The renal clearance of free and peptide-bound deoxypyridinoline: response to pamidronate treatment of Paget's disease.

Bisphosphonate treatment of Paget's disease results in a large decrease in urinary peptide-bound pyridinolines but a smaller decrease in urinary free pyridinolines. This discrepancy could be explained by changes in renal handling of pyridinoline forms. We studied eight patients with Paget's disease treated with pamidronate. We collected blood and urine at baseline and at 3 and 14 days after treatment. We measured free and total deoxypyridinoline (DPD) in serum (S) and urine (U) by high-performance liquid chromatography (HPLC). The ratio of free to total DPD at baseline was (mean +/- SE) 13 +/- 1% in serum and 37 +/- 3% in urine; at 3 days, this had increased to 25 +/- 3% in serum and 62 +/- 7% in urine. Peptide-bound (pb) DPD decreased significantly 3 days after treatment: UpbDPD -63 +/- 11%, p < 0.001; SpbDPD -51 +/- 8%, p < 0.01. Free DPD decreased in the urine after 14 days: UfDPD -48 +/- 5%, p < 0.01; there was no significant change in SfDPD. The fractional excretion of pbDPD relative to creatinine was less than one at all time-points; however, the fractional excretion of fDPD was significantly greater than one throughout the study. As a consequence, the proportion of free DPD in the urine increased as bone turnover decreased. This resulted in a smaller decrease in urine free compared with peptide-bound DPD in response to bisphosphonate therapy. Thus, the conversion of peptide-bound to free DPD in the kidney may become more efficient as bone turnover decreases as a consequence of pamidronate treatment.     

Facial reanimation with the VII-XII anastomosis: analysis of the functional and psychologic results

The VII-XII anastomosis has been employed for more than a decade by The Otology Group, P.C., in the facial reanimation of patients undergoing extirpation of tumors involving the cerebellopontine angle and the skull base. A retrospective review based upon a detailed questionnaire and submitted photographic documentation from 61 patients forms the basis for this review. Details and analysis of the functional results include onset of function, synkinetic activity, corneal irritation and associated ophthalmologic problems, facial tone and symmetry, and volitional mimetic function. From a psychosocial perspective, evaluation was made regarding workplace and home acceptance, self consciousness, adaptation, and overall satisfaction. Because of the nature of its technical performance and reliability, the VII-XII anastomosis is an important technique for the otolaryngologist to be familiar with. Cognizance of the functional and psychologic results with this procedure will ensure optimal (yet realistic) rehabilitation for this patient population.     

Desmoplastic malignant melanoma: An aggressive tumor

Summary The clinical features and histological appearance of desmoplastic malignant melanoma are presented. Aggressive surgical management and close follow-up are mandatory if this highly aggressive tumor is to be controlled. Despite this, the prognosis is poor.     

Electron microscopic evidence for the association of M 2 protein with the influenza virion

Summary Immunogold electron microscopy revealed that site-specific antibodies elicited by a synthetic peptide representing the N-terminal sequence (residues 2–10) of influenza virus M 2 protein were capable of binding to the surface of virions. Antibody binding was observed with two human influenza virus strains but not with an avian virus strain which has amino acid substitutions in the appropriate sequence of M 2. These results provide direct evidence for the presence of M 2 in the influenza virion.     

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.     

NIFEDIPINE BLOCKS ACTH AND CORTISOL RELEASE IN MAN

1. The present study investigated the effect of prior administration of nifedipine on AVP-induced ACTH release in seven normal volunteers. Three protocols were used: 20 mg oral nifedipine; 0.14 pressor units intramuscular (i.m.) per kg bodyweight aqueous AVP; oral nifedipine plus i.m. AVP 90 min later. Plasma ACTH and cortisol were measured at intervals for 2.5 h during each test. 2. The mean peak plasma ACTH and cortisol levels and the mean peak changes from basal in these levels were significantly lower in the nifedipine/AVP test than in the AVP alone test. The integrated area under the cortisol time curve was significantly lower for the nifedipine/AVP test than that for the AVP test alone. Nifedipine alone caused no changes in ACTH or cortisol. 3. Acute administration of oral nifedipine caused an inhibition of AVP-stimulated ACTH and cortisol release in normal humans. This effect may be due to blockade of plasma membrane calcium channels normally activated during AVP stimulation of pituitary corticotrophs.