A necrotising fasciitis: case report.

Necrotizing fasciitis is one of the most common soft tissue infections, with a high risk of major amputation and a mortality ranging from 6 to 33% which has not changed in the past 20 years. Early surgical resection of necrotic tissue plays a key role in determining the prognosis. Nawijn et al. identified an optimal 6 hours window from presentation to surgery. Symptoms of necrotizing fasciitis mimic those of common skin infections, such as erysipelas and cellulitis, making rapid surgical management difficult. In this context, the aid of point-of-care-ultrasound is a valuable tool for early diagnosis, detecting the presence of subcutaneous thickening, gas and perifascial liquid. Other characteristic ultrasound findings include the "cobblestone" appearance of the subcutaneous soft tissues and reverberation artifacts due to hyperechoic outbreaks, defined as "snow globes" due to the presence of heterogeneous swirling material, and "dirty shadowing" due to the foggy shadow created by the gas.

Neuronal isoform of nitric oxide synthase is expressed at low levels in human retina.

1. The expression of neuronal isoform of nitric oxide synthase (nNOS) was studied in human retinal tissues. The cDNA sequence was cloned in human retinal poly (A)+ RNA by the RT-PCR method and encompassed an open-reading frame of 4,302 bp encoding 1,434 amino acids. This sequence showed a possibility of genetic polymorphism in comparison to human brain form. 2. Restriction fragment length polymorphism (RFLP) patterns of a partial cDNA fragment suggest that there is genetic polymorphism in the neuronal form of NOS. Important differences were observed in a certain region between human retinal and brain froms. This region is a result of frame shift by the addition of three cytidines. In this study, regions from human brain (cerebellum) and skeletal muscle as well as retina were sequenced to confirm the difference in this region. The sequences from these tissues were completely identical. This indicated that genetic polymorphism of nNOS gene was due to single base substitution and not frame shift phenomenon by addition or deletion of bases. 3. The nNOS mRNA of approximately 12 kb was detected by northern blot analysis. The lower level of the expression was distinguished in comparison to those of human brain and skeletal muscle. The cDNA transiently transfected into CHO-K1 cells expressed a protein which contained a significant level of NOS activity. The size of the nNOS was found to be approximately 160 kDa by both in vitro and in vivo translation systems. This NOS was calcium dependent and the K(m) for arginine was 4.4 microM. 4. The Ca+2, L-arginine and NADPH dependency along with the inhibitory effect of N-nitro-L-arginine on NOS activity were evaluated. The finding of a constitutive from of NOS in human retina, which is calcium-NADPH dependent, gives further credence to the possible role of nitric oxide in retinal function and neuronal diseases.

Human retina expresses both constitutive and inducible isoforms of nitric oxide synthase mRNA.

The present study provided evidence for the presence of two forms of nitric oxide synthase(NOS) gene in the human retina. Expression of retinal constitutive type(rbNOS) and inducible type(riNOS) of NOS was detected in human retinal poly A+RNA by reverse transcriptase polymerase chain reaction (RT-PCR) method. The deduced amino acid sequence of the human retinal rbNOS showed more than 99% homology with human brain bNOS and that of riNOS was identical to the chondrocytes inducible iNOS with the exception for one amino acid. These differences in amino acid sequences of rbNOS and riNOS, with their counterparts in human brain and human chondrocytes sequences, were only in the non-cofactor binding sites. Northern blot analysis of the human retinal poly A+RNA and total RNA, using the PCR-amplified riNOS probe revealed the existence of riNOS message with the appearance of the band with the expected size of 4.4kb, while the message for rbNOS was not detectable. This was the first report of the deduced nucleotide sequence identification of two NOS genes from a human tissue, while there had been earlier reports from culture cells.

B-50/GAP-43 phosphorylation in hippocampal slices from aged rats: effects of phosphatidylserine administration.

Phosphorylation of the presynaptic protein B-50/GAP-43, a substrate of protein kinase C (PKC), has been implicated in neuronal mechanisms related to learning and memory. We evaluated both basal (5 mM KCl) and stimulated (30 mM KCl) B-50/GAP-43 phosphorylation in 32P-prelabeled hippocampal slices obtained from adult and senescent male Sprague-Dawley rats. The in situ B-50/GAP-43 phosphorylation was assayed by quantitative immunoprecipitation. There was no age-related difference in B-50/GAP-43 basal phosphorylation. However, B-50/GAP-43 phosphorylation in depolarized slices from aged rats was significantly decreased relative to that of adult animals. Aged rats were treated with either tris buffer or sonicated suspension of phosphatidylserine (PS) in tris buffer (15 mg/kg IP for 7 and 17 days). PS did not affect basal and high K(+)-induced B-50/GAP-43 phosphorylation in the 7-day treatment. However, after 17 days, PS restored the K(+)-induced B-50/GAP-43 phosphorylation. It is proposed that repeated PS administrations might be beneficial to the age-induced deterioration of endogenous B-50/GAP-43 phosphorylation by acting on Ca++ homeostatic mechanisms and/or PKC.

Phosphorylation of the presynaptic protein B-50 (GAP-43) is increased during electrically induced long-term potentiation.

The protein B-50 (F1, GAP-43) is a presynaptic-specific substrate of protein kinase C, functionally related to neurotransmitter release. An increase in phosphorylation of this protein has been proposed as a molecular mechanism underlying long-term potentiation (LTP). B-50 phosphorylation measured by quantitative immunoprecipitation in rat hippocampal slices incubated in the presence of radiolabeled inorganic phosphate was increased for at least 1 hr after the induction of LTP in the CA1 region. No significant changes in B-50 phosphorylation were observed in untetanized slices stimulated at low frequency. The direct demonstration of an increased phosphorylation of the protein B-50 during LTP is consistent with the hypothesis that presynaptic mechanisms contribute to maintenance of LTP.

4-Aminopyridine stimulates B-50 (GAP43) phosphorylation and [3H]noradrenaline release in rat hippocampal slices.

In situ phosphorylation of the presynaptic protein kinase C substrate B-50 was investigated in rat hippocampal slices incubated with the convulsant drug 4-aminopyridine (4-AP). Phosphorylation of B-50 was significantly enhanced 1 min after the addition of 4-AP (100 microM). This increase by 4-AP was concentration dependent (estimated EC50 30-50 microM). Concomitant with the changes in B-50 phosphorylation, 4-AP also dose-dependently stimulated [3H]noradrenaline [( 3H]NA) release from the slices. 4-AP stimulated [3H]NA release within 5 min to seven times the control level. The B-50 phosphorylation induced by 4-AP remained elevated after removal of the convulsant, this is contrast to B-50 phosphorylation induced by depolarization with K+. A similar persistent increase was observed for [3H]NA release after a 5-min incubation period with 4-AP. These results give more insight into the molecular mechanisms underlying 4-AP-induced epileptogenesis and provide further evidence for the correlation between B-50 phosphorylation and neurotransmitter release in the hippocampal slice.

Verapamil-induced changes in digoxin kinetics in cirrhosis.

The influence of a single low dose of verapamil (80 mg) on the serum levels of digoxin (single dose of 0.5 mg) was studied in 6 patients with hepatic cirrhosis and in 6 healthy volunteer controls. In the cirrhotic patients verapamil increased the peak serum level and the total AUC of digoxin by 98% and 32%, respectively. There was an associated 23% decrease in the renal digoxin clearance. In normal subjects only marginal alterations in digoxin kinetics were observed following verapamil administration. The results indicate that cirrhosis magnifies the influence of verapamil on digoxin kinetics.