Therapeutic approach to a cerebrovascular accident

The therapeutic approach to vascular lesions, which in fact represents the effective prevention of potential or recurrent brain damage, is discussed. The following problems are considered: asymptomatic localized vascular bruit; transient ischemic attack; minor strokes; progressive strokes; total strokes; and hemorrhages. Supportive therapy in the patient with brain damage is presented.     

Radiology in primary hyperaldosteronism

Autonomous hypersecretion of aldosterone (primary hyperaldosteronism) is caused by either hyperplasia (usually bilateral) or an adenoma (frequently unilateral) of the adrenal cortex. Systemic hypertension due to an aldosteronoma is a potentially curable condition through surgical extirpation of the offending organ. In our experience with 37 patients clinically suspected to have primary hyperaldosteronism, radiological methods contributed significantly in preoperative diagnosis. These included (1) selective bilateral adrenal vein catheterization and blood sample collection, (2) adrenal venography, and (3) radioisotope adrenal scan. Unilateral hyperfunction could be accurately detected by the aldosterone assays from the collected samples. When adrenal venography was technically satisfactory, a nodule or aggregate of nodules measuring at least 7 mm and located on the margin of the gland or 1.5 cm or more in diameter when located in the center of the gland were readily identified. Enlarged adrenal gland on venography, in itself, was not a dependable index of a hyperfunctioning gland. Presence of a higher uptake on one side on the radioisotope adrenal scan did not always indicate the hyperfunctioning gland, but lack of lateralization of adrenal hyperfunction was more accurately predicted on the radioisotope scan than by venography. Four histopathological patterns were recognized in the surgically removed adrenal glands, but no correlation between these patterns and clinical behavior or postoperative course was found.     

Cortisol in physiological concentrations acts within minutes to modify effects of prolactin and growth hormone on prostaglandin secretion: importance of effect in modulating cellular responses to calcium and cyclic nucleotides

We propose that intracellular prostaglandins (PGs) are essential for the final expression of the effects of second messengers in most cells. We suggest that the amounts of PGs required are very small (in the picomolar range) and are much lower than those used in most current PG studies. We suggest that while therapeutic levels of inhibitors of PG synthetase may be adequate to block the overflow of PGs from cells, they are in most cases unlikely to reduce intracellular PGs sufficiently to test the role of such PGs. We propose that there is a basal level of PG synthesis unaffected by hormones but that above this level PG synthesis is regulated by the interplay between physiological levels of cortisol, prolactin, growth hormone and thyroid hormones. For the most part prolactin seems to stimulate PG synthesis and cortisol to inhibit it: cortisol has, however, no inhibitory effect on basal PG synthesis. In reducing prolactin-stimulated PG synthesis cortisol is 1000-2000 times more potent than indomethacin on a molar basis. We suggest that the regulation of intracellular PG levels is the mechanism of the so-called "permissive" actions of these hormones. These concepts could prove important in the understanding of many aspects of physiology and pathophysiology including diurnal and seasonal changes in hormone responsiveness. They are also relevant to the use of established drugs and the design of new ones.     

Structural studies on RNA from Bombyx mori L. I. Nucleoside composition of enriched tRNA species from the posterior silkgland purified by coutercurrent distribution

The effect of light deprivation on the flickering beta-wave was investagated. Results indicate that the flickering beta-wave is extremely reduced in the eye light-deprived for 14 to 20 days relative to the normal eye. The ratio of the second beta-wave (in a series of flickering beta-waves) to the ratio of the first beta-wave appears relatively unaffected by light deprivation, but the ratio of the fourth beta-wave to the first is significantly affected by light deprivation. The effect of light deprivation on the beta-waves evoked by a 13.4 milliambert flickering light is greater for beta-waves evoked later in the series than for beta-waves evoked earlier in the series.     

Uptake of benomyl by the cultivated mushroom, Agaricus bisporus

Of 96 cancers which have been detected as a result of the first annual screening of 10,470 volunteers, 46 have been clinically occult. Forty-one of these have been Stage 1 or less carcinoma, and 26 of these 41 have been minimal cancer. For the radiographic parameters used, the benefit of detecting these cancers vs. the risk of induced cancer is estimated as 103:1 and 65:1, respectively.     

Acceptability of three convenience chicken products

Three convenience products--frozen, precooked chicken apple fritters, chicken breast fillets, and chicken patties--provided by one processor were subjectively evaluated by two taste panels of older adults, ranging in age from the sixties to middle eighties. The panelists represented a middle-income group maintaining private homes and a low-income group living in public housing. Both panels rated each product above "good" (score=4) or "fair" (score=3) on four acceptability factors and the overall score. Although mean scores of the low-income taste panel on all factors were generally higher for all products, the only significant difference (P less than .01) pertained to the appearance factor. Both panels indicated willingness to buy all three products.     

Aldosterone secretion during high sodium cerebrospinal fluid perfusion of the brain ventricles

Conscious sheep with permanent indwelling cannulae in the lateral ventricles and the cisterna magna were Na depleted and then perfused for 9 h with an artificial CSF solution. There were 3 experimental groups: Group I (n=5) received perfusion with aritifical CSF containing NA 170 MEq./1, Group II (n=7) received perfusion with artificial CSF containing Na 145 mEq./1, Group III (n=7) received no perfusion. In Group I the blood aldosterone level fell from 26.4 +/- 7.4 to 8.6 +/- 2.3 ng/100 ml by 9 h after perfusion. There was no significant change in plasma [Na] or [K], blood angiotensin II or plasma renin concentration. Blood cortisol and corticosterone levels rose. There was also a fall in post-perfusion. Group III showed no significant change in blood aldosterone concentration. Multivariate statistical analysis showed that the fall in aldosterone levels during 170 mEq./l Na perfusion could not be accounted for by changes, either alone or together, of ACTH as evidenced by alteration in blood cortisol or corticosterone, or by change of plasma [Na], [K] or renin concentrations. This data supports the hypothesis of an additional factor which may be of CNS origin being involved in the control of aldosterone secretion.     

Association of Sj?gren's syndrome with HLA-B8

HLA antigens were examined by microdroplet lymphocyte cytotoxicity in 31 patients with Sj?grens syndrome. Fifty percent of 22 Causcasian patients (7 of 17 females and 4 of 5 males) had HLA-B8, as compared to 21% of 1205 controls (P=0.002). The presence of HLA-B8 was not correlated with parotid salivary flow, keratoconjunctivitis sicca, or focus score. Because of its association with a number of autoimmune diseases, including Sj?gren's syndrome, it is suggested that HLA-B8 is genetically liked to an immune response gene(s) that predisposes the individual to autoimmune phenomena. The expression of autoimmunity may be determined by infectious or environmental factors.