Haemoptysis associated with pulmonary varices: demonstration using computed tomographic angiography

A 67 yr old female with mitral stenosis presented with an acute haemoptysis caused by the rupture of pulmonary varices. Chest radiography and bronchoscopy showed nonspecific abnormalities. The diagnosis of this rare but potentially lethal complication was made using computed tomographic angiography with three-dimensional volume rendering.     

Modulation of excitatory synaptic transmission in locus coeruleus by multiple presynaptic metabotropic glutamate receptors

Metabotropic glutamate receptors have been implicated in modulation of synaptic transmission in many different systems. This study reports the effects of selective activation of metabotropic glutamate receptors on synaptic transmission in intracellularly recorded locus coeruleus neurons in brain slice preparations. Perfusion of either L-2-amino-4-phosphonobutyric acid (L-AP4; 0.1-500 microM) or (+/-)-1-aminocyclopentane-trans-1,3,dicarboxylic acid (t-ACPD; 0.1-500 microM) caused a depression of excitatory postsynaptic potentials in a dose-dependent fashion to about 70% inhibition. Both agonists exerted their effects at relatively low concentrations with estimated EC50s of 2.6 microM and 11.5 microM for L-AP4 and t-ACPD, respectively. This inhibition was not observed with the potent group I metabotropic glutamate receptor agonist (RS)-3,5-dihydroxyphenylglycine (DHPG; 100 microM). Conversely, (R)-4-carboxy-3-hydroxyphenyl-glycine (4C-3H-PG), a group I antagonist/group II agonist, and 2R,4R-4-aminopyrrolidine-2,4-dicarboxylate (APDC), a novel and specific group II agonist, also caused an inhibition of excitatory postsynaptic potentials. Both t-ACPD and L-AP4 produced an increase in paired-pulse facilitation, and failed to change the locus coeruleus response to focally applied glutamate, indicating a presynaptic locus of action. The L-AP4 inhibition was antagonized by (S)-amino-2-methyl-4-phosphonobutanoic acid (MAP4: group III antagonist) but not by (RS)-alpha-methyl-4-carboxyphenylglycine [(RS)-MCPG; mixed antagonist], suggesting that this agonist acts through a type 4 metabotropic glutamate receptor. Conversely, t-ACPD was antagonized by MCPG and by ethyl glutamate (group II antagonist), but not by aminoindan dicarboxylic acid (AIDA; group I antagonist) or MAP4, suggesting that this agonist acts on a type 2 or 3 metabotropic glutamate receptor. Taken together, these results suggest that two pharmacologically distinct presynaptic metabotropic glutamate receptors function in an additive fashion to inhibit excitatory synaptic transmission in locus coeruleus neurons. These receptors may be involved in a feedback mechanism and as such may function as autoreceptors for excitatory amino acids.     

Phase I studies with Baker's Antifol (BAF) (NSC 139105)

Phase I studies were conducted in 58 adult cancer patients with Baker's Antifol (BAF), a new active-site directed inhibitor of dihydrofolate reductase. Dose escalation ranged from 10 to 250 mg/m2/day X 5 days and courses of treatment were repeated every 2-3 weeks. Biologic effects were observed mostly at doses greater than 100 mg/m2/day X 5 days. The patients developed myelosuppression during 19% of the trials. Other types of toxicity were dermatitis in 12 to 30% and stomatitis in 7 to 38% of the trials. Toxicity was directly related to the impairment of the patient's liver function. Two partial responses (in a patient with adenocarcinoma of the lung and a patient with transitional cell carcinoma of the bladder) occurred. BAF is an active new chemotherapeutic agent which deserves further clinical trials in patients with various malignancies.     

Quantification and identification of particle movement in epidermis after thermal injury

Skin samples from a rabbit hind limb were taken from controls and at 5 min, 2 and 6 hr after a mild thermal injury (60 degrees C for 1 min). Large aggregates of intercellular particles, usually ribosomal in appearance, were seen in 6 hr samples and were accompanied by some peripheral aggregates of particles and by granule-coated vesicles. These structures were present in earlier samples to a lesser extent and were absent from control material. Quantitative assessment showed that intercellular particles apparently increased up to 6 hr whereas peripheral aggregation was maximum at 2 hr. Histochemical analysis confirmed that the particles contained ribonucleoprotein. Other larger particles were seen occasionally and contained carbohydrate. Lymph draining the site showed cellular changes, little change in enzyme activities, and no aggregates of particles.     

Establishing generalized verb-noun instruction-following skills in retarded children

