Cigarette smoke and human plasma lycopene depletion.

It is known that smokers have a higher risk of developing cardiovascular disease and lung cancer. Plasma carotenoid concentrations in smokers are generally lower than in non-smokers and this may be due to modifications in diet or a direct or indirect action of cigarette smoke on carotenoids in the plasma. Recently it was reported that reactive nitrogen species derived from cigarette smoke could diffuse across the lung alveolar cell wall into the plasma. Such species may modify circulating low density lipoprotein (LDL) and in the process reduce circulating carotenoid concentrations. In an effort to address this rational we have treated lycopene solutions, human plasma and isolated LDL with cigarette smoke and monitored all-(E)-lycopene, 5(Z)-lycopene and beta-carotene depletion. In plasma, the depletion of all-(E)-lycopene (15.0+/-11.0%, n=10) was greater than 5(Z)-lycopene (10.4+/-9.6%) or beta-carotene (12.4+/-10.5%). In LDL, both all-(E)- and 5(Z)-lycopene were more susceptible than beta-carotene (20.8+/-11.8%, 15.4+/-11.5% and 11.5+/-12.5%, n=3 respectively). The effects have been compared with Sin-1 reactions and isomerization of all-(E) lycopene is common to both treatments. The results clearly indicate that low plasma lycopene may be a direct consequence of smoke inhalation.

Factor V Leiden: association with venous thromboembolism in pregnancy and screening issues.

Disturbances of the natural balance between procoagulant and anticoagulant mechanisms can result in bleeding or thrombotic tendencies. Factor V, on activation by thrombin to factor Va, forms an essential component of the prothrombinase complex, in which it demonstrates its cofactor activity for factor Xa. Down-regulation of factor Va by activated protein C (APC) occurs through cleavage of specific peptide bonds in the heavy chain of the molecule. Factor V Leiden (FV Leiden) is a mutation of factor V that renders factor Va resistant to APC, due to loss of one of these cleavage sites. This mutation predisposes the patient to thrombosis. Prevalence of FV Leiden varies; however, heterozygosity for the FV Leiden mutation is recognised as the most common heritable thrombophilic defect in Caucasian populations. The association this inherited thrombophilia has with venous thromboembolism (VTE) is well established. Pregnancy is notably an acquired hypercoagulable state, due in part to physiological changes that occur in the coagulation system. This seems to have potential for interaction with FV Leiden to cause adverse experiences. A role has been suggested for FV Leiden in VTE events during pregnancy. At present only selected women are screened for FV Leiden. Pregnant women with a history of VTE or with a family history of the mutation are investigated. Whether or not the introduction of a routine screening plan for this mutation is justified remains a matter for debate.

Antioxidant and prooxidant properties of carotenoids.

The ability of dietary carotenoids such as beta-carotene and lycopene to act as antioxidants in biological systems is dependent upon a number of factors. While the structure of carotenoids, especially the conjugated double bond system, gives rise to many of the fundamental properties of these molecules, it also affects how these molecules are incorporated into biological membranes. This, in turn, alters the way these molecules interact with reactive oxygen species, so that the in vivo behavior may be quite different from that seen in solution. The effectiveness of carotenoids as antioxidants is also dependent upon their interaction with other coantioxidants, especially vitamins E and C. Carotenoids may, however, lose their effectiveness as antioxidants at high concentrations or at high partial pressures of oxygen. It is unlikely that carotenoids actually act as prooxidants in biological systems; rather they exhibit a tendency to lose their effectiveness as antioxidants.

Magnetic resonance imaging of intramedullary spinal cord tumors.

The advent of MRI has significantly changed the diagnosis of spinal cord tumors. Standard imaging provides excellent localization and characterization of the tumor in a noninvasive fashion. Exact histologic diagnosis of the two most common tumors, ependymoma and astrocytoma, remains elusive but there are some suggestive imaging characteristics. It is hoped that some of the newer MR imaging sequences will improve characterization of the tumor and thereby influence therapy. Several of these pulse sequences are already used routinely in brain imaging. Evaluation of new imaging sequences in the spine has lagged behind brain MR imaging, mainly due to technical factors. Work on animal spine models and extrapolation from brain imaging studies suggest that it is only a matter of time before some of these techniques become clinically relevant.

