Comparison of three jet nebulizer aerosol delivery systems used to administer recombinant human DNase I to patients with cystic fibrosis. The Pulmozyme rhDNase Study Group

The soma membrane of the fast coxal depressor (Df) motoneurone of the cockroach, Periplaneta americana possesses a population of acetylcholine receptors which respond to both nicotinic and muscarinic ligands. Activation of these 'mixed' acetylcholine receptors by McN-A-343 or oxotremorine results in the generation of an inward current at potentials positive to - 40 mV. A large proportion of the outward current induced by membrane depolarization in Df somata is due to a calcium-activated potassium conductance (IKCa) which shows a characteristic N-shape voltage-dependence. This N-shape of the membrane current-voltage relationship is suppressed by McN-A-343 or oxotremorine indicating that the agonist-induced inward current is due to a reduction in IKCa.     

Left hemispheric neuronal heterotopia: a PET, MRI, EEG, and neuropsychological investigation of a university student

A 21-year-old left-handed medical student had a prominent unilateral cerebral cortical malformation due to an ontogenetic migration disorder. We performed neuropsychological studies, EEG, T1- and T2-weighted and proton-density MRI, and positron emission tomography (PET) (under both the resting condition and neuropsychological activation). Neuropsychological testing revealed normal intelligence and generally normal memory functioning but selective deficits in tests of verbal fluency and spatial-figural relationships. Proton-density and T2-weighted MRI revealed extensive left cortical heterotopia that included parts of the Wernicke area. PET under the resting condition revealed a small interhemispheric difference with slightly reduced glucose metabolism in the left temporoparietal cortical zone. An activation PET (with the patient performing a verbal fluency test) resulted in a normal overall increase in metabolism but marked deviations in cortical areas. The highest activity changes were in the Broca and Wernicke areas of the right hemisphere, and there was very little activation in those regions of the left hemisphere that were expected to respond well to the activation--the temporal, parietal, and temporo-occipital cortical zones. We conclude that there can be large compensations for unilateral heterotopia.     

Implantable catheter systems. Experiences with 1000 patients with central venous ports

OBJECTIVE: To assess retrospectively duration of functioning and rate of complications of a totally implantable venous access system used for long-term chemotherapy. PATIENTS AND METHODS: Between 1985 and 1993, a central venous access system (Port-a-Cath) had been implanted subcutaneously for long-term chemotherapy in 1000 patients (479 males, 521 females; mean age 49 [15-86] years). Follow-up observations lasted until the end of the chemotherapy or the removal of the system. RESULTS: Mean time of functioning of the catheter system was 284 (2-1563) days. The complication rate was 12.8%: catheter infection in 4.9% and catheter thrombosis in 3.2%. A further 4.7% of patients had less common complications (malfunction, catheter dislocation, skin necrosis, catheter break or disconnection, pneumothorax). A total of 119 (11.9%) systems had to be removed because of complications. The rates of infection and of other complications were significantly lower in patients with solid tumours (2 and 4%, respectively) than in those with haematological disease (6 and 8%) (P < 0.05 for each). CONCLUSION: Totally implantable venous access systems are suitable for long-term chemotherapy and cause few complications.     

Beagle model used in a tissue tolerance study of the response of normal and surgically manipulated liver to single high-dose intraoperative radiotherapy

To investigate the feasibility of delivering a single large dose of intraoperative electron beam radiotherapy (IORT) to the liver of clinically normal and partially hepatectomized beagles, an experimental study was designed. The purpose of the study was to obtain dose guidelines for the delivery of IORT to the liver of human patients with colorectal cancer metastases to the liver. After partial resection of the liver, IORT in doses up to 30 Gy was applied to the resection plane as well as to a nonsurgically manipulated part of the liver of 25 beagles. The temporal sequence of histologic changes of these irradiated parts of the liver tissue was investigated. There were no postoperative complications and no morbidity or mortality associated with a minimal follow-up of 3 years. Necropsy performed 3 months after IORT revealed only mild histopathologic changes. One year after IORT, more distinct histopathologic changes consisting of capsular thickening, diffuse parenchymal fibrosis, and subcapsular hepatocellular atrophy were found. Three years after IORT, the parenchymal architecture seemed to be restored, although loss of liver tissue was definitive at the irradiation site; liver function remained intact. These results indicate that IORT to part of the liver in the canine model can be safely applied and that, although doses up to 30 Gy can result in severe local tissue damage, wound healing and liver function are not disturbed.     

