Platelet serotonin and interleukin-1β after sleep deprivation and recovery sleep in humans

Summary Sleep deprivation (SD) represents a well-established therapy for major depression. Recent findings suggest that the antidepressive effects of sleep deprivation are mediated at least in part by pro-serotoninergic mechanisms. Furthermore, SD has been demonstrated to modify different host defense activities. We therefore investigated the serotonin (5-HT) content in platelets, platelet density distribution and 5-HT-induced IL-1 release from platelets in 10 healthy men before and after total SD (TSD) as well as after recovery sleep. Blood samples were drawn on 3 consecutive days at 7.00 h, 13.00 h, and 19.00 h, respectively. In addition, the psychophysiological parameters tiredness and wakefulness were assessed.After TSD the normal daily variation of IL-1 release with high morning levels and low evening levels was found to be significantly inverted. The release of IL-1 corresponded positively to the subjectively experienced tiredness of the probands. Analysis of platelet density distribution indicated a significant daily variation of low density platelets with low levels in the morning and high levels in the evening, which was absent after TSD. Our findings favour an increased pro-serotoninergic effect after TSD, which comprises respective variations of the host defense system, but is abolished by consecutive recovery sleep.     

Effects of drugs combining H1 and H2 receptor antagonist activity on histamine release and life threatening anaphylactoid reactions in pigs

Summary Two recently synthetized drugs combining H1- and H2-receptor antagonist activity in a single molecule (alitidine, clophetidine) were compaired for their potency in preventing histamine release and lifethreatening anaphylactoid reactionin vivo with the usually tested H1/H2-blocker combination dimetindene/cimetidine. Saline premedication in a fourth group served as control. Anaesthetized and ventilated pigs were administered H1/H2-blockers or placebo and 500 ml of blood were removed. Subsequently, 500 ml saline solution containing 1 mg/kg compound 48/80 for initiating histamine release were rapidly reinfused (n=15 pigs per group). The system proved reliable in creating hypotension and histamine release in the placebo group. The extent of histamine release did not differ between the placebo, alitidine and dimetindene/cimetidine groups. However, clophetidine was shown to be effective in preventing increases in plasma histamine after compound 48/80. Tachycardia was almost completely prevented by dimetindene/cimetidine, was diminished by clophetidine, but was not affected by alitidine. Hypotension following 48/80 was best reversed by clophetidine. This investigation suggests that clophetidine is a most promising drug in preventing histamine release and its circulatory effects in a pig anaphylactoid shock model. It requires, however, further quantitative confirmation in experiments with a two-group design only, since the analysis of variance is less suitable for the extreme variation of the plasma-histamine values after administration of compound 48/80.     

Genetic variation in the vasopressin receptor 1a gene (AVPR1A) associates with pair-bonding behavior in humans

Pair-bonding has been suggested to be a critical factor in the evolutionary development of the social brain. The brain neuropeptide arginine vasopressin (AVP) exerts an important influence on pair-bonding behavior in voles. There is a strong association between a polymorphic repeat sequence in the 5′ flanking region of the gene (avpr1a) encoding one of the AVP receptor subtypes (V1aR), and proneness for monogamous behavior in males of this species. It is not yet known whether similar mechanisms are important also for human pair-bonding. Here, we report an association between one of the human AVPR1A repeat polymorphisms (RS3) and traits reflecting pair-bonding behavior in men, including partner bonding, perceived marital problems, and marital status, and show that the RS3 genotype of the males also affects marital quality as perceived by their spouses. These results suggest an association between a single gene and pair-bonding behavior in humans, and indicate that the well characterized influence of AVP on pair-bonding in voles may be of relevance also for humans.     

überprüfung eines diagnostischen Scoresystems (Ohmann-Score) für die akute Appendicitis

Ein von Ohmann et al. in dieser Zeitschrift vorgestellter diagnostischer Score für die akute Appendicitis wurde überprüft. Dazu wurden die klinikopathologischen Verlaufsdaten von 2359 Patienten mit dem Verdacht auf eine akute Appendicitis analysiert und die Ergebnisse des Scores mit denen der Beurteilung durch einen Erst- und Abschlu?untersucher verglichen. Die diagnostische F?higkeit des Scores wurde schlu?folgernd mit den Zielvariablen‚esamtgenauigkeit’ und‚ositiver Vorhersagewert’ mit dem χ ²-Test untersucht. Seine F?higkeit Einflu? auf die klinische Entscheidungsfindung zu nehmen, wurde in gleicher Weise anhand der Zielvariablen‚egative Laparotomierate’ und‚ate diagnostischer Fehler’ bewertet. Bei den 2359 mit dem Verdacht auf eine akute Appendicitis vorgestellten Patienten wurde in 662 F?llen histologisch eine akute Appendicitis nachgewiesen (Pr?valenz 28 %). Sensitivit?t, Spezifit?t, positiver und negativer Vorhersagewert sowie die Gesamtgenauigkeit betrugen für den Erstuntersucher 0,50; 0,94; 0,77; 0,83; 0,82, für den Score 0,63; 0,93; 0,77; 0,86 und 0,84 sowie 0,90; 0,94; 0,85; 0,96 und 0,93 für den Abschlu?untersucher. Bezüglich der Hauptvariablen der diagnostischen Eignung war einzig die Gesamtgenauigkeit des Scores im Vergleich zum Erstuntersucher signifikant besser (p < 0,05). Für den Score errechnete sich eine negative Appendektomierate von 14,3 %. Das beste Resultat erreichte der Score bei der Rate effektiv übersehener F?lle einer akuten Appendicitis: 0,9 %. Die Anzahl der potentiellen Perforationen sowie der stattgehabten Perforationen war nahezu vierfach h?her als die des Abschlu?untersuchers (245 vs. 63). Bezüglich der Hauptvariablen der prozeduralen Eignung zeigte sich für den Score erneut nur im Vergleich zum Erstuntersucher eine signifikant bessere Rate diagnostischer Fehler (p < 0,05). Die Ergebnisse dieser Untersuchung zeigen, da? dieser Diagnosescore sinnvoll eingesetzt werden k?nnte, insbesondere wenn erfahrene chirurgische Untersucher oder weiterführende diagnostische Modalit?ten wie z. B. der Ultraschall nicht verfügbar sind. Er kann deshalb m?glicherweise in der pr?station?ren Diagnostik bei Patienten mit Verdacht auf eine akute Appendicitis als Entscheidungshilfe eingesetzt werden. Dieser Score k?nnte auch bei der Qualit?tssicherung oder innerhalb klinischer Leitlinien Anwendung finden.     

Treatment of sleep apnoea with continuous positive airway pressure in children with craniofacial malformations.

We conducted sleep studies in a consecutive series of 21 children with craniofacial malformations and suspected obstructive sleep apnoea. Thirteen had sleep apnoea, and one patient with a tracheostomy could not be tested. Twelve children were admitted for initiation of treatment with nasal continuous positive airway pressure (nCPAP). Ten patients accepted nCPAP, two did not. Seven children use home treatment successfully. Obstructive sleep apnoea in most children is completely eliminated with nCPAP. The treatment is safe, effective, and leads to a reduction in the number of operations done for children with craniofacial malformations. Aesthetic operations can be delayed until facial growth is complete.     

Leukocyte infiltration and secretion of cytokines in pleural drainage fluid after thoracic surgery: impaired cytokine response in malignancy and postoperative complications.

STUDY OBJECTIVE: To assess the postoperative course of pleural leukocyte counts and cytokine concentrations in patients with malignant and nonmalignant lung disease who underwent thoracic surgery. PATIENTS AND INTERVENTIONS: A total of 21 patients undergoing thoracic surgery were included in the study. Twelve patients had a malignant disease, and 9 had a nonmalignant disease. Six patients underwent video-assisted thoracoscopy and 15 underwent thoracotomy. Pleural drainage fluid from the chest tubes was collected postoperatively at Oh, 3h, 6h, 12h, 24h, 48h, 72h, and 96 h. The same schedule, as well as one additional preoperative sample, was applied for blood collections. RESULTS: A trend toward lower concentrations of tumor necrosis factor-alpha (TNF-alpha), granulocytemacrophage colony-stimulating factor, and interleukin-10 was observed in patients with malignant disease compared to those without malignancy. These differences achieved significance for TNF-alpha in the drainage fluid of those patients with nonmalignant disease who had undergone formal thoracotomy. Patients with malignant disease showed significantly lower macrophage fractions in drainage fluid and lymphocyte fractions in serum. All patients with complications had malignant disease and showed the lowest cytokine concentrations, as well as the lowest fractions of both macrophages in drainage fluid and lymphocytes in serum. CONCLUSION: The data suggest that malignancy may lead to impairment of the wound-healing process via modification of the inflammatory cell infiltrate and locally released cytokines.     

Contractile patterns in patients with severe chronic dyspepsia

Objective: Antroduodenojejunal interdigestive and postprandial pressure recordings were analyzed in 41 consecutive patients referred for evaluation of severe chronic dyspepsia. In addition to traditional manometric evaluation we also focused on the propagation pattern of individual pressure waves in the proximal duodenum. Methods: Catheters with closely spaced side holes for temporospatial analysis of the computerized recordings were used. The dominating symptoms were unexplained nausea and vomiting (n = 18), chronic abdominal pain (n = 16), or both (n = 7). The patients’ mean age was 45 yr (31 women and 10 men). Gastric surgery had been performed on 11 patients. Results from 20 healthy volunteers served as a reference range. Results: Findings were suggestive of neuropathy in 16 (39%) and myopathy in 1 (2.4%) using conventional criteria. Another 19 patients of the 24 with normal condensed recordings showed abnormalities in the propagation pattern of individual pressure waves in phase II and/or during the fed state, when compared with the controls. Absence of phase III of the migrating motor complex was found in 12 patients during the 5-h fasting recording, compared with none in the controls (p < 0.01). Retroperistalsis at the end of phase III in the duodenum was present in at least one of the activity fronts in all patients having migrating motor complex except one, which was similar to the controls. During phase II, unpropagated bursts of phasic and tonic activity were more frequent in patients than in controls (mean 13.2% vs 3.7% of the time; p < 0.05), and a higher proportion of individual contractions was retrograde in patients than in controls (17.4% vs 5% of propagated contractions; p < 0.05). Patients had higher postprandial motility index in the distal duodenum than did controls (p < 0.05). Moreover, after feeding more individual contractions were retrograde in patients than in controls (33.1% vs 10% of propagated contractions; p < 0.01). Sequences of localized supratachyarrythmia, 25–35/min in the antrum and 50–60/min in the small bowel associated with symptoms, were observed in two patients. Conclusion: Manometry is important for demonstration of pathophysiology in patients with unexplained abdominal pain, nausea, and vomiting. Simultaneous analysis of the propagation of individual contractions of interdigestive and fed motility is superior to conventional manometry alone.