Carotenoid composition and antioxidant potential in subfractions of human low-density lipoprotein.

Carotenoids and vitamin E are transported in human plasma complexed with lipoproteins. The bulk of them are associated with low-density lipoprotein (LDL), in which form they may act as antioxidants and thus delay the onset of atherosclerosis. We used a simple, rapid, ultracentrifugation technique to fractionate plasma lipoproteins in self-generating gradients of iodixanol (Optiprep), a non-ionic iodinated density gradient medium. The carotenoid content and composition of a number of LDL subfractions was determined by reversed-phase high-performance liquid chromatography. Lycopene, beta-carotene and beta-cryptoxanthin were mainly located in the larger, less-dense LDL particles whereas lutein and zeaxanthin were found preferentially in the smaller, more dense LDL particles. When the antioxidant content of these fractions was expressed per milligram of LDL protein, significantly lower concentrations of carotenoid and vitamin E were found to be associated with the smaller, protein-rich fractions of LDL. Strong positive correlations were found between total carotenoid and vitamin E plasma concentrations and the lag-time of Cu(2+)-mediated oxidation of LDL subfractions. The more dense LDL subfractions, which had lower levels of these antioxidants, were more readily oxidized, highlighting their possible role in atherosclerotic events.

Lycopene and beta-carotene protect against oxidative damage in HT29 cells at low concentrations but rapidly lose this capacity at higher doses.

Epidemiological studies have clearly demonstrated a link between dietary carotenoids and the reduced incidence of certain diseases, including some cancers. However recent intervention studies (e.g. ATBC, CARET and others) have shown that beta-carotene supplementation has little or no beneficial effect and may, in fact, increase the incidence of lung cancers in smokers. This presents a serious dilemma for the scientific community - are carotenoids at high concentrations actually harmful in certain circumstances? Currently, a significant number of intervention studies are on-going throughout the world involving carotenoids (of both natural and synthetic origin). Our approach has been to study the ability of supplementary carotenoids in protecting cells against oxidatively-induced DNA damage (as measured by the comet assay), and membrane integrity (as measured by ethidium bromide uptake). Both lycopene and beta-carotene only afforded protection against DNA damage (induced by xanthine/xanthine oxidase) at relatively low concentrations (1-3 microM). These levels are comparable with those seen in the plasma of individuals who consume a carotenoid-rich diet. However, at higher concentrations (4-10 microM), the ability to protect the cell against such oxidative damage was rapidly lost and, indeed, the presence of carotenoids may actually serve to increase the extent of DNA damage. Similar data were obtained when protection against membrane damage was studied. This would suggest that supplementation with individual carotenoids to significantly elevate blood and tissue levels is of little benefit and, may, in fact, be deleterious. This in vitro data presented maybe significant in the light of recent intervention trials.

Free radical stimulation of tyrosine kinase and phosphatase activity in human peripheral blood mononuclear cells.

Human lymphocytes were challenged with reactive oxygen species (ROS) generated by xanthine/xanthine oxidase leading to an increase in tyrosine phosphorylation, together with an increase in tyrosine phosphatase activity. In the presence of 50 microM vanadate and xanthine/xanthine oxidase, tyrosine phosphatase activity was inhibited and a marked increase in tyrosine phosphorylation was observed. The addition of catalase abolished the increase in tyrosine phosphorylation while the addition of superoxide dismutase had no effect. This suggests that vanadate together with hydrogen peroxide derived from xanthine/xanthine oxidase activity, interact to produce an agent that is an effective inhibitor of tyrosine phosphatase activity. When human lymphocytes were challenged with xanthine/xanthine oxidase in the presence of 50 microM CuCl2, an increase in both tyrosine phosphatase and kinase activity was observed. Cupric ions inhibited xanthine oxidase activity by 84%; neither superoxide or hydroxyl radicals could be detected, but traces of hydrogen peroxide were detected in the medium. We conclude that unbound metals can interact with ROS and readily influence signalling mechanisms in human lymphocytes.