Transesophageal echocardiographic findings in blue toe syndrome exacerbated by anticoagulation

The role of anticoagulation in the blue toe syndrome is unresolved. We describe the sonographic appearance of atherosclerotic plaques in the thoracic aorta imaged by transesophageal echocardiography in 2 patients with blue toe syndrome who had reembolization while taking therapeutic levels of anticoagulants. The findings of complex atheromas associated with mobile highly echodense linear structures by transesophageal echocardiography may be predictive of reembolization in patients with blue toe syndrome who are taking anticoagulants.     

Acute inflammatory response in the mouse: exacerbation by immunoneutralization of lipocortin 1

1. An immuno-neutralization strategy was employed to investigate the role of endogenous lipocortin 1 (LC1) in acute inflammation in the mouse. 2. Mice were treated subcutaneously with phosphate-buffered solution (PBS), non-immune sheep serum (NSS) or with one of two sheep antisera raised against LC1 (LCS3), or its N-terminal peptide (LCPS1), three times over a period of seven days. Twenty four hours after the last injection several parameters of acute inflammation were measured including zymosan-induced inflammation in 6-day-old air-pouches, zymosan-activated serum (ZAS)-induced oedema in the skin, platelet-activating factor (PAF)-induced neutrophilia and interleukin-1 beta (IL-1 beta)-induced corticosterone (CCS) release. 3. At the 4 h time-point of the zymosan inflamed air-pouch model, treatment with LCS3 did not modify the number of polymorphonuclear leucocytes (PMN) recruited: 7.84 +/- 1.01 and 7.00 +/- 0.77 x 10(6) PMN per mouse for NSS- and LCS3 group, n = 7. However, several other parameters of cell activation including myeloperoxidase (MPO) and elastase activities were increased (2.2 fold, P < 0.05, and 6.5 fold, P < 0.05, respectively) in the lavage fluids of these mice. Similarly, a significant increase in the amount of immunoreactive prostaglandin E2 (PGE2; 1.81 fold, P < 0.05) and IL-1 alpha (2.75 fold, P < 0.05), but not tumour necrosis factor-alpha (TNF-alpha), was also observed in LCS3-treated mice. 4. The recruitment of PMN into the zymosan inflamed air-pouches by 24 h had declined substantially (4.13 +/- 0.61 x 10(6) PMN per mouse, n = 12) in the NSS-treated mice, whereas high values were still measured in those treated with LCS3 (9.35 +/- 1.20 x 10(6) PMN per mouse, n = 12, P < 0.05). A similar effect was also found following sub-chronic treatment of mice with LCPS1: 6.48 +/- 0.10 x 10(6) PMN per mouse, vs. 2.77 +/- 1.20 and 2.64 +/- 0.49 x 10(6) PMN per mouse for PBS- and NSS-treated groups (n = 7, P < 0.05). Most markers of inflammation were also increased in the lavage fluids of LCS3-treated mice: MPO and elastase showed a 2.47 fold and 17 fold increase, respectively (P < 0.05 in both cases); TNF-alpha showed a 11.1 fold increase (P < 0.05) whereas the IL-1 alpha levels were not significantly modified. PGE2 was still detectable in most (5 out of 7) of the mice treated with LCS3 but only in 2 out of 7 of the NSS-treated mice. 5. Intradermal injection of 50% ZAS caused a significant increase in the 2 hoedema formation in the skin of LCS3-treated mice in comparison to PBS- and NSS-treated animals: 16.7 +/- 1.5 microliters vs. 10.8 +/- 1.2 microliters and 10.2 +/- 1.0 microliters, respectively (n = 14 mice per group, P < 0.05). ZAS-induced oedema had subsided by 24 h in control animals but a residual significant amount of extravasation was still detectable in LCS3-treated mice: 4.4 +/- 0.8 microliters (P < 0.05). 6. A recently described model driven by endogenous glucocorticoids is the blood neutrophilia observed following administration of PAF. In our experimental conditions, a single bolus of PAF (100 ng, i.v.) provoked a marked neutrophilia at 2 h (2.43 and 2.01 fold) in NSS- and PBS-treated mice (n = 11), respectively, which was significantly attenuated in the animals treated with LCS3: 1.26 fold increase in circulating PMN (n = 11, P < 0.01 vs. NSS- and PBS-groups). 7. Intraperitoneal injection of IL-1 beta (5 micrograms kg-1) caused a marked increase in circulating plasma CCS by 2 h, to a similar extent in all experimental groups. In contrast, measurement of CCS levels in the plasma of mice bearing air-pouches inflamed with zymosan revealed significant differences between LCS3 and NSS-treated mice at the 4 h time-point: 198 +/- 26 ng ml-1 vs. 110 +/- 31 ng ml-1 (n = 8, P < 0.05). 8. In conclusion, we found a remarkable exacerbation of the inflammatory process with respect to both humoral and cellular components in mice passively immunised agains     

