Biologic effects of 17 alpha-dihydroequilin sulfate

OBJECTIVE: To determine the independent biologic effects of 17 alpha-dihydroequilin sulfate. DESIGN: Prospective randomized study. SETTING: University of Southern California Medical Center. PATIENTS(S): Twenty-one postmenopausal women, mean age 50 +/- 2 (+/-SEM) years, and mean body mass index 27 +/- 2. INTERVENTION(S): Women were randomized to receive daily oral doses of either 1.25 mg of estrone sulfate (E1S), 0.2 mg of 17 alpha-dihydroequilin sulfate, or a combination. Three blood and urine samples were obtained before and after 30 and 90 days of treatment. RESULT(S): After 30 and 90 days of treatment, E1S alone increased sex hormone-binding globulin (SHBG) levels significantly, 19.7% +/- 6.0% and 61.3% +/- 13.0%, whereas 17 alpha-dihydroequilin sulfate reduced SHBG levels, 20.8% +/- 68% and 12.4% +/- 7.5%, respectively. Nevertheless, the combination of E1S and 17 alpha-dihydroequilin sulfate significantly increased SHBG levels, 103% +/- 27.9% and 98.2% +/- 19.1%, compared with baseline at 30 and 90 days. Fewer changes were evident with corticosteroid-binding globulin (CBG). After 90 days of treatment, CBG levels significantly increased 30.9% +/- 5.5% with E1S, decreased by 7.2% +/- 5.0% with 17 alpha-dihydroequilin sulfate, and, with the combination, significantly increased by 10.5% +/- 2.4% compared with baseline. Changes in lipids and lipoproteins were more variable. However, high-density-lipoprotein cholesterol increased significantly with E1S at 30 and 90 days compared with baseline, 96.5% +/- 39% and 91.5% +/- 22.6%, and with the combination increased 66.4% +/- 13.3% and 79.2% +/- 24.4%, respectively. Fewer changes were evident with 17 alpha-dihydroequilin sulfate alone, decreasing 4.4% +/- 22% and 2.6% +/- 21.3%. Urinary ratios of bone collagen equivalents-creatinine and calcium-creatinine decreased in all three groups. However, the combination group resulted in a significantly greater percentage decrease in bone collagen equivalents-creatinine than with E1S alone. CONCLUSIONS(S): 17 alpha-Dihydroequilin sulfate could modify some of the first-pass effects of conjugated equine estrogens and act synergistically with other conjugated equine estrogens to reduce bone resorption.     

Functional MR of frontal lobe activation: comparison with Wada language results

PURPOSE: Our purpose was to determine the utility of functional MR imaging in conjunction with a word-generation paradigm in the assessment of language lateralization. METHODS: Functional MR imaging and Wada testing for language lateralization was performed in patients with complex partial seizures during the performance of word-generation tasks. A language lateralization quotient was calculated from the number of activated pixels in the right and left hemispheres. A language laterality score was derived from the Wada results as the percentage of correct responses during right internal carotid artery injection minus the percentage of correct responses during left internal carotid injection. A correlation coefficient between the functional MR imaging results and the Wada language laterality scores was calculated. RESULTS: In 13 patients, hemispheric dominance based on Wada testing was confirmed by functional MR imaging during silent word generation. The Wada laterality scores varied from 100 to -100 and the functional MR imaging scores varied from 100 to -10. The language lateralization scores determined by functional MR imaging correlated significantly with the language lateralization scores derived from Wada testing. CONCLUSION: Functional MR imaging performed during word generation is an accurate method for lateralizing language function in patients with complex partial epilepsy.     

Effects of nimodipine on acute cerebral ischemia and reperfusion injury of rats

AIM: To study the effect of nimodipine (Nim) on ischemic cerebral damage. METHODS: The four-vessel occlusion method was performed on rats. Monoamines were measured by fluorospectrophotometry. RESULTS: Intraperitoneal injection of Nim 0.75 and 1.5 mg.kg-1 quickened the recovery of EEG changes to 19 +/- 3 and 17 +/- 4 min (P < 0.01), respectively. Nim reduced the decreases of monoamines (NE, DA, 5-HT, and 5-HIAA) contents after 30-min cerebral ischemia and 1-h reperfusion. CONCLUSION: Nim protects the brain from ischemic damage.     

Aneurysm in a persistent sciatic artery. Apropos of 2 cases

Persistent sciatic is a vascular malformation resulting in the embryo from the preferential growth of the ischiatic posterior axis remaining atrophic. We report here two cases of unilateral, complete and incompleted, persistent sciatic arteries, complicated by buttock aneurysm.     

Management of tumor lysis syndrome with standard continuous arteriovenous hemodialysis: case report and a review of the literature

Tumor lysis syndrome (TLS) is a critical illness with few treatment options. This report describes the clinical course of a patient with non-Hodgkin's lymphoma, who developed TLS and required renal replacement therapy. Institution of the standard therapeutic approach, intermittent hemodialysis, was not possible because of persistent hypotension. Instead, the patient was treated with a short course of continuous arteriovenous hemofiltration (CAVH) and conventional continuous arteriovenous hemodialysis (CAVHD) with dialysate flow rate of 1 L/h), which resulted in effective control of serum uric acid, potassium, urea nitrogen, phosphorus, and extracellular fluid volume. This case is in distinction to a previous report of TLS treatment with CAVHD using 4 L/h dialysate flow rate. We conclude that continuous renal replacement therapies with standard dialysate flow rates and replacement volumes should be considered for the treatment of TLS, particulary if the syndrome is accompanied by hypotension.     

Sources of cholesterol during development of the rat fetus and fetal organs

Female rats at various stages of pregnancy were injected intraperitoneally with [3H]water; 4 h later, they were killed, the uterus was removed, and the fetuses were dissected. Lipids were isolated and fractionated by HPLC and the total amount of cholesterol in each organ, as well as radioactivity incorporated into cholesterol and cholesterol precursors, were determined. From the data for cholesterol content at each age we calculated the rate of accumulation of cholesterol during fetal development. As incorporation of label from [3H]water takes place with a stoichiometry defined by a known biosynthetic pathway, we were also able to determine the fraction of cholesterol accumulating in each organ that had been newly synthesized. For the fetus as a whole, more than 93% of the cholesterol accumulating during development was newly synthesized. As the specific radioactivity of cholesterol in the maternal circulation was negligible (because synthesis of cholesterol by maternal liver was suppressed by inclusion of cholesterol in the diet), we conclude that the fetus synthesizes nearly all of its own cholesterol; neither the maternal circulation nor the placenta/yolk sac contribute significant amounts of cholesterol to the fetus. We were also able to quantitate trafficking of cholesterol between fetal organs. Fetal brain is responsible for the synthesis of all of its own cholesterol. In contrast, fetal liver exports cholesterol into the fetal circulation and supplies about half of the cholesterol for development of heart, lung, and kidney.