Conventional drug therapy in inflammatory bowel disease

The conventional treatment of inflammatory bowel disease should center around the liberal use of one of the many available forms of 5-ASA. Sulfasalazine should be used initially with the newer mesalamine-only containing drugs being reserved for sulfasalazine-intolerant patients or for those patients who require larger doses of medication. The choice of the delivery method should be made with the knowledge of the extent of disease and the potential coverage areas of the individual delivery methods. Systemic and topical glucocorticoids are an invaluable adjunct to 5-ASA therapy, but their use must be directed with the goal of remission induction. The tapering of glucocorticoids should be as prompt as the maintenance of remission allows, with a useful general guideline of decreasing the dose by 1 mg per day. Immunosuppressive therapy, including azathioprine and 6-mercaptopurine, holds promise for refractory cases of inflammatory bowel disease and for their potential steroid sparing properties; antibiotic therapy with metronidazole and ciprofloxacin in the absence of documented infectious disease offers additional routes to control disease. The majority of patients require a combination of drugs to attain remission. Only further study will reveal the ideal regimen for each of the different subsets of inflammatory bowel disease.     

Differential effects of nerve impulses on adrenergic storage vesicles in rat heart

The effects of increasing and decreasing activity in sympathetic neurons on light (D420 = 1.05) and heavy (D420 = 1.15) populations of adrenergic vesicles have been determined. Norepinephrine (NE) was used as a marker for the soluble contents of the vesicles, and dopamine beta-hydroxylase was used as a marker for the vesicle membranes. Cold exposure was used to increase activity in the sympathetic nervous system. A 40% decrease in the NE content of the rat heart with no change in the activity of dopamine beta-hydroxylase was observed after 70 minutes at 5 degrees C. The fall in NE content was completely blocked by pretreating the animals with chlorisondamine. Separation of light and heavy populations of vesicles was achieved with linear sucrose density gradients. Cold stress of 70 minutes duration led to a marked decrease in the NE content of the light vesicles. Blocking adrenergic nerve impulses with chlorisondamine resulted in an increase in total NE in the heart but had no effect on dopamine beta-hydroxylase activity. The initial effect of chlorisondamine was to increase the NE content of the light vesicles. The administration of alpha-methyl-p-tyrosine for 6 hours caused an approximately equal loss of NE from both vesicle populations. The decrease in total heart NE was about 25% and could be prevented by pretreating the animals with chlorisondamine. These results suggest that the light vesicle fraction is involved in the rapid or short-term responses to changes in nerve impulse frequency. Changes in the NE content of the heavy vesicles in rat heart were seen only after longer times, suggesting that these particles may function only as auxiliary storage sites for the neurotransmitter.     

Gonadoblastoma: clinicopathologic correlation in six patients

Six patients with a total of nine gonadoblastomas are presented; three--and possibly a fourth--had dysgerminomatous overgrowth which was massive in two patients. Calcification detected by abdominal films was present in three sufficient for preoperative diagnosis. All patients were found to have a Y stem line on peripheral leukocyte chromosome cultures except one patient, who had a 46 XX/45 XO karyotype. She was found to have Y chromatin bodies in the germ cells of her tumor which was in a normal ovary found at exploration for an ectopic pregnancy. Three were found in virilized phenotypic females investigated for amenorrhea, and two for therapy of pelvic masses due to dysgerminomatous overgrowth. Y chromatin studies are reported on gonadal tissue.     

Prognostic value of bacteriological studies in peritonitis

Based on multiple bacteriological assays of lymph and blood, it is concluded that single detection of pathogenic microorganisms in lymph and blood should not be considered an unfavourable prognostic sign. A provisional external drainage of the thoracic duct would reduce intoxication in patients with peritonitis, and it is estimated as a valuable prophylactic method of combating against bacteriemia.