Diazotized (125I)-diiodosulfanilic acid (DD125ISA) binds specifically to the exposed proteins on the surface of the rabbit platelet plasma membrane. This was demonstrated by the following observations with the use of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) of whole platelets and the isolated plasma membrane fraction: (1) the specific activity of isolated membrane protein was sevenfold that of whole platelet protein, (2) no proteins of intact platelets were labeled which were not represented in the isolated plasma membrane, (3) DD125ISA-labeled proteins were altered by trypsin treatment of intact, labeled platelets, and (4) the pattern of labeling produced by reaction of isolated membranes with DD125ISA differed from that produced by the labeling of intact platelets. Reaction of DD125ISA with intact platelets produced labeling of only the three membrane glycoproteins (molecular weights: 180,000, 125,000, and 92,000 daltons) with greatest labeling of the largest glycoprotein and least labeling of the smallest glycoprotein. When rabbit platelets were labeled simultaneously with DD125ISA and 51Cr, the two isotopes were similarly distributed in various density populations of platelets. Some DD125ISA was solubilized from labeled and washed platelets by sonication, but all platelet DD125ISA was recovered in the plasma membrane fraction after 30 minutes' circulation in vivo. In vivo 51Cr recovery and survival were not altered by simultaneous labeling of platelets with DD125ISA. The disappearance of DD125ISA from circulating platelets (T 1/2 = 17 hours) was more rapid than 51Cr (T 1/2 = 30 hours) and appeared exponential in contrast to the linear 51Cr disappearance. On the other hand, DD125ISA did not disappear from platelets faster than 51Cr when doubly labeled platelets were harvested after 3 hours' circulation and incubated in autologous plasma (T 1/2 of DD125ISA elution = 43 hours, 51Cr = 33 hours). SDS-PAGE analysis of DD125ISA-labeled platelets after 14 to 20 hours' circulation in vivo demonstrated the same pattern of DD125ISA distribution on membrane glycoproteins as on the platelets prior to infusion. We interpret this symmetrical loss of the membrane label to indicate symmetrical loss of membrane proteins, suggesting that the platelet may lose pieces of membrane and not specific surface proteins during circulation. This could occur during reversible adhesion encounters during the process of hemostasis and cause the smaller size and decreased effectiveness of older platelets.     

Gastric and biliary excretion of meperidine in man

The role and importance of enterogastric secretion in the disposition and elimination of the weak base, meperidine (pKa 8.63), was studied after intravenous administration (50 mg) of the drug to 6 normal volunteers. Continuous collection of the gastric fluid over a 4-hr period demonstrated the establishment of high gastric fluid/plasma concentration ratios for meperidine (mean about 50, range, 10 to 200). However, the total amount of drug recovered, even after correction for incomplete collection, was only a small percentage of the administered dose. Under basal conditions a mean +/- SE of 1.9 +/- 0.3 mg, equivalent to 3.7% of the administered dose, was found in the total gastric aspirate. Stimulation of gastric secretion by subcutaneous injection of betazole (1.5 mg/kg) increased this recovery to 3.6 +/- 0.3 mg (7.2%) primarily due to the increase in gastric volumen output. Aspiration of the gastric fluid in either the basal or stimulated situation had no observable effect upon the plasma concentration/time profile of meperidine whether assessed by the terminal half-life, t 1/2 beta, or the plasma clearance; control values were 3.8 +/- hr and 1,190 +/- 130 ml/min, respectively. In 2 subjects "bile fluid" was also collected for 2.5 hr and found to contain less than 0.2% of the administered dose. Enterosystemic recycling is therefore of minor importance in the disposition and elimination of meperidine in man.     

Antibody-mediated suppression of grafted lymphoma. IV. Influence of time of tumor residency in vivo and tumor size upon the effectiveness of suppression by syngeneic antibody

In the suppression of the growth of a mouse lymphoma 6C3HED by antibody, the effectiveness of antibody in suppressing growing or established tumor cells and comparable number of freshly injected tumor cells is quantitatively similar. The effectiveness of antibody diminishes markedly when the number of tumor cells per mouse reaches the level of 10(6) due to the development of a macrophage shortage. At the 10(5) tumor cells level, antibody-mediated suppression takes place in an optimal manner and between 10(5) and 10(4) tumor cell numbers, the amount of antibody required to suppress 50% of the tumor cells is directly proportional to the number of tumor cells suppressed.     

Symptomatic recurrent carotid stenosis and aneurysmal degeneration after endarterectomy

BACKGROUND: Aneurysmal degeneration of a carotid reconstruction was not recognized until the patient, who was known to have recurrent carotid artery stenosis, had a thromboembolic stroke. This sequelae of carotid endarterectomy is a serious complication, associated with a high morbidity and mortality rate. This review was conducted to establish the risk of transient ischemic attack and stroke for patients found to have recurrent carotid stenosis associated with aneurysmal degeneration of the carotid artery after endarterectomy. METHODS: A case is reported, and 100 literature references of aneurysmal degeneration of the carotid artery after endarterectomy were reviewed. RESULTS: False aneurysm from anastomotic disruption was the most common presentation identified in the cases reviewed. Nineteen of the patients had a significant neurologic event; however, three (50%) of six patients with aneurysm and recurrent carotid artery stenosis had a transient ischemic attack or stroke. CONCLUSIONS: The incidence of neurologic symptoms is markedly increased when recurrent carotid artery stenosis is associated with carotid aneurysm. During postoperative surveillance after endarterectomy, the identification of recurrent carotid artery stenosis requires evaluation for aneurysmal degeneration of the carotid artery with duplex scanning. These patients are at significant risk for transient ischemic attack and stroke. This rare complication merits operative repair.     

Cervical esophageal web associated with a patch of heterotopic gastric mucosa

Cervical esophageal webs are a relatively common finding on esophograms. We report a web resulting from the squamocolumnar junction produced by heterotopic gastric mucosa. The clinical significance of this lesion is discussed and the importance of differentiating it from Barrett's esophagus is stressed.