Spinal headaches after myelograms: comparison of needle types.

OBJECTIVE: We compared traditional bevel-tip end-hole spinal needles and pencil-point-tip side-hole needles for the incidence, severity, and duration of spinal headaches in subjects who had myelograms. Age, sex, and myelographic findings were examined. SUBJECTS AND METHODS: We studied 138 subjects referred for myelograms. For 108 procedures, we randomly used 22-gauge Quinke bevel-tip end-hole needles or 22-gauge Sprotte pencil-point-tip needles. The 30 additional subjects were examined with Gertie Marx pencil-point-tip needles. All myelograms were performed by one of two neuroradiologists using recommended doses of iohexol. The myelograms were examined by an independent neuroradiologist for quality of image and presence of extraarachnoid contrast material. Five to 14 days after myelography, subjects were telephoned by an independent observer and asked about the presence, severity, duration, and positional quality of headache. Spinal headache is defined by positional quality and increases in severity when the subject moves from horizontal to sitting or standing. RESULTS: We found that four (8%) of 52 subjects who had myelograms with Sprotte needles had spinal headaches. Likewise, 14 (25%) of 56 subjects who had myelograms with Quinke needles had spinal headaches. We calculated a statistically significant difference in the incidence of spinal headaches using chi-square analysis (p = .02). The average grade and duration of the spinal headaches did not differ significantly, although they were less marked in the Sprotte group. Spinal headaches occurred more frequently in young and middle-aged subjects than in older subjects. We found one definite extraarachnoid injection in each group. For the Gertie Marx needles, two (7%) of 30 subjects had spinal headaches. The average grade of postmyelogram headache was 2.5, and the mean duration was 1 day. There were no mixed injections. CONCLUSION: We found a significant reduction in spinal headaches after myelograms when we used the pencil-point-tip side-hole needle. These results support the routine use of these needles for myelography in young and middle-aged patients.

Cerebellar hemorrhage complicating temporal lobectomy. Report of four cases.

Four cases of cerebellar hemorrhage complicating temporal lobectomy are presented. A case of postoperative hemorrhage located remote from the operative site as a complication of intracranial surgery is rare, especially when it involves the cerebellum after supratentorial craniotomy. In a review of the literature, the authors identified only 12 such cases, none of which was described in the setting of a temporal lobectomy. The possible etiologies for cerebellar hemorrhage in the four cases presented are examined, including the role of epidural suction drains and the position of the head during surgery. The mechanism of cerebellar hemorrhage in this series of patients is probably multifactorial. Special attention throughout the perioperative course must be given to hemodynamic, anatomical, and physiological factors that together can affect the patient negatively.

GTPgammaS-stimulated phospholipase D activation in human neutrophils occurs by protein kinase C-dependent and -independent pathways but not tyrosine kinases.

Addition of GTPgammaS to saponin-permeabilised human neutrophils activated both the NADPH oxidase and phospholipase D (PLD). This PLD activation was hardly affected by staurosporine or Ro31-8220 (at concentrations which inhibited PMA stimulated PLD activity), indicating that it was largely independent of protein kinase C (PKC). This GTPgammaS stimulated PLD activity was enhanced by 1 mM ATP, but this ATP-enhanced activity was blocked by inhibitors of PKC. Addition of GTPgammaS resulted in very low levels of phosphorylation on tyrosine residues, but higher levels of phosphorylation on serine/threonine residues. Addition of pervanadate hydroperoxides stimulated phosphorylation on tyrosine residues and activated PLD which was blocked by addition of inhibitors of tyrosine kinases. Thus, GTPgammaS can stimulate PKC-dependent and -independent pathways of PLD activation. Whilst phosphorylation on tyrosine residues can result in activation of PLD, this is regulated independently of activation via G-proteins.

Characterisation of a purified phospholipase A2 from the venom of the Papuan black snake (Pseudechis papuanus).

