Recurrent unexplained syncope: the role of head-upright tilt table testing

Recurrent episodes of sudden unexplained syncope are a common complaint of patients referred to health care professionals for evaluation. Traditional evaluations are both time consuming and expensive and leave many patients without a diagnosis. Although vasovagally mediated episodes of hypotension and bradycardia have been thought to be a common cause of unexplained syncope, this was traditionally a diagnosis of exclusion. Head-upright tilt table testing has recently emerged as a valuable method for confirming the diagnosis of vasovagal syncope and has allowed a better understanding of this phenomena. This article reviews the pathophysiology of vasovagal syncope, the use of head-upright tilt table testing in its diagnosis, and potential therapies used to prevent recurrences.     

Molecular cDNA cloning and tissue distribution of mRNA encoding a novel ATP-binding cassette (ABC) half-transporter

After feeding a commercial rodent chow for 8 weeks, tissues from male and female rats were collected and examined for selenium content, glutathione peroxidase (GPX) activities and selenoprotein W (Se-W) levels. There were no differences (P > 0.05) between plasma selenium content, plasma GPX activity, whole blood selenium content, or whole blood GPX activity between male and female rats. There was also no gender effect on selenium concentration in muscle, brain, spleen, and skin, but selenium concentration in liver was higher (P < 0.05) in female than in male rats. Western blots indicated that the tissue distribution of Se-W was similar in male and female rats. Se-W protein level was high in testes of male rats but very low in ovaries of female rats. Muscle and skin from female rats had significantly higher (P < 0.05) Se-W levels than from male rats. Consistent with Se-W content, the Se-W mRNA levels from female skins were significantly higher (P < 0.05) than from male rats. The expression of Se-W was different in various tissues and gender influenced this regulation in some tissues.     

Mediators of septic shock: new approaches for interrupting the endogenous inflammatory cascade

OBJECTIVES: To review the molecular pathogenesis of septic shock, with particular emphasis on the induction of cytokines by endotoxin. By understanding the mechanisms that result in the systemic inflammatory response, novel clinical interventions may be more effectively studied. DATA SOURCES: The English medical literature was reviewed, including human clinical trials, animal experiments, and in vitro studies elucidating cellular and molecular interactions. Expert testimony from the Roundtable Conference on Sepsis (Brussels, March 1992) was also used to synthesize emerging concepts and to ensure inclusion of ongoing investigations. STUDY SELECTION: Emphasis on controlled experimental studies which elucidated the molecular and cellular interactions during sepsis. DATA EXTRACTION: This study focused only on data that directly involved the induction and regulation of protein mediators of sepsis, especially tumor necrosis factor (TNF) and interleukin-1. Data concerning the role of TNF during health were extracted from the author's peer-reviewed data. DATA SYNTHESIS: Information concerning the many facets of the systemic inflammatory response was integrated into a chronological, clinically oriented model of cytokine induction during endotoxemia. CONCLUSIONS: The induction of inflammation during sepsis is a complex, but increasingly understood, biological cascade that is dependent on inter- and intracellular signaling. Novel biotherapies may improve patient outcome in sepsis by interrupting any or all points of signal transduction.     

Soluble IL-15 receptor alpha-chain administration prevents murine collagen-induced arthritis: a role for IL-15 in development of antigen-induced immunopathology

IL-15 has recently been detected in the synovium of patients with rheumatoid arthritis. IL-15-activated T cells induce significant TNF-alpha synthesis by macrophages via a cell contact-dependent mechanism, suggesting a key regulatory role for IL-15. Here, we report that the administration of a soluble fragment of IL-15Ralpha into DBA/1 mice, profoundly suppressed the development of collagen-induced arthritis. This was accompanied in vitro by marked reductions in Ag-specific proliferation and IFN-gamma synthesis by spleen cells from treated mice compared with control mice and in vivo by a significant reduction in serum anti-collagen Ab levels. These data directly demonstrate a pivotal role for IL-15 in the development of inflammatory arthritis and also suggest that antagonists to IL-15 may have therapeutic potential in rheumatic diseases.     

Measurement of extracellular fluid volume in patients on maintenance hemodialysis

Angiosarcoma of the breast, a rare tumor with very poor prognosis and insidious early manifestations, frequently is far advanced when first detected clinically. The clinical and pathologic changes in two women with primary, unilateral angiosarcoma of the breast are reviewed and the results are compared with 46 cases already published in the literature. Both patients were middle aged with symptoms for approximately 6 months prior to operation. Both frozen section reports were benign and only called malignant on permanent section. Microscopically the tumors were composed of varying sized, tortuous, elongated vascular channels. The operation varied--a modified radical and a simple mastectomy--and both patients are free from disease 4 and 2 years following operation. It is considered that, in view of the proclivity of this tumor for hematogenous metastases, an axillary dissection may not be justified.