Cervical radiculopathies: comparison of surgical and EMG localization of single-root lesions

To identify the various electrodiagnostic (EDX) patterns of C-5, C-6, C-7, and C-8 cervical radiculopathy, we compared 50 cases of surgically proven solitary-root lesions with their preoperative EDX patterns. We excluded patients with polyradiculopathy, myelopathy, and previous surgery. We classified EDX studies as abnormal only by the needle electrode examination, and only by the demonstration of fibrillation potentials (either the positive sharp wave or the biphasic spike form). Seven patients (14%) had C-5 radiculopathy, nine (18%) had C-6, 28 (56%) C-7, and six (12%) C-8. With C-5, C-7, and C-8 radiculopathies, changes were relatively stereotyped, with involvement of the spinati,deltoid, biceps, and brachioradialis with C-5; the pronator teres, flexor carpi radialis, triceps, and anconeus with C-7; and the first dorsal interosseous, abductor digiti minimi, abductor pollicis brevis, flexor pollicis longus, and extensor indicis proprius with C-8. The root lesion with the most variable presentation was C-6--in half the patients, the findings were similar to C-5 radiculopathies, except that the pronator teres tended to be involved, whereas in the other half, the findings were identical to those with C-7 radiculopathies.     

Metoclopramide does not affect renal function and atrial natriuretic peptide release in response to acute saline loading in conscious rats

The medication regimens of 243 children aged 1-16 years were analysed. The children were resident in five Districts in the Northern Region, England and were taking medication orally in liquid or syrup form for chronic disease. 39% of the children were under 5 years of age and 44% were aged 5-11 years, with slightly more males in most age groups. Epilepsy, chronic renal disease and cystic fibrosis were the most common medical problems for which the medicines were prescribed long-term. The duration of medication ranged between 3 months and 12 years; the average duration varied according to the disease and the type of medicine. Most of the anticonvulsants and vitamins had been used for 2 years or more, whereas most of the anti-asthmatic drugs were used for a period of up to a year only. Twenty six (39%) of the 67 different preparations used contained sugar, 19 (28%) were sugar-free, and the sweetening agent in the remainder varied according to how they were prescribed. Specificity of prescribing was the major determinant in the dispensing of either the sugar-containing or the sugar-free medicines.