IgG from patients with Lambert-Eaton syndrome blocks voltage-dependent calcium channels.

Lambert-Eaton syndrome, an autoimmune disorder frequently associated with small-cell carcinoma of the lung, is characterized by impaired evoked release of acetylcholine from the motor nerve terminal. Immunoglobulin G (IgG) antibodies from patients with the syndrome, applied to bovine adrenal chromaffin cells, reduced the voltage-dependent calcium channel currents by about 40 percent. When calcium was administered directly into the cytoplasm, however, the IgG-treated cells exhibited normal exocytotic secretion, as assayed by membrane capacitance measurement. Measurement with the fluorescent calcium indicator fura-2 indicated that the IgG treatment reduced potassium-stimulated increase in free intracellular calcium concentration. The pathogenic IgG modified neither kinetics of calcium channel activation nor elementary channel activity, suggesting that a reduction in the number of functional calcium channels underlies the IgG-induced effect. Therefore, Lambert-Eaton syndrome IgG reacts with voltage-dependent calcium channels and blocks their function, a phenomenon that can account for the presynaptic impairment characteristic of this disorder.

Transplantation of human chromaffin cells for control of intractable cancer pain.

Adrenal medullary chromaffin cells produce high levels of endogenous opioid peptides. Recent data suggest that transplantation injected locally into the spinal subarachnoid space reduced intractable malignant pain. In order to determine the feasibility, the efficacy and the risks of using adrenal medullary tissue for control of irreducible pain, we have developed a transplantation protocol on cancer pain patients selected when they required chronic intrathecal injection of morphine and progressively increasing doses to maintain the level of analgesic effects. At the present time, our clinical trial involves 8 patients. We report here our initial results (mean follow-up: 5 months). The various data collected before and after the intrathecal administration of chromaffin cells included: 1) Pain evaluation over time, with concomitant narcotic intake, 2) CSF sampling through an implanted access port to determine the following biological parameters: biochemical assay for opioid peptides, cell count and phenotyping of lymphocytes, 3) peripheral blood samples for lymphocyte typing. The results confirm the efficacy of adrenal medullary transplantation into spinal CSF for controlling irreducible cancer pain. Complementary intrathecal and oral morphine were totally stopped in 2 cases and stabilized in 5 others. It seems essential to have an important volume of grafted tissue to achieve analgesia with high levels of metenkephalin in CSF. A progressive decrease in metenkephalin release was observed from 2 to 4 months after the transplantation. Two patients with a long-term follow-up (8 and 12 months) needed another intrathecal chromaffin cell graft.

[Clinico-neurohumoral interrelationships in neuroses]. / Kliniko-neirogumoral'nye vzaimootnosheniia pri nevrozakh.

The paper is related to studies of the sympathico-adrenal activity, hypophysisadrenal and entero-chromaphine systems in patients with hysterical and phobic neuroses. They detected certain regularities in the initial activities of these systems as well as of their reactivity depending upon the character of the functional symptom, psychological personality traits and cerebral dysfunctions.

Physiological disturbances in hypoglycaemia: effect on subjective awareness.

Deficiencies in the release of glucagon and adrenaline during hypoglycaemia in diabetic patients are associated with a high frequency of severe hypoglycaemic episodes. These have been attributed to a resulting inability to increase hepatic glucose output acutely. A more important consequence may be reduced awareness of impending hypoglycaemia. Such hypoglycaemia unawareness is related to, but not entirely explained by, diminished sympathetic activity, perhaps due to failure to activate the sympathoadrenal system until a lower blood glucose level is achieved. The patient's subsequent failure to act appropriately would then be due to impaired cerebral function preventing the perception of sympathoadrenal activation during the more severe hypoglycaemia. Unawareness of moderate hypoglycaemia is common in diabetic patients. Autonomic neuropathy probably accounts for only a few cases of hypoglycaemia unawareness and other factors which are potentially important include duration of diabetes, glycaemic control, insulin species, and the degree and frequency of hypoglycaemia. Further research is required to discover both the pathophysiological mechanisms of, and the treatment needed to reverse or prevent, the abnormality.

[Echotomographic and angiographic finding in pheochromocytoma of the organs of Zuckerkandl (author's transl)]. / Aspetti ecotomografici ed angiografici del feocromocitoma dell' organo di Zuckerkandl.

The Authors, as they present two rare cases of pheochromocytoma of Zuckerkandl's organ, prove how patient's history physical examination and laboratory findings can at the most address towards a presumptive diagnosis of pheochromocytoma; they also prove that for a sure diagnosis is necessary first echotomography and after arteriography.

[Morphological evidence of celiac ganglion hyperfunction in spontaneous hypertension in rats]. / Morfologicheskie dokazatel'stva giperfunktsii chrevnogo gangliia pri spontannoi gipertenzii u krys.

To elucidate the role of the autonomous nervous system in formation of a specific renal "resetting", typical for arterial hypertension, in 8-week-old spontaneously hypertensive rats, a study was made of the morphology of the celiac ganglion as one of the main sources of renal innervation. Light and fluorescent microscopy demonstrate the hypertrophy of the neurons and their nuclei, an increase in the whole ganglion volume and the volume density of the SIF cells. This evidence for hyperactivity of the celiac ganglion attests to the involvement of the renal nervous system in the structural and functional reorganization ("resetting") at the early stages of hypertension as well as a manifestation of hyperactivity of the nervous system in this disease.