow (rCBF) changes were measured in Vietnam combat veterans with and without posttraumatic stress disorder (PTSD) during exposure to combat-related stimuli.

METHODS

Positron emission tomography was used to measure rCBF in 7 combat veterans with PTSD (PTSD group) and 7 healthy combat veterans (control group) who viewed and generated visual mental images of neutral, negative, and combat-related pictures.

RESULTS

Unlike control subjects, subjects with PTSD had increased rCBF in ventral anterior cingulate gyrus and right amygdala when generating mental images of combat-related pictures; when viewing combat pictures, subjects with PTSD showed decreased rCBF in Broca's area.

CONCLUSIONS

Results suggest that ventral anterior cingulate gyrus and right amygdala play a role in the response of combat veterans with PTSD to mental images of combat-related scenes. Reexperiencing phenomena of PTSD, which often involve emotional visual mental imagery, may be likewise associated with increased rCBF in these regions.

Neural effects of visualizing and perceiving aversive stimuli: a PET investigation

Cerebral blood flow was recorded (using positron emission tomography) while middle-aged subjects viewed or visualized pictures of neutral or aversive stimuli, and then determined whether auditorily presented statements correctly described the stimuli. Visualizing aversive stimuli enhanced cerebral blood flow, relative to visualizing neutral stimuli, in areas 17 (right) and 18 (bilateral), as well as the anterior insula (bilateral) and middle frontal cortex (left). Areas 17 and 18 have been identified as supporting the representations that underlie the experience of imagery, and the anterior insula is a major cortical recipient of input from the autonomic nervous system. Perceiving aversive stimuli enhanced cerebral blood flow, relative to neutral stimuli, in area 46, the angular gyrus and area 19, area 47, and the middle temporal gyrus (all in the left hemisphere). All of these areas have previously been implicated in visual object identification. It is striking that negative emotion did not modulate activation in any areas in the same way during imagery and perception.

Using the World-Wide Web to train and certify physicians in the safe use of fluoroscopy

OBJECTIVE

We sought to create a computer-generated certification examination that concurrently tests and educates fluoroscopy users.

MATERIALS AND METHODS

A trial examination was placed on the Internet for area physicians who requested fluoroscopic privileges at our institution. The name and address of each individual who achieves a passing score is automatically sent by e-mail to the examination administrator.

RESULTS

Physicians expressed widespread satisfaction with this certification process. The difference in number of attempts and score of the first attempt between groups of radiologists and nonradiologists favored the radiologists (p approximately .03 in both cases) when analyzed using an unpaired t test.

CONCLUSION

This examination ensures understanding of the procedural parameters that contribute to skin injury in patients and affords an easy approach to self-education.

Encoding words and pictures: a positron emission tomography study

Subjects viewed words, pictures, crosshairs, or a large X flanked by two smaller xs on either side while their brain activity was monitored using positron emission tomography (PET). When activation from the pictures, crosshairs, or Xs condition was subtracted from activation in the words condition, the left angular gyrus and Broca's area were found to be activated. In the comparison of words and pictures, additional language areas were activated. These results provide support for the classical neurological model of reading. The results also suggest that a "word form area" is near the margin of the left angular gyrus.

Changes in cortical activity during mental rotation. A mapping study using functional MRI

Mental imagery is an important cognitive method for problem solving, and the mental rotation of complex objects, as originally described by Shepard and Metzler (1971), is among the best studied mental imagery tasks. Functional MRI was used to observe focal changes in blood flow in the brains of 10 healthy volunteers performing a mental rotation task. On each trial, subjects viewed a pair of perspective drawings of three-dimensional shapes, mentally rotated one into congruence with the other, and then determined whether the two forms were identical or mirror-images. The control task, which we have called the 'comparison' condition, was identical except that both members of each pair appeared at the same orientation, and hence the same encoding, comparison and decision processes were used but mental rotation was not required. These tasks were interleaved with a baseline 'fixation' condition, in which the subjects viewed a crosshair. Technically adequate studies were obtained in eight of the 10 subjects. Areas of increased signal were identified according to sulcal landmarks and are described in terms of the Brodmann's area (BA) definitions that correspond according to the atlas of Talaraich and Tournoux. When the rotation task was contrasted with the comparison condition, all subjects showed consistent foci of activation in BAs 7a and 7b (sometimes spreading to BA 40): 88% had increased signal in middle frontal gyrus (BA 8) and 75% showed extrastriate activation, including particularly BAs 39 and 19, in a position consistent with area V5/human MT as localized by functional and histological assays. In more than half of the subjects, hand somatosensory cortex (3-1-2) was engaged, and in 50% of subjects there was elevated signal in BA 18. In frontal cortex, activation was above threshold in half the subjects in BAs 9 and/or 46 (dorsolateral prefrontal cortex). Some (four out of eight) subjects also showed signal increases in BAs 44 and/or 46. Premotor cortex (BA 6) was active in half of the subjects during the rotation task. There was little evidence for lateralization of the cortical activity or of engagement of motor cortex. These data are consistent with the hypothesis that mental rotation engages cortical areas involved in tracking moving objects and encoding spatial relations, as well as the more general understanding that mental imagery engages the same, or similar, neural imagery as direct perception.

