Secular trend in unipolar depression: a hypothesis

To address the observation of a secular trend in the incidence of major depression, we have evaluated prevalence of unipolar depression in first-degree relatives of unipolar depressed probands, all of whom were studied in the sleep laboratory. A threshold value of reduced (less than or equal to 65.0 min) or non-reduced (greater than 65.0 min) REM latency was used to define groups for both parents and siblings. Unipolar depression occurred at the same rate in both reduced REM latency siblings (57.1%) and parents (66.7%). Siblings with non-reduced REM latency had a higher rate of depression (36.8%) than non-reduced REM latency parents (0.0%). Implications for biological and environmental factors associated with liability for unipolar depression are discussed.     

Open surgical synovectomy of the knee in rheumatoid arthritis

Surgical Principles Although there has been an increase in the popularity of less invasive methods of synovectomy such as radiation synovectomy and arthroscopic synovectomy the open operation remains the procedure of choice in the management of severe synovitis of the knee joint even quite late in the disease process. Removal of all the chronically inflamed synovial tissue does seem to control the disease at a local level in the majority of cases. The operation should not be performed in a grossly destroyed joint with significant bone loss from the articular surfaces.     

Peripheral projections of a subpopulation of dorsal root ganglion neurons defined by ovalbumin immunoreactivity

Summary Previous studies from this laboratory have used antisera to aldehyde-conjugated ovalbumin to localize ovalbumin-like immunoreactivity within a subpopulation of sensory neurons. We have now combined retrograde tracing and immunohistochemical procedures to identify the tissues innervated by sensory neurons which are either immunoreactive or non-immunoreactive for ovalbumin. The fluorescent tracer Di-I was administered to feather follicles, flexor ulnar muscle, subdermis, expansor secundariorum, heart and liver and identified seven days later within corresponding dorsal root ganglia. Most neurons innervating the follicles had large cell somata, and fewer than 3% were immunoreactive for ovalbumin. In contrast, most sensory neurons projecting to subdermis, muscle and expansor secundariorum muscle were of a medium diameter. Approximately 25% of those neurons projecting to the expansor secundariorum, and 60% projecting to the subdermis and muscle, were immunoreactive for ovalbumin. Sensory neurons innervating heart and liver were the smallest, and only 8% were immunoreactive for ovalbumin. The study indicates that sensory neurons innervating different organs have somata with significantly different sizes, suggesting a functional specificity. Moreover, neurons demonstrating either the ovalbumin-IR positive or negative phenotypes show distinct peripheral projections, suggesting that this phenotype may be at least partially controlled by retrograde signals derived from the cells they innervate.     

Dedicated coil for carotid MR angiography

A magnetic resonance imaging coil was developed to improve contrast in direct coronal and sagittal time-of-flight carotid angiograms. The sensitive volume of the coil extends from the carotid origins to the siphons. Angiographic contrast can be optimized for an arterial segment of interest by repositioning the coil to minimize presaturation of blood before it enters the segment.     

Neurotrophin 3 is increased in the spontaneously hypertensive rat.

OBJECTIVE: To determine whether the noradrenergic sympathetic hyperinnervation in the spontaneously hypertensive rat (SHR), a genetic model of essential hypertension, is associated with changes in neurotrophin 3 (NT3) concentrations. METHODS: NT3 levels were measured using a sensitive enzyme-linked immunosorbent assay (ELISA) in the superior cervical ganglia (SCG), heart, mesenteric artery (MA) and blood of postnatal and mature SHR and normotensive Wistar-Kyoto (WKY) rats. RESULTS AND CONCLUSIONS: NT3 levels in SHR are significantly higher in the SCG during the first 4 postnatal weeks, and in the heart and MA from 2 to 10 weeks of age, compared with levels in WKY rats. The elevated NT3 found in the sympathetic ganglia and hyperinnervated organs of SHR indicates that NT3 may play an important role in the development of hyperinnervation, possibly by enhancing the survival and/or nerve sprouting of sympathetic neurons.     

Influenza in patients with human immunodeficiency virus infection

Although patients infected with human immunodeficiency virus (HIV) might be expected to have more severe illness due to influenza virus infection than normal persons, the course of influenza in such patients has not been well delineated. We describe six consecutive HIV-infected patients at San Francisco General Hospital in whom influenza virus was isolated from induced sputum or bronchoalveolar lavage specimens between December 1988 and March 1989. Although neither clinical presentation of influenza nor rate of secondary complications appeared to be altered from that in healthy individuals, our power of comparison was limited by small sample size. However, a high prevalence of hypoxemia and a trend toward prolonged duration of illness were identified. Larger, controlled studies are needed to define the course of influenza virus infection in HIV-infected patients as compared with nonimmunosuppressed patients.     

Management of the waiting list for cadaveric kidney transplants: report of a survey and recommendations by the Clinical Practice Guidelines Committee of the American Society of Transplantation.

The Clinical Practice Guidelines Committee of the American Society of Transplantation developed a survey to review the policies of kidney transplant programs in the United States with respect to the management of the steadily expanding waiting list for cadaveric kidneys. The survey was sent to 287 centers, and 192 (67%) responded. The survey indicated that regular follow-up monitoring, most frequently on an annual basis, is required by the majority (71%) of programs. Patients considered to be at high risk and candidates for combined kidney-pancreas transplantation may be monitored more frequently. Annual screening for coronary artery disease is typically required for asymptomatic patients considered to be at high risk for covert disease. Noninvasive techniques are typically used, and a designated cardiologist is usually available to the transplant program. The dialysis nephrologist or the potential transplant recipient is expected to inform the transplant program of intercurrent events that may affect transplant candidacy. Standard health maintenance screening is required, together with the routine updating of serologic and other blood tests that may be relevant to the posttransplant course. Smaller transplant programs (<100 patients on the waiting list) are more likely to maintain closer contact with the wait-listed patients and to attempt to influence their treatment during dialysis and are less likely to cancel transplants because of unanticipated pretransplant medical problems. The work load necessitated by the follow-up monitoring of wait-listed patients was assessed and, in the absence of specific evidence-based information, a series of recommendations were developed to reflect current standards of practice and to suggest future research initiatives.     

11β-HYDROXYSTEROID DEHYDROGENASE TYPE I ENZYME IN THE HEARTS OF NORMOTENSIVE AND SPONTANEOUSLY HYPERTENSIVE RATS

1. The enzyme 11β-hydroxysteroid dehydrogenase (11βHSD) converts glucocorticoids to their inactive 11-keto metabolites. The ubiquitous expression of the NADP-dependent isoform (11βHSD1) suggests an important role in modulