Human pepsinogens: A review of clinical and genetic aspects

In recent years clinical interest in the study of the proteolytic enzymes of the stomach has greatly increased. Human pepsinogens belong to the group of aspartic proteases and are categorized into two main groups: Pepsinogen A (PGA = PG I) and Pepsinogen C (PGC = PG II). Genetic models have been proposed to explain the inheritance of PGA, and a recent multigene model may be of value. PGA phenotypes in urine and gastric mucosa have been determined in healthy volunteers as well as in patients with different gastric disorders. An increased frequency of the ‘intense Pg5’ phenotype seems to be associated with gastric cancer and pre-malignant conditions, such as atrophic gastritis. Reliable radio-immunoassay and enzyme-linked immunosorbent assay techniques have facilitated the study of serum levels of PGA and PGC in different patient groups; in particular, duodenal ulcer patients (high PGA levels) and patients with atrophic gastritis and/or gastric cancer (low PGA levels). The ratio serum PGA/PGC may be introduced for clinical application, being the most convenient non-invasive marker for the detection of fundic atrophy. While the chromosome localization of pepsinogen has been established, further research is likely to concentrate on the structure and organization of the pepsinogen genes at the DNA-level, as well as on the development of new isozyme specific monoclonal antibodies.     

Specific IgE determination by RAST compared with skin and provocation tests in allergy diagnosis with birch pollen, timothy pollen and dog epithelium allergens

In sixty-five patients with asthma or allergic rhinitis, intracutaneous tests and provocation tests were performed with birch pollen, timothy pollen and/or dog epithelium allergen. The clinical diagnosis was compared with RAST results obtained with identical allergen preparations for in vivo as well as in vitro testing in two different laboratories. An overall correlation between in vitro and in vivo diagnosis was found in 85% of the cases. It is suggested that a scoring system using the sum of case history score and RAST values could be used for screening allergic patients with different allergens, making in vivo tests necessary only in a limited number of the cases.     

Cardiac Stimulation Threshold in Familial Amyloidosis with Polyneuropathy

It has been suggested that a higher cardiac stimulation threshold reduces the applicabilty of pacemaker therapy in cardiac amyloidosis. We therefore reviewed threshold data in patients with familial amyloidosis with polyneuropathy (FAP), which is an inherited type of systemic amyloidosis, invariably involving the heart. Fourteen FAP patients treated with a pacemaker were studied. The mean (±SD) voltage stimulation threshold during implantation was 1.0 ± 0.5 V, and noninvasive follow-up 6 months later revealed a mean Vario threshold of 1.9 ± 0.5 V. Beyond this time, the threshold tended to be stable, and high threshold exit block did not occur in any patient. Several FAP patients did show a moderately elevated threshold, and a multiprogrammable pulse generator with a high output capability is recommended when pacemaker therapy is considered in these patients.     

SOBER-STATE CORTISOL AS A PREDICTOR OF DRUNKEN VIOLENCE

Basal cortisol levels were compared in prisoners convicted ofviolent crimes, in men previously convicted of violent crimesbut currently not in prison, in non-violent alcoholics, andin randomly selected control males. Most of the violent menwere diagnosed with antisocial personality disorder (DSM-III-R301.70). Morning, afternoon, and evening levels of plasma cortisolwere assessed after a minimum alcohol abstinence of 24 h. Theimprisoned violent men had significantly lower cortisol levelsthan the unimprisoned. which may reflect their prolonged alcoholabstinence and/or habituation to chronic stress. The unimprisonedviolent men were heavy drinkers and their elevated sober-statecortisol may reflect temporary alcohol withdrawal or acute stress.We suggest that variations in basal cortisol are influencedmore by environmental factors than by violent predispositionor antisocial personality disorder.