Funding resuscitation research

The present trend in managed care has meant downsizing expectations concerning the availability of support for resuscitation research. This trend applies to funding possibilities from industry, governmental agencies, and nongovernmental agencies (Table 1). There will be increasing barriers to making innovations. Truth, science, and good patient care alone will not make potential donors give grants. Investigators must also understand the potential donors' expectations and be persuasive. "Delight your donor". Industries' concerns include intellectual property rights and publications. The National Institutes of Health, recently favoring molecular biology over lifesaving therapies or integrated physiologic research, is an anomaly. The current peer review system propagates itself without having advocates for resuscitation research. This system has become a self-fulfilling prophecy. The American Heart Association is only recently, after 30 yrs of educational activities concerning cardiopulmonary resuscitation, considering putting some basic research money into resuscitation research. In university hospitals, where clinical departments have made significant contributions to innovative, clinically relevant life-support research, funded with incomes from patient care, the sky is beginning to fall. Resuscitation researchers need persuasive advocates with clout and hard data to convince funding agencies to give support to multilevel research and development in areas of pathophysiology and reversibility of terminal states and clinical death--to give these topics a higher priority than is currently available.

Reactivity of magnetic parieto-occipital alpha rhythm during visual imagery

Spontaneous MEG signals were recorded during visual imagery from 13 healthy adults with a whole-scalp neuromagnetometer. The parieto-occipital 7-14 Hz alpha activity was suppressed strongly while subjects visualized and evaluated letters. The act of forming a visual image caused a smaller suppression than did inspection of the imaged pattern for a named property. The maximum suppression depended on the baseline alpha level and, for the majority of the subjects, occurred close to the area with the strongest alpha, showing no systematic hemispheric asymmetry. Sources for the alpha activity, modeled with equivalent current dipoles, clustered in the parietal and occipital lobes. The strongest suppression of the activity occurred near the parieto-occipital sulcus.

Topographical representations of mental images in primary visual cortex

We report here the use of positron emission tomography (PET) to reveal that the primary visual cortex is activated when subjects close their eyes and visualize objects. The size of the image is systematically related to the location of maximal activity, which is as expected because the earliest visual areas are spatially organized. These results were only evident, however, when imagery conditions were compared to a non-imagery baseline in which the same auditory cues were presented (and hence the stimuli were controlled); when a resting baseline was used (and hence brain activation was uncontrolled), imagery activation was obscured because of activation in visual cortex during the baseline condition. These findings resolve a debate in the literature about whether imagery activates early visual cortex and indicate that visual mental imagery involves 'depictive' representations, not solely language-like descriptions. Moreover, the fact that stored visual information can affect processing in even the earliest visual areas suggests that knowledge can fundamentally bias what one sees.

Two types of image generation: evidence for left and right hemisphere processes

The results from seven experiments provide evidence that visual mental images can be generated by either the left or right cerebral hemisphere, but in different ways. Subjects were cued to form images within a grid or within a set of four corner brackets; a single X mark was enclosed within each stimulus, and the subjects were to determine whether the X mark was enclosed within each stimulus, and the subjects were to determine whether the X mark would have fallen on an imaged pattern. When subjects memorized descriptions of how parts were arranged, they could later form images of the composite pattern when cued in the right visual field (left hemisphere) more accurately than when they were cued in the left visual field (right hemisphere). In contrast, when subjects memorized individual segments on a screen, and 'mentally glued' them into a single pattern, they later could form images more accurately, at least in some circumstances, when cued in the left visual field. These results were predicted by the theory that images are built up by arranging parts, and that two different processes can be used to arrange them. One process uses stored descriptions to arrange parts, and is more effective in the left cerebral hemisphere; the other process uses stored memories of metric positions to arrange parts, and is more effective in the right cerebral hemisphere. Convergent evidence was obtained by having subjects memorize letters in grids (which are easily encoded using descriptions of the positions of segments) or within a space delineated by four brackets (which require memorizing the precise positions of the segments). Subjects were relatively more accurate when cued in the left visual field with bracket stimuli, but tended to be relatively more accurate when cued in the right visual field with grids stimuli. Control experiments showed that this finding was not due to hemispheric differences in the ease of forming images at different sizes or differences in the ease of perceptually encoding the probes.

Brain mechanisms in human classical conditioning: a PET blood flow study

Five healthy male subjects participated in a classical conditioning experiment, and positron emission tomography (PET) was used to compare regional cerebral blood flow before and after conditioning. The subjects participated in three different experimental phases. In the first (habituation) phase they listened to 24 repetitions of a tone with random intervals. In the second (acquisition) phase, the tone was paired with a brief shock to the wrist. In the third (extinction) phase, the tone was presented alone again. 15OPET scans were taken during the habituation and extinction phases. Because the habituation and extinction phases were similar, any difference in blood flow to the tones presented during extinction probably reflected conditioning that occurred during the acquisition phase. Statistical parametric mapping (SPM) analysis of the PET data showed significantly increased activation in the right hemisphere in the orbito-frontal cortex, dorsolateral prefrontal cortex, inferior and superior frontal cortices, and inferior and middle temporal corticies. The only activated areas in the left hemisphere were area 19 and the superior frontal cortex. The results are interpreted as evidence for the involvement of cortical areas in human classical conditioning.

The distribution of [125I]ricin in mice following aerosol inhalation exposure

Studies were conducted to examine the uptake and redistribution of [125I]ricin from the lungs of mice following nose-only aerosol inhalation exposure. Radiolabelled contents were measured in lung and various extra-pulmonary tissues 15 min through 30 h following 10 min aerosol exposures. Pharmacokinetic analyses were performed on whole-organ data obtained for lungs, stomach, liver and spleen. Radioactivity within the lungs, maximal at 15 min post-exposure, was eliminated in a biexponential fashion with a long beta half-life (approximately 40 h). Large amounts of radiolabel were also found within the gastrointestinal tract. Radiolabel within the stomach exhibited an absorption phase and two-compartment elimination. Radiolabel content of many other tissues, including known accumulation sites for intravenously administered toxin, was significantly (p < 0.05) increased (relative to 15 min post-exposure) in association with the early elimination of radiolabel from the lungs, but levels in these tissues were very low and did not increase after 4 h post-exposure. The only exception was our sample of trachea, which showed delayed elevations in radiolabel (peak at 24 h); this pattern was attributable to the contained thyroid (not removed at necropsy) and its trapping of free [125I] released upon tissue [125I]ricin degradation. The overall data indicate that ricin administered by aerosol inhalation is delivered to both respiratory and gastrointestinal tracts; however, it is not extensively transported from either tract to other potential target sites. Ricin delivered to the lungs is primarily sequestered within the lungs until degradation. Only small amounts of ricin delivered to the gastrointestinal tract are absorbed into the circulation.

Drugs that show protective effects from ricin toxicity in in vitro protein synthesis assays

We used an in-vitro, inhibition of protein synthesis assay (PSI) to test a wide variety of drugs for possible therapeutic use against ricin, a toxic glycoprotein that causes death in animals by inhibiting protein synthesis. Selection of test drugs was based on possible interference with ricin activity at different stages of the toxic process. Most of the drugs tested had no effect on ricin-induced PSI, were toxic when tested alone, or enhanced the toxicity of ricin. The only ones showing protection were galactose, lactose, and several derivatives of these sugars, Brefeldin A (BFA), 3'-azido-3'-deoxythymidine (AZT), and a purine derivative (BM33203). THe sugar derivatives provided 50% protection against a PSI ED99 of ricin (0.1 micrograms/ml). Concentrations of BFA greater than 0.5 micro M caused about 50% PSI by itself, but blocked any further inhibitory effects of ricin. AZT, at optimum concentrations, reached a maximum protection level of about 40% in the presence of an ED99 dose of ricin, while the nucleoside derivative, BM33203 and AZT appeared to have an additive effect, showing up to 80% protection from an ED99 dose of ricin. Drugs showing protection in the PSI cell assay showed no protection from ricin in a cell-free translation assay used to determine if they would block ricin at the protein synthesis site.

Identifying objects seen from different viewpoints. A PET investigation

Positron emission tomography scans were acquired when subjects performed three tasks, each in a separate block of trials. They decided whether words named pictures of objects viewed from a canonical perspective, decided whether words named pictures of objects viewed from a non-canonical (unusual) perspective or saw random patterns of lines and pressed a pedal when they heard the word (this was a baseline condition). The dorsolateral prefrontal region was activated when subjects identified objects seen from non-canonical perspectives, as expected if the frontal lobes are involved in top-down perceptual processing. In addition, several areas in the occipital, temporal and parietal lobes were selectively activated when subjects identified objects seen from non-canonical perspectives, as specifically predicted by a recent theory. Overall, the pattern of results supported the view that the human brain identifies objects by using a system of areas similar to that suggested by studies of other primates.

Characterization of 3'-azido-3'-deoxythymidine inhibition of ricin and Pseudomonas exotoxin A toxicity in CHO and Vero cells

Ricin (RIC), modeccin (MOD), Pseudomonas exotoxin A (PE), and diphtheria toxin (DT) are protein toxins that enter cells by receptor-mediated endocytosis. After intracellular transport and membrane translocation to the cytosol, these toxins inhibit protein synthesis by enzymatically removing a specific adenine residue from ribosomal RNA (RIC, MOD), or by ADP-ribosylation of elongation factor-2 (PE, DT). Recently, Thompson and Pace (1992) reported that AZT (3'-azido-3'-deoxythymidine) inhibited RIC toxicity in Vero cells, and this inhibition was not due to a block of RIC enzymatic activity. This paper extends these findings and examines the effects of AZT treatment on the toxicities of other protein toxins in Chinese hamster ovary (CHO) and Vero cell lines. AZT treatment did not significantly alter the toxicity of DT or MOD in either cell line, but it markedly reduced RIC and PE toxicity in both cell lines. The ID50 values (concentration of toxin required to inhibit protein synthesis by 50%) for RIC and PE in CHO cells increased approximately 6.5- and 12.5-fold, respectively; while in Vero cells the ID50 values increased ca. 8.5- and 4.5-fold, respectively. Results of further studies revealed differences in the mechanisms by which AZT inhibited RIC and PE toxicity. Results of cell-free translation indicated that, unlike its effects on RIC, AZT blocked the ability of PE to perform its enzymatic activity. As AZT did not block RIC enzymatic activity, we examined the effects of AZT on earlier steps in the RIC intoxication process. AZT treatment did not inhibit cell-surface binding or internalization of [125I]-RIC. Results of kinetic studies showed that when AZT was incubated with cells at the time of RIC exposure, it caused no major change in the lag phase, during which RIC reaches the site of translocation. However, it clearly reduced the subsequent first-order reduction in the rate of protein synthesis, suggesting an effect on translocation. Monensin (an ionophore that perturbs intracellular trafficking and increases the toxicities of RIC and PE) reduced AZT protection against both toxins. Nocodazole and colchicine (agents that disrupt microtubules and some routes of intracellular trafficking) reduced the ability of AZT to inhibit RIC, but not PE, toxicity. In summary, our results suggest that (1) AZT acts within the cytosol to inhibit (directly or indirectly) the enzymatic action of PE, and (2) the AZT inhibition of RIC cytotoxicity does not involve perturbations of RIC cell-surface binding, internalization, or enzymatic activity but might result from an alteration in RIC translocation.

Psychiatric disorders complicating treatment of patients with pulmonary disease

Treatment of pulmonary disease can be significantly complicated by the presence of psychiatric disorders. It is therefore essential to evaluate and understand the interaction of the pulmonary and psychiatric disorders in order to optimize patient care and management.

In vivo effects of T-2 mycotoxin on synthesis of proteins and DNA in rat tissues

Rats were given an ip injection of T-2 mycotoxin (T-2), the T-2 metabolite, T-2 tetraol (tetraol), or cycloheximide. Serum, liver, heart, kidney, spleen, muscle, and intestine were collected at 3, 6, and 9 hr postinjection after a 2-hr pulse at each time with [14C]leucine and [3H]thymidine. Protein and DNA synthesis levels in rats were determined by dual-label counting of the acid-precipitable fraction of tissue homogenates. Rats given a lethal dose of T-2, tetraol, or cycloheximide died between 14 and 20 hr. Maximum inhibition of protein synthesis at the earliest time period was observed in additional rats given the same lethal dose of the three treatments and continued for the duration of the study (9 hr). With sublethal doses of T-2 or tetraol, the same early decrease in protein synthesis was observed but, in most of the tissues, recovery was seen with time. In the T-2-treated rats. DNA synthesis in the six tissues studied was also suppressed, although to a lesser degree. With sublethal doses, complete recovery of DNA synthesis took place in four of the six tissues by 9 hr after toxin exposure. The appearance of newly translated serum proteins did not occur in the animals treated with T-2 mycotoxin or cycloheximide, as evidenced by total and PCA-soluble serum levels of labeled leucine. An increase in tissue-pool levels of free leucine and thymidine in response to T-2 mycotoxin was also noted. T-2 mycotoxin, its metabolite, T-2 tetraol, and cycloheximide cause a rapid inhibition of protein and DNA synthesis in all tissue types studied. These results are compared with the responses seen in in vitro studies.

Taking care of culturally different and non-English speaking patients

Many physicians evaluate and care for non-English speaking patients and patients from different cultures. If not carefully considered, cultural factors, including language, often interfere with optimal diagnosis and treatment of these patients. In addition to improved clinical care, increased awareness and assessment of these issues will often enhance patient and family satisfaction and cooperation with therapeutic recommendations. A number of cultural examples are given to illustrate various points, which of course cannot be comprehensive, but which should alert the physician for areas to focus upon. The knowledge and skills to perform a sociocultural differential diagnosis and to initiate treatments in these areas are especially important for consultation-liaison psychiatrists.

Distribution and elimination of brevetoxin PbTx-3 in rats

After i.v. administration, [3H]PbTx-3 was rapidly cleared from the blood; less than 10% remained after 1 min. Within 30 min, radiolabel distributed to skeletal muscle (69.5%), liver (18.0%), and intestinal tract (8.0%). Over 24 hr, radiolabel decreased in muscle, remained constant in liver, and increased in the intestinal tract and feces. Elimination occurred via feces (75.1%) and urine (14.4%), with 9.0% remaining in the carcass after 6 days. This distribution and elimination profile suggested that the liver was the major organ of metabolism and that biliary excretion was an important route of elimination. Thin-layer chromatography confirmed the presence of brevetoxin metabolites in fecal extracts. Skeletal muscle does not appear to be a site of metabolism, but a storage compartment, from which toxin is slowly released prior to clearance by the liver. These studies are the first demonstration of in vivo brevetoxin metabolism in mammals.

Coronavirus-like particles in adults in Melbourne, Australia

Coronavirus-like particle(s) (CVLP) are faecal-derived pleomorphic membrane bound virus-like particles characterised by a fringe of club-shaped spikes that measure about 27 nm in length. The association of CVLP with a variety of social, clinical, and epidemiological factors was examined after a 69 month survey of faeces received for routine testing at an infectious diseases hospital. CVLP was found most commonly in three groups: first, intellectually retarded individuals who were usually inmates of institutions; second, recent overseas travellers who were either Indochinese refugees/immigrants or were overseas travellers who had usually visited developing communities for lengthy periods; and, third, male homosexuals who had a history of multiple sexual contacts and/or venereal disease. It was concluded that the excretion of CVLP had a strong association with unhygienic living or working conditions irrespective of any clinical symptoms the individual might show.

Beneficial effects of pinacidil on blood lipids: comparisons with prazosin and placebo in patients with hypertension. Pinacidil-Prazosin and Pinacidil-Placebo Research Groups, Lilly Research Laboratories

In two randomized, double-blind clinical trials comparing pinacidil with prazosin and with placebo in patients with hypertension, a number of statistically significant and potentially beneficial effects on blood lipids were detected in the patients taking pinacidil. Patients treated with pinacidil exhibited significant average decrements from baseline in concentrations of total and low-density lipoprotein cholesterol and triglycerides and a significant average increment in high-density lipoprotein cholesterol. The mean effects seen in the pinacidil group were significantly greater than those in the placebo group for both total cholesterol (-9.8 vs +4.2 mg/dl, p less than 0.001) and triglycerides (-21.6 vs +8.6 mg/dl, p less than 0.001). The effects seen in patients given pinacidil were also significantly greater than those seen in the patients treated with prazosin for both high-density lipoprotein cholesterol (+3.6 vs -1.0 mg/dl, p = 0.002) and triglycerides (-14.8 vs +30.3 mg/dl, p less than 0.001). Negative effects of hydrochlorothiazide and propranolol on blood lipids were not apparent in patients given pinacidil. Thus, pinacidil treatment of hypertension is associated with a beneficial effect on blood lipids, which may be of clinical significance.

Clinical pharmacokinetics of pinacidil, a potassium channel opener, in hypertension

Pinacidil is a potassium channel opener that decreases blood pressure by reducing peripheral arterial resistance. In two multicenter trials, we studied the concentrations and apparent clearance of pinacidil (406 patients) and concentrations of its pyridyl-N-oxide metabolite (147 patients). Responding patients had plasma samples collected hourly for 12 hours on 2 occasions after weeks to months of treatment. Pinacidil dose was titrated from 12.5 to 75 mg b.i.d. The peak concentration of pinacidil and N-oxide and the area under the concentration-time curve (AUC) were proportional to the dose of pinacidil, with an average pinacidil concentration of 268 micrograms/L (1.02 microM) and N-oxide concentration of 172 micrograms/L (0.65 microM) for every 1 mg/kg pinacidil administered. Clearance of pinacidil (Clp = Dose/AUC) was 31 L/hr in patients younger than 45 years and 27 L/hr in those older than 60. Clp was significantly smaller in white patients compared with other races (Clp = 28 vs. 34 L/hr). Clp was significantly less in patients taking hydrochlorothiazide (27 vs. 31 L/hr) and greater in smokers (33 vs. 29 L/hr). Concomitant propranolol use did not influence Clp.

Use of fluoxetine, a selective serotonin-uptake inhibitor, in the treatment of obesity: a dose-response study (with a commentary by Michael Weintraub)

Pharmacologic measures which increase serotonergic activity in the brain decrease food consumption and lead to decreased weight in animals. Fluoxetine, an inhibitor of serotonin reuptake, decreases food intake in animals and is associated with weight loss in depressed and otherwise healthy obese patients. To determine the most effective daily fixed dose which causes weight loss in nondepressed obese patients, fluoxetine (10, 20, 40 or 60 mg) or placebo was administered once daily for 8 weeks to 655 patients consisting primarily of women (mean age 40 years, mean weight 95 kg). Diet and activity were not controlled. The placebo-treated patients lost 0.6 +/- 2.3 kg. With the 60-mg fluoxetine dose, patients lost an average of 4.0 +/- 3.9 kg (P less than 0.001), with intermediate responses at the lower doses. Weight loss was proportional to the initial body mass index (weight/height squared). There were no statistically significant differences between any fluoxetine treatment group and placebo for discontinuations from the study. There were statistically significant dose-dependent increases in reports of asthenia, somnolence and sweating. Thus, fluoxetine 60 mg daily appears to be potentially effective for use in weight reduction.

Vasodilator monotherapy in the treatment of hypertension: comparative efficacy and safety of pinacidil, a potassium channel opener, and prazosin

We compared antihypertensive effects of monotherapy with pinacidil (N = 197) or prazosin (N = 204) in a randomized, parallel, double-blind dose-titration study in which hydrochlorothiazide or propranolol could be added for adverse events or lack of efficacy. Pinacidil (12.5 to 75 mg b.i.d.) was a more potent vasodilator, producing a mean decrease in supine diastolic blood pressure (baseline = 102 to 103 +/- 9 mm Hg) of 18.8 +/- 10.0 (SD) mm Hg compared with 15.5 +/- 9.2 mm Hg with prazosin (1 to 10 mg b.i.d.; p less than 0.001). Patients responding to each drug had similar average blood pressure levels during 12-hour monitoring (137/85 mm Hg). More patients taking pinacidil required hydrochlorothiazide for edema (p = 0.008) and more taking prazosin required hydrochlorothiazide and propranolol for lack of efficacy (p less than 0.001). Tachycardia (15% to 20%) and palpitation (13% to 15%) were frequent events with both drugs. Edema (38.2% vs 22.3%) was more frequent with pinacidil (p less than 0.001) and postural hypotension (4.7% vs 1.0%) and asthenia (20.2% vs 13.2%) were more frequent with prazosin (p = 0.025; 0.062). No significant laboratory toxicity was noted. In conclusion, both pinacidil and prazosin are effective as monotherapy for hypertension. Monotherapy with pinacidil is limited by adverse events related to vasodilatation and monotherapy with prazosin is limited by lack of efficacy.

Virus and virus-like particles in the faeces of cats with and without diarrhoea

Negative staining electron microscopy was used to identify viruses in 166 normal and 62 diarrhoeal faecal samples from 208 cats admitted to an animal shelter during a 16-month period (March 1984 to June 1985). On the basis of size and shape 7 distinct viral types were detected: 24 nm parvovirus-like particles, 30 nm astrovirus, 30 nm picornavirus-like particles, reovirus, rotavirus, coronavirus and a 75 nm "togavirus-like" particle. The incidence of these particles in the 208 cats was 11%, 7%, 6%, 0.4%, 5%, 1% and 1% respectively. Virus isolation studies using 40 of the faecal samples succeeded in isolating reovirus 1 in 2 cases. Immune electron microscope studies demonstrated the presence of antibody in a human serum to cat astrovirus, but failed to clarify the identity of the parvovirus-like particles and picornavirus-like particles, other than showing that some of the parvovirus-like particles were not related to feline panleukopenia virus. It was found that parvovirus-like particles, astrovirus, picornavirus-like particles, reovirus and rotavirus could be excreted by cats with normal faeces as well as cats with diarrhoeal faeces. Parvovirus-like particles, astrovirus, picornavirus-like particles and rotavirus could be excreted in high concentration in normal faeces. There was no simple relationship between age and diarrhoea in the population of cats studied. Age was not a critical factor in the excretion of parvovirus-like particles, astrovirus, picornavirus-like particles and rotavirus. The incidence of diarrhoea was not clearly associated with the seasons.

