Angiotensin-II induction of plasminogen activator inhibitor-1 gene expression in astroglial cells of normotensive and spontaneously hypertensive rat brain.

Angiotensin-II (AII) stimulates plasminogen activator inhibitor-1 (PAI-1) gene transcription, translation, and protein secretion from astroglial cells derived from normotensive [Wistar-Kyoto (WKY)] rat brain, an effect mediated by AII type 1 (AT1) receptors. Since abnormal expression of the brain AII system has been demonstrated in spontaneously hypertensive (SH) rats, we investigated the regulation of PAI-1 gene expression by AII in astroglial cells from the brains of these animals. AII caused an increase in PAI-1 gene expression in SH rat astroglia in a manner similar to that observed in WKY-derived cultures. However, both the basal and AII-stimulated levels of PAI-1 mRNA in SH rat astroglia were only 20% of those observed in WKY rat astroglial cultures. Consequently, there was a significant reduction in the de novo synthesis and secretion of PAI-1 from astroglia of SH rat brain. The reduced synthesis and secretion of PAI-1 from SH rat brain astroglia was associated with lower numbers of AT1 receptors in these cells. However, the steady state levels of AT1 receptor mRNA were comparable in both WKY and SH rat astroglia. This reduction in AII-modulated PAI-1 levels in SH rat astroglia is consistent with a proposed role of these interactions in the development of hypertension in these animals.


[Planar charged clusters--structural invariants of the gamma-crystallin family of the crystalline lens: functional role and evolutionary conservatism].

Plane charge clusters from the calf eye lens protein gamma-crystallin are considered. The clusters consist of four to six side chain charged groups with interatomic distances in ionic pairs from 4 to 7 A. The charge clusters appear to decrease the hydrophilic potential of the molecular surface which maintains the transparent refracting lens medium of vertebrates with a very high protein concentration. It is shown that the charge pattern for different gene products of one species is conservative as well as for whole set of 25 sequences of vertebrates, including carp, frog, mouse, rat, calf and human. Taking into account "neutral mutations", Asp-Glu and Arg-Lys the homology of those charge positions is equal to 95-100%. Functionally important charge clusters are absent in the ancient structural motifs of gamma-crystallin.


[Effective diameter of DNA].

Different methods of determination of effective diameter of DNA double helix under different ionic conditions in solution are reviewed. This value is a characteristic of excluded volume effects in DNA and allows for electrostatic repulsion between segments of the molecule. The values of the effective diameter found by completely different methods are in excellent agreement. This allows to conclude that in wide range of ionic and DNA concentrations a model of unpermeable cylinders provides adequate description of DNA conformational properties. The effective double helix diameter grows rapidly with decreasing salt concentration and can be several times higher than the geometric one. Even in solutions of physiological ionic strength corresponding to 200 mM NaCl the value of the effective diameter is 5 nm. Such a sharp dependence of DNA effective diameter on salt concentration should be taken into account when analyzing conformational properties of superhelical DNA.


Regulation of Sertoli cell differentiation by the testicular paracrine factor PModS: potential role of immediate-early genes.

Testicular peritubular cells produce a paracrine factor, PModS, under androgen control that modulates Sertoli cell functions that are essential for the process of spermatogenesis. PModS has a more dramatic effect on Sertoli cell differentiated functions in vitro than any regulatory agent previously shown to influence the cell, including FSH. Investigation of the actions of PModS on a molecular level have used transferrin expression as a marker of Sertoli cell differentiation. PModS was found to stimulate transferrin gene expression while having no effect on transferrin mRNA stability. The ability of PModS to elevate transferrin mRNA levels was inhibited by cycloheximide. Therefore, the actions of PModS require ongoing protein synthesis and appear to be indirectly mediated through trans-acting early event genes. PModS was found to dramatically increase mRNA levels for c-fos, but had no effect on c-jun mRNA levels. The c-fos mRNA levels increased transiently within a few minutes to a maximal level of stimulation at 1 h and returned to basal levels within 6 h. The rise in c-fos mRNA preceded the elevation in transferrin mRNA, which started to increase at 2 h to a maximum level between 6-12 h that was maintained at high levels for several days in cell culture. Treatment of Sertoli cells with an antisense c-fos oligonucleotide was found to inhibit the actions of PModS on transferrin expression. Combined results support the hypothesis that PModS acts indirectly through transcription factors (e.g. c-fos) to induce Sertoli cell differentiated functions (e.g. transferrin expression). Therefore, PModS appears to act as a differentiation-type factor to promote and maintain optimal Sertoli cell function.


Expression of the rat carboxypeptidase-E gene in neuroendocrine and nonneuroendocrine cell lines.

To identify cis-acting elements involved with the expression of the rat carboxypeptidase-E (CPE) gene, constructs containing various regions of the 5'-flanking region of the CPE gene attached to the luciferase reporter gene were transiently expressed in cell lines derived from pituitary (AtT-20 and GH4C1), liver (SK-HEP-1), and kidney (HEK293 and COS1). Regions of the CPE gene spanning the major transcription initiation site (-12 to 47) are sufficient for low levels of transcription. Activity is enhanced 3- to 15-fold by sequences present between -12 and -395 in all cell lines examined. Sequences between -395 and -3081 influenced transcription activity up to 5-fold in some, but not all, cell lines. There was no correlation between the transcription activities of the various constructs and the level of endogenous CPE mRNA in the cell lines, indicating that the tissue-specific elements responsible for the large variations in endogenous CPE mRNA levels are not present within -3081 to 47. The region between -395 and 45 was examined in greater detail using transient expression assays and DNase-I protection analysis. Transcription activity is enhanced in GH4C1 and HEK293 cells by sequence present between -12 and -84; this region contains a potential GC box, which binds factors present in GH4C1 nuclear extracts. Other regions between -340 and 80 that bind proteins in the GH4C1 nuclear extracts include the major transcription initiation site, which has homology to the initiator sequence; the pituitary-specific transcription initiation sites (-101 and -105); and sequences with homology to NF-1, Pan-1, simian virus-40 enhancer core, and AP-2-binding sites. Taken together, these results suggest that basal expression of the CPE gene from its major transcription initiation site, which does not contain an up-stream TATA box, is primarily under the control of an initiator-like element together with an upstream GC box.


Ligand-dependent down-regulation of stably transfected human glucocorticoid receptors is associated with the loss of functional glucocorticoid responsiveness.

The effect of glucocorticoids on the regulation of stably transfected human glucocorticoid receptors has been examined. Exposure of a Chinese hamster ovary-derived cell line containing stably transfected human glucocorticoid receptor genes and glucocorticoid-responsive dihydrofolate reductase genes to 5 nM dexamethasone resulted in a rapid, time-dependent reduction in the level of glucocorticoid receptor protein to 50% of control levels within 5 h of steroid treatment. This decrease in receptor protein was persistent, with a maximal 70% reduction observed even after 4 weeks of dexamethasone treatment. Immunocytochemical analysis of the influence of dexamethasone on stably transfected glucocorticoid receptors revealed efficient translocation of receptors to the nucleus within 1 h of hormone treatment. However, upon longer exposure to dexamethasone (5 h), immunoreactive glucocorticoid receptors were localized primarily to the cytoplasm. By 24 h of treatment, glucocorticoid receptors were absent from the cytoplasm and the nucleus, suggesting that the ligand-induced loss of glucocorticoid receptors may be a cytoplasmic event. The decrease in transfected glucocorticoid receptor protein was largely reflected by similar changes in steady state levels of human glucocorticoid receptor mRNA; however, the effects of hormone on receptor protein levels were more profound than on receptor mRNA. There was an initial rapid reduction in transfected glucocorticoid receptor mRNA to 50% of control levels within 2 h of dexamethasone treatment. This reduction was followed by a transient rise in mRNA expression after 12 h of hormone treatment. With prolonged exposure to dexamethasone (> 12 h) a second, more gradual decline in human glucocorticoid receptor mRNA was observed. This biphasic pattern of glucocorticoid receptor gene expression was not reflected at the level of receptor protein, suggesting that both transcriptional and translational control mechanisms may be involved in ligand-dependent receptor regulation. When cells were removed from dexamethasone after up to 48 h of treatment, glucocorticoid receptor mRNA levels fully recovered within 12 h. Receptor protein recovered only partially during this same time period. Down-regulation of glucocorticoid receptor protein and mRNA levels by dexamethasone in stably transfected cells led to corresponding reductions in the hormone sensitivity to two glucocorticoid-regulated genes: a transiently transfected chloramphenicol acetyltransferase receptor gene and a stably integrated dihydrofolate reductase gene. These results demonstrate that stably transfected human glucocorticoid receptors are subject to ligand-induced down-regulation in a heterologous cell line. Moreover, glucocorticoid receptor autoregulation appears to be a highly conserved mechanism for attenuating cellular responsiveness to hormone.


Transforming growth factor-alpha and epidermal growth factor receptor gene expression and action during pubertal development of the seminiferous tubule.

The potential role of transforming growth factor-alpha (TGF-alpha) as a mediator of cell-cell interactions in the growth and development of the testis was examined. Developing rat testes were collected, and preparations of mesenchymal-derived peritubular cells and epithelial-like Sertoli cells were isolated from prepubertal, midpubertal, and late pubertal rat testes. The developmental expression of TGF-alpha and its receptor, the epidermal growth factor receptor (EGFR), in whole testis and isolated cell types was determined using a nuclease protection assay. TGF-alpha and EGFR gene expression were predominant early in testis development and decreased during pubertal development. TGF-alpha expression was greatest in prepubertal peritubular cells. Sertoli cell TGF-alpha expression remained relatively constant during development, with a slight decline at the later pubertal stages. EGFR gene expression was predominant in peritublar cells throughout development. A low level of EGFR expression was detected in Sertoli cells. Scatchard analysis confirmed the presence of high affinity receptors on peritubular cells; however, no functional receptors were detected on Sertoli cells from any stage of development examined. Interestingly, low-level EGFR gene expression was also detected in pachytene spermatocytes and round spermatids. TGF-alpha was found to stimulate [3H] thymidine incorporation into DNA and increase cellular proliferation of peritubular cells from each developmental stage, while having no effect on Sertoli cells. The in vivo physiological significance of TGF-alpha was evaluated in a line of transgenic mice which overexpress TGF-alpha in the mature testis. These transgenic animals had no abnormal testicular morphology or alterations in spermatogenesis. Observations demonstrate that gene expression of TGF-alpha and its receptor is high during early pubertal stages when somatic cell growth is predominant and low at late pubertal stages when somatic cell proliferation is reduced. TGF-alpha can act as an autocrine/paracrine mitogen for the mesenchymal-derived peritubular cell, while actions on the Sertoli cell population are not evident. The observation that spermatogenic cells express the EGFR gene, although the protein remains to be identified, implies that TGF-alpha may potentially mediate Sertoli-germinal cell interactions.


