Recurrent herpes simplex encephalitis

Recurrent herpes simplex virus (HSV) encephalitis is a rare disorder with only a few cases reported. We report a case of HSV encephalitis with documented recurrence in the same anatomic location, lending support to the theory of reactivation as the mechanism of disease.     

Arg16 homozygosity of the beta2-adrenergic receptor improves the outcome after beta2-agonist tocolysis for preterm labor

BACKGROUND: Beta(2)-adrenergic receptor (beta(2)AR) agonists are not consistently successful when administered as tocolytic therapy. The beta(2)AR displays genetic variability; an arginine-to-glycine substitution at codon 16 (Arg16Gly) has been shown to increase receptor desensitization in response to agonist exposure, whereas a substitution of glutamate for glutamine at codon 27 (Gln27Glu) decreases down-regulation. We have demonstrated that homozygosity for Arg16 protects against preterm delivery. Our goal was to determine whether beta(2)-agonists are more effective in women with the Arg16 genotype and preterm labor. METHODS: Sixty white women with preterm labor between 24 and 34 weeks' gestation were treated for 48 hours with intravenous hexoprenaline. The effect of tocolysis and outcome of pregnancy were recorded. The beta(2)AR genotypes at codons 16 and 27 of ADRB2 were determined. A control group of 116 women delivered at term was also genotyped. RESULTS: Preterm labor was not associated with beta(2)AR genotype at codon 16 (17% of patients with preterm labor were Arg16 homozygotes versus 19% of control subjects) or codon 27. Gestation was significantly prolonged in Arg16 homozygotes (median, 69 days; interquartile range, 63-79 days) compared with the other 2 genotypes (median, 58 days; interquartile range, 2-72 days) (P = .04). Tocolysis was 100% successful in delaying delivery for 48 hours in Arg16 homozygotes (n = 10), just failing to achieve statistical significance (P = .069). In contrast, only 37 of 50 women carrying 1 or 2 glycine alleles (74%) had delivery delayed by more than 48 hours with tocolysis. Neonatal outcomes were significantly better in babies born to mothers homozygous for arginine than in women with 1 or 2 Gly16 alleles. CONCLUSIONS: This is the first study examining the pharmacogenetics of beta(2)AR agonist therapy for preterm labor. It appears that Arg16 homozygosity improves pregnancy outcome after beta(2)-agonist tocolysis. The relatively low frequency of Arg16 homozygotes in our population limited the power of this investigation. Future assessments of tocolytic therapy may need to assess beta(2)AR genotype.     

Interactions between estrogen and progesterone in neural tissues that mediate sexual behavior of guinea pigs

(1) Interactions of estrogen and progesterone with each other and with the neural tissues that regulate sexual behavior in female guinea pigs were studied. (2) Long-acting preparations of estradiol-17β (E₂) were more effective in facilitation of lordosis than other estrogens. (3) A major behavior-facilitating site of action of E₂ is in the medial basal hypothalamus. (4) E₂ is selectively taken up by a saturable receptor system in fractions of hypothalamic tissue. (5) Although early effects of E₂ on neural tissues that mediate lordosis can be mimicked by certain anti-estrogens, anti-estrogens do not mimic long-term effects of E₂ that are required for optimum expression of lordosis behavior. (6) Progesterone (P) is required in extremely small quantities for facilitation of lordosis behavior in estrogen-primed female guinea pigs. (7) Facilitation of sexual behavior is a short-term effect of P that is mediated by the medial basal hypothalamus. (8) P inhibits the expression of lordosis behavior via a mechanism that is represented in the midbrain. (9) This inhibitory action of P has a longer latency than the facilitatory action of P. (10) Prolonged residence of E₂ in the hypothalamus temporarily favors the expression of short-term facilitatory actions of P on lordosis. (11) The long-term lordosis-antagonizing effects of P are not due to inhibition of E₂ uptake in the hypothalamus. (12) Inhibitory effects of P on lordosis may not depend on neural cells that have the ability to concentrate E₂ in their nuclei.     

Intraperitoneal insulin administration produces a positive portal-systemic blood insulin gradient in unanesthetized,unrestrained swine

The present study was performed to evaluate the porto-systemic insulin gradient in response to (1) glucose feeding (2) intramuscular insulin administration, and (3) peritoneal insulin administration in unanesthetized swine. The experiment was designed to verify the hypothesis that intraperitoneal insulin administration might lead to a more physiologic portal vein insulin concentration than systemic administration of a similar insulin dose. Studies were performed in 4 domestic swine with chronic, indwelling catheters in the inferior vena cava and portal vein. Unpaired studies of the absolute portal venous and systemic venous insulin concentrations were performed in response to glucose prn(n = 4), 1 unit regular insulin/kg i.m.(n = 4), and 1 unit regular insulin/kg i.p.(n = 5). Timed blood samples were obtained and serum insulin concentrations determined by RIA. Portal and caval serum insulin concentrations following intramuscular insulin injection showed no significant difference. A significant portal vein insulin excess (p < 0.001) was demonstrated following both feeding and intraperitoneal insulin.     

