Immunotoxicological Profile of Morphine Sulfate in B6C3F1 Female Mice

This study was undertaken to investigate a number of immuneparameters which may be compromised with exposure to morphinesulfate. Mice were implanted subcutaneously with 8-, 25-, or75-mg morphine sulfate pellets. Placebo pellets of identicalmakeup to the 75-mg morphine pellet (without morphine of course)were used as a control. Twenty-four hours after implantationof a 75-mg morphine pellet, blood levels reached a peak of 1610ng/ml. Corticosterone increased in parallel with morphine andreached a peak level of 966 ng/ml 24 hr after implantation.The dose response of morphine to increase corticosterone, however,was fiat. The weight of the lymphoid organs, spleen and thymus,and the liver were significantly reduced in the morphine-treatedgroups. Morphine treatment was associated with an increase inserum albumin, SGPT, BUN, and alkaline phosphatase indicativeof hepatic damage. In contrast to increased serum proteins,the C3 component of complement was reduced in a dose-dependentmanner. Leukocyte number in the peripheral blood was significantlyreduced, while erythro-cyte number and hematocrit were bothincreased. The number of B cells and T cells was decreased inmorphine-treated animals. However, the percentage of T cellsrelative to B cells was increased. The primary IgM antibodyresponse to the T-depen-dent antigen, sheep red blood cells,was decreased. Natural killer cell activity was reduced in responseto morphine, as was the phagocytic capacity of Kupffer cells.Host-resistance models of Listeria monocytogenes or Streptococcuspneumoniae showed an increased resistance following administrationof morphine. This increased host resistance, however, was notdue to an increase in antimicrobial action of sera obtainedfrom mice treated with morphine. The majority of morphine'seffects on the immune system exhibited a flat dose response,suggesting that these effects may be mediated secondarily throughcorticosterone.     

RESPONSIVENESS OF KEITEL FUNCTIONAL INDEX COMPARED WITH LABORATORY MEASURES OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS

This study compares functional changes to change in measuresof disease activity following the introduction of slow-actinganti-rheumatic drugs (SAARD) in patients with active rheumatoidarthritis (RA). Clinical and laboratory variables were simultaneouslymonitored at 6-monthly intervals, over approximately 18 months.Function was measured by a performance testing, the Keitel functionindex (KFI), which was divided into sections representing smalland large joints [and (HFI); wrist (WFI) and limb function index(LFI)]. One-hundred-and-fifteen patients were studied, of whom21 were male. The mean age of the subjects was 49 yr (s.D. ±12) and mean duration of disease 7 yr (S.D. ± 7). Themean KFI at entry was 38 (S.D. ± 18) while at the endof the study it was 31 (s.D. ± 17) (P < 0.0001). Thechange in KFI following therapy correlated with the change inRitchie articular index (RAI) (r = 0.4; P < 0.0001), earlymorning stiffness (EMS) (r = 0.3; P = 0.004), swollen jointcount (JC) (r = 0.4; P = 0.0005). C-reactive protein (CRP) (r= 0.2; P < 0.05) and Lansbury systemic index (LSI) (r = 0.35;P = 0.002), but not with change in Westergren erythrocyte sedimentationrate (ESR) or change in time to onset of fatigue. Multiple regressionanalysis showed that 32% of the variation in KFI at the endof the study could be predicted by a combination of ESR, sulphasalazinetherapy, RAI, disease duration and chloroquine treatment atonset (P < 0.05). When HFI at end of study was the dependentvariable, 21 % of the variation could be predicted by a combinationof ESR, CRP, Lansbury systemic index and JC at onset (P <0.05). The duration of disease did not significantly influencethe potential for change in functional status. This study showedthat detailed measurement of function is important in assessingRA activity. Functional impairment in RA is a dynamic processinfluenced by changes in clinical disease activity with treatment. KEY WORDS: Keitel function index, Disease activity, Outcom, Hand function index     

Primary carcinoma of the pelvic peritoneum intercepted by screening for ovarian cancer

An asymptomatic woman found to have primary pelvic peritoneal carcinoma following serum CA125 assay and ultrasound examination is reported. The close proximity of this screen detected tumor to the normal ovary supports the possibility that an extra ovarian primary origin of carcinoma with subsequent involvement of the ovary may be more common than has previously been recorded.     

