Biomedical subjects
Publications and source records attributed to S Gray.
Intracranial vascular anomalies uncommonly present as a nasal mass. We report the first documented intranasal extension of a venous angioma of the anterior and middle cranial fossas. The diagnostic evaluation and differential diagnosis of an intranasal vascular mass is emphasized. In addition, recommendations are offered regarding the surgical approach of such a lesion.
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Oxygen consumption was measured before and during infusion of the catecholamine isoproterenol in age-matched spontaneously hypertensive (SHR) and Wistar-Kyoto (WKY) normotensive rats. Mass-independent rates of oxygen consumption of anesthetized 7-week-old rats were similar in the WKY and SHR rats (11.08 +/- 0.74 and 11.33 +/- 0.82 ml O2 min-1 kg-.67, respectively). Catecholamine infusion elicited increased total oxygen consumption in both WKY and SHR animals (15.0 +/- 1.0 and 14.9 +/- 1.2 ml O2 min-1 kg-.67, respectively), and the magnitude of these increases did not significantly differ. To assess whether there were changes in the metabolic state of brown adipose tissue, the major site of catecholamine-induced thermogenesis in rats, enzymes whose activity is proportional to aerobic capacity were assayed in vitro. In both the interscapular and cervical brown fat depots, maximal citrate synthase and maximal HOAD (beta-hydroxyacyl-CoA dehydrogenase) activities were similar in SHR and WKY rats. There were also no significant differences in brown fat protein content, suggesting no differential growth of this tissue in the two rat strains. Our results indicate that the nonshivering thermogenic capacity of the hypertensive SHR rats does not differ from that of the normotensive WKY animals.
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Plasma cortisol response to 1 mg dexamethasone suppression test was investigated in 37 patients with primary major depressive illness. Non-suppression of plasma cortisol was found in 14 of 37 (38%) patients. Duration of the index episode of illness was significantly shorter in the non-suppressors (11.1 +/- 9.1 weeks) than in the suppressors (29.7 +/- 25.6 weeks). The two groups were not distinguished by age, sex, polarity or severity of depressive symptoms. Eighty per cent of the non-suppressors (4/5) and 57% of the suppressors (8/14) had severe life events or major difficulties in the 6 months preceding the onset of illness, but this difference failed to reach statistical significance.
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Strapping with adhesive tape plays a significant part in the prevention of joint injuries, particularly at the ankle and hand, and is important during early management of injury and rehabilitation. Recurrence of injury when the athlete recommences training is less likely when supportive strapping is applied.
Forty-five chronic agoraphobics were randomly assigned to treatment by placebo or imipramine in doses up to 200 mg/day for 28 weeks. All patients also had systematic self-exposure homework with an instruction manual. In addition, half of each drug group had therapist-aided exposure and half had therapist-aided relaxation, each totalling three hours. Patients in both drug groups improved substantially and maintained their gains for one year of follow-up. Imipramine had no significant therapeutic effect despite satisfactory plasma levels and significant drug side effects. Patients' low initial Hamilton depression scores might explain the absence of any drug effect. Antidepressants may be ineffective for agoraphobics who have normal mood. Brief therapist-aided exposure improved phobias and panics to a significant but limited extent, and is a useful adjuvant to self-exposure homework, which can be a powerful therapeutic agency by itself.
Steady-state plasma concentrations of desipramine (DMI), unconjugated 2-OH DMI, and total 2-OH DMI were measured in 82 depressed inpatients, 35 of whom were concurrently receiving a phenothiazine or butyrophenone antipsychotic drug. In the patients not on an antipsychotic, the ratio of unconjugated metabolite to parent varied from 0.01 to 1.5, with a median of 0.48, and was inversely related to the parent drug level. Antipsychotic drug was associated with higher DMI levels and a lower proportion of OH-metabolite (median, 0.23). In both groups the unconjugated form accounted for only about 10% of the total metabolite. No relationship of age, sex, drinking history, or smoking to DMI or 2-OH DMI levels was found.
