CT and CT angiography in massive haemoptysis with emphasis on pre-embolization assessment.

Massive haemoptysis is a respiratory emergency. Computed tomography angiography (CTA) can play a crucial role in assessing the cause and origin of the haemoptysis and directing the interventional radiologist prior to treatment. The bronchial arterial supply and to a lesser extent the non-bronchial systemic arterial supply are responsible for the majority of cases of massive haemoptysis, but uncommon causes of massive haemoptysis should be considered to avoid misdiagnosis and delayed treatment. Failure to assess the imaging appropriately prior to endovascular treatment may result in early recurrent massive haemoptysis or patient death.

Cognitive Motor Dual Task Costs in Older Adults with Motoric Cognitive Risk Syndrome.

The purpose of this study was to characterize Cognitive Motor Dual Task (CMDT) costs for a community-based sample of older adults with Motoric Cognitive Risk Syndrome (MCR), as well as investigate associations between CMDT costs and cognitive performance. Twenty-five community-dwelling older adults (ages 60-89 years) with MCR performed single and dual task complex walking scenarios, as well as a computerized cognitive testing battery. Participants with lower CMDT costs had higher scores on composite measures of Working Memory, Processing Speed, and Shifting, as well as an overall cognitive composite measure. In addition, participants with faster single task gait velocity had higher scores on composite measures of Working Memory, Processing Speed, and overall cognition. Taken together, these results suggest that CMDT paradigms can help to elucidate the interplay between cognitive and motor abilities for older adults with MCR.

cDNAs of cell adhesion molecules of different specificity induce changes in cell shape and border formation in cultured S180 cells.

The liver cell adhesion molecule (L-CAM) and N-cadherin or adherens junction-specific CAM (A-CAM) are structurally related cell surface glycoproteins that mediate calcium-dependent adhesion in different tissues. We have isolated and characterized a full-length cDNA clone for chicken N-cadherin and used this clone to transfect S180 mouse sarcoma cells that do not normally express N-cadherin. The transfected cells (S180cadN cells) expressed N-cadherin on their surfaces and resembled S180 cells transfected with L-CAM (S180L cells) in that at confluence they formed an epithelioid sheet and displayed a large increase in the number of adherens and gap junctions. In addition, N-cadherin in S180cadN cells, like L-CAM in S180L cells, accumulated at cellular boundaries where it was colocalized with cortical actin. In S180L cells and S180cadN cells, L-CAM and N-cadherin were seen at sites of adherens junctions but were not restricted to these areas. Adhesion mediated by either CAM was inhibited by treatment with cytochalasin D that disrupted the actin network of the transfected cells. Despite their known structural similarities, there was no evidence of interaction between L-CAM and N-cadherin. Doubly transfected cells (S180L/cadN) also formed epithelioid sheets. In these cells, both N-cadherin and L-CAM colocalized at areas of cell contact and the presence of antibodies to both CAMs was required to disrupt the sheets of cells. Studies using divalent antibodies to localize each CAM at the cell surface or to perturb their distributions indicated that in the same cell there were no interactions between L-CAM and N-cadherin molecules. These data suggest that the Ca(++)-dependent CAMs are likely to play a critical role in the maintenance of epithelial structures and support a model for the segregation of CAM mediated binding. They also provide further support for the so-called precedence hypothesis that proposes that expression and homophilic binding of CAMs are necessary for formation of junctional structures in epithelia.

Central pontine myelinolysis, an update.

Central pontine myelinolysis (CPM) can be regarded as one of the demyelinating syndromes. First described by Adams et al. in 1959 in their chronic alcoholic patients, it has now been described in the malnourished, the chronically debilitated, the renal, the hepatic and the transplant patient among others. Pathologically, it is defined as a symmetric area of myelin disruption in the center of the basis pontis, although similar symmetric lesions have also been described occurring with CPM as well as independently in other brain areas (extrapontine myelinolysis or EPM) including the cerebellar and neocortical white/gray junctional areas, thalamus and striatum. Possible mechanisms include a hyperosmotically induced demyelination process resulting from rapid intracellular/ extracellular to intravascular water shifts producing relative glial dehydration and myelin degradation and/or oligodendroglial apoptosis. The process most often occurs during rapid rebalancing of the electrolyte parameters in the hyponatremic patient. Avoidance of CPM/EPM is dependent upon recognizing those patients with conditions pre-disposing them to osmotic myelinolysis and then moderating the rate of normalization of the electrolyte imbalance. The morbidity and mortality of CPM/EPM has been greatly reduced by recognition of pre-disposing conditions, increased understanding of the pathophysiology, intensive treatment, and rapid diagnosis and monitoring with advanced neuroimaging.

Separation of luminal and abluminal membrane enriched domains from cultured bovine aortic endothelial cells: monoclonal antibodies specific for endothelial cell plasma membranes.

