Levosimendan for post-partum cardiomyopathy.

OBJECTIVE: To describe the use of levosimendan, a novel inotropic agent, for the treatment of post-partum cardiomyopathy (PPCMO). METHODS: The authors present the second recorded use of levosimendan for a woman with PPCMO. RESULTS: Levosimendan improved cardiac performance which was associated with symptomatic relief and echocardiographic improvement in ventricular function. The patient recovered from this episode of acute cardiac failure and continues to show steady improvement in cardiac function. CONCLUSIONS: Levosimendan proved a useful agent when used as initial therapy in this case of PPCMO.

The effects of 3,4,3'-triiodo-l-thyronine on didehydroretinol synthesis by isolated coho salmon retinal pigment epithelial cells.

The effects of thyroid hormone on the production of vitamin A(2) retinoids from vitamin A(1) precursor were investigated in retinal pigmented epithelial (RPE) cells obtained from juvenile coho salmon. Specifically, changes in the production of both the storage and the free forms of radiolabeled 3,4-didehydroretinoids were measured after 24 and 48 h incubation with [11,12-(3)H]all-trans-retinol with (or in the absence of) exogenous 3,4,3'-triiodo-l-thyronine (T(3)). RPE cells incubated with radiolabeled all-trans-retinol showed double the production of radiolabeled 3,4-didehydroretinoids (both storage and free forms) after 48 h compared to 24 h incubation. The addition of T(3) had no significant effect on the production of didehydroretinyl esters (storage form) after 24 h incubation, but did have a significant effect after 48 h, with a ca. 50% reduction in the amount of labeled didehydroretinyl produced compared to the amount produced by the controls after 48 h. Essentially the same observation was made for the production of radiolabeled didehydroretinol (free form) where, after 48 h of incubation with T(3), there was a ca. 50% reduction in the amount of labeled didehydroretinol produced compared to the amount produced by the controls after 48 h. The reduction in both the storage and the free forms of didehydroretinoids indicates that T(3) probably had the effect of altering the activity of the "terminal ring dehydrogenase" enzyme which acts on the outer ring of retinoids. The scope of this experiment, however, does not indicate whether the production of didehydroretinoids is specific to the free or to the storage forms as retinoids within the RPE can shuttle between both forms. The results of this experiment do indicate that the in vitro observations of this experiment may be extended to in vivo and field observations. In vitro, T(3) by itself altered the production of didehydro-derivatives of retinoids. The changes in visual pigment complement seen in salmonids, which are due to changes in relative proportions of 11-cis-retinal and 11-cis-3,4-didehydroretinal in the photoreceptors, may also be the result of T(3) acting by itself on the RPE cells.

Physiological and endocrinological responses during prolonged exercise in hatchery-reared rainbow trout (Oncorhynchus mykiss).

Rainbow trout (Oncorhynchus mykiss) were subjected to vigorous exercise (1.5 body length s-1), low exercise (0.5 body length s-1) or still-water (0.0 body length s-1). Hematocrit, glucose, growth hormone (GH), cortisol and triiodo-L-thyronine (T3) were monitored at the start of exercise, after 24 h, and after 2, 4, 8, 16 and 32 days of continuous swimming. Morphological indices and food intake were also monitored. At the end of the experiment, trout subjected to low exercise had gained significantly (p < 0.05) more weight than both the control (still-water) and vigorously exercised fish. This low exercised group of fish also consumed more food than the 2 other groups. Hematocrit increased significantly in both exercised groups at the onset of swimming but returned to pre-exercise levels within 8 hrs. Plasma glucose appeared to be generally unaffected by exercise. Likewise, plasma concentrations of both GH and T3 were not influenced by exercise. Plasma cortisol levels increased in an exercise dependent fashion at the onset of swimming, but returned to pre-swimming levels within 24 h and there was no apparent effect of sustained swimming. The results suggest: (i) the onset of exercise elicits transient changes in plasma components, (ii) the observed weight gain in low exercising salmonids occur without increases in circulating levels of GH or T3.

Intimal hyperplasia within biliary Wallstents: failure of recanalisation by insertion of a second endoprosthesis.

We report two patients with benign biliary strictures in whom we attempted recanalisation of metallic biliary endoprostheses, occluded by intimal hyperplasia, by the insertion of further endoprostheses within the occluded stents. Initial technical success was achieved in deploying the stents and restoring patency with elimination of mural filling defects. However, we found the intimal hyperplasia to be restrained for less than 48 h. From our initial results it appears that biliary metallic stent occlusion by intimal hyperplasia is not effectively treated by insertion of a second endoprosthesis.

Evaluation of three lines of immunodeficient mice for the study of spontaneous metastatic tumors.