Guidelines for the management of hypertensive disorders of pregnancy 2008

This is the Executive Summary of updated guidelines developed by the Society of Obstetric Medicine of Australia and New Zealand for the management of hypertensive diseases of pregnancy. They address a number of challenging areas including the definition of severe hypertension, the use of automated blood pressure monitors, the definition of non-proteinuric pre-eclampsia and measuring proteinuria. Controversial management issues are addressed such as the treatment of severe hypertension and other significant manifestations of pre-eclampsia, the role of expectant management in pre-eclampsia remote from term, thromboprophylaxis, appropriate fluid therapy, the role of prophylactic magnesium sulfate and anaesthetic issues for women with pre-eclampsia. The guidelines stress the need for experienced team management for women with pre-eclampsia and mandatory hospital protocols for treatment of hypertension and eclampsia. New areas addressed in the guidelines include recommended protocols for maternal and fetal investigation of women with hypertension, preconception management for women at risk of pre-eclampsia, auditing outcomes in women with hypertensive diseases of pregnancy and long-term screening for women with previous pre-eclampsia.     

Evidence‐based recommendations for the monitoring and treatment of ankylosing spondylitis: results from the Australian 3E initiative in rheumatology

Aim: To develop a set of Australian recommendations for the monitoring and treatment of ankylosing spondylitis (AS) through systematic literature review combined with the opinion of practicing rheumatologists. Methods: A set of eight questions, four in each domain of monitoring and treatment, were formulated by voting and the Delphi method. The results of a systematic literature review addressing each question were presented to the 23 participants of the Australian 3E meeting. All participants were clinical rheumatologists experienced in the daily management of AS. Results: After three rounds of breakout sessions to discuss the findings of the literature review, a set of recommendations was finalized after discussion and voting. The category of evidence and strength of recommendation were determined for each proposal. The level of agreement among participants was excellent (mean 84%, range 64–100%). Conclusions: The 12 recommendations developed from evidence and expert opinion provide guidance for the daily management of AS patients. For most recommendations, we found a paucity of supportive evidence in the literature highlighting the need for additional clinical studies.     

Bovine lymphocyte antigens (BoLA) of bovine lymphocytes and derived lymphoblastoid lines transformed by Theileria parva and Theileria annulata

Summary The BoLA phenotypes of lymphocytes from seven cattle have been compared with those of 19 lymphoblastoid cell lines derived from them by infection in vitro with either Theileria parva or T. annulata. Two long-established lines were also studied. In all cases except one, the BoLA phenotypes of the lymphoblastoid lines were identical with those of the original animal from whose lymphocytes they were derived. The one exception was a chimeric twin where a minor population appeared to have been transformed by T. parva. The antigens present on this line were present in the parents of the chimera, but not detectable in its own peripheral blood. The implications of these results as they relate to the use of these cell lines in immunizing cattle against East Coast fever and tropical theileriosis are discussed.     

Nitric oxide inhibits establishment of macroschizont-infected cell lines and is produced by macrophages of calves undergoing bovine tropical theileriosis or East Coast fever

Nitric oxide (NO) was produced when bovine peripheral blood mononuclear cells (PBMC) or purified, adherent PBMC (macrophages) were incubated in vitro with bovine recombinant interferon gamma (Bo rIFN-γ). NO was produced by cells from naive, uninfected calves as well as by cells from cattle either infected with or recovered from infection with Theileria annulata or Theileria parva. PBMC of cattle undergoing tropical theileriosis (T. annulata infection) or East Coast fever (T. parva infection) synthesized NO spontaneously in vitro. NO was also induced when PBMC of immune, but not of naive, cattle were cultured with T. annulata macroschizont-infected cell lines. Macrophages alone were not stimulated to produce NO by such infected cells. In vitro establishment of macroschizont-infected cell lines was suppressed either by incubating sporozoites with S-nitroso-N-acetyl-DL-penicillamine (SNAP), a NO releasing molecule, prior to invasion of PBMC or by pulsing developing cultures of trophozoite-infected cells with SNAP. Proliferation of established macroschizont-infected cell lines was not affected by SNAP. Taken together with the well documented roles of NO in neurotransmission, vasodilatation, cell and tissue damage and immunosuppression, the results presented here indicate that NO may not only protect cattle against T. annulata and T. parva but, if produced in excess, play a prominent role in the pathogenesis of tropical theileriosis and East Coast fever.     

Pneumatosis Coli Associated with Sigmoid Volvulus and Colonoscopy

A case of interstitial emphysema involving the mesentery and serosa of the sigmoid colon after volvulus reduced by colonoscopy is presented. The case is reported as a form of pneumatosis intestinalis although it does not conform to the classical clinicopathologic picture of pneumatosis cystoides intestinalis. The infrequent occurrence of this condition in association with volvulus and/or colonoscopy is discussed.