Two kinds of membrane (luminal and abluminal membrane domains) fractions have been isolated from bovine aortic endothelial cells by fractionation of whole cell homogenate on discontinuous sucrose density gradients. The luminal membrane domain was enriched 12-16-fold for angiotensin-converting enzyme activity and 8-10-fold in alkaline phosphatase activity. The abluminal membrane domain displayed an enrichment of 8-fold in (Na+ + K+)-ATPase activity. Both of the membrane domains were minimally contaminated with mitochondria, microsomes and Golgi bodies, as assessed by their corresponding marker enzyme activities. 125I-labeling of endothelial cell monolayers by the Enzymo-Bead lactoperoxidase-catalyzed iodination procedure, followed by isolation of membranes, revealed that the radioactivity was predominantly associated with membranes enriched in angiotensin-converting enzyme activity, corresponding to the luminal membrane domain. However, when cells were radioiodinated in suspension culture, radioactivity was found equally associated in both the luminal and abluminal membrane fractions. Electron microscopy of freeze-fractured and sectioned material showed both luminal and abluminal membrane domains to be in the form of vesicles varying in size from 100 to 400 nm in diameter. To characterize the separation of endothelial cell membrane domains, we have attempted to prepare monoclonal antibodies specific for endothelial cells. Several clones were obtained, producing antibodies which bound to endothelial cells of arterial, venous and capillary origin. Two antibodies of these clones, XIVC6 and XVD2, were studied in more detail. In the ELISA assay, these antibodies reacted with bovine vascular endothelial cells, but not with human umbilical cord endothelial cells, nor with bovine corneal endothelial cells, smooth muscle cells or fibroblasts. Both of these antibodies are directed against an antigen of approximately 130 kDa, under reducing and non-reducing conditions, as assayed by the immunoprecipitation method. Western blot analysis of luminal and abluminal membrane fractions revealed that only MAb XVD2 reacted with an antigen, indicating that the antibody XIVC6 is directed against an epitope which is denatured by SDS. Moreover, MAb XVD2 preferentially reacted with the luminal membrane compared to the abluminal membrane domain of the endothelial cell. These monoclonal antibodies do not react with platelet membrane proteins, indicating that this 130 kDa membrane antigen is not common to both endothelial cells and platelets.(ABSTRACT TRUNCATED AT 400 WORDS)

Alterations in organization of phospholipids in erythrocytes as factor in adherence to endothelial cells in diabetes mellitus.

Erythrocytes from patients with diabetes mellitus exhibit increased adherence to cultured human vascular endothelial cells. We investigated the alterations in erythrocyte surface characteristics that may contribute to their abnormal adherence. The organization of phospholipids in the lipid bilayer, as determined by phospholipase A2 treatment and chemical labeling with fluorescamine and trinitrobenzene sulfonic acid (TNBS), is altered in erythrocytes from diabetic patients. Specifically, 12-18% of phosphatidylserine in diabetic erythrocytes (n = 25) is accessible to phospholipase A2 hydrolysis and TNBS labeling, compared to none in normal subjects. These results suggest either a loss in lipid asymmetry or in vivo destabilization of erythrocyte membranes in diabetic patients, causing increased accessibility to phospholipase A2 degradation. The dye merocyanine 540 (MC-540), which is sensitive to the packing of lipids in the bilayer of the membrane, revealed more binding and fluorescence in erythrocytes from diabetic patients than in those from normal subjects. On flow cytometric analysis, 64.5 +/- 17.0% red blood cells (RBCs) in diabetic patients, compared to 35.1 +/- 25.9% RBCs in normal subjects, showed positive MC-540 binding, indicating significant (P less than .001) differences in the packing of lipids in the external leaflet of the bilayer. The results of our study suggest that a loss of lipid asymmetry and/or less ordered packing in the outer leaflet of the diabetic erythrocyte membrane may be responsible for the increased propensity of erythrocytes to adhere to vascular endothelium.

Intranasal abuse of prescribed methylphenidate by an alcohol and drug abusing adolescent with ADHD.

A rare case is described where an adolescent with attention deficit hyperactivity disorder diagnosed in childhood subsequently developed alcohol and drug abuse. He later developed intranasal methylphenidate abuse and dependence after realizing that urine drug screens were expected to be positive for prescribed methylphenidate. This report is to alert physicians to the rare possibility of intranasal methylphenidate abuse in chemically dependent teenagers treated for ADHD and also to the possibility of group methylphenidate abuse at special education schools where many teenagers may be treated with stimulant medication.

Effect of opioid antagonism on beta-endorphin processing and proopiomelanocortin-peptide release in the hypothalamus.

Previous studies have shown that chronic opioid receptor blockade has significant effects on POMC gene expression and peptide levels in the hypothalamus. We have now examined the effects of the opioid antagonist naltrexone on beta-EP processing in the hypothalamus and on the release of 2 POMC-derived peptides, beta-EP and gamma 3-MSH, from the perifused hypothalamus in vitro. The beta-EP immunoactivity in the medial basal hypothalamus (MBH) of 7 rats infused for 1 week with naltrexone by osmotic minipump, was individually analyzed by HPLC and compared to 7 control rats. The mean ratio of beta-EP1-31 compared to beta-EP1-27 plus beta-EP1-26 was 2.34 +/- 0.41 in the naltrexone treated rats, significantly higher than the ratio of 1.26 +/- 0.09 in the control rats (P < 0.02). Thus in the setting of chronic opioid antagonism although beta-EP content decreases, there is relatively more beta-EP1-31, the biologically active opioid form of the peptide, compared to the C-terminally cleaved forms of beta-EP which have reduced biological activity. To study the effects of naltrexone on beta-EP and gamma 3-MSH release, hypothalami were perifused in vitro with 10(-6) M naltrexone. Basal release of gamma 3-MSH was significantly higher from the naltrexone treated brains compared to the controls (221 +/- 20 pg/60 min vs. 161 +/- 6.7 pg/60 min) (P < 0.01); KCl stimulated gamma 3-MSH was also significantly higher in the naltrexone group (951 +/- 94 vs. 543 +/- 85 pg/60 min) (P < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

A controlled study for gender selection.

OBJECTIVE: To evaluate the success for gender selection of insemination with a sample of semen separated by a serum albumin density separation gradient. DESIGN: We retrospectively compared the gender outcome of conceptions of couples who conceived spontaneously with those who conceived secondary to an insemination with separated semen. SETTING: Private practice of one author (M.A.K.). PATIENTS, PARTICIPANTS: The study group consisted of 48 pregnancies of couples who conceived by the separation technique. The control group consisted of 46 pregnancies of couples who initially presented for consultation for gender selection but conceived spontaneously. INTERVENTIONS: In the study group, one timed intrauterine insemination with separated semen was performed per cycle, with a mean of 2.3 cycles per couple. Patients desiring a female were also treated with clomiphene citrate and human chorionic gonadotropin. MAIN OUTCOME MEASURE: The gender outcome of the pregnancies of the two groups was evaluated based on the known desired gender. RESULTS: The success rate for conceiving a desired male was 56.5% in the study group and 60.9% in the control group (P = 1.000). Of couples seeking females, 78.6% of the procedure group versus 35.3% of the control group were successful (P = 0.019). CONCLUSIONS: This study debates the albumin gradient as definitively enriching the proportion of Y-bearing sperm after in vitro separation.

Nonclassical 3 beta-hydroxysteroid dehydrogenase deficiency: a review of our experience with 25 female patients.

OBJECTIVE: To report 15 new menarcheal women affected with nonclassical 3 beta-hydroxysteroid dehydrogenase deficiency (nonclassical 3 beta-HSD) and evaluation of glucocorticoid therapy in treated patients. DESIGN: Diagnosis of these new patients using a standard adrenocorticotropin test. Effects of glucocorticoid therapy on clinical hormonal and sonographic features of each patient are appreciated for periods varying between 4 months and 7 1/2 years. SETTING: All at The New York Hospital-Cornell Medical Center. The Pediatric Endocrinology Ambulatory Service; the Children's Clinical Research Center Core Laboratories; and the Department of Radiology. PATIENTS, PARTICIPANTS: Fifteen menarcheal women (14 to 30 years of age) newly diagnosed and 10 women previously diagnosed were evaluated for symptoms of hyperandrogenism and/or irregular menses. MAIN OUTCOME MEASURE(S): Positive effect of glucocorticoid therapy on signs and symptoms, hormonal levels, and ovarian imaging. RESULTS: Polycystic ovarian syndrome is noted in approximately half the cases. Glucocorticoid treatment greater than 3 months duration results in a reversal of symptoms in most cases.

MRI of central nervous system: early clinical results.

In patients with central nervous system problems, a comparison of the results obtained with high-field MRI (1.5 T) to those achieved with more conventional imaging studies, primarily CT, reveals significant improvement in the demonstration of various abnormalities by MRI (56.5%), with increased specificity in some (29.5%). High-field MRI provides advantages over CT by providing both multiplanar images and superior contrast resolution. The diagnostic specificity of MRI is increased when acute, subacute, and chronic hematomas are visualized and when flowing blood within vessels is demonstrated in addition to the location and extent of the disease process. In this series, MRI produced a more accurate diagnosis in 8.7% of cases, revealed clinically unexpected abnormalities in 3.9% of cases, and was less invasive or avoided the risk of complications in 17.4% of cases. Despite the success of MRI, CT continues to play an important role in demonstrating calcification and contrast enhancement, and in evaluating patients in whom MRI is contraindicated or impossible because of an unsuitable clinical state.