Various immunodeficient animals have been used as transplantation recipients for studying the growth of human tumors. We have been assessing the value of immunodeficiencies for the study of naturally arising tumors, using a model system of transgenic mice that spontaneously develop cancer of the pancreas as a result of elastase promoter-driven expression of the large tumor antigen gene of simian virus 40. We previously reported the establishment of transgenic mice that carried the SCID and/or beige mutations, eliminating B- and T-cell function and reducing lytic NK cell activity, respectively. In SCID beige animals, metastasis rates and target organs for metastases were similar to those observed in humans with pancreatic cancer. We describe here analysis of subsequent more highly inbred generations of these mice. The data show that inbreeding has almost negated the value of these immunodeficiencies for enhancing disease progression, and we observe high rates of metastasis even in immunocompetent animals. The data suggest that SCID and beige immunodeficiencies may not always have the same value for the modeling of spontaneous tumors as they do for the study of xenografts.

The use of rectosigmoid stents in the management of acute large bowel obstruction.

The management of the acutely obstructed colon is controversial. Initial decompression of the bowel is still favoured by many surgeons, but the resulting colostomy has significant morbidity and mortality. Instead, stenting of the obstruction would permit defunctioning of the bowel, without the need for surgery and stoma formation. In this study we present our experience of the use of stents in the initial management of six patients with acute and sub-acute large bowel obstruction.

The Bruce treadmill protocol: does walking or running during the fourth stage alter oxygen consumption values?

OBJECTIVE: To investigate heart rate (HR) and relative oxygen consumption (VO2) measures during two modes (walking or running stages four) of the Bruce treadmill protocol. PARTICIPANTS: Male volunteers (n = 27), ranging in age from 25 to 56 years (M = 39.1 +/- 10.7 yrs). EXPERIMENTAL DESIGN: S's performed to volitional fatigue on the two randomly assigned treadmill tests. MEASURES: HR and VO2 were taken each minute and at point of exhaustion. RESULTS: Dependent "t"-tests revealed a significantly (p < or = 0.05) difference between the protocols at 11 minutes (running = 46.7 +/- 3.9 > walking = 44.6 +/- 3.7 ml[kg.min-1]) and at 12 minutes (running = 49.3 +/- 4.1 > walking = 47.6 +/- 3.5 ml[kg.min-1]) on the VO2 values. A significant differences was noted on HR at 11 minutes (running = 158.1 +/- 13.5 > walking = 156.0 +/- 13.0 bpm) and at 12 minutes (running = 160.4 +/- 11.0 > walking = 157.8 +/- 11.4 bpm) between the protocols. The two-way ANOVA technique revealed no significant differences or interactions on VO2 or HR between younger (< 45 yrs) and older (> or = 45 yrs) subjects during either protocol. A one-way ANCOVA indicated no significant differences between taller and shorter subjects on VO2 during the fourth stage of the Bruce protocol. The correlations, between the two protocols, for HR were strong but were weaker and inconsistent for VO2. The repeated measures ANOVA indicated significant within subject variability between test administrations. CONCLUSIONS: When testing endurance trained males, modality, age and height are not factors in differences of VO2 values during the 4th stage of the Bruce treadmill test but learning effect could be.

Expression and regulation of the myc proto-oncogene in the pituitary gland of rainbow trout.

We have isolated two c-myc cDNA clones from a trout pituitary gland (PG). One of these clones (tmyc2) is expressed as a 1.9-2.0 kb transcript in the PG, brain and heart, but not in the liver and codes for a protein of 398 amino acids. The second clone (tmyc3) is expressed in the PG (1.6 kb), but not in brain, liver or heart and codes for a protein of 401 amino acids. The expression level of tmyc3 in the PG is 10-fold greater than that of tmyc2. This profile is markedly different from a previously isolated genomic c-myc clone (tmyc1) that is expressed primarily in the liver (2.4 kb) and codes for a larger protein consisting of 417 amino acids. In situ hybridization and Northern blot analysis showed that tmyc3 is expressed primarily in somatolactotrophs of the intermediate lobe (IL) of the PG. Tmyc2 is expressed at similar levels in both the IL and the pars distalis (PD). In vitro stimulation experiments show that releasing factors, known to control cells in the PD, failed to stimulate tmyc2 or tmyc3. However, dopamine and norepinephrine (two neurotransmitters known to control hormone release from the IL) increased tmyc3 expression two to five times. Two other neurotransmitters (GABA and serotonin) failed to stimulate tmyc3 expression. None of the neurotransmitters tested affected tmyc2 expression. These results suggest that tmyc3 is involved in regulating hypertrophy of somatolactotrophs and may have a role in stimulating production of somatolactin, the only hormone known to be synthesised by these cells.

Cloning and expression of the proteolipid protein DM20 cDNA from the brain of the rainbow trout, Oncorhynchus mykiss.

The myelin sheath in higher vertebrates consists predominantly of proteolipid protein (PLP) and its smaller isoform DM20. Mutations in the PLP gene produces several neurological disorders such as Pelizaeus-Merzbacher disease and the rumpshaker phenotype in mice. This paper describes the cloning and expression of DM20 from the brain of Rainbow trout. We have isolated a nearly full-length cDNA clone containing 1835 bp that codes for a protein of 258 amino acids. Trout DM20 shows extensive homology with DM20 from higher vertebrates and includes the four hydrophobic regions that are believed to span the myelin membrane. The DM20 transcript is expressed throughout the central nervous system of the trout but appears at its highest levels in the spinal cord and medulla oblongata. The transcript is expressed at very low levels on hatching day but increases 179-fold by the 5th week. Contrary to higher vertebrates, there is no switch to the PLP transcript in maturing trout. Moreover, the rsh mutation (186 Thr to Ile) that produces the rumpshaking neurological disorder in mice has no effect in trout.