The alpha- and beta-isoforms of the inhibitor protein of the 3',5'-cyclic adenosine monophosphate-dependent protein kinase: characteristics and tissue- and developmental-specific expression.

The inhibitor protein (PKI) of the cAMP-dependent protein kinase was first characterized from rabbit skeletal muscle. More recently a form of PKI was isolated and cloned from rat testis which shares relatively limited amino acid sequence with the rabbit skeletal muscle form. We have now isolated a cDNA from rat brain which encodes a protein corresponding to the rabbit skeletal muscle PKI. This establishes the presence of the "skeletal muscle" and "testis" proteins in the same species and therefore that they clearly represent distinct isoforms. We have also demonstrated that the isoform from testis, like the skeletal muscle isoform, is specific for the cAMP-dependent protein kinase and that it is able to inhibit this enzyme when expressed in cultured JEG-3 cells. Both forms contain the five specific amino acid recognition determinants which have been shown to be required for high affinity binding to the protein kinase catalytic site, although there is some noted lack of conservation of codons used for these residues. Overall, the two rat isoforms are only 41% identical at the amino acid level and 46% at the level of coding nucleotides. We propose that the rabbit skeletal muscle and rat testis forms be designated PKI alpha and PKI beta, respectively. Using Northern blot analysis, we have examined the tissue distribution of the two forms in the rat and their relative expression during development. In the adult rat, mRNA of the PKI alpha species is highest in muscle (both skeletal and cardiac) and brain (cortex and cerebellum).(ABSTRACT TRUNCATED AT 250 WORDS)


Heparin-binding keratinocyte growth factor is a candidate stromal-to-epithelial-cell andromedin.

The growth of isolated epithelial and stromal cells from both androgen-dependent normal rat prostate and an androgen-responsive model rat prostate tumor is androgen-independent. When added to co-cultures of epithelial and stromal cells separated by a semipermeable membrane, androgen stimulated epithelial cell growth without an effect on stromal cell growth. Northern blot and nuclease protection analysis of mRNA revealed that stromal cells specifically expressed an androgen-sensitive secreted member of the heparin-binding fibroblast growth factor family [keratinocyte growth factor (KGF)/fibroblast growth factor-7]. KGF was mitogenic for epithelial cells, but not for stromal cells. Epithelial cells expressed specifically a splice variant of the bek receptor gene that specifically binds KGF. Expression of the bek receptor gene in stromal cells was undetectable by Northern blot and nuclease protection analyses. The results suggest that stromal cell-derived KGF has the properties of an andromedin, which mediates the indirect control of epithelial cell proliferation by androgen through a directional stromal-to-epithelial cell paracrine mechanism.


Identification of a new brain-specific transcription factor, NURR1.

We have identified and cloned a novel member of the nuclear receptor superfamily. The cDNA was isolated from a mouse brain cDNA library and encodes a protein 598 amino acids in length with a predicted mol wt of 66 kilodaltons. The amino acid sequence of the protein is closely related to an additional family member and immediate early gene product, Nur77, and the novel factor is referred to as Nurr1 (Nur-related factor 1). The relationship between Nurr1 and Nur77 suggests that these proteins constitute an additional subfamily within the nuclear receptor superfamily. Like Nur77, the expression of Nurr1 is induced by membrane depolarization of PC12 cells. However, while Nur77 shows an early transcriptional response to nerve growth factor stimulation, the failure of Nurr1 to respond to this agent suggests a differential selectivity of the two proteins in terms of their transcriptional responses to specific stimuli. Finally, both proteins are differentially expressed during development and in tissues of the adult mouse. Unlike Nur77, Nurr1 appears to be predominantly located in brain tissue, suggesting a primary role for this putative transcription factor in regulation of gene expression in the central nervous system.


Identification of two cysteines closely positioned in the ligand-binding pocket of the human estrogen receptor: roles in ligand binding and transcriptional activation.

We have previously identified cysteine 530 in the human estrogen receptor (ER) as the major site of attachment for covalently binding affinity ligands and have shown that when this cysteine is mutated to alanine (C530A mutant), the affinity ligand [tamoxifen aziridine (TAZ)] can still bind covalently to the ER, presumably by interaction with a different cysteine(s) in the hormone-binding domain (HBD). Using site-directed mutagenesis, we have determined the alternative ligand attachment site and the functional importance of the cysteines (residues 381, 417, 447, and 530) in the HBD of the ER to the hormone-binding and transcriptional responses to estrogens and antiestrogens. Cysteine 530 plus one or more of these other cysteines were mutated to alanines. Analysis of these mutant ERs expressed in Chinese hamster ovary cells provides strong evidence that cysteine 381 is the residue that is preferentially covalently labeled by TAZ in the C530A mutant. Hence, portions of the HBD that are far apart in the linear receptor sequence, namely regions near C381 and C530, are probably closely positioned in the ligand-binding pocket, with the cysteine thiols being 1.1 nm or less apart. The affinity of estradiol binding to receptors was reduced only 2- and 5-fold, respectively, in the double and quadruple Cys to Ala mutants, and estradiol was an effective stimulator of transcription from an estrogen-responsive reporter gene [(ERE)2-TATA-CAT].(ABSTRACT TRUNCATED AT 250 WORDS)


Point mutation of estrogen receptor (ER) in the ligand-binding domain changes the pharmacology of antiestrogens in ER-negative breast cancer cells stably expressing complementary DNAs for ER.

The antiestrogen tamoxifen is used in the treatment of hormone-responsive breast cancer. However, therapeutic failure has frequently been observed in both patients and animal models after long term treatment. We have studied the effect of a point mutation that leads to the substitution of Val for Gly at codon 400 in the ligand-binding domain of the estrogen receptor (ER) on estrogenic and antiestrogenic activities of 4-hydroxytamoxifen (4-OHT) and its derivatives. Stable ER transfectants derived from MDA-MB-231 CL10A, an ER-negative breast cancer cell line, have been used in these studies. 4-OHT and its fixed ring derivatives showed more estrogen-like activity in ER transfectants than in MCF-7, an ER-positive breast cancer cell line. In this study, 4-OHT was a partial agonist of cell growth in the transfectant S30 cells, which express the wild-type ER. However, it was a full agonist in the mutant ER transfectant ML alpha 2H, which expressed ER with Val at codon 400. The increased estrogenic activity of 4-OHT in ML alpha 2H cells was not due to the preferential isomerization of trans 4-OHT to cis 4-OHT, since the nonisomerizable fixed ring trans 4-OHT was a partial agonist for cell growth in S30 cells and was a full agonist in ML alpha 2H cells. Transient transfection using a reporter plasmid containing an estrogen response element demonstrated that fixed ring trans 4-OHT had estrogenic activity in ML alpha 2H cells.(ABSTRACT TRUNCATED AT 250 WORDS)


Inhibition of pancreatic glucagon gene expression in mice bearing a subcutaneous glucagon-producing GLUTag transplantable tumor.

Transgenic mice that express a glucagon gene-simian virus-40 large T-antigen (GLUTag) fusion gene develop neuroendocrine carcinoma of the large bowel. This glucagon-producing tumor was implanted sc and reproducibly formed tumors in nude mice. The transplanted GLUTag tumor expressed large amounts of proglucagon mRNA transcripts, and the levels of proglucagon mRNA transcripts remained constant during 2-8 weeks of tumor growth. The posttranslational processing of proglucagon in the transplantable tumor resembled that detected in the original transgenic tumor, with the liberation of glicentin, oxyntomodulin, glucagon, glucagon-like peptide (1-37) [GLP-1-(1-37)] and GLP-1-(7-37). Tumor-bearing mice demonstrated progressive elevations in the plasma levels of proglucagon-derived peptides. Elevated plasma levels of glucagon-like immunoreactive peptides and immunoreactive glucagon were associated with a marked reduction in the levels of pancreatic glucagon mRNA transcripts by 4 weeks, and after 8 weeks of tumor growth, the levels of glucagon mRNA transcripts in the pancreas were not detectable by Northern blot analysis. Synthesis of the proglucagon-derived peptides was also significantly suppressed at 4-8 weeks in the pancreas of tumor-bearing animals. Histological examination of the endocrine pancreas in mice carrying the GLUTag tumor for 6-8 weeks demonstrated a marked reduction in the number and size of the islets of Langerhans and a disproportionately greater decrease in the number of cells exhibiting glucagon immunoreactivity. By electron microscopy, the residual A-cells were small, compressed at the periphery of the islets, and had poorly developed cytoplasmic organelles. In contrast, no changes in mouse glucagon gene expression or islet morphology were detected in control animals without tumors or mice carrying a sc v-jun-induced fibrosarcoma. The suppression of pancreatic A-cell function and islet size in mice with elevated plasma levels of the proglucagon-derived peptides raises the possibility that a proglucagon-derived peptide may participate in a negative feedback loop, inhibiting expression of the glucagon gene in the A-cells of the endocrine pancreas.


Expression of a peptide processing enzyme in cultured cells: truncation mutants reveal a routing domain.

Peptidylglycine alpha-amidating monooxygenase (PAM) is a bifunctional enzyme responsible for the alpha-amidation of peptides in secretory granules of neuroendocrine cells. The single gene encoding PAM undergoes tissue-specific alternative splicing and endoproteolytic processing to generate bifunctional membrane proteins with a single transmembrane domain as well as soluble proteins that are mono- or bifunctional. In order to examine the endoproteolytic processing and subcellular localization of the various forms of PAM in cells lacking regulated secretory granules, we established stably transfected hEK-293 cell lines expressing naturally occurring and mutant forms of PAM. As expected, newly synthesized soluble PAM proteins were rapidly secreted into the medium. Integral membrane protein forms of PAM were largely localized in the perinuclear region with punctate staining visible throughout the cell and 2-5% of the enzyme activity detectable on the cell surface. Bifunctional PAM proteins were slowly released into the medium after expression of integral membrane protein forms of PAM. Deletion of 77 amino acids from the COOH-terminus of the integral membrane forms of PAM resulted in a membrane-bound protein which retained both enzymatic activities but accumulated on the cell surface. Rapid internalization of full-length PAM proteins was observed by incubating live cells with antiserum to PAM; deletion of the COOH-terminal domain eliminated the ability of cells to internalize PAM. Thus the cytoplasmic domain of integral membrane PAM contains a routing determinant recognized by cells lacking the regulated secretory pathway.


Identification and characterization of a luteinizing hormone/chorionic gonadotropin (LH/CG) receptor precursor in a human kidney cell line stably transfected with the rat luteal LH/CG receptor complementary DNA.

It is well established that the LH/CG receptor expressed in gonadal cells is an 85- to 92-kilodalton (kDa) glycoprotein. Additionally, however, a number of reports have noted the existence of other putative receptor species, but few attempts have been made to characterize these variant receptor species. A cell line [293L(wt1)] had previously been isolated which expresses large numbers of high affinity cell surface LH/CG receptors. Visualization of the LH/CG receptor species expressed in these cells and in rat luteal cells using ligand blots revealed 85- and 90-kDa LH/CG receptors, respectively, while immunoblots revealed another 68-kDa glycoprotein receptor in both cell types. The presence of both the 85- and 68-kDa receptor species was confirmed using immunoprecipitation and affinity purification of metabolically labeled 293L(wt1) cells. Enzymatic deglycosylations established that the 85-kDa receptor is a sialoprotein, while the 68-kDa species contains exposed high mannose residues. Protease digestion before LH/CG receptor immunoprecipitations localized the 85-kDa receptor on the plasma membrane, while the 68-kDa receptor was shown to be located intracellularly. Pulse-chase experiments were then used to positively establish that the 68-kDa receptor protein is actually a precursor of the 85-kDa LH/CG receptor species.


A consensus DNA-binding site for the androgen receptor.

We have used a DNA-binding site selection assay to determine a consensus binding sequence for the androgen receptor (AR). A purified fusion protein containing the AR DNA-binding domain was incubated with a pool of random sequence oligonucleotides, and complexes were isolated by gel mobility shift assays. Individually selected sites were characterised by nucleotide sequencing and compiled to give a consensus AR-binding element. This sequence is comprised of two 6-basepair (bp) asymmetrical elements separated by a 3-bp spacer, 5'-GGA/TACANNNTGTTCT-3', similar to that described for the glucocorticoid response element. Inspection of the consensus revealed a slight preference for G or A nucleotides at the +1 position in the spacer and for A and T nucleotides in the 3'-flanking region. Therefore, a series of oligonucleotides was designed in which the spacer and flanking nucleotides were changed to the least preferred sequence. Competition experiments with these oligonucleotides and the AR fusion protein indicated that an oligonucleotide with both the spacer and flanking sequences changed had greater than 3-fold less affinity than the consensus sequence. The functional activity of these oligonucleotides was also assessed by placing them up-stream of a reporter gene in a transient transfection assay and correlated with the affinity with which the AR fusion protein bound to DNA. Therefore, sequences surrounding the two 6-bp half-sites influence both the binding affinity for the receptor and the functional activity of the response element.


The transcription factor interferon regulatory factor-1 is expressed during both early G1 and the G1/S transition in the prolactin-induced lymphocyte cell cycle.

PRL induces quiescent Nb2 rat T-lymphoma cells to undergo mitogenesis. Upon PRL stimulation, the transcription factor interferon regulatory factor-1 (IRF-1) is induced as a novel T-cell activation gene in Nb2 cells. Surprisingly, IRF-1 is expressed twice during a single PRL-induced growth cycle: first during the early G1 phase, in an immediate transient peak from 15 min to 2 h, and second during the G1/S phase transition, in a broader peak beginning at 8 h. The unusual biphasic expression of IRF-1 mRNA is accompanied both times by de novo IRF-1 protein synthesis. However, the rate of IRF-1 protein turnover appears to be different in G1 and S phases. IRF-1 protein expressed in G1 exhibits a half-life of about 25 min, whereas in the S phase, the half-life is about 60 min. By washing out PRL at various times during G1, we found a direct correlation among the length of PRL exposure, the second peak of IRF-1 mRNA expression, and DNA synthesis. Our data suggest that PRL and one putative nuclear mediator, IRF-1, may be important in two distinct phases of the cell cycle: first in cell cycle activation, and then in S phase progression.


[What is the cause of recurrent urinary tract infection?].

The increased susceptibility of patients prone to recurrent urinary tract infection (UTI) has been explained by an imbalance of bacterial virulence properties versus host defense capacities. In fact, the presence of certain virulence factors of the invading gram-negative bacteria (i.e. O-antigens, K-antigens, flagellae, hemolysine production, siderophores and fimbriae) determines the severity of clinical symptoms--whether UTI will present as a severe pyelonephritis or merely as an asymptomatic bacteriuria. On the other hand, an increased periurethral bacterial colonization, a deficiency of the uromucoid defense line, the increased density of globoseries glycolipids on uroepithelial cells, that function as receptors for type II mannose-resistant bacterial fimbriae and the defense defect of the uroepithelium itself contribute to the assumption that a localized defense deficiency within the non-obstructed urinary tract promotes the generalized susceptibility to recurrent UTI.


[How dangerous is a urinary tract infection?].

Urinary tract infections (UTI) may become dangerous if ascending bacteria reach the kidney and subsequently induce an inflammatory reaction within the renal parenchyma. Host factors like vesicorenal reflux or obstructive uropathies increase the risk of ascending infection and facilitate renal damage even by bacteria of "low virulence". Inadequate antibiotic therapy and young age are further predisposing factors for pyelonephritic scars. Hypertension, reduced kidney function and complications during pregnancy are the potential long term problems arising from renal damage. Early recognition of obstructive uropathies by sonographic screening, undelayed diagnosis and consequent treatment of symptomatic UTI, and early identification of reflux after symptomatic UTI's may reduce the incidence of these problems.


[Effectiveness of Haemophilus influenzae B-diphtheria conjugate vaccination in German children].

In 1990 the Haemophilus influenzae b-Diphtheria conjugate vaccine (Hib-D) was introduced in Germany. In addition, most children under 18 months of age failed to develop protective levels of Hib antibodies in response to systemic infections. To evaluate the protective efficacy of the Hib-D vaccine in Germany a post marketing case-control study was performed during 1.5. 1990-30.4. 1992. Surveillance for invasive Hib-infections was maintained by pediatricians of 8 hospitals in the Rhein-Main area. The antibody responses to Hib were evaluated by ELISA at the onset (days 0-3) and during remission of disease. During the first year of the study 23 cases per 100,000 children of invasive Hib-infections were recorded. Of these children, 15 suffered from meningitis, 6 from epiglottitis and one from cellulitis and pericarditis respectively. None of these patients had been vaccinated except for one, who received two injections of Hib-D. Due to increased acceptance of the Hib-D vaccine we found a significant reduction of invasive Hib-infections (6 cases per 100,000 children) in the second year of the study. Again, of these children only one child was vaccinated. As expected, in all patients investigated the initial Hib antibody level was below 1 microgram/ml. The development of Hib specific immunity to invasive disease was clearly age dependent: 10 of 11 children below 18 months failed to produce any Hib antibodies (> 0.15 microgram/ml) in response to their infection. In contrast 8 of 10 children older than 18 months developed protective antibody levels to Hib. The incidence of serious Hib-disease has significantly decreased in Germany since the introduction of the Hib-D vaccine. Because no other Hib vaccine was licensed in Germany our data confirm efficacy and safety of Hib-D reported previously. In addition, children, who contracted disease before 18 months of age, remain susceptible to Hib and require active immunization for protection.


[Procollagen III propeptide. Values in the course of pediatric celiac disease].

An explanation for an incomplete catch-up growth in children with coeliac disease has not yet been found. The marker of growth procollagen-III-propeptide could possible provide a better understanding of the actual regulation of growth in the situation. The investigation was made in children with established coeliac disease (n = 30). A commercial radioimmunoassay was used for the measurement of PC-III-P. A close relationship (r = 0.75; P < 0.0001) was found between height velocity and PC-III-P in serum of coeliac children. There was also a good correlation (r = 0.54; P < 0.001; n = 72) with serum levels of alcaline phosphatase. Only weak correlations were found to insulin-like growth factor I (r = 0.33; P < 0.05; n = 62), to urinary calcium (r = 0.27; P < 0.05; n = 62), and to the maturation of bones (r = 0.25; P < 0.05; n = 54). In accordance with the good correlation between height velocity and PC-III-P normal results were found in normal growing children with coeliac disease. Reduced serum levels of PC-III-P were found in coeliac children who failed to show a complete catch-up growth while on a gluten-free diet. Gluen challenge, as required for the confirmation of the diagnosis, led to a significant further decrease of the values of PC-III-P. Parallel investigations for IgA endomysium antibodies in serum suggest that besides dietary errors additional factors may impede growth, or in other words that disorders of growth regulation persist in some patients with coeliac disease even under treatment. This assumption will have to be tested by further investigations.


[Cardiopulmonary capacity in patients with mucoviscidosis. Comparison of ergospirometry findings with clinical and radiological scores].

Shwachman-Kulczycki- and Chrispin-Norman-Scores are widely used scoring systems for CF-patients. Maximum bicycle exercise testing was performed in 15 patients (medium age 13.4 years) to investigate whether clinical and radiographic scores or pulmonary function testing could predict cardiorespiratory fitness. A progressive exercise test was used to determine maximum working capacity (Wmax). Prior to exercise testing, lung function and blood gases were investigated. Chest radiographs were scored by an independent radiologist (G.B.) applying the Chrispin-Norman-Score. The Shwachman-Kulczycki-Score was determined by two observers (F.F., H.S.). Chrispin-Norman-Score, Schwachman-Kulczycki-Score, results of lung function testing and blood gas values were significantly correlated to each other. However no significant correlation was found to the degree of exercise limitation. Clinical, radiographic scores and lung function testing cannot predict exercise tolerance. Exercise testing is mandatory to evaluate cardio-respiratory fitness in CF-patients.


[Irreversible valproate-associated liver failure].

A very severely retarded infant with a Dandy-Walker malformation was treated with valproate since the age of 6 months on account of infantile spasms. Three weeks after start of therapy dexamethasone was applied additionally because valproate was ineffective. Seventy-six days after initiation of valproate therapy the infant died with the clinical signs of fulminant valproate-associated hepatotoxicity despite the discontinuation of valproate. In combination with a febrile otitis media the child had been periodically restless and lethargic during the last week prior to liver coma. Activity of liver enzymes remained within normal limits up to two days before coma occurred. Analysis of valproate metabolites by gas chromatography/mass spectrometry yielded unusually high concentrations of the di-unsaturated metabolite E,E-2,3'-dien-valproate before and during liver failure. The concentrations of the main metabolites E-2-en-valproate und 3-keto-valproate remained within the usual range found during valproate therapy at steady state. The oxydation products 4-en-valproate and E-2,4-dien-valproate which are formed by alternative pathways and are considered to be hepatotoxic were detected in very low concentrations only. The application of carnitine, of antioxidants thought to improve the capacity of the free radical scavenger system (selen, vitamin E), and of N-acetylcysteine which can detoxify reactive drug metabolites could not prevent the fatal outcome.


[Hospitalism. A current problem?].

The development of the term "hospitalism" since Spitz is described. The phases of hospitalism, protest, despair and separation are illustrated, as are preventive measures. Mother-childwards, rooming-in in obstetrics and generous visiting regulations have led to a major decrease in hospitalism in Germany. Outdated wards, social orphans and intensive care units are still current problems of hospitalism.


Fungal contamination of Kashar cheese in Turkey.

Fifty random samples of Kashar cheese were collected from shops in different localities in Erzurum, all contained moulds. Mean count of total surface mould was 3.02 x 10(10)/g cheese and that of inner mould was 3.02 x 10(3)/g cheese. The genera Penicillium, Aspergillus, Mucor, Rhizopus and Geotrichum sp. were isolated from cheese samples. Aflatoxins were not detected in cheese samples. Potassium sorbate inhibited mould growth and sporulation in YES broth. The public health importance and economic significance of fungal contamination, and suggested measure for cheese quality are discussed.


Cannabinoid receptors: which cells, where, how, and why?

Localization of the mRNA for this receptor has identified many regions of the rat brain in which the gene for this receptor is active. Several of these regions are consistent with the cannabinoid- or marijuana-induced effects that occur in both laboratory animals and humans. However, other labeled regions are not easily associated with well-known effects of marijuana (Matsuda et al., submitted for publication). Although great progress has been achieved in elucidating the mechanism of action of cannabis in recent years (Howlett et al. 1990), much remains to be discovered about the expression of cannabinoid receptors in the brain and exactly how this receptor influences numerous brain functions.


Regulation of opioid gene expression: a model to understand neural plasticity.

The recent finding that neurotransmitters and drugs that affect neurotransmission have important influences on gene expression suggests that drug-induced alterations in gene expression may underlie many long-term effects of addictive drugs, for example, dependence and drug-seeking behaviors. These long-term adaptive responses to opiate drugs have been particularly difficult to understand at a mechanistic level. Data presented here indicate that the gene encoding the opioid precursor proenkephalin is highly regulated by neural activity, second-messenger pathways, and PKA. These observations raise the possibility that drugs of abuse (e.g., opiates acting through opiate receptors) may act at the genetic level to modulate the expression of endogenous opiates and that these effects may underlie one component of the brain's long-term adaptive response to exogenous opiates. The transgenic animals described above can be used to investigate opiate drug-induced changes in proenkephalin gene expression, allowing rapid analysis of changes in proenkephalin gene expression in highly restricted populations of neurons in a fashion previously impossible. In addition, by analyzing the effects of specific enhancer mutations on tissue-specific and transsynaptic regulation of proenkephalin expression, transgenic models will permit mechanistic investigations within the intact nervous system that cannot otherwise be undertaken. Investigation of mechanisms underlying this process requires the analysis of intracellular signaling pathways, responsive DNA regulatory elements, and the transcription factors transducing synaptic signals into gene regulation. In the studies described herein, we demonstrate that AP-1 complexes consisting of different Jun proteins differentially regulate proenkephalin transcription at the CRE-2 element. c-Jun constitutively activates proenkephalin transcription, whereas JunD activates in a fashion completely dependent on the activation of second-messenger pathways and the cAMP-dependent PKA. JunB alone has no effect on proenkephalin gene expression, yet this molecule effectively blocks activation mediated by JunD and, hence, may act as a repressor. These data are consistent with a model (figure 4) in which preexisting JunD mediates the rapid cAMP-dependent activation of the proenkephalin enhancer, whereas IEGs such as JunB or c-Fos mediate the protein synthesis-dependent inactivation. Because c-Jun activates proenkephalin transcription constitutively, induction of c-Jun may lead to a further and prolonged activation of proenkephalin gene expression. Hence, the ratio of c-Jun to JunB induction may determine whether proenkephalin is repressed or further activated.


New monoclonal antibodies specific to HLA class I and their application in the study of acid treatment effect on cell surface antigens.

New monoclonal antibodies (mAbs) against HLA class I antigens were prepared and characterized. Three mAbs (CLI-1, CLI-2, CLI-3) were directed to the heavy chain of HLA class I molecules and one mAb (B2M-1) is specific to beta 2-microglobulin. Using these mAbs, it was confirmed that acid treatment selectively eliminated cell surface HLA class I antigenicity. The treatment with citric acid solution resulted in preparation of cells with lower residual HLA class I surface molecules than was seen after the treatment with glycine buffer.


Detection of cytoplasmic and surface membrane markers in cells of some human hematopoietic cell lines.

The cells of some human leukemia-lymphoma T cell lines (JURKAT, MOLT4), B cell lines (DAUDI, U-266) and of myeloid U-937 cell line were characterized for their surface membrane and cytoplasmic marker profiles. The usefulness of some fixation and permeabilization methods of cell membrane for detection of cytoplasmic markers by flow cytometry was studied. The methods of cell fixation in suspension were found to be more sensitive than the methods of cell fixation in smears. With the very short buffered formaldehyde-acetone (BFA) fixation used in this study an optimal penetration of the monoclonal antibodies (MoAbs) through the plasma membrane and specific binding to the appropriate structures were achieved. CD22 antigen was detected in cytoplasm but not on membrane of DAUDI cells. In another B cell line, U-266, CD22 antigen was present both in cell membrane and cytoplasm. The marker corresponding to anti-CD19 MoAb was detected in cytoplasm but was absent on membrane of U-266 cells. Furthermore, the antigen estimated by anti-CD3 MoAb could be detected intracellularly in cells of both T cell lines tested, while it was absent on cell membrane of these cells. The phenotypic study of U-937 cells showed that the majority of cells expressed myeloid associated antigens. In our study the CD14 marker detected on cell surface membrane of U-937 cells was missing in their cytoplasm. The surface antigens remained intact after BFA fixation enabling a simultaneous detection of membrane and cytoplasmic markers in double immunofluorescence studies. Through this combination of markers minor cell populations could be detected. Human hematopoietic cell lines could serve as a reliable model system for a rapid and quantitative immunodiagnosis.


Regulation of the proto-oncogenes c-sis, c-fos, c-myc and c-myb in acute myeloid leukemias.

RNA transcriptional levels of the proto-oncogenes c-sis, c-fos, c-myb and c-myc were measured in peripheral blood leukemic blast cells of 16 patients with acute myeloid leukemia (AML) of different FAB subtypes, 8 being at diagnosis and 8 upon relapse. The studied proto-oncogenes were found to be regulated but varied considerably within morphologically identical subtypes. This is consistent with the clinically observable diverse behavior of seemingly identical AMLs as to the course and outcome of the individual disease. Overexpression of c-sis and c-myc was found more often in AML upon relapse than at diagnosis and in two cases overexpression not found at diagnosis was present at relapse. This implies alterations of biological behavior in the course of antileukemic drug therapy. A decline of c-myb expression was observed in one patient studied throughout therapy which was found to be associated with a complete but transient hematological remission after chemotherapy.


Estrogen and progesterone receptor status of primary breast cancer: relationship with the pattern of first metastasis and survival.

Estrogen (ER) and progesterone receptor (PR) contents in primary tumors from 127 advanced breast cancer patients were measured by DCC method. The patients were followed for 2 years and the prognostic value of the receptor levels was evaluated and compared with other tumor and patient characteristics. No relation was found between receptor levels and tumor, first relapse site as well as short-term survival (2 years) which might be due to the advanced stage of disease at diagnosis.


Flow cytometry (FCM) of early radiation response in epidermoid carcinoma of uterine cervix.

DNA flow cytometry (FCM) investigation of tumor specimens before and after 30 Gy 137Cs radiation treatment was performed in 33 cases of epidermoid uterine cervix carcinoma. Distinct differences in the type of FCM response to radiation were seen when the results of DNA index (DI) in diploid and aneuploid tumors and proliferation index (PI) values in diploid tumors from pretreatment and 30 Gy irradiated specimens were compared. We observed partial or total reduction of PI in 12 of 17 diploid and near diploid tumors, and total reduction of the aneuploid population in 14 of 16 aneuploid tumors. No significant correlation was found between the type of FCM response and clinical stage of the disease or the histological degree of differentiation.


Studies on the natural killer cell activity of human nonadherent mononuclear cells (nMNC) with tumor necrosis factor, interleukin-1, interferon-gamma and cisplatin.

The potential for additive or synergistic augmentation of NK cell activity of nMNC with recombinant tumor necrosis factor (TNF-alpha), interleukin-1 (IL-1), interferon-gamma (IFN-gamma) and cisplatin in different combinations was examined. Significant augmentation in NK activity of nMNC was observed when treated with cisplatin, rIFN-gamma, rIL-1 or rTNF-alpha in vitro. Combined treatment of nMNC with rIL-1 and rTNF-alpha resulted in moderate increase in NK cell activity. However, killing of K 562 target cells was markedly augmented by co-stimulation of nMNC with rIL-1 plus rIFN-gamma and rIL-1 plus cisplatin. Further, only a moderate augmentation of NK activity was observed when nMNC were treated with cisplatin plus TNF or IFN-gamma. These observations demonstrated the individual and co-stimulative effects on NK function of nMNC in vitro by rTNF-alpha, rIL-1, cisplatin and rIFN-gamma.


HPLC determination of a new anticancer agent (acylfulvene) in serum.

High performance liquid chromatography (HPLC) combined with effective preseparation steps (liquid extraction, solid-phase extraction, preconcentration procedures) was used in pharmacokinetic studies of a novel anticancer agent (acylfulvene) in serum. HPLC conditions were optimized for the analysis of model clinical samples and real serum samples with different contents of acylfulvene. Extraction recoveries for both extraction procedures were evaluated and linearity was achieved for a wide concentration range. Detection limit for acylfulvene in serum was 0.075 microgram/ml, preconcentration minimum 5 times was recommended, especially after the solid-phase extraction step. The HPLC assay was applied for pharmacokinetic studies of acylfulvene in dogs and rats and pharmacokinetic parameters were determined.


Sarcomas of the breast: a multicenter series of 70 cases.

A multicenter retrospective series of 70 breast sarcomas (malignant cystosarcoma phyllodes (25), osteosarcoma (12), liposarcoma (10), stromal sarcoma (8), angiosarcoma (7), mixed types sarcoma (4), malignant histiocytoma (3), leiomyosarcoma (1)) was reviewed. The average follow-up was 5.9 years. Diagnostic tests (palpation, mammography, sonography and cytology) were poorly sensitive, and a large proportion of cases, appearing as regular, sharp bordered, rounded masses were diagnosed as benign fibroadenomas. Surgery (limited (29), mastectomy (41)) was the treatment of choice. Axillary nodes were rarely involved (2 of 31) at pathologic staging. No significant predictors of local recurrences (12 cases) were observed although recurrences were more frequent in larger lesions (0-20 mm = 1.1%, 21-50 mm = 1.7%, > 50 mm = 6.1% women-year) and in cases treated with limited surgery (limited surgery 4.6%, mastectomy 2.0% women-year). Distant metastases (16 cases) were less frequent in malignant cystosarcoma phyllodes or liposarcoma patients, but no other significant predictors of distant metastases were evidenced. Five-year disease-free or overall survival was 50% or 66%, respectively. The study confirms that breast sarcomas are rare, difficult to diagnose, but can be cured by surgical treatment in a considerable proportion of cases.


Efficacy of a hospital based cytology screening program.

From 1976 to 1986, a total of 117,471 women attending gynecologic outpatient departments of six hospitals in Delhi, India, were screened cytologically. The cytodiagnosis revealed 30,399 (25.9%) normal finding, 84,889 (72.3%) inflammatory changes, 1910 (1.6%) dysplasia of various grades and 213 (0.2%) malignant lesions. Of the 213 cases detected as malignant, clinical suspicion of cervical cancer was not present in 125 women (58.7%). Histologically malignancy was confirmed in 192 women (90.1%) of the 213 cytologically diagnosed malignant cases. The diagnosis revealed 94 (49.0%) as carcinoma in situ and the rest of the cases were invasive lesions. This was in contrast to only 5.2% (10/194) of cases with carcinoma in situ seen at the cancer clinic during 1983-1986 in one of the major collaborating hospitals of Delhi. The analysis of data according to age revealed that median age at detection of mild/moderate, severe dysplasia, carcinoma in situ (CIS) and invasive cancers was 34.0, 37.9, 38.6, and 47.8 years, respectively, indicating a latency period of one and a half decade from the onset of precursor lesions to invasive disease. Mass population screening in our country is not feasible in the near future and this may be true also for other developing countries. In its absence cytological screening of patients attending hospitals and maternity homes can give a large yield of early cervical cancers, which are curable.


Profiling of endogenous brain peptides and small proteins: methodology, computer-assisted analysis, and application to aging and lesion models.

Significant advances in the technology for the isolation of peptides and small proteins have permitted their identification as biologic markers and enhanced the study of the posttranslational life of proteins. The protocol described here examined large numbers of tissue-derived peptides and small proteins, extracted in low pH and boiled so that proteolysis was interrupted. These were then fractionated batchwise using size exclusion and ion-exchange chromatography. Profiles of species in the peptide pools were then generated on reverse-phase high-performance liquid chromatography (HPLC). The HPLC profiles were evaluated with chromatographic analysis software to identify and quantify peptide peaks and with data compilation programs to sort this information into spreadsheets for comparison of profiles among groups. Using rodent brain, the effects of postmortem delay or age were examined. Postmortem delay produced limited alterations to the profiles, but the effect of age was more pronounced. Many changes were apparent until 12 months, after which the profiles became more constant. Additional peptide profiling of the hippocampus demonstrated changes in peptide content as a function of perforant pathway ablation. The major strengths of HPLC-mediated peptide profiling are that it lends itself to automation and can be used to detect changes in peptides and small proteins among experimental groups or subjects without any prior assumptions concerning which ones might be altered.


Hsp70 mRNA induction is reduced in neurons of aged rat hippocampus after thermal stress.

Levels of heat-shock 70 mRNAs, relative to those of 18S rRNA, were quantitated in specific cell types of hippocampus of adult and aged rats subjected to identical heat shock regimens. Body temperature changes in response to the heat stress were no different in adult and aged rats. In control rats, as well as 3 h after initiation of heat shock in both adult and aged rats, relative levels of the constitutively synthesized heat-shock cognate 70 (hsc70) mRNA were highest in hippocampal neurons and much lower in glia. No heat-shock protein 70 (hsp70) mRNAs were present in any cell type of control adult or aged rats. In heat-shocked adult rats, the relative levels of the heat-shock-inducible hsp70 mRNAs were highest in a subpopulation of glia, intermediate in granule cells of the dentate gyrus, and lowest in pyramidal cells of Ammon's horn. Relative levels of hsp70 mRNA were several-fold lower in the dentate gyrus granule cells of aged rats compared to relative levels in controls and were also reduced in many pyramidal cells of the hippocampus but not in hippocampal glia. These findings suggest that some neuronal populations in the hippocampus may be at increased risk for stress-related injury in the aged animal.


Soluble and membrane-bound forms of brain acetylcholinesterase in Alzheimer's disease.

In order to determine the effect of Alzheimer's disease on the relative distribution of soluble and membrane-bound molecular forms of acetylcholinesterase (AChE) in the brain, postmortem samples (delay interval less than 12 h) were obtained from parietal cortex (Brodmann area 40) and hippocampus as well as the areas containing their respective projection nuclei, i.e., substantia innominata and septal nucleus, in 9 patients with Alzheimer's disease (AD) and 4 normal controls. The monomer (G1), dimer (G2), and tetramer (G4) forms of AChE were examined. In AD compared to controls, significant changes occurred in area 40 and hippocampus but not in the areas containing projection nuclei, and included loss of mean total AChE activity, decrease in the relative percentage of membrane-bound G4, and increase in the relative percentage of soluble G1-G2. Percent of soluble G4 was unaffected in AD brain. In area 40 but not hippocampus a large increase in percent membrane-bound G1-G2 occurred. Thus, these results emphasize that the selective decrease in membrane-bound G4 accounts for the decrease in total G4 activity in AD brain.


Age-dependent cerebral metabolic effects of unilateral nucleus basalis magnocellularis ablation in rats.

To investigate the age-dependent functional importance of cholinergic neocortical inputs, and to explore whether cortical cholinergic denervation in aged animals might better model the cerebral metabolic changes of Alzheimer's disease, the effects of unilateral ablation of the nucleus basalis magnocellularis (NBM) on cerebral glucose metabolism were studied in young and aged rats. Regional cerebral metabolic rates for glucose (rCMRglc) were determined, using the [14C]deoxyglucose method, in 48 brain regions of 3- and 24-month old Fischer-344 rats at 3, 7, 14 and 28 days after stereotaxic injection of ibotenate into the right NBM, and in sham-operated animals at 3 and 14 days later. For both ages the peak effect of unilateral NBM ablation occurred 3 days later: in young rats, rCMRglc was significantly reduced (compared to the contralateral side) in all 24 anterior cortical areas examined (mean decline 20%), whereas in aged animals, only 9 of 24 areas showed a significant decline in glucose utilization, and the magnitude of rCMRglc reduction (9%) was smaller. Near complete recovery of rCMRglc occurred by 7 days in young and old rats. We conclude that the basalocortical cholinergic projection plays a smaller role in neocortical function of aged rats, possibly because its tonic activity is reduced. Both young and aged rats undergo cortical metabolic normalization after unilateral NBM ablation; hence the NBM-lesioned aged rat is not a better model of the progressive decline in rCMRglc that occurs in Alzheimer's disease.


Are thrombocyte membranes altered in Alzheimer's disease? A morphometric and biochemical study.

Morphometric analysis of thrombocytes from patients with Alzheimer's disease, from patients with multi-infarct dementia, and from young and age-matched healthy control donors, did not reveal any Alzheimer-related increase in internal membranes. Biochemical analysis showed a reduced cholesterol content of thrombocyte membrane preparations from Alzheimer patients relative to age-matched controls, but not relative to multi-infarct dementia patients. Overall distribution of protein kinase C activity (PKC) between cytosol and membrane, in resting as well as in activated thrombocytes from Alzheimer patients, was similar to that in the control groups. However, both Alzheimer and multi-infarct dementia patients had lower cytosolic levels of basal kinase and PKC activities than age-matched controls, while only Alzheimer patients had lower cytoskeletal PKC activity than controls.


Diabetes mellitus and brain atrophy: a computed tomography study in an elderly population.

Previous studies have suggested that noninsulin dependent diabetes mellitus (NIDDM) could lead to learning and memory deficits. We studied cognitive performance and computed tomography (CT) findings of the brain in elderly subjects with drug treated NIDDM (n = 12), with diet treated NIDDM (n = 13), and in nondiabetic individuals (ND, n = 59). The cognitive performance (orientation and up-to-date knowledge, praxic functions, understanding of speech, expressive speech, memory, general reasoning) did not differ between the groups. The drug treated diabetics had more pronounced central temporal atrophy compared to that in the ND subjects as evidenced by wider right temporal horn (ANCOVA adjusted for age, p = 0.011). The drug treated diabetics (all women) also had wider frontal horns than did the ND women. The CT measures of diet treated diabetics were comparable with those of the ND group. The fasting glucose level was positively correlated with the width of the right temporal horn but not with other CT measures in diabetic subjects. The results suggest that NIDDM and poor glucose control may carry a risk for accelerated brain atrophy in the elderly.


Differential effects of age on subpopulations of hippocampal theta cells.

The possible contribution of age-related changes in the firing properties of hippocampal theta cells to spatial learning deficits was addressed in the present study. The behavioral correlates of theta cells in strata oriens, pyramidale, and granulosum were compared as young and old rats performed a radial maze spatial working memory task. Behaviorally, the old animals made significantly more errors on the maze and required more time to solve the task than did young animals. Firing rates were compared in four different locomotion states: still, running radially inward and radially outward, and forward motion. The discharge rates of theta cells in strata pyramidale and granulosum were significantly modulated by these movements in both age groups. Stratum oriens theta cells recorded from young animals, on the other hand, were not movement-sensitive, while similar cells from old animals demonstrated exaggerated responses to movement. In old animals, the mean discharge rates were higher in stratum granulosum and lower in stratum oriens than in the young rats. The discharge rates of cells in stratum pyramidale did not differ between age groups. These region specific changes in the firing characteristics of hippocampal theta cells are likely to have important consequences for information processing in this structure.


Increased synaptic input to gonadotropin-releasing hormone neurons in aged, virgin, male Sprague-Dawley rats.

Using double-label ultrastructural immunocytochemistry, we found the synaptic input to gonadotropin-releasing hormone (GnRH) neurons in the preoptic area of aged (20 months old), virgin, male Sprague-Dawley rats to be denser than that in young adults (3 months old). These results confirmed earlier observations on F-344 virgin male rats. The aging F-344 rat, however, is prone to testicular tumor and so it was essential to see if the phenomenon was reproducible in another rat strain. In the first study, a portion of the increase in synaptic density was due to an increase in the proportion of synapses containing pleiomorphic vesicles, frequently associated with the neurotransmitter GABA. We tested the possibility directly using a double-label protocol for GnRH and glutamic acid decarboxylase (GAD). However, in the present study the density of input by GABA did not change with age. This inhibitory amino acid represented about 10% of the total innervation in young animals; but, in aged animals, because the total synaptic input was greater, GABA represented only about 4% of the innervation. Synaptic vesicles within GAD-immunoreactive terminals were uniformly clear and spherical, suggesting that pleiomorphic vesicle shape is not an appropriate criterion for GABAergic innervation.


Effects of combined acetylcholinesterase inhibition and serotonergic receptor blockade on age-associated memory impairments in rats.

We recently reported that post-training administration of serotonergic receptor antagonists attenuated the inhibitory-avoidance memory deficits normally exhibited by aged rats. In the present study, we determined whether a subeffective dose of the serotonergic type-2 receptor antagonist, ketanserin, would augment the facilitative effects produced by the acetylcholinesterase inhibitor, physostigmine, on memory in aged rats using the same task. The drugs were injected intraperitoneally alone, or in combination, immediately following training. Retention testing occurred 24 hours following training. A dose-dependent enhancement of memory was demonstrated as a result of the two treatment conditions (physostigmine 0.01-10.0 micrograms/kg, ketanserin 1.0 mg/kg + physostigmine 0.001-0.01 micrograms/kg). The facilitation of memory produced by the combined treatment was observed at doses well below those required to produce a similar effect when each drug was administered alone. The results provide additional evidence for an interaction between the cholinergic and serotonergic neurotransmitter systems in learning and memory, and may have important implications in the treatment of age-related memory impairments.


Nature of mental retardation and dementia in Down syndrome: study with PET, CT, and neuropsychology.

Recent evidence suggests that Alzheimer's disease is an etiologically heterogeneous disorder. A human model of Alzheimer's disease exists that avoids such problems of etiologic heterogeneity. Down syndrome (DS), trisomy 21, is a genetic disorder in which an extra portion of chromosome 21 leads to mental retardation, short stature, and phenotypic abnormalities. Prior investigations by others have shown that DS subjects over 40 years of age demonstrate neuropathologic and neurochemical defects postmortem that are virtually indistinguishable from those found in brains of Alzheimer's disease patients and a universal cognitive deterioration more severe in demented than nondemented older DS subjects. In our study, these nondemented older DS subjects show a distinctive pattern of age-related deficits, while a more global pattern is seen in demented older DS subjects. Dementia occurs in 40% of older DS subjects. We find that in older demented DS subjects positron emission tomography (PET) shows identical patterns of abnormal glucose metabolism as those described previously in Alzheimer's disease patients, selectively involving the phylogenetically newer association areas of parietal and temporal neocortices but sparing primary sensory and motor regions. Further, we find in older demented DS patients quantitative computer-assisted tomography (CT) indicates accelerated neuronal loss and brain atrophy, similar to that previously shown in Alzheimer's disease patients. As a potential use of the DS model, we observed a case of DS with dementia but without mental retardation. This case suggests that expression of dementia in DS may involve genes on chromosome 21 other than in the "obligatory" distal segment of the q arm. Alternatively, differential expression of genes on the q arm of chromosome 21 might cause dementia without phenotypic features and mental retardation.


Sigh-related heart rate changes during sleep in premature and full-term newborns.

The functional linkage in the cardio-respiratory system demands precise coordination of their activity. Sighs provide an opportunity to study the interaction and the maturation of the autonomic nervous system. In 4 groups of normal, sleeping newborns (31 to 41 weeks conceptional age [wCA], 2 to 10 days postnatal age) we investigated heart rate changes caused by sighs by means of polygraphy. In full-term (39-41 wCA) and near-term newborns (37-38 wCA) sighs during quiet sleep (QS) were accompanied by heart rate acceleration (p < 0.01) and thereafter by heart rate deceleration (p < 0.01). During active sleep (AS) only heart rate acceleration (p < 0.01) was observable. In prematures (35-36 wCA) acceleration could be observed in QS (p < 0.01) and AS (p < 0.01) but no deceleration in QS. In prematures of 31-34 wCA no changes during AS and QS could be detected. Body movements caused heart rate acceleration but no heart rate deceleration. In conclusion, it can be hypothesized that heart rate acceleration may be caused by reduced vagotonus initiated by augmented lung volume and movements. Sigh-related changes responsible for heart rate deceleration occur solely during quiet sleep. In prematures of 31-34 wCA these reflexes are not developed.


Tacrine restores cholinergic nicotinic receptors and glucose metabolism in Alzheimer patients as visualized by positron emission tomography.

Three patients with Alzheimer's disease, a 68-year-old woman with mild dementia and 2 men (aged 64 and 72 years) with moderate dementia were treated orally with the cholinesterase inhibitor tacrine (tetrahydroaminoacridine), 80 mg daily, for several months. The patients were investigated using positron emission tomography (PET) prior to, and after 3 weeks and 3 months of treatment. The PET studies involved a multi-tracer system consisting of [18F]-fluoro-deoxy-glucose (18F-FDG) (tracer for glucose metabolism); 11C-butanol (cerebral blood flow) and (S)(-)- and (R)(+)-[N-11C-methyl]-nicotine (nicotinic receptors; cholinergic neural activity). Tacrine treatment increased the uptake of 11C-nicotine to the brain. Significant reduced difference in uptake between the two enantiomers (S)(-)- and (R)(+)11C-nicotine was observed in the frontal and temporal cortices after tacrine treatment in all three patients. The kinetic analysis indicated increased binding of (S)(-)11C-nicotine in brain compatible with a restoration of nicotinic cholinergic receptors. The most pronounced effect was observed after 3 weeks and 3 months treatment in the patient with mild dementia. An increase in cerebral glucose utilization was found in the 68-year-old patient with mild dementia but also slightly in the 64-year-old man with moderate dementia when treated with tacrine for 3 months. Tacrine administration did not affect cerebral blood flow. The PET data obtained after 3 weeks of tacrine treatment was paralleled by improvement in neuropsychological performance. This study shows in vivo by PET neurochemical effects induced in brain by treatment with tacrine to Alzheimer patients. Intervention with tacrine in the early course of the disease might be necessary for clinical improvement.


Acrocallosal syndrome: association with cystic malformation of the brain and neurodevelopmental aspects.

The acrocallosal syndrome (ACS) is a rare malformation syndrome characterized by a distinct pattern of craniofacial, brain and limb anomalies. It was first described by Schinzel in 1979 and followed by 25 other cases reported in the literature. Neurodevelopmental aspects include hypotonia of prenatal onset, seizures and moderate to severe mental retardation. The condition is probably of autosomal recessive inheritance but is closely resembles the Greig cephalopolysyndactyly syndrome (GCPS), an autosomal dominantly inherited disorder mapped to the short arm of chromosome seven. We reviewed the literature for aspects of associated cystic malformations in addition to agenesis of the corpus callosum and report on another patient with ACS. Prognosis is dependent on the degree of hypotonia and early onset of epilepsy rather than the degree of craniofacial and limb malformations.


Development of the relationship between active and passive muscle power in preterms after term age.

Fifty-eight infants were assessed with an instrument which is designed to evaluate the development of the relationship between active and passive muscle power. The purpose of this longitudinal assessment was to investigate whether preterms show a different development course than fullterms in the relationship between these two components of muscle power. Thirty-seven low-risk preterms and twenty-one healthy fullterms were followed from term until 24 weeks corrected age. It is concluded that preterms differ markedly from fullterms in the developing interrelationship between active and passive muscle power. The value of the instrument for detecting signs of early pathology is discussed.


Oxytocin concentration changes in different rat brain areas but not in plasma during aging.

The concentration of oxytocin was measured by radioimmunoassay in different brain areas, hypophysis, and plasma of male Wistar Kyoto rats during aging. Although no difference in the concentration of oxytocin in any of the above tissues among 2- and 6-month-old rats was found, in 12-month-old rats a 21% decrease was observed in both septum and hippocampus, but not in the hypothalamus, hypophysis, and plasma, when compared to values of 2- and 6-month-old rats. In 18-month-old rats, the decrease of septal and hippocampal oxytocin content was higher than that found in 12-month-old rats, but no change was found in the hypothalamus, neurohypophysis, and plasma. In 24-month-old rats, oxytocin content was similar to that found in 18-month-old rats in all tissues analyzed. The results suggest that aging induces an impairment of oxytocinergic transmission in the central nervous system but not in the neurohypophyseal system.


Serial magnetic resonance imaging studies in a case of late onset globoid cell leukodystrophy.

The late onset type of globoid cell leukodystrophy (GLD) is a rare disorder and only three magnetic resonance imaging (MR) studies have been reported for this disease. We report a sporadic case of late onset GLD. The illness started at the age of 3 years and 8 months with spastic gait. He became bedridden at the age of 4 years and 7 months. The diagnosis was made by deficient activity of galactosylceramidase in lymphocytes, and the biochemical and morphological examinations of the biopsied sural nerve were also conducted. Computed tomography (CT) and MR study revealed that the degenerative change of the white matter was initially recognized in the occipital and parietal lobes and then extended forward. Literature of the CT or MR findings of GLD is also reviewed.


Acute encephalopathy with bilateral striatal necrosis. A distinctive clinicopathological condition.

Two patients with acute encephalopathy with bilateral striatal necrosis are presented and the literature on the subject is reviewed. The disease is characterized by abrupt onset following a systemic infectious illness, with disturbance of consciousness, absence of speech, dystonic movements of the limbs, general stiffness, opisthotonus, tremor, facial grimacing, and stereotyped reaction to painful stimuli. After a variable period of time, there is gradual improvement of the neurological status with clearing of consciousness and recovery of motor functions. Mild CSF pleocytosis is the only abnormal laboratory test encountered. Cranial imaging shows from the beginning of the illness, bilateral involvement of the striatum that may persist indefinitely. The pathogenesis of this disorder remains unknown although an infectious or para-infectious mechanism seems to be the most likely possibility.


Failure of dietary restriction to retard age-related neurochemical changes in mice.

Age-sensitive neurochemical measures and estrous cyclicity were studied in female mice from the long-lived C3B10F1 strain fed either a control diet or subjected to dietary restriction (DR) from 3 weeks of age. Striatal dopaminergic D2 receptor density decreased by 25% from 9-10 months to 28-30 months of age in the control group. This decline was uninfluenced by DR. Anterior pituitary dopamine + dihydroxyphenylacetic acid content increased by 2.5 fold with age in the control group but DR failed to oppose this age-related change. In contrast to DR's lack of influence on these two neurochemical measures were findings on estrous cyclicity. Although mice on DR did not display estrous cycles, cyclicity was rapidly initiated when these mice were switched to the control diet at 12 and even at 22 months of age. Thus, limited aspects of neuroendocrine aging were retarded by DR in this long-lived mouse model.


Neuroimmunology of Alzheimer's disease: a conference report.

A multidisciplinary group met under the auspices of the National Institute on Aging and the Dell Foundation at the Princess Resort in San Diego, CA on April 5-6, 1991. The meeting was organized by Dr. Caleb E. Finch, University of Southern California, Dr. Zaven Khachaturian, National Institute on Aging, Dr. William Markesbery, University of Kentucky, Dr. Patrick McGeer, University of British Columbia, and Dr. Joseph Rogers, Institute for Biogerontology Research, and covered recent data suggesting neuroimmune correlates of Alzheimer's disease (AD). These findings span many of the major immune system phenomena, from major histocompatibility complex (MHC) antigens through cytokines and the complement cascade and suggest that some facets of AD pathogenesis may be immune related.


Congenital muscular dystrophy with eye and brain malformations in six Dutch patients.

From four Dutch families six patients, who have congenital muscular dystrophy, involvement of the central nervous system and of the eyes, or the so-called "muscle, eye and brain disease" (MEB-D), are reported. Two patients are still alive, in four autopsy could be performed. The clinical and morphological data of our patients are compared to those described in recent literature. The progression of the disease was rapid in five of our six patients. Our study supports the idea that within the MEB-D syndrome there are at least two different types of clinical expression, one with a rapid progression as described by Dobyns et al 1989 (9) and one with a slower progression as described in most patients of Santavuori et al 1989 (23). The study also confirms the autosomal recessive mode of inheritance of MEB-D.


Sleep-disordered breathing in healthy and spousally bereaved elderly: a one-year follow-up study.

This study examined the progression of sleep-disordered breathing (SDB) over 1 year in two samples of elderly subjects: 45 healthy controls (20 men; 25 women mean age 74.8 years) and 27 recently spousally bereaved elders (9 men; 18 women, mean age 69.7 years). Although controls and bereaved subjects did not differ in the proportions with SDB, both groups showed a rise in the proportion of subjects with apnea hypopnea index > or = 5 and > or = 10 at 1-year follow-up and a small but statistically significant worsening in average maximum desaturation. The severity of SDB did not correlate with medical burden or with other clinical variables, such as severity of depressive symptoms. In summary, SDB increased longitudinally in both samples. This finding may have health implications for the aging population although at this time the implications are unclear.


Glutaric aciduria type 1 an atypical presentation together with some observations upon treatment and the possible cause of cerebral damage.

This report describes an infant diagnosed aged twenty-five months as having glutaric aciduria Type 1 (GA 1). Initial presentation was with isolated macrocephaly at four months of age. Severe hypertonia, and dystonia, within 24 hours of minor head injury occurred at nineteen months of age. Serial cranial imaging showed subdural fluid collections, and increasing underlying cerebral atrophy, mainly frontal and temporal. Confirmation of the clinical diagnosis required repeated blood and urine analysis by high performance liquid chromatography and gas chromatography/mass spectrometry; diagnosis was later confirmed enzymologically. Treatment with riboflavin, L-carnitine, vigabatrin and baclofen, produced some symptomatic relief; a low protein diet, nitrazepam and sodium valproate appeared of less obvious use. The rationale for these attempts at treatment is discussed. The possible role of quinolinic acid in the genesis of the fronto temporal and striatal atrophy is discussed and measurement of the quinolinate concentration in cerebrospinal fluid (CSF) of this case and age-related controls is presented.


Cervical cord birth injury and subsequent development of syringomyelia: a case report.

A 2830 g full-term baby, born by breech delivery, exhibited weak crying and sucking and severe hypotonia of the extremities after birth. Magnetic resonance imaging (MRI) showed marked thinning of the cervical cord at the level of C4 and C5. This lesion evolved into focal syringomyelia by the fourth month after birth. In this patient, MRI was useful in detecting the initial spinal cord injury, which appeared as marked thinning, and the subsequent syringomyelia as well. The role of birth trauma in cervical spinal cord injuries is discussed.


Aging changes in the beta-endorphin neuronal system in the preoptic area of the C57BL/6J mouse: ultrastructural analysis.

In hypothalami of aging rodents, beta-endorphin (beta-EP) neuron number and content are reduced. The objectives of this study were: first, to analyze ultrastructurally the population of neuronal elements in a selected region of the preoptic area (POA) in young and old mice; second, to study the beta-EP neuronal system in the same region to determine whether or not this population remains stable with age. Vibratome sections from the most caudal POA through the diagonal band of Broca were examined by light microscopy and immunocytochemistry in mature, cycling (5-6 months old) and old, acyclic, disease-free (24-26 months old) mice. A subset of beta-EP-like perikarya and associated structures was observed in the periventricular POA. When this subregion was examined at the ultrastructural level, there was a significant decrease in the number of recipient dendrites [3.78 +/- 0.04 SEM/micron 2 young vs. 0.82 +/- 0.03/micron 2 old; p < 0.007, analysis of variance (ANOVA)], but a significant increase in the number of nonmyelinated axons (20.0 +/- 2.6/micron 2 young vs. 26.8 +/- 0.7/micron 2 old; p < 0.05). Immunolabeled terminals that contained a synapse comprised 2.56 +/- 0.08% of all terminals with synapses in young mice but only 0.34 +/- 0.04% in old ones when corrected for surface area examined (p < 0.03). A significant age-related loss was also observed in the nonmyelinated beta-EP-labeled axon population (1.50 +/- 0.10% young vs. 0.40 +/- 0.01% old; p < 0.009, ANOVA). We conclude that there are critical changes in the microenvironment of the POA in old, noncycling female mice that are likely to affect neuron function.


Neuropathy with lysosomal changes in Marinesco-Sjögren syndrome: fine structural findings in skeletal muscle and conjunctiva.

The light- and electron-microscopical findings in the skeletal muscle and conjunctiva of 6 patients with Marinesco-Sjögren syndrome (MSS) were presented. All patients were related and showed the cardinal clinical symptoms of the syndrome: congenital cataracts, mental retardation, delayed statomotor development, and cerebellar ataxia. The most prominent alteration found in the skeletal muscle of four patients was extensive neurogenic atrophy with conspicuous groups of atrophic muscle fibers. Additional findings were vacuolar degeneration and secondary, unspecific changes like slight mitochondrial alterations and increased variability in muscle fiber calibers. The ultrastructural examination revealed double-membrane structures near to, but not in direct contact with the nucleus. The nuclear changes described earlier (7, 20) were not found in any of the cases. Conjunctival biopsies revealed a marked increase in the number of lysosomes in fibroblasts. In summary, to the well known myopathic damage of muscles in MSS a neurogenic component should be added. Disturbed lysosomal function is to be considered as the basic abnormality, though the enzyme defect has not yet been identified. In cases of clinically suspected MSS, examination of a conjunctival biopsy is highly recommended.


[Cholelithiasis. Ultrasonography and other diagnostic methods. Usefulness, indications, and limitations].

It is reported that 12.5% of the Italian population suffer from cholecystopathy. The Authors carried out a retrospective analysis of the cases observed over an 18-month period. It was found that ultrasonography was the most appropriate screening method to reveal cholecystic pathologies and diseases of the biliary tract since it is specific and sensitive and also enables adjacent organs to be examined (liver, kidneys, aorta, pancreas, spleen).


[Defecography and manometry in the postoperative follow-up of patients treated with colo-anal anastomosis by the Parks technique for neoplasm stenosis of the rectum].

The Authors report 15 cases of patients with adenocarcinoma of the rectum who were treated using Park's resection. Morphofunctional parameters are evaluated 3 months after surgery using defecography and manometry before the closure of the neostoma and the reactivation of the ano-rectal canal. Opaque defecography enables the morphology and dimensions of the anal canal to be examined together with modifications to the area between the rectum and the anal canal, and the impression of the pubo-rectal sling. In conclusion these data confirm the importance of surgery, whereas the correlation between defecographic and manometric results allows the functional recovery "ad integrum" of the area to be checked.


[Compliance problems in chronic pain].

The aim of this paper is to focus on a medical issue which is not held in due consideration in Italy. In chronic pain control and management, specialists may advise at various times drugs, physical therapies, behavioral modification techniques, and not demolitive antinociceptive procedures. Quite often patients do not follow medical prescriptions as one should expect, especially if they are not inpatients. The Authors examine this clinical problem known as compliance and try to explain the reasons for this behaviour from different points of view.


[Lipid behavior during hemodialysis using heparin and prostacyclin].

Ten patients have been studied for lipidic behaviour during hemodialysis using as anticoagulant heparin and prostacyclin. Hearing has been administered at infusion rate of 2000 U/h and prostacyclin in 5 ng/kg/min. Lipidic behaviour (before and after hemodialysis) has been studied for apolipoproteins A and B, total serum cholesterol and serum triglycerides, HDL-cholesterol, lipoprotein. Total serum cholesterol/HDL-cholesterol, apolipoproteins A/apolipoproteins B, apolipoproteins A/HDL-cholesterol ratios have been also studied. Our findings show that heparin produces acute changes in lipidic behaviour after hemodialysis and suggest that administrations may contribute to lipidic derangement of uremic dialytic patient while heparin free dialysis (prostacyclin infusion) doesn't show lipidic derangement after dialytic treatment. Prostacyclin infusion suggests that may be a useful anticoagulant and therapeutic drug especially in uremic dialytic subject with high atherosclerosis involvement, dyslipidemia and arterial hypertension.


[Mid-term clinical study of the effectiveness of and tolerability to simvastatin ++ in dyslipidemic patients].

The HGM-CoA reductase inhibitors, blaking up intracellular synthesis of cholesterol, support the receptorial captation of cholesterol with a reduction in plasma levels. The simvastatin efficacy was evaluated in 12 patients, mean age 59 +/- 10 years with a primary hypercholesterolemia. All the patients were on a pharmacologic wash out for at least 6 weeks and dietetic treatment (according to their weight and daily needs) for a week. Total cholesterol, HDL-cholesterol and triglycerides plasma levels were taken at time 0. Then a treatment with simvastatin 10 mg/die was begin for 4 weeks and than increased to 20 mg in patients with plasma cholesterol > 200 mg/100 ml at the end of fourth week. In some patients the dose was increased up to 40 mg for the elevated levels of plasma cholesterol at the end of the second month. All the parameters above were controlled monthly for three months. A control was performed at the end of sixth month of treatment. After 4 weeks treatment, simvastatin induced reduction in cholesterol plasma levels (p < 0.005), that continued during the whole time treatment (228 mg/dl at 24 week, p < 0.005 vs basal). The mean dosage of the simvastatin at fourth month was of 25 mg/die. During the treatment an increase of HDL plasma levels was noted, but this increment wasn't statistical significant (40 +/- 7 vs 45 +/- 9 mg/100 ml). No significant impairment of principal metabolic and laboratory parameters were observed during the treatment. These data indicate that simvastatin in small dose induce a reduction in cholesterol plasma levels with a significant increase in HDL without side effects.


[Effectiveness of and tolerability to oral desmopressin in the treatment of central diabetes insipidus].

Intranasal desmopressin represents the treatment of choice in Central Diabetes Insipidus. Nevertheless, this route of administration bears some practical disadvantage, linked to either difficult delivering technique, or the status of nasal mucose. The antidiuretic effectiveness of oral desmopressin has been recently demonstrated, both in experimental animals and in man. In our study we compared oral vs. intranasal desmopressin efficacy in 13 patients affected by Central Diabetes Insipidus. The results show that the peroral administration of Desmopressin at a mean dose of 500-600 micrograms/die determines an antidiuretic effect comparable to that of intranasal route, without affecting body weight, arterial pressure and chemical analysis. Side effects, generally limited to the first week of treatment, were described (nausea, vomiting, headache, dizziness [corrected], bitter taste, epygastralgia, asthenia, epystassis), inducing 4/13 patients to withdrawal the trial.


[Diabetes mellitus, hypercholesterolemia, and therapeutic prospects with simvastatin. General considerations and personal contribution].

The Authors examine the relationship between diabetes mellitus, lipid metabolism and atherosclerosis with particular emphasis on the role of insulin and on the therapeutic consequences. The results of a study on the efficacy and tolerability of simvastatin in the treatment of hypercholesterolemia in non insulin-dependent diabetic patients are reported. Simvastatin administration induce a significant reduction and increase in total and HDL cholesterol levels respectively contributes to the decrease of triglycerides without interfering with the metabolic control of diabetic condition.


[Long-term local tolerability to intranasally administered salmon calcitonin in post-menopausal osteoporosis].

The aim of this study was to acquire further knowledge relative to the local tolerability of synthetic salmon Calcitonin, administered by the intranasal route. The Authors have evaluated several olfactometry parameters in a group of patients treated for twelve months with the drug. The Wright matrix test and the olfacto-respiratory reflex test were performed. An evaluation regarding mucociliary transport time was additionally effected. No interference on the part of the drug was reported regarding the functional parameters of the nasal mucosa. The excellent local tolerability of intranasal salmon Calcitonin, as already indicated by other Authors, was confirmed, even in terms of specific parameters relative to the olfactory functions.


[Monosialoganglioside (Sygen) in amateur boxers suspended from sport activities].

Thirty boxers, suspended from sport activity for EEG alterations (delta and theta localized) and for alterations of evoked potentials (brain stem and visual potentials) have been examined after KO. Every boxer has been administered with GM1 40 mg per die for twenty days after performing the EEG with brain map, encephalic TAC, audiovestibular examination, evoked potentials. These controls (tests) have been repeated after 30 days. In particular, the cerebral mapping has been examined comparing it with significant statistic tests before and after the administration of GM1; a shift in the power spectrum of the alpha activity toward central derivation and a decrease in delta and theta activities have been observed. The hypothesis of a noradrenergic action of GM1 has been formulated.


[Primary hyperparathyroidism with prevalent neuro-muscular manifestations].

A case of primary hyperparathyroidism with prevalent neuromuscular symptoms is described. Clinical, diagnostic and therapeutic implications are emphasized. Particular attention must involve a full clinical examination, electromyographic data and neuromuscular biopsy to make differentiation from primary myopathy or denervation pathology. Some similarity of electromyographic data with those observed in botulism and myastenia gravis should also be taken in mind. Hypercalcemia could play a pathological role in conditioning abnormalities of nervous impulse conduction at the level of neuromuscular junction. Another possible interference might be related to a direct effect of parathormone and hypophosphataemia on nervous impulse conduction. "Glandular hyperplasia", as observed in this case at istologic examination, rises some problems as far as the prognosis is concerned.


[Rhabdomyolysis during acute poisoning with drugs and narcotics. Experience with 7 clinical cases].

Numerous and extremely varied conditions (intense muscular activity, ischemia, metabolic and genetic disorders, infections, immunological diseases and toxic causes) may play a role in the genesis of non-traumatic rhabdomyolysis. Over the past years there has been an increased number of reports of forms due to drug or narcotic intoxication. Seven cases of rhabdomyolysis are reported in patients admitted to emergency wards in a state of coma due to heroin overdose (4 cases), cocaine overdose (1 case), carbamazepin (1 case), and tricyclic anti-depressives (1 case). In all cases it was possible to hypothesise a multifactorial pathogenesis of the disease in which other factors, such as acidosis, hypoxia, hypothermia and compression of the muscle mass during coma, were associated with the direct toxic damage caused by the drug. The most frequent complication was acute renal failure. One case of myocardial involvement with non-Q infarction characteristics was also observed.


[Echographic measuring of the length of the fetal femur in the screening for Down syndrome].

Our purpose was to assess the value of sonographic measurement of fetal femur length in the second trimester, as a screening tool for Down's syndrome. We evaluated a consecutive series of fetuses scanned by a single sonologist at the time of amniocentesis between 15 and 19 weeks. The study group consisted of fetuses with Down's syndrome (N = 16); the control group comprised normal fetuses (N = 1163). A linear regression model of the normal femur length based on biparietal diameter (BPD), was established for our population; the ratios of measured to expected femur length for a viven BPD (FL M/E) were calculated in the two groups. To test statistical significance of observed differences between case and control population, unpaired t test was used. The ability of specific FL M/E cut-off values to discriminate between Down syndrome and normal fetuses was assessed by Fisher's exact test. The mean ratio of measured to expected femur length was significantly lower in the Down syndrome as compared with control population (0.9473, DS 0.0795) versus 1.0, DS 0.0745) (p < 0.0045). The ratio of 0.91 or less predicted Down's syndrome with a sensitivity of 43.7% and a false-positive rate of 8.6%. For women with risk of one in 250 and one in 1000 of having an affected fetus based on maternal age, a shortened femur yielded positive predictive values of one in 26 and one in 105, respectively. These results suggest that the sonographic measurement of fetal femur length for the screening of Down syndrome in the low-risk population is hindered by a high false positive rate (about 9%). It follows that the percentage of women requiring an amniocentesis would increase to un unacceptably high level. The utilization of this biometric marker may be helpful, in our opinion, for identifying fetuses at risk for Down syndrome in women between 35 and 38 years of age. These women in fact, are not offered amniocentesis for the prenatal diagnosis of Down's syndrome in the majority of italian institutions. The sonographic measurement of fetal femur length could detect about 45% of fetal Down's syndrome, offering an amniocentesis to 9% of women, with a consequent reduction of the cost required. Only a prospective study can evaluate the efficacy of this method to predict Down syndrome in such group of women.


[Diagnostic and therapeutic value of hysteroscopy in intrauterine synechiae].

The paper evaluates the diagnostic and therapeutic value of hysteroscopy in a group of women suffering from intrauterine synechiae secondary to intrauterine mechanical manipulation following spontaneous abortion.


[Myomectomy via hysteroscopy. Indications, technics, results].

Nowadays operative hysteroscopy represents the elective treatment of submucous and partially intramural fibroids. Seventy patients underwent hysteroscopic resection of fibroids, because of abnormal uterine bleeding in 58 (82.8%) cases, and infertility in 12 (17.2%) cases. The evaluation of the lesion was performed by diagnostic hysteroscopy and abdominal (57 patients) or transvaginal (13 patients) ultrasounds. In particular, for the evaluation of the intramural portion of the lesion, the hysteroscopic study of the angle between fibroid and myometrium was fundamental: the more acute the angle is the more intracavitary the myoma is. Forty-six (65.7%) out of 70 had a completely intracavitary fibroid; in 14 (20%) cases the intramural development was less than 1.5 cm and in the remaining 10 (14.3%) cases was more than 1.5 cm. Integration of hysteroscopy and ultrasounds for the assessment of myomas and the preoperative preparation by LH-RH analogues allow to perform an endoscopic resection of myomas which has up to, and sometimes over, 50% of their volume in the uterine wall.


[Italian multicenter study for the verification of the efficacy and tolerability of short-term substitution hormone therapy using conjugated estrogens and progestagens administered orally in the postmenopausal a period].

Three hundred and sixty-three postmenopausal women received 6 months of cyclic hormone replacement therapy with conjugated estrogens in differing doses (0.625 mg and 1.25 mg) associated in a sequential pattern lasting 12 days with progestagens (medroxyprogesterone acetate or medrogestone) in 16 italian health centres. The results of the multicentre study confirm the efficacy of this conjugated estrogen-progestogen regimen in resolving climacteric syndrome, offering cardiovascular protection and vaginal trophic effect and preventing postmenopausal osteoporosis, as well as confirming its tolerability in relation to blood pressure, body weight, breast, endometrium, blood coagulation and hepato-renal function.


[Short-term therapy of uterine fibromyomatosis with GN-Rh analog].

A short term therapy of leiomyomata uteri with leuprolide acetate depot 3.75 i.m. every 28 days for 4 months was started in 19 patients. Uterine volume, based on the ultrasound data, was calculated, utilizing the formula for a prolate ellipsoid, before and after treatment. Before the treatment the uterine mean volume was 207.3 cc and decreased to 122.2 cc after therapy. The efficacy of the treatment was evaluated by means of the "t" test for paired data and showed a p < 0.002.


[Diagnosis and therapy of low-risk endometrial hyperplasia. Experience with LH-RH-A].

Endometrial hyperplasia is a endometrial condition often found in perimenopausal age. AUB is the most frequent symptom of endometrial hyperplasia. The combination of hysteroscopy and endometrial biopsy is the most suitable approach for the diagnosis of endometrial hyperplasia in symptomatic patients. The Authors have studied endometrial modifications due to LH-RH analogue, a depot formula, in 60 perimenopausal patients with AUB and with hysteroscopic and histologic picture of low-risk endometrial hyperplasia. They report the result of treatment efficacy (disappearance of symptoms and tendency to hypoatrophy of the mucosa). The use of LH-RH A seems to have a good result in the management of oestrogen-dependent gynaecological benign diseases.