Nocardia asteroides: an unusual cause of breast abscess.

A case of nocardial breast infection is presented and infection by nocardia organisms must be considered as a rare differential diagnosis of chronic inflammation of the breast.

Changes in responsiveness to newborn pups in pregnant, nulliparous golden hamsters.

Virgin female hamsters were mated and tested once daily for maternal retrieving behavior beginning on days 0, 5, 9, 13, 15, of the 16 day gestation period to determine if responsiveness toward newborn pups changes as pregnancy proceeds. Upon initial exposure to 3 newborn pups, only a small percentage of early-to-mid-pregnant females exhibited maternal retrieving behavior spontaneously. In contrast, over half of the 15 day pregnant females displayed retrieving during the first test. Despite the high frequency of initial pup-directed aggression and cannibalism, maternal retrieval was induced in the majority of the females in all groups by repeated daily exposure to 3 newborn pups. However, no significant differences were observed in the number of pup exposure periods required to induce maternal retrieving in 0, 5, and 9 day pregnant females. It is concluded that the high level of maternal responsiveness observed in the parturient hamster develops somewhat abruptly during late pregnancy. In this respect, the pattern observed in the hamster differs from the more gradual increase in maternal responsiveness reported in mid-to-late-pregnant mice and rats.

Syndromal vertigo identified by magnetic resonance imaging and angiography.

The advent of magnetic resonance imaging and angiography has clarified the location and vascular basis for vertigo of a syndromal type. The composite presentation of a vestibular symptom with evidence of cranial nerve or cerebellar dysfunction suggests a lesion within the pons, medulla, or cerebellum. The location may be exactly defined by noninvasive techniques and appropriate therapy can be initiated. Clinical examples are presented; the syndromes of vertebrobasilar artery perfusion disorder are described, and appropriate images are illustrated for confirmation.

Evaluation of the vestibular system by magnetic resonance angiography.

This report describes the normal arterial patterns of the vestibulocerebellar regions visualized by magnetic resonance angiography. Variations in the vertebrobasilar arterial system are described, limitations in imaging are discussed, and collateral connections within the cerebellar vessels and the circle of Willis are reviewed. Clinical correlations are defined between the vestibular nuclei, the associated intraaxial tracts, and with specific posterior cerebral and brain stem arteries.

The startle response in rats: effect of ethanol.

The effects of acute and chronic ethanol intake on the startle response was examined in male rats. Ethanol given IP produced a dose-dependent decrease in the amplitude of the startle response measured 30 min later. With a dose of 1 g/kg, the effect was evident at 15 min and had recovered substantially by 60 min. The effect of ethanol on the startle response was potentiated by pretreatment of the animals with pimozide, haloperidol, and p-chlorophenylalanine but not by propranolol, phenoxybenzamine, alpha-methyltyrosine, or pargyline. After 3 weeks on an ethanol-containing diet, the startle response was greater than that shown by rats on the control iso-caloric, sucrose-containing diet. After ethanol withdrawal, the startle response was further increased, with a peak about 9 to 12 hr after discontinuation of ethanol; thereafter, the response declined. This time course of heightened startle response during ethanol withdrawal corresponds to the time course of the activation of noradrenergic neurons during withdrawal. It appears that dopaminergic and serotonergic neurons are involved in the mediation of the startle response in rats.

Preventing relapse. Guidelines for the pediatrician.

Preventing relapse into substance use means first helping the teenager to develop a state of recovery. This involves completing a First Step of a 12-Step program, whereby the teenager accepts that drugs and alcohol have been destructive in his or her life and that moderate use is impossible. Thus, abstinence is necessary in a productive life. Parental support is also established. The two more common causes of relapse are being in the presence of alcohol- and drug-using peers and the presence of co-existing psychiatric problems.

The multislice cylinder: a new approach to quantification of cardiac single photon emission tomography.

A new method of displaying SPECT (single photon emission tomography) thallium-201 images is described in which cardiac activity is constructed as a cylindrical map. Exercise thallium-201 scintigrams from 52 patients with known or suspected coronary artery disease are analysed by this technique and a simplified severity score devised.

Cytogenetics of müllerian agenesis. A case report.

A 38-year-old woman presented with primary infertility and primary amenorrhea. The evaluation revealed müllerian agenesis and mosaicism, 45,X/46,XX/47,XXX.

Foster child health care supervision policy.

Foster children represent a high-risk group for physical, emotional, and social health problems, yet few federal or state policies explicitly address foster child health. This article reviews foster child health and the legal background for policy, then discusses components of a comprehensive health care supervision program.