Structural variation in the alleles of a short tandem repeat system at the human alpha fibrinogen locus.

This paper reports the sequences of 22 alleles identified at the HumFGA (human alpha fibrinogen) short tandem repeat locus in the British Caucasian and Afro-Caribbean populations. Alleles at the lower end of the observed size range were found to increase in size by 4-bp increments with the repeat unit following the pattern TC(TCTT)n. However, 5 alleles were identified that differed in size by 2 bp from the 4 bp increment as a result of the deletion of a TC dinucleotide, or the addition of a TT dinucleotide, immediately prior to the 1st repeat unit. Alleles at the upper end of the observed size range were found to have a more complex repeat unit structure and also exhibited duplication of both 5' and 3' flanking sequences. A nomenclature for the designation of HumFGA alleles is proposed on the basis of this sequence data.

Cloning and expression of a myc family member from the pituitary gland of the Rainbow trout, Oncorhynchus mykiss.

A myc gene cloned from a Rainbow trout pituitary gland cDNA library is described. This clone (Tmyc2) shows extensive homology to Rainbow trout C-myc, which is expressed in the liver. Tmyc2 does not appear in the liver but is expressed in the pituitary gland (1.9 kb transcript), brain (2.0 kb transcript) and, at very low levels, in the heart (2.0 kb transcript). Tmyc2 contains three highly modified areas within the coding sequence, one of which shows an extensive loss of acidic residues that is uncommon in C-myc family members and may be important in determining the function of Tmyc2 in the pituitary gland and brain.

Short-term femoral nerve complications following percutaneous transfemoral procedures.

PURPOSE: To determine the prevalence of transient femoral nerve anesthesia following transfemoral angiographic procedures. PATIENTS AND METHODS: Fifty-eight patients undergoing a variety of routine transfemoral procedures underwent a neurologic assessment within an hour of the procedure. RESULTS: Nine patients (16%) were found to have complete or partial deficits in the ipsilateral femoral nerve territory. All deficits were transient. CONCLUSIONS: Transient femoral nerve deficits are not uncommon following transfemoral procedures. With the advent of true outpatient vascular procedures (where the patient may walk away after only a 30-minutes recovery period following a transvenous intervention or after 60 minutes following arteriography), transient neurologic problems related to the infiltration of local anesthetic around the femoral artery assume real clinical importance.

PRESS-related statistics: regression tools for cross-validation and case diagnostics.

In the health science literature, a common approach of validating a regression equation is data-splitting, where a portion of the data fits the model (fitting sample) and the remainder (validation sample) estimates future performance. The R2 and SEE obtained by predicting the validation sample with the fitting sample equation is a proper estimate of future performance, tending to correct for the natural upward bias of the R2 and SEE obtained from fitting sample alone. Data-splitting has several disadvantages, however. These include: 1) difficulty, arbitrariness, and inconvenience of matching samples; 2) the need to report two sets of statistics to determine homogeneity; and 3) the lack of equation stability due to diluted sample size. The PRESS statistic and associated residuals do not require the data to be split, yield alternative unbiased estimates of R2 and SEE, and provide useful case diagnostics. This procedure is easy to use, is widely available in modern statistical packages, but is rarely utilized. The two methods are contrasted here using a simulation from original data for predicting body density from anthropometric measurements of a group of 117 women. The PRESS approach is particularly appropriate for smaller datasets; methods of reporting these statistics are recommended.

Generation of minisatellite variant repeat codes on an automated DNA sequencer using fluorescent dye-labeled primers.

We demonstrate the potential to generate unambiguous minisatellite variant repeat PCR profiles on an automated DNA sequencer using fluorescent dye-labeled primers. The products of a 24-cycle PCR amplification using 100 ng of template DNA were analyzed by conventional blot hybridization and also on an Applied Biosystems 373A DNA Sequencer. The results from the sequencer were clear to the 20th repeat when using a primer labeled with 6-FAM, whereas conventional analysis allowed codes to be defined to in excess of the 60th repeat. Use of a modified Tag primer sequence, which eliminates the potential for self-annealing, did not improve the clarity of the results under the PCR cycling conditions used.

Aortocaval fistulae presenting with renal failure: CT diagnosis.

We describe two patients who presented with acute renal failure secondary to aortocaval fistulae, which were demonstrated by computed tomography (CT) and confirmed at surgery. Renal function rapidly returned to normal following appropriate surgery. In addition to the expected CT findings of early equal enhancement of the inferior vena cava and aorta and dilation of the inferior vena cava, there was early enhancement of dilated renal veins despite poor contrast enhancement of the kidneys. It is postulated that retrograde flow of blood from the aortocaval fistula may cause renal impairment secondary to renal venous hypertension.