Test objects were the sera of 57 North American Indian and 67 Inuit subjects. The paraoxon-hydrolyzing activity, a, was determined, as well as the paraoxonase-phenotyping ratio, c/b, a ratio designating enzyme activation by Na+ in the presence of Ca2+. The values of c/b were clearly bimodally distributed. Location of the modes and of the antimodal gap were in perfect agreement with the results previously obtained on Caucasian sera. This allowed us to retain the criterion which had been already established in the study of Caucasians, i.e., c/b less than 1.5 = "low-activity" phenotype, and c/b greater than 1.5 = "high-activity" phenotype. The proportions of individuals in each mode differed, however. In Caucasians, the frequency of the "low-activity" phenotype had been estimated as 51.2%. In Indians and Inuits, it was 7.0% and 6.0%, respectively. Independent of phenotype, Indian and Inuit sera displayed lower paraoxon-hydrolyzing activity than did Caucasian sera.
Patients with hepatic cirrhosis often have demonstrable glucose intolerance. We studied 21 patients with cirrhosis of the liver. Oral glucose tolerance tests (OGTT), intravenous arginine stimulation tests (IVAST), and intravenous insulin tolerance tests (IVITT) were performed, and timed blood samples were obtained for the assay of glucose immunoreactive insulin (IRI), C-peptide (C-P), and immunoreactive glucagon (IRG). The 125I-insulin binding to circulating monocytes was studied in some of the patients. All results were compared to those of similar studies performed on healthy controls. During OGTT significant glucose intolerance was demonstrable in the patients with cirrhosis (2 hr plasma glucose 198.8 +/- 14.3 mg/dl in cirrhosis and 116.4 +/- 4.2 in controls; p less than 0.001). Two-hour plasma IRI, C-P, and IRG were significantly higher in the cirrhotic patients than in controls (p less than 0.001; less than 0.001; less than 0.025). In response to IVAST, the patients with cirrhosis showed a greater first-phase insulin secretion and controls had a slightly better second-phase insulin release. Plasma IRG rose from a basal value of 446 pg/ml to 1100 in the patients with cirrhosis and from 171 pg/ml to 494 in controls. After intravenous insulin administration, there was only a 40% decline in plasma glucose concentration from basal values in the patients with cirrhosis whereas the controls showed a 60% decline, demonstrating that the patients with cirrhosis had significant insulin resistance. Moreover, the half-life of insulin was prolonged in the patients with cirrhosis (t 1/2 = 15.5 min in cirrhosis and 10.3 in controls; p less than 0.001); and the ratio of C-P to insulin during OGTT was also reduced, indicating that the patients with cirrhosis have reduced hepatic clearance of insulin. The specific binding of 125I-insulin to circulating monocytes was 2.7% in cirrhosis, 2% in obese controls, and 4% in lean controls. There was a significant negative correlation between the fasting plasma insulin values and the specific binding of insulin. In conclusion, patients with hepatic cirrhosis have significant glucose intolerance characterized by hyperinsulinemia, hyperglucagonemia, insulin resistance, and down-regulation of insulin receptors. Although hyperinsulinemia is probably caused by reduced hepatic clearance of insulin, hyperglucagonemia is primarily due to increased pancreatic secretion.
Plasma concentrations of the geometric isomers of 10-OH amitriptyline (10-OH AT) and 10-OH nortriptyline (10-OH-NT) were determined by reversed-phase high-pressure liquid chromatography. Steady-state concentrations of At, NT, and the four 10-OH metabolites were measured in 27 patients taking AT for depression. All of the unconjugated hydroxylated metabolites were usually detectable and trans-10-OH NT always predominated. Mean concentrations, expressed as percentage of the sum of all six compounds, were: AT 30%, NT 27%, cis-10-OH AT 1.1%, trans-10-OH AT 4.0%, cis-10-OH NT 4.0%, and trans-10-OH NT 33%. Repeated measurements on 10 patients over several weeks indicated that interindividual variations in absolute and relative 10-OH metabolite concentrations are much greater than day-to-day variations. Five patients who also received a phenothiazine had a lower proportion of 10-OH metabolites.
In a replication study three performance variables measured at the beginning of 200 patients' rehabilitation courses were combined to form an index to quantify the degree of initial disability. The Index score was significantly associated with the ten-year outcome, and hence has predictive value. With it a level of disability can be specified beyond which a patients' prospect of resettlement is predictably hopeless from the outset, despite prolonged and intensive rehabilitative efforts. On the other hand, many less disabled patients cannot achieve resettlement unless such efforts are made. There are, therefore, humanitarian and economic reasons for seeking to distinguish these two groups.
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