A role for calcitonin gene-related peptide in protection against gastric ulceration.

OBJECTIVE: The goal of this investigation was to determine the role of calcitonin gene-related peptide (CGRP) in gastric mucosal resistance to ulceration. SUMMARY BACKGROUND DATA: CGRP is a 37-amino acid peptide found in the peripheral ends of afferent gastric neurons. CGRP is known to inhibit acid secretion, stimulate mucosal blood flow, and stimulate release of somatostatin. METHODS: The release of CGRP in response to intragastric and intra-arterial administration of capsaicin in the isolated, vascularly perfused rat stomach was measured by radioimmunoassay. The molecular forms of CGRP released were analyzed by gel filtration chromatography. The effect of intravenous CGRP or intragastric capsaicin on gastric ulceration induced by 100 mmol/L HCl and indomethacin was studied in intact and endogenous CGRP-depleted rats. RESULTS: Intra-arterial capsaicin (concentration range, 10(-7) to 10(-5) mol/L) stimulated a prompt and sustained release of immunoreactive CGRP, of which 84% coeluted with rat 1-37 CGRP I by gel filtration. Intragastric capsaicin (range, 10(-5) to 10(-4) mol/L) failed to release CGRP into the vascular perfusate. In intact rats, intragastric capsaicin (10(-6) mol/L) or intravenous CGRP I (10 micrograms/kg/hr) reduced the number and area of mucosal lesions caused by HCl and indomethacin compared with the findings in control rats. Rats depleted of endogenous CGRP were more susceptible to gastric ulceration than were normal rats. Intragastric capsaicin failed to protect the mucosa of CGRP-depleted rats, whereas exogenous intravenous CGRP was effective. CONCLUSIONS: These data support the hypothesis that CGRP released from gastric enteric neurons mediates gastric mucosal resistance to ulceration by noxious agents.     

Flow dynamics through spinal needles

We examined the flow pattern produced when liquid dye was actively injected into a fluid medium at various flows through five different commonly used spinal needles. At all flows, the Whitacre-type needles produced a directional stream exiting at an angle from the longitudinal axis. At intermediate rates the stream developed tracks which disappeared at faster rates. The Quincke needle always produced an undeviated stream of dye and did not form tracks at any flow rate. When a perspex plate (representing the spinal cord) was interposed in front of the needle, the dispersion of dye was always unidirectional from the Whitacre needle and bidirectional from the Quincke needle. The dye adhered to the surface of the plate as a concentrated film at slow rates and at faster rates it dispersed turbulently for both types of needle.     

Validation of the survey of work styles: a profile measure of the type A behaviour pattern

The present study compares the Type A classification accuracy of the Jenkins Activity Survey (JAS), The Framingham Type A Scale, and a new Type A behaviour pattern (TABP) measure. The Survey of Work Styles (SWS), a self-report measure of the TABP, was developed using a construct approach to scale construction. It consists of six content scales. Impatience, Anger, Work Involvement, Time Urgency, Job Dissatisfaction and Competitiveness. In addition to the six content scales, a seventh scale, Scale A, is comprised of items empirically selected to relate to the Rosenman Structured Interview. In the present study the SWS was found to be significantly related to both the JAS, and the Framingham Type A Scale in a sample of 163 business managers. Median reliability of the SWS subscales was 0.82, and for the total scale 0.90. Discriminant function analysis using cross validational jackknifing procedures resulted in a classification accuracy of 83% of the Type A managers in relation to the Structured Interview. Classification using the SWS was found to correlate significantly higher with the Structured Interview than did either classification with the JAS or with the Framingham Type A Scale. Modal profile analysis yielded three independent bipolar typal dimensions, indicating that a single dimension or classification of the TABP represents an oversimplification of a complex behaviour pattern. These results support the reconceptualization of the TABP in terms of distinct facets and profile patterns.     

Melbourne trial of adjuvant immunotherapy in operable large bowel cancer

A controlled randomized clinical trial was undertaken to assess the ability of combined non-specific and specific immunotherapy to alter the disease-free interval and overall survival of patients with Stage B or C large bowel cancer. The immunotherapy consisted of a 2 year programme of vaccinations with BCG and neuraminidase-treated autologous tumour cells. Three hundred and one patients entered the trial. At 5 years of follow-up there is no evidence that this form of immunotherapy can alter either the disease-free interval or survival in this group of patients.     

Successful treatment of empyema thoracis with polymethylmethacrylate antibiotic-impregnated beads in the guinea pig

Two hundred nine Duncan-Harley guinea pigs had intrathoracic inoculation with 10(8) Staphylococcus aureus, accompanied by blood and umbilical tape. One hundred fifty-two animals were excluded because of clinical recovery, early death, or complications related to intrathoracic polymethylmethacrylate (PMMA) bead placement. The remaining 57 animals had clinical signs of empyema thoracis and were the subjects of this study. Group I animals (N = 24) served as the controls and had no therapy. Group II animals (N = 14) were treated by intrathoracic placement of placebo PMMA beads. Group III animals (N = 19) were treated by intrathoracic placement of tobramycin sulfate-impregnated PMMA beads. There were no differences between the groups in pleural reaction or pneumonia scores. These findings demonstrate a similar host response to the established infection. Group III, however, had a higher sterilization rate than Groups I and II (p less than 0.05), a finding underlining the therapeutic effect of tobramycin-treated PMMA beads. We conclude that intrathoracic local antimicrobial therapy with slow-release tobramycin-impregnated PMMA beads may enhance empyema treatment by increasing the rate of local sterilization. More experiments are necessary to assess the efficacy of this potentially important therapeutic arm for the treatment of thoracic empyema.     

Certification: serving the public interest

The certification program has undergone an exciting change. The AOTA leadership and AOTA members are to be applauded for making this important step. The AOTCB is still a fledgling organization; nonetheless, it has already made great strides in carrying out its mission. The AOTCB will continue to build on the very excellent foundation AOTA has laid for the certification program. The AOTCB welcomes questions, comments, and suggestions concerning the certification program. To contact AOTCB, write to AOTCB, 1383 Piccard Drive, Rockville, MD 20850-4375 or call (301) 948-9626.     

Mitral incompetence associated with lipoma infiltrating the mitral valve

A 54 year old man presented with presyncopal symptoms. Echocardiography and subsequently computed tomography showed a mass in the posterior mitral annulus causing incompetence of the valve. At operation a lipoma was found which could not be resected. Mitral incompetence was the result of chordal rupture where the lipoma had engulfed the papillary muscle. The valve was replaced and the patient made an uneventful recovery. This case report shows a potential danger of an otherwise benign lesion.