The retention of [99mTc]-d,l-HM-PAO in the human brain after intracarotid bolus injection: a kinetic analysis

[99mTc]-d,l-HM-PAO (HM-PAO) was injected rapidly into the internal carotid artery and its retention in the brain was recorded by external scintillation cameras in eight human subjects. A model is described based on three compartments: the lipophilic tracer in the blood pool of the brain, the lipophilic tracer inside the brain, and the hydrophilic form retained in the brain. The retention curve initially drops abruptly, corresponding to the nonextracted fraction of the injectate leaving the brain; it then falls exponentially towards the asymptotic level of the fractional steady-state retention R. Cerebral blood flow (F) was measured using the xenon-133 intracarotid injection method. The first-pass extraction E of HM-PAO was calculated from F using an empiric regression equation. The residue curves for the whole brain after intracarotid HM-PAO injection were analyzed to yield a retention fraction (R') and the brain clearance backflux constant of lipophilic HM-PAO (k). From the kinetic model and the measured values of R', k, and F, the following parameter values could be calculated: the average retained fraction of all tracer supplied to the brain, R = 0.38 +/- 0.05 (mean +/- SD), the conversion rate constant (lipophilic to hydrophilic tracer) in the brain k3 = 0.80 +/- 0.12 min-1, the efflux rate constant (brain to blood) k2 = 0.69 +/- 0.11 min-1, the conversion/clearance ratio alpha = k3/k2 = 1.18 +/- 0.25, the influx (blood clearance) constant K1 = 0.45 +/- 0.11 ml/g/min, and the brain/blood partition ratio lambda = K1/k2 = 0.67 +/- 0.23 ml/g. Using the kinetic model and assuming constancy of alpha, an algorithm was developed that corrects for the blood flow dependent backflux of HM-PAO and results in a more linear relation between regional cerebral blood flow (rCBF) and HM-PAO distribution.     

Endocrinology: Predictive value of serum oestradiol concentrations and oocyte number in severe ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is a serious complicationof gonadotrophin usage but it is difficult to accurately predictits occurrence. Previous investigators have identified the combinationof high oestradiol concentrations and oocyte number as beingpredictive in 80% of cases. In this study we sought to identifythe incidence of severe OHSS in patients with high oestradiolconcentrations and large numbers of oocytes and to evaluatethe importance of pregnancy in the development of OHSS. Between1990 and 1993, we studied 139 cycles using two assisted reproductivetechniques [oocyte donor, n =72; in-vitro fertilization (IVF),n = 67] in which either oestradiol (>4000 pg/ml), oocytenumber (>25), or both were elevated. OHSS was diagnosed bystandard criteria. There were no cases of severe OHSS in theoocyte donor group and six in the IVF group. Among 10 patientswith oestradiol concentration >6000 pg/ml and >30 oocytes,only one had OHSS (10%). The relative risk of OHSS with pregnancywas 12 (confidence interval 2.18–66.14). We conclude thatthe risk of OHSS even at high levels of stimulation is lowerthan previously believed. Secondly, donors have a very low riskof OHSS, probably because of the absence of pregnancy. As such,cryopreservation of all oocytes in IVF cycles is a reasonablealternative to cycle cancellation or use of adjunctive medication.     

Peritonsillar abscess — Do we need anaerobic cover?

Objective To find out the usability and advantage with regard to the advent of new and more costly antibiotics. In the treatment of Peritonsillar abscess the demonstration of, both aerobic and anaerobic organisms has raised the question of possible need to treat with antibiotics effective against anaerobes. It was in this very context that this study was planned to find out if we still have an economically and easily available antibiotic to treat Peritonsillar abscess. Conclusions Injectable penicillin is the drug of choice in PTA as GABHS and staphylococcus aureus coagulase positive are the most common organism associated with this condition. Even where penicillin resistant organism is present, effective management of the abscess is possible if it is drained well and weak hydrogen peroxide gargles are used along with injectable penicillin.     

Radical prostatectomy: anatomical predictors of success or failure

A total of 143 patients underwent radical prostatectomy. Surgical specimens were evaluated with respect to local extent of disease, Gleason grade of the primary and relative nuclear roundness of the surgical specimen. The probability of disease control in the total population was 88 per cent at 5 years. Only 8 per cent of the patients who had disease confined to the specimen failed compared to 14 per cent of those who demonstrated extension outside of the surgical margins. The incidence of failure increased as a function of seminal vesicle involvement. Seminal vesicle involvement was greatest among patients with a Gleason grade greater than 7. Postoperative radiation did not offer any apparent advantage in patients with positive margins.     

State of the art of alexithymia measurement

The purpose of this study using hypertensive patients was to examine the validity and reliability of the current measures of alexithymia. Instruments investigated were the MMPI Alexithymia Scale developed in Denver, the Schalling-Sifneos Scale developed in Boston, and the Beth Israel Hospital Questionnaire (BIQ). Based on the sample of 53 outpatient subjects, no additional estimates of validity were gained to recommend the use of the MMPI Alexithymia Scale or the Schalling-Sifneos Scale as acceptable research instruments at this time. Inter-rater reliability of the BIQ was strong and supports its continued use. Recommendations for further standardization in alexithymia research are discussed.     

Polyorna virus adsorbs to specific sialyloligosaccharide receptors on erythrocytes

Hemagglutination by polyoma virus has been shown to require sialic acid residues on cell surface oligosaccharides. This report presents evidence which suggests that adsorbtion of polyoma virus to erythrocytes is not due simply to a nonspecific electrostatic interaction with negatively charged sialic acids but rather requires the presence of specific sialyloligosaccharide structures. Newcastle disease virus (NDV) neuraminidase hydrolyzes sialic acids in the sequences NeuAcα2,3Gal and NeuAcα2,8NeuAc. Erythrocytes treated with NDV lost 40% of their surface sialic acid, retained full hemagglutination by certain influenza viruses which also bind sialyloligosaccharides, and yet were not agglutinated by polyoma virus. Erythrocytes treated with Vibrio cholerae neuraminidase, which removes virtually all sialic acid, were no longer agglutinated by influenza virus or polyoma virus. Selective replacement of sialic acid on V. cholerae neuraminidase-treated cells with purified β-galactoside α-2,3-sialytransferase in the sequence NeuAcα2, 3Gal completely restored hemagglutination by polyoma virus. In contrast, replacement of sialic acid by other sialyitransferases in the sequences NeuAcα2,6Gal or NeuAcα2,6GalNAc does not restore hemagglutination by polyoma virus.