A neutral phospholipase A2 (PLA2) was separated from Pseudechis papuanus venom by a two-stage FPLC procedure of cation exhange and phenyl-Superose chromatography. It had a molecular mass of 15 kDa and a lower LD50 value than a co-separated haemorrhagic fraction, indicating a higher lethal potency. In vitro tests confirmed the powerful inhibition of platelet aggregation by the PLA2 and strong anticoagulant activity initially observed with whole venom. Ultrastructural studies showed that platelets lost their discoid shape and developed membranous projections with a general decrease in electron-density of the cytosol and disruption of the microfilaments following incubation with the enzyme. Amino acid sequence analysis of the N-terminus and some internal peptides demonstrated a high degree of homology with PLA2s from other Pseudechis venoms. Our results indicate that this fraction is the main agent responsible for the haemostatic disorders in envenomed patients.

Biological properties of the venom of the Papuan black snake (Pseudechis papuanus): presence of a phospholipase A2 platelet inhibitor.

The whole venom of Pseudechis papuanus, in addition to its anticoagulant activity, powerfully inhibited platelet aggregation induced by ADP, adrenaline, collagen, ristocetin and thrombin. High levels of phospholipase A2 (PLA2) activity were detected. A mild procoagulant activity was also observed. Following exposure of platelets to P. papuanus venom, platelet factor 3 (procoagulant platelet phospholipid) showed decreased cofactor activity in factor X activation by Russell's viper, venom suggesting that the venom PLA2 plays a major role in the inhibition of the coagulation mechanism. In vivo rodent assays confirmed the inhibitory effect on platelets and the haemorrhagic and neurotoxic activities. It is possible that PLA2 is responsible for anticoagulation and that this, combined with the effect on platelet aggregation, a mild procoagulant and a moderately potent haemorrhagin, is responsible for the haemorrhagic diathesis observed in systemically envenomed patients. Polyvalent (Australia-Papua New Guinea) Commonwealth Serum Laboratories antivenom, currently used for clinical treatment of snakebite in Papua New Guinea, proved highly effective against P. papuanus venom in rodent and in vitro assays, despite the absence of this particular venom from the immunising mixture.

Phospholipase D-dependent and -independent activation of the neutrophil NADPH oxidase.

Stimulation of the respiratory burst of human neutrophils by fMet-Leu-Phe (in the absence of cytochalasin B) is largely unaffected when the activities of protein kinase C and phospholipase D are inhibited. This has been confirmed using three separate assays to measure the respiratory burst. However, whilst these enzymes are not required for the initiation or maximal rate of oxidant generation, they are required to sustain oxidase activity. In contrast, in the presence of cytochalasin B, fMet-Leu-Phe stimulated oxidase activity is much more dependent on phospholipase D activity. It is proposed that (in the absence of cytochalasin B) activation of the NADPH oxidase utilises cytochrome b molecules that are already present on the plasma membrane and activation occurs independently of phospholipase D and protein kinase C. Once these complexes are inactivated, then new cytochrome b molecules must be recruited from sub-cellular stores. This translocation and/or activation of these molecules is phospholipase D dependent. Some support for this model comes from the finding that the translocation of CD11b (which co-localises with cytochrome b) onto the cell surface is phospholipase D dependent.

Identification of a subgroup of myelodysplastic patients with a neutrophil stimulation-signalling defect.