Sexual problems in chronic respiratory disease. Achieving and maintaining intimacy

Chronic obstructive pulmonary disease (COPD) may be linked to several types of sexual dysfunction, but presence of the disease does not preclude enjoyment of sexual activity. A thorough medical and biopsychosocial evaluation of the patient with sexual dysfunction will help the physician to ascertain the cause of dysfunction and to assess contributory physical and psychological factors. In addition to appropriate medical and psychiatric treatment, management should include patient education and supportive psychotherapy. Open communication between the physician, patient, and partner is essential to a successful outcome. The patient and partner may need to alter their attitudes and develop new approaches to sex. The primary care physician can serve as a source of reassurance, information, and recommendations to help the patient live a full life, including a satisfying sex life.

Structure-function relationships of 12,13-epoxytrichothecene mycotoxins in cell culture: comparison to whole animal lethality

Nineteen 12,13-epoxytrichothecene mycotoxins were tested for their relative capabilities to inhibit protein synthesis in Vero cells and rat spleen lymphocytes. Although the lymphocytes were generally more sensitive to the mycotoxins, good correlation existed between the relative potencies of the various trichothecenes in the two cell systems. The most potent mycotoxins (T-2, verrucarin A and roridin A) have acetyl side groups on, or a hydrocarbon chain between, carbons 4 and 15 of the basic ring structure. Loss of side groups from either of these positions or an isovaleryl group at carbon 8 resulted in reduced protein synthesis inhibition (T-2 to HT-2, neosolaniol or diacetoxyscirpenol). Any combination of loss from all three positions (T-2 triol, T-2 tetraol, 15-monoacetyl DAS, scirpentriol, fusarenon X and deoxynivalenol) further weakens their effect. Reduction of the hydroxyl groups to hydroxides, forming verrucarol and deoxyverrucarol, reduced their effectiveness by over a thousand-fold compared to the most potent mycotoxins. Addition of side groups resulted in reduced effectiveness only when an acetyl group was added to the carbon 3 position of T-2 (acetyl T-2) and deoxynivalenol (3-acetyl deoxynivalenol) or on substitution of an epoxide across the 9,10 carbons of diacetoxyscirpenol (beta-epoxide DAS). Effects of combining these and other mycotoxins were additive and showed no synergism or competition for binding to the active site. When in vitro effects of the mycotoxins were compared with results from whole animal lethality tests, several of the trichothecenes were weak inhibitors of protein synthesis in vitro but had in vivo toxicities similar to that of T-2 toxin. Thus, the in vitro cell response of a given trichothecene is not always an accurate predictor of toxicity in whole animals.

Integration of database capabilities into a patient reporting system

A database design is described which automatically archives computer-generated patient imaging and radioassay reports. Selected phrases are condensed so that data storage will be efficient without sacrificing a prose style of report. An indexed file structure has been used to facilitate rapid record retrieval even when several hundred thousand records are stored. Personnel time is considerably reduced for recalling patient records, preparing periodic summaries of studies completed, and performing administrative functions such as billing and keeping track of checked out images. Complex queries, such as "list all the patients between the ages of 50 and 60 on digitalis referred for a stress cardiac study, with left ventricular ejection fraction less than 40% and apical dyskinesis," become feasible. A system for data backup is described to protect against catastrophic data loss.

Detection and quantitation of T-2 mycotoxin with a simplified protein synthesis inhibition assay

We describe a simple, rapid, and sensitive bioassay for the detection and quantitation of T-2 mycotoxin by using a protein synthesis assay in cultured cells. Increased sensitivity of the cells to the mycotoxin occurred with time up to ca. 60-min. Time and dose response curves show that an average of 10 to 20 ng of T-2 per ml was sufficient to cause 50% inhibition of protein synthesis in tissue culture cells. A wide range of tissue culture cells with varied type, tissue, and species sources and growth characteristics were tested by this system. All showed approximately the same sensitivity to the mycotoxin. A slight modification of the procedure was used for suspended cultures of mitogen-stimulated lymphocytes, which also showed an equal degree of sensitivity to the mycotoxin. By simply changing the labeled precursor, the inhibition of RNA, DNA, and protein synthesis by T-2 mycotoxin can be compared. Although T-2 mycotoxin had little effect on RNA synthesis, DNA and protein synthesis were equally inhibited. Because of its sensitivity and its capacity to quickly assay a large number of samples, this technique has been a valuable tool in screening samples for the presence of active toxin and has been used to help establish laboratory safety standards for the inactivation of T-2 mycotoxin by chemical agents. It is presently being used in studies of mycotoxin mechanism of action and approaches toward in vivo neutralization of the toxic effects of mycotoxins.

