Outpatient lumbar myelography. Initial results in 79 examinations using a low-dose metrizamide technique

Seventy-nine patients underwent lumbar myelography on an outpatient basis, with a low (3.75 g) dose of metrizamide as the radiocontrast agent and a 25-gauge spinal needle used for lumbar puncture. No patient experienced significant neurotoxicity following the examination; 70.8% (56 of 79) experienced minimal (23%) or no (48%) side effects. Three patients (3.8%) were admitted to the hospital for management of common side effects (headache, nausea/vomiting, back pain). We obtained postmyelographic computed tomographic scans on 96% (76 of 79) of the patients. Our initial results suggest that outpatient lumbar myelography is safe and can be performed with a very acceptable incidence of side effects.     

Platelet adhesion to collagen types I through VIII under conditions of stasis and flow is mediated by GPIa/IIa (alpha 2 beta 1-integrin)

Platelet adhesion to fibrillar collagens (types I, II, III, and V) and nonfibrillar collagens (types IV, VI, VII, and VIII) was investigated in the presence of physiologic concentrations of divalent cations under conditions of stasis and flow. Under static conditions, platelet adhesion was observed to collagen types I through VII but not to type VIII. Under flow conditions, platelet adhesion to collagen types I, II, III, and IV was almost independent of shear rates above 300/s. Collagen type V was nonadhesive. Platelet adhesion to collagen type VI was shear rate-dependent and optimal at a rate of 300/s. Collagen types VII and VIII showed minor reactivity and supported platelet adhesion only between shear rates 100 to 1,000/s. Monoclonal antibody (MoAb) 176D7, directed against platelet membrane glycoprotein Ia (GPIa; very late antigen [VLA]-alpha 2 subunit), completely inhibited platelet adhesion to all collagens tested, under conditions of both stasis and flow. Platelet adhesion to collagen type III at shear rate 1,600/s was only inhibited for 85%. The concentration of antibody required for complete inhibition of platelet adhesion was dependent on the shear rate and the reactivity of the collagen. An MoAb directed against GPIIa (VLA-beta subunit) partially inhibited platelet adhesion to collagen. These results show that GPIa-IIa is a major and universal platelet receptor for eight unique types of collagen.     

Human cardiac beta-adrenoceptors: both beta 1- and beta 2-adrenoceptors are functionally coupled to the adenylate cyclase in right atrium

We investigated properties of catecholamine-sensitive adenylate cyclase in membranes from human right atria. Basal adenylate cyclase was activated by Mg2+-ions and guanyl nucleotides [Gpp(NH)p, GTP] in a concentration-dependent manner; guanyl nucleotide activation was strongly dependent on the presence of Mg2+-ions. Catecholamines stimulated adenylate cyclase activity in the following order of potency: (-)-isoprenaline greater than (-)-adrenaline = (-)-noradrenaline greater than phenylephrine, indicating that, in human right atrium, beta 1-adrenoceptors predominate. The beta 1-agonist dobutamine and the beta 2-agonists fenoterol and procaterol activated adenylate cyclase with an intrinsic activity of 0.5-0.7 (isoprenaline = 1.0). Adenylate cyclase activation by dobutamine or procaterol was not additive with the activation induced by isoprenaline. On the contrary, combination of dobutamine (100 microM) and procaterol (10 microM) resulted in activation of adenylate cyclase which was not different from that evoked by saturating concentration of isoprenaline (10 microM), indicating that dobutamine (beta 1) and procaterol (beta 2) produce adenylate cyclase activation through stimulation of different beta-adrenoceptor subtypes. The beta 2-selective antagonist ICI 118,551 was much more potent in inhibiting procaterol-than isoprenaline-stimulated adenylate cyclase activity, whereas the beta 1-selective antagonist betaxolol inhibited isoprenaline-stimulated activity more potently. We conclude that in human right atrium, both beta 1- and beta 2-adrenoceptors are functionally coupled to the adenylate cyclase system.     

The immotile cilia syndrome: radiological manifestations

The immotile cilia syndrome (ICS) is an uncommon disorder characterized by specific and genetically determined defects of cilia that cause upper and lower respiratory disease. We reviewed the radiographic patterns in 30 patients who had ICS (15 females, 15 males) and ranged in age from newborn to 26 years. Except for two neonates, sinusitis and otitis were present in all patients. Chest radiographic abnormalities, universally present, included bronchial wall thickening, hyper-inflation, segmental atelectasis or consolidation, and segmental bronchiectasis. Situs inversus, present in 50% (7 females, 8 males), was not an essential part of this disorder. Radiologically, the disease progresses from bronchial wall thickening with or without hyperinflation, to increasing hyperinflation plus parenchymal changes including segmental atelectasis, consolidation, and bronchiectasis. There is also a predilection for anatomic middle lobe abnormalities. The radiological appearance and clinical state have similarities to cystic fibrosis, although they are less severe and less progressive. ICS should be considered in the differential diagnosis of slowly progressive chronic lung disease, sinusitis, and otitis.