Naloxone fails to reverse pain thresholds elevated by acupuncture: acupuncture analgesia reconsidered

We were unable to demonstrate the reversal of dental acupunctural analgesia following the injection of 0.4 mg naloxone using evoked potential methodology. Since our findings differed from those of Mayer, Price and Rafii who used pain threshold methods, we attempted to replicate their study. Subjects who demonstrated acupunctural analgesia during electrical stimulation of the LI-4 point on the hands received either 1.2 mg naloxone or normal saline under double blind conditions. Pain thresholds elevated by acupuncture failed to reverse when naloxone was given. Review of experimental design issues, other related human subjects research, and animal studies on acupunctural analgesia provided little convincing evidence that endorphins play a significant role in acupunctural analgesia. Because endorphins can be released in response to a stressor, endorphin presence sometimes correlates with acupunctural treatment in animal studies and some human studies, especially those involving pain patients. The primary analgesia elicited by acupunctural stimulation seems to involve other mechanisms.     

Mitral and aortic valve orifice area in normal subjects and in patients with congestive cardiomyopathy: Determination by two dimensional echocardiography

Previous determinations of normal valve orifice areas have been mainly from postmortem studies. In this study mitral and aortic valve orifice area were determined from two dimensional echocardiograms in 20 normal subjects and 20 patients with congestive cardiomyopathy. Mitral valve orifice area was larger than quoted in standard textbooks. Both mitral and aortic valve orifice area were reduced in patients with cardiomyopathy. Valve opening was assessed relative to left ventricular and aortic root size. The ratio of mitral valve orifice area to left ventricular cross-sectional area was markedly reduced in patients with cardiomyopathy compared with normal subjects. The ratio of aortic valve orifice area to aortic root size also was reduced in patients with cardiomyopathy.Anterior mitral leaflet E point-septal separation was similar to that in previous reports contrasting normal subjects with patients with myopathy. Among patients with cardiomyopathy, mitral E point-septal separation was primarily a function of left ventricular size and was not significantly correlated with fractional shortening or ejection fraction within this group having uniformly poor systolic function.     

Oral isotretinoin therapy for familial Muir-Torre syndrome

Two representative cases of familial Muir-Torre syndrome are presented. Multiple benign sebaceous neoplasms in both cases and a solitary keratoacanthoma in one were successfully treated with oral isotretinoin. Low-dose maintenance therapy has stabilized the cutaneous manifestations in the two patients, and no new epithelial neoplasms have appeared. This report emphasizes (1) the rationale for the use of isotretinoin in the Muir-Torre syndrome and (2) the potential for a familial pattern of inheritance and a possible association with the cancer family syndrome. It speculates on the prevention of future internal malignancies in Muir-Torre syndrome patients by maintenance oral isotretinoin treatment.     

Factors influencing the increase in glomerular filtration rate in the remaining kidney of transplant donors

Measurement of glomerular filtration rate (GFR) in 49 kidney donors on 259 occasions before and at varying periods after nephrectomy revealed that the predominant increase in GFR after nephrectomy occurs within three weeks. This initial percentage increment was not influenced by age, sex or GFR before nephrectomy. However, multiple-linear regression analysis of data derived from subsequent studies, performed up to four years after nephrectomy, indicates that there is a modest secondary increase which occurs subsequently and is inversely related to age, with time after nephrectomy and the GFR before nephrectomy also comprising significant variables. Analysis of concomitant creatinine and urea clearance data reveals that these parameters bear an inconstant relationship to true GFR, although they follow the same general trend.     

Effects of apolipoprotein C-II (apoC-II) on the lipolysis of very low density lipoproteins from apoC-II deficient patients

Lipoprotein lipase requires apolipoprotein C-II (apoC-II) from plasma very low density lipoproteins (VLDL) and high density lipoproteins (HDL) for maximal activity. To understand the mechanism by which apoC-II enhances the activity of the enzyme, the kinetic parameters for the hydrolysis of VLDL-triglycerides and phospholipids by purified bovine milk lipoprotein lipase have been determined in two patients with apoC-II deficiency. The absence of apoC-II in these patients was demonstrated by a specific radioimmunoassay for apoC-II (<0.05 mg apoC-II/dl plasma; normals ?5.0 mg/dl) and by isoelectric focusing of the isolated apoVLDL. The plasma levels of apoC-III, another apoprotein of VLDL, in the two subjects were 18.8 and 22.0 mg/dl (normals 11.1 ± 0.9 mg/dl). The kinetics of lipolysis of VLDL in either the presence or absence of apoC-II were monitored by using the patients' VLDL which were labeled in vitro with tri[1-¹⁴C]oleoyl glycerol and dansyl phosphatidylethanolamine (DPE). The release of [¹⁴C]oleic acid and the rate and extent of the DPE fluorescence increase were dependent on lipoprotein lipase and apoC-II concentration. Maximal hydrolysis of VLDL-triglycerides by lipoprotein lipase occurred at 2.5 μg apoC-II/mg triglyceride. The value of the Michaelis-Menten constant (K_m) of lipoprotein lipase for apoC-II deficient VLDL-triglycerides decreased from 7.8 mM in the absence of apoC-II to 1.0 mM at 2.5 μg of apoC-II; there was only a slight change in V_max. When normal HDL were used as the source of apoC-II, the rate of lipolysis of apoC-II deficient VLDL also increased and the value of K_m decreased to 1.0 mM. These results suggest that the effects of apoC-II on the rate of lipolysis of VLDL result from an apoC-II induced decrease in the apparent K_m of the enzyme for the substrate. One possible explanation for this decrease in K_m is that apoC-II enhances the interaction between lipoprotein lipase and triglyceride within the surface monolayer of the lipoprotein particle.     

Echocardiography: Pericardial thickening and constrictive pericarditis

A total of 167 patients with pericardial thickening noted on M mode echocardiography were studied retrospectively. After the echocardiogram, 72 patients underwent cardiac surgery, cardiac catheterization or autopsy for various heart diseases; 96 patients had none of these procedures. In 49 patients the pericardium was directly visualized at surgery or autopsy; 76 percent of these had pericardial thickening or adhesions. In another 8 percent, pericardial adhesions were absent, but no comment had been made about the appearance of the pericardium itself. In the remaining 16 percent, no comment had been made about the pericardium or pericardial space. Cardiac catheterization in 64 patients revealed 24 with hemodynamic findings of constrictive pericarditis or effusive constrictive disease.Seven echocardiographic patterns consistent with pericardial adhesions or pericardial thickening are described and related when possible to the subsequent findings at heart surgery or autopsy. The clinical diagnoses of 167 patients with pericardial thickening are presented. The hemodynamic diagnosis of constrictive pericardial disease was associated with the echocardiographic finding of pericardial thickening, but there were no consistent echocardiographic patterns of pericardial thickening diagnostic of constriction. However, certain other echocardiographic abnormalities of left ventricular posterior wall motion and interventricular septal motion and a high E-F_o slope were suggestive of constriction.     

Disseminated paracoccidioidomycosis (South American blastomycosis) in the United States

Paracoccidioidomycosis or South American blastomycosis (SAB) is a systemic mycosis endemic to South America but rarely recognized in North America. Visceral dissemination has not been described in the eight cases previously reported from the United States. The patient we describe represents the first case of visceral disseminated SAB, with testicular, adrenal and probable hepatic involvement, diagnosed in the United States. The pathogenesis, clinicopathologic manifestations and therapy of SAB, with particular attention to disseminated paracoccidioidomycosis with adrenal insufficiency, is reviewed.     

Hemophilus influenzae pneumonia in adults.

Hemophilus influenzae pneumonia was diagnosed in 41 adult patients based on cultures of blood, pleural fluid or transtracheal aspirate. Bacteremia occurred in all age groups, but was most frequent in patients over the age of 50 years with severe underlying pulmonary disease. Chest films usually demonstrated multisegmental or multilobar infiltrates without evidence of cavitation. Pleural involvement was evident in half of the patients, although empyema occurred infrequently. Mortality was almost always associated with serious underlying diseases and bacteremia. Encapsulated strains of H. influenzae (usually type B) were identified in 18 of 22 (82 per cent) patients. The use of transtracheal aspirations and the adoption of routine subculturing of blood cultures on chocolate agar appear to be important factors in our increased recognition of this disease.