Shock. Diagnosis and management

Recent investigations have underscored the great diversity in both the causes and manifestations of clinical shock. The emphasis has shifted toward more specific therapy when that has been possible. Pure vasoconstrictors have assumed a secondary therapeutic role, as volume replacement or expansion has become the initial management of shock. Agents, such as naloxone hydrochloride, corticosteroids, fructose diphosphate, amrinone and milrinone , and nonsteroidal antiinflammatory agents, while still experimental, offer improved understanding and management of the shock syndrome.

Automated patient report-generation in nuclear medicine

The proliferation of computer-based office-management systems in the past few years has involved the private physician's office as well as the hospital laboratory. Many radiology departments have already adopted this approach for patient report generation and data storage. Due to the absence of commercially available software, some nuclear medicine departments will be interested in writing their own, but may not have enough experience in nonimaging computer applications to determine the performance needed for a practical system. A report-generation system for scintigraphic studies has been developed in our department over the past 2 yr. During this time an essential hardware/software performance level was established. Ideas for design of program flow that enhance staff acceptance of this concept are presented. Significant reduction of errors in report transcription and billing, together with reduced requirements for secretarial and clerical staff, make a general system like this cost effective.

Tc-99m glucoheptonate estimation of glomerular filtration rate. Correlation with endogenous creatinine clearance

Estimation of GFR using radioisotope techniques has been successfully accomplished with I-125 iothalamate, Cr-51 EDTA, and Tc-99m DTPA. However, the techniques have required up to several hours to complete with blood and/or urine sampling. A method introduced by Schlegel and modified by Gates provides a simple and rapid technique of GFR quantitation that obviates the need for blood and urine sampling. In the present study an evaluation of Tc-99m GHA was undertaken to assess its ability to reflect GRF using a modification of Gates' technique. When the GFR determinations were compared with a current 24-hour CrC1, a correlation coefficient of 0.91 was obtained. Tc-99m GHA-derived GFR appears to closely correlate with endogenous CrC1 over a wide range of renal function.

Effect of thiopental therapy on cerebral blood flow after total cerebral ischemia

The effect of barbiturate coma upon regional cerebral blood flow (RCBF) and ultimate neurologic outcome was examined after total cerebral ischemia (TCI). TCI was induced in dogs using a relatively noninvasive double-occlusion balloon technique; cardiopulmonary protection was provided during the period of ischemia. RCBF was measured using 15-mu radioactively labeled microspheres. A reproducible pattern of impaired reperfusion of the central nervous system (CNS) was observed in control animals after the restoration of cerebral perfusion pressure after TCI. This pattern was accentuated by the administration of pentothal to induce barbiturate coma. The additional depression in RCBF in those animals receiving pentothal was most prominent in cortical gray matter and brainstem structures at 3 and 6 h after TCI. It was also observed in cortical white matter. No untreated animal surviving TCI achieved a neurologic functional level better than persistent vegetative (decerebrate) survival over 1 wk of observation. Animals receiving 90 mg/kg body weight of pentothal post-TCI demonstrated irreversible cardiogenic shock related to the myocardial depressant effect of the drug. Animals receiving 40 to 60 mg/kg of pentothal post-TCI demonstrated a survival rate similar to that of untreated animals. Although this study did not establish the possible effectiveness of barbiturate coma in improving residual neurologic damage after TCI, the data do demonstrate that any possible effectiveness in this model is not associated with any improvement in the markedly decreased cerebral perfusion after TCI.

Clinical utility of a two-site immunoradiometric assay for creatine kinase-MB in the detection of perioperative myocardial infarction

In 144 patients, creatine kinase MB was measured serially at 0, 8, 16, 24, 48, and 72 hr using a two-site immunoradiometric assay (IRMA). Cardiac enzymes were also measured, including SGOT, LDH, total CPK, and CK-MB by electrophoresis. The presence of perioperative myocardial infarction (poMI) was established in 24 patients by the appearance of new electrocardiographic Q waves and/or new wall motion abnormalities detected by radionuclide ventriculography. In patients without poMI, CK-MB (IRMA) was elevated (6.4 +/- 4.9 equivalent units per liter) at 0-8 hr but decreased to 3.4 +/- 1.3 EU/l by 16 hr. In patients with poMI, peak values occurred at 16-24 hr (21.0 +/- 19.8 EU/l). Using a threshold value of 8.5 EU/l, patients with poMI could be distinguished from those without with 97% accuracy (sensitivity = 88%, specificity = 99%). The CK-MB (IRMA) was more reliable than the other enzyme assays, for which we used both empirically elevated threshold values based upon previous experience, and also threshold values retrospectively optimized for the study population. We conclude that the CK-MB (IRMA) can serve as a valuable postoperative screening test for poMI.