Advances in deep chemical peels

Deep chemical peels have been used in dermatology for more than a century and their popularity increased dramatically during the past decade. The main indications for this procedure include photoaging, perioral wrinkling, acne scars, and precancerous skin lesions. Deep chemical peel is a nonsurgical procedure that compares favorably with other surgical and nonsurgical procedures for skin rejuvenation, such as surgical face-lifting, dermabrasion, and laser resurfacing. It is a safe and cost-effective method that provides significant results and a high degree of patient satisfaction.     

Early psychological intervention for auditory hallucinations: an exploratory study of young people's voices groups

Twenty to fifty percent of people with a diagnosis of schizophrenia continue to hear voices despite taking neuroleptic medication. Trials of group cognitive behavioral therapy for adults with auditory hallucinations have shown promising results. Auditory hallucinations may be most amenable to psychological intervention during a 3-year critical period after symptom onset. This study evaluates the effectiveness of group cognitive behavioral therapy (CBT) for young people with recent-onset auditory hallucinations (N = 22), using a waiting list control. Outcome measures were administered at four separate time points. Significant reductions in auditory hallucinations occurred over the total treatment phase, but not over the waiting period. Further investigations in the form of randomized controlled trials are warranted.     

Magnesium-induced vasodilation in the dorsal hand vein

OBJECTIVE: Magnesium affects blood pressure by modulating vascular tone and reactivity. In obstetric patients, magnesium is administered to prevent eclamptic seizures and as a tocolytic to treat preterm labour. Prior to studying vascular sensitivity in women with pre-eclampsia, we sought to determine the effect of magnesium on venous tone in healthy women of childbearing age. DESIGN: Dose-response study. SETTING: Columbia-Presbyterian Medical Center, New York. POPULATION: Ten healthy non-pregnant women (age range 21-47 years). METHODS: Vascular response to magnesium sulphate (MgSO4) was measured in a dorsal hand vein using the linear variable differential transformer (LVDT) technique. Complete dose-response curves to MgSO4 (0.0000275-0.088 mmol/min) were determined after 50% preconstriction of the vein with phenylephrine. MAIN OUTCOME MEASURES: The ED50 of MgSO4 (dose resulting in 50% of maximal effect, Emax) was determined. Blood samples from the contralateral upper extremity were obtained to assess total plasma magnesium levels at baseline and at the highest infused dose of magnesium. ED50 results are expressed as geometric mean (95% confidence interval, CI). Emax results and magnesium plasma concentrations are expressed as mean [SD]. RESULTS: The ED50 of MgSO4 was 0.000307 mmol/min (95% CI 0.138, 0.666) and Emax was 102% [20%]. CONCLUSION: Magnesium induces dose-dependent venodilation in healthy women in the absence of systemic haemodynamic effects. The dose resulting in vasodilation using the LVDT/hand vein model is two to three orders of magnitude less than the therapeutic doses of magnesium used for tocolysis or seizure prophylaxis. Studies of the effect of systemically administered therapeutic doses of magnesium on vascular reactivity in pre-eclampsia will be of interest.     

Alpha 1A-adrenergic receptor polymorphism and vascular response

OBJECTIVE: The alpha(1A)-adrenergic receptor is highly expressed in human vasculature including resistance arteries and veins, and its stimulation is primarily responsible for adrenergically mediated smooth muscle contraction. Variability in sensitivity to phenylephrine, an alpha(1A) adrenergic agonist, has a large genetic component. We examined the hypothesis that a common polymorphism of alpha(1A)-adrenergic receptor (Arg347Cys) affects in vivo response. METHODS: We measured vascular sensitivity to phenylephrine using the dorsal hand vein linear variable differential transformer technique and determined alpha(1A)-adrenergic receptor genotype in 74 healthy, nonsmoking adults (28 Arg/Arg, 30 Arg/Cys, and 16 Cys/Cys). RESULTS: Sensitivity to phenylephrine, expressed as the dose of phenylephrine resulting in 50% venoconstriction (Phe(50)), was not significantly different in subjects with the 3 alpha(1A) adrenergic receptor genotypes: Phe(50) geometric mean (95% confidence interval) was 513 ng/min (287-918 ng/min) for Arg/Arg, 431 ng/min (274-680 ng/min) for Arg/Cys, and 471 ng/min (197-1124 ng/min) for Cys/Cys (P =.90). CONCLUSION: We conclude that the Arg347Cys receptor polymorphism does not alter agonist-mediated venoconstriction in vivo.