Appendicitis as the presenting manifestation of Kawasaki disease

In cases of Kawasaki’s disease (KD) presenting as acute surgical abdomen, rarely has the presence of acute appendicitis been found. We report two cases of histologically confirmed acute appendicitis in the presence of KD and a review of the literature as it pertains to acute abdomen and atypical presentations of KD.     

Development of local connections in ferret somatosensory cortex

Ferrets have become recognized as a useful and interesting model for study of neocortical development. Because of their immaturity at birth, it is possible to study very early events in the ontogeny of the brain. We used living slices of ferret somatosensory cortex to study the formation and development of intrinsic elements within the neocortex. A small number of fixed, hemisected brains injected with 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate (DiI) were also used. The slices were obtained from ferret kits aged postnatal day (P)1 to P62 and maintained in a chamber; each slice received injections of fluorescent-labeled dextrans. The injections were made at different ages in several distinct sites, which included the proliferative ventricular zone, the intervening white matter (or intermediate zone), and different sites of developing cortex, including the deeper cortical plate, which incorporated the subplate in young animals, and more superficial cortical sites, depending on the age of the animal. Several animals also received injections into the ventrobasal thalamus. Injections into young animals (P1–7) produced a dominant radial pattern that extended from the ventricular zone into the cortex. Injections into the ventricular zone labeled many cells that appeared morphologically like radial glia as well as presumptive neurons. Although the predominant pattern was radial, injections in the ventricular zone often produced tangentially oriented cells and horizontally arranged fibers at the outer edge of the proliferative zone. These cells and fibers may provide a substrate for tangential dispersion of neurons within the neocortex. More superficial injections within the slice labeled lines of cells that appeared to be stacked upon one another in a radial pile in the cortex; the cortical plate received very few lateral projections. Data obtained from more mature slices indicated that, although the overall pattern of staining remained radial, the precise character of the pattern changed to include more lateral spread into surrounding cortex, which eventually refined and developed into distinct patches by P28, when the overall cortical architecture appeared adult like. The data involving thalamocortical connections were more limited, but they indicated that the thalamus projects precisely to the somatosensory cortex in a point-to-point fashion from the earliest date studied (P0) and that the ventrobasal nucleus terminates upon the somatosensory cortex in a patchy manner during the early postnatal days of development. This study of the development of the somatosensory cortex confirms the ubiquitous nature of column-like connections throughout the neocortex and provides a novel view of the radial nature of early neocortical maturation. © Wiley-Liss, Inc.     

Mitral valve prolapse in eating and panic disorder: A pilot study

The prevalence of echocardiographic mitral valve prolapse (MVP) and arrhythmias was studied in controls (n = 23) and patients with panic disorder (n = 14), bulimia nervosa (n = 14), and anorexia nervosa (n = 21). There was approximately twice the rate of MVP in patient groups compared to controls, a statistically insignificant difference. Importantly, the presence of prolapse was not associated with measures of weight or depression but there was a trend for MVP to be associated with anxiety disorder in bulimic patients. There were no significant arrhythmias found. These results raise the possibility that MVP may not be a state weight-related phenomenon as has been proported, but rather a trait phenomenon reflecting comorbidity with anxiety disorder.     

p‐Synephrine,ephedrine, p‐octopamine and m‐synephrine: Comparative mechanistic,physiological and pharmacological properties

Confusion and misunderstanding exist regarding the lack of cardiovascular and other adverse health effects of p‐synephrine and p‐octopamine relative to ephedrine and m‐synephrine (phenylephrine) which are known for their effects on the cardiovascular system. These four molecules have some structural similarities. However, the structural and stereochemical differences of p‐synephrine and p‐octopamine as related to ephedrine and m‐synephrine result in markedly different adrenergic receptor binding characteristics as well as other mechanistic differences which are reviewed. p‐Synephrine and p‐octopamine exhibit little binding to α‐1, α‐2, β‐1 and β‐2 adrenergic receptors, nor are they known to exhibit indirect actions leading to an increase in available levels of endogenous norepinephrine and epinephrine at commonly used doses. The relative absence of these mechanistic actions provides an explanation for their lack of production of cardiovascular effects at commonly used oral doses as compared to ephedrine and m‐synephrine. As a consequence, the effects of ephedrine and m‐synephrine cannot be directly extrapolated to p‐synephrine and p‐octopamine which exhibit significantly different pharmacokinetic, and physiological/pharmacological properties. These conclusions are supported by human, animal and in vitro studies that are discussed.     

Melatonin disturbances in anorexia nervosa and bulimia nervosa

The pineal gland releases melatonin into the blood stream in response to sympathetic noradrenergic stimulation of pinealocytes. This process is inhibited by light via the retino-hypothalamic-pineal pathway. Hence melatonin is predominantly released in darkness. Because serotonin is a precursor of melatonin, the intake of dietary tryptophan may also influence melatonin levels. Although the exact physiological role of melatonin in humans is unclear, it appears to be implicated in reproductive physiology, especially in terms of the onset of menarche. Low levels of melatonin also occur in depression. In this review, studies of melatonin in patients with anorexia nervosa and bulimia nervosa are considered in relation to potential abnormalities of noradrenergic function and circadian rhythm. The influence of weight loss, binging and purging, and depression on melatonin is discussed. Other studies involving the assessment of melatonin in relation to menstrual function are required. © 1994 by John Wiley & Sons, Inc.     

Methotrexate in rheumatoid arthritis. a five-year prospective multicenter study

Objective. To evaluate the efficacy and tolerability of oral methotrexate (MTX) in rheumatoid arthritis (RA) in a long-term prospective trial. Methods. One hundred twenty-three patients with RA who completed a 9-month multicenter randomized trial comparing MTX and auranofin enrolled in this 5-year prospective study of MTX. Results. Significant (P = 0.0001) improvement compared with baseline was noted in all clinical disease variables, functional status, and the Westergren erythrocyte sedimentation rate (ESR). “Marked improvement” occurred in 87 (71%) and 85 (69%) of the patients, respectively, in the joint pain/tenderness index and the joint swelling index at the last evaluable visit. Forty-four patients (36%) withdrew during the study. Eight (7%) withdrew due to lack of efficacy, and 8 (7%) due to adverse experiences, including 1 patient with cirrhosis. At 5 years, 64% of patients were still taking MTX and completed the study. Conclusion. This large prospective study of long-term MTX treatment demonstrates sustained clinical response and improvement in the Westergren ESR and functional assessment scores, with an acceptable toxicity profile.