f-Met-Leu-Phe-stimulated luminol-enhanced chemiluminescence was found to be repeatedly defective in some MDS patients. This defect was not attributed to myeloperoxidase deficiency, nor to a defect in NADPH oxidase function, because PMA chemiluminescence was found to be normal in these individuals. An arbitrary value of 7 mV (half the mean control value) was chosen to subdivide the group: MDS patients with values < 7 mV had a mean f-Met-Leu-Phe chemiluminescence response of 2.5 +/- 0.5 compared to MDS patients with values > 7 mV who had a mean response of 15.6 +/- 1.6 mV, P < 0.01 (healthy controls 14 +/- 2 mV). The characteristics of the f-Met-Leu-Phe receptor and initial calcium flux results suggested that the receptor itself was normal in number and function in low f-Met-Leu-Phe responders. The rate of superoxide generation, which is calcium-dependent, was also found to be in the normal range in low f-Met-Leu-Phe responders, although total superoxide production was reduced in some of these patients. When MDS neutrophils with a low f-Met-Leu-Phe response were stimulated with PMA, chemiluminescence was normal, suggesting normal activity of the NADPH-oxidase complex. Furthermore, myeloperoxidase activity was reduced in only three out of the 11 low f-Met-Leu-Phe responders. Following priming with GM-CSF, f-Met-Leu-Phe chemiluminescence was 27 +/- 1.6 mV in low f-Met-Leu-Phe responders compared to controls (87.7 +/- 11 mV, P < 0.005). Thus, although responses were improved, they were not as marked as in control neutrophils. These data suggest that a subgroup of MDS patients have a low f-Met-Leu-Phe chemiluminescence response which is not due to a defect in the f-Met-Leu-Phe receptor or oxidase activity, and in the majority of cases MPO activity is normal. Initial patient survival data suggest that these patients may have an increased risk of infective mortality. It is proposed that defective f-Met-Leu-Phe chemiluminescence results from a putative defect in cell-signalling mechanism upstream of PKC, and GM-CSF priming only partially improves responsiveness.

The effects of GM-CSF on myeloperoxidase release in normal and myelodysplastic neutrophils.

When purified control neutrophils were primed with GM-CSF, a significant increase in FMLP-induced MPO release was observed (mean +/- S.E.M., 3.4 +/- 0.8 mU/10(7) unprimed cells compared to 6.5 +/- 1.1 mU/10(7) primed cells, p < 0.001). This MPO release was greatly augmented by Cytochalasin B (Cy B), but after the addition of Cy B the priming effects of GM-CSF became less obvious. Exposure to GM-CSF without FMLP did not enhance MPO release. Within whole blood, FMLP produced negligible MPO release, but priming with GM-CSF prior to FMLP always resulted in a significant increase in MPO release. Myelodysplastic neutrophils released similar amounts of MPO in response to FMLP, compared with control cells (3.4 +/- 0.8 mU/10(7) control cells compared to 2.7 +/- 0.3 mU/10(7) MDS cells, p > 0.05). Priming with GM-CSF produced an increase in FMLP-stimulated MPO release comparable with control cells. In terms of total MPO content, although some MDS patients exhibited low levels, as a group there was no significant difference from controls (169 +/- 21 mU/10(7) control cells compared with 157 +/- 19 mU/10(7) MDS cells). These findings suggest that MPO activity is not a universal defect in MDS and cannot account for the defects in respiratory burst activity in these neutrophils.

Vascular rings: 10-year review of imaging.

Radiologic studies of 47 children with surgically proved vascular rings were retrospectively reviewed. On radiographs, a right-sided or bilateral aortic arch and the presence of tracheal narrowing were signs indicative of vascular rings. On barium esophagograms, a double or right aortic arch appeared as deep persistent posterior indentation of the esophagus. On computed tomographic (CT) scans and magnetic resonance (MR) images, the diagnosis of vascular rings was based on vascular branching patterns, the side of the aortic arch or presence of two arches, and narrowing of the airway. Although the diagnosis of a complete vascular ring can usually be established with certainty by means of radiography and esophagography, CT and MR imaging add valuable anatomic detail about exact arch configuration, tracheobronchial compression, and brachiocephalic vessel branching.

Gastric pneumatosis: sign of biliary stent-related perforation.

Gastric pneumatosis developed 4 months after a Carey-Coons biliary endoprosthesis was placed in an 85-year-old woman with pancreatic carcinoma. Radiographs revealed a change in the position of the stent. This combination of findings suggested that more than simple stent migration had occurred. At endoscopy, duodenal perforation was confirmed and the stent repositioned. Subsequently, the pneumatosis resolved.