Neuropeptide Y modulates non-adrenergic, non-cholinergic neural bronchoconstriction in vivo and in vitro.

Non-adrenergic, non-cholinergic (NANC) neural mechanisms regulate airway tone in guinea-pigs, and it is possible that they may be regulated by other nerves. We have investigated effects of neuropeptide Y (NPY), a co-transmitter of adrenergic nerves, on the excitatory (bronchoconstrictor) NANC (e-NANC) response elicited both in vivo (via bilateral vagal nerve stimulation) and in vitro (via electrical field stimulation [EFS]), and on inhibitory (bronchodilator) NANC (i-NANC) responses in upper trachea elicited by EFS. NPY inhibited the e-NANC to vagal stimulation in vivo in a dose-dependent manner (90.0 +/- 3.4% inhibition at 500 micrograms/kg), but failed to alter the bronchoconstrictor response to exogenous substance P (SP). NPY also inhibited the e-NANC response to EFS in main and hilar bronchi (57.2 +/- 8.6% in main and 46.34 +/- 7.5% in hilar bronchi at 10(-6) M), whilst having no effect on the contractile response to SP. In contrast NPY had no effect on the i-NANC response in vitro. Thus, NPY exerts a powerful inhibitory action on tachykinin release from peripheral endings of capsaicin-sensitive airway sensory nerves, but has no effect on the i-NANC neural mechanisms. This suggests that adrenergic nerves may modulate e-NANC responses in the airways.     

Recurrent inguinal hernia in relation to ideal body weight

The records of 686 patients who underwent herniorrhaphy for primary or initially recurrent inguinal hernia during the years 1975 through 1985 were reviewed. Patients were divided into groups according to percentage of ideal body weight. Analysis showed that, compared with the patients with primary hernia, a larger proportion of patients with recurrent hernia were near or below ideal body weight. A follow-up survey of 64 patients who underwent primary repair of hernia indicated that the percentage of ideal body weight of a patient had no apparent effect on the recurrence rate of inguinal hernia.     

A comparison of dual-energy digital radiography and screen-film imaging in the detection of subtle interstitial pulmonary disease

An ROC study is described which compares the performance of three types of images--conventional screen-film, single-energy digital and dual energy bone cancelled (soft tissue) digital--in detecting subtle interstitial pulmonary disease. Marginally detectable nodular and reticulonodular patterns (12 different patterns of each) were superimposed over the lungs of a frozen human chest phantom to simulate the clinical situation. The digital images were formatted on film at full size (ie, 35 cm X 43 cm). A total of 156 images (52 of each type, of which 28 were normal and 24 had simulated pathology) were used in the study and read by five experienced chest radiologists. Using a paired t-test, the areas under the individual ROC curves were compared for three combinations of images--single-energy digital and conventional, soft tissue digital and conventional, and soft tissue and single-energy digital. No statistically significant difference was observed between the conventional and single-energy digital images. The readers performed better with both conventional and single-energy digital images than with the soft tissue digital images at statistically significant levels (P = 0.05 for conventional vs. soft tissue digital and P = 0.02 for single-energy digital vs. soft tissue digital). The results suggest that there is no advantage in employing dual-energy soft tissue images to assist in diagnosing interstitial disease in the clinical setting. They also suggest that spatial resolution requirements are less demanding in digital chest systems that obtain scatter-free images than in digital systems utilizing conventional scatter control techniques.     

Extended wear disposable soft contact lenses as an alternative to photorefractive keratectomy: Report of 4 years experience

Purpose: To establish whether; in a well-informed population, the use of extended wear disposable soft contact lenses (EWDSCL) poses an unacceptable risk to vision and corneal health due to complications associated with their use. Methods: A 4 year retrospective review of EWDSCL, involving 371 patients in Melbourne from a single general ophthalmology practice. The important aspects of this group were that all patients were given written instructions about the methods of ensuring initial and ongoing cleanliness of lenses, no lenses were cleaned and reinserted, and no solutions other than the saline in the original packaging, and comfort drops, were used. Two types of EWDSCL were used, in powers from - 9.0 to + 6.0 D, and with an initial aim of 4 weeks uninterrupted extended wear. Follow-up was from 2 to 52 months, with an average of 24 months. Results: Of the 354 patients followed up, 236 (66%) regularly wore them on an extended overnight basis, and of these 180 (76%) wore them for the suggested 4 week period before renewal of lenses. In the 471 eyes of 236 patients, adverse reactions occurred at the following rates: marginal infiltrates (12 cases, 2.5%); corneal oedema (10 cases, 2%); peripheral corneal vascularization (2 cases, 0.4%); and presumed infective keratitis (1 case, 0.2%). No eyes lost one or more lines of Snellen acuity. Conclusions: When disposable soft contact lenses do not come into contact with cleaning solutions, saline from bottles or aerosol cans, or storage cases, their use on an extended wear basis (up to 4 weeks continuous) appears to be associated with a low risk of minor or major complications. The results of this review indicate that controlled usage of EWDSCL is safer than previous reports have indicated.     

Developmental changes in endothelium-dependent pulmonary vasodilatation in pigs.

1. We compared in vitro endothelium-dependent vasorelaxant responses to acetylcholine (ACh) and the endothelium-independent vasodilator response to sodium nitroprusside (SNP) in prostaglandin F2 alpha (PGF2 alpha)-precontracted muscular pulmonary arteries (PA) from pigs aged 5 min to 2 h (neonatal), 3-10 days, 3-8 weeks and adults. 2. In the pulmonary artery (PA) rings from neonatal animals, the vasodilator response to ACh was negligible. However, responses to ACh were present in all PA rings from older animals, being greatest at 3-10 days and then decreasing with age (P less than 0.001, ANOVA). ACh (30 microM) induced a 1 +/- 1%, 92 +/- 9%, 62 +/- 5% and 51 +/- 6% reduction of the PGF2 alpha-generated tension in neonatal, 3-10 days, 3-8 weeks and adult groups, respectively. 3. The relaxant response to SNP was present in the PA rings from all age groups and increased with age (P less than 0.001, ANOVA). SNP (1 microM)-induced relaxation was 55 +/- 9%, 73 +/- 7%, 97 +/- 5% and 93 +/- 6% in neonatal, 3-10 days, 3-8 week and adult groups, respectively. 4. Removal of the vascular endothelium abolished the relaxant response to ACh but had no effect on the response to SNP in any groups. 5. NG-monomethyl-L-arginine (30 microM), a nitric oxide synthesis inhibitor, inhibited the response to ACh but not to SNP. The lipoxygenase inhibitor, nordihydroguaiaretic acid, had no significant effect on responses to ACh or SNP in any group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Valproate hepatotoxicity in an adult patient taking Simvastatin

Hepatotoxicity is an exceedingly rare complication of sodium valproate monotherapy. Valproate is metabolized by a number of different pathways and interaction with other anticonvulsants, in particular cytochrome P₄₅₀ inducers such as phenobarbital, are thought to be major contributing factors to hepatotoxicity. Simvastatin is also known to cause an elevation of hepatic transaminases but there have been no previously documented reports of a hepatic enzyme pathway interaction with valproate. We report a case of symptomatic valproate hepatotoxicity in an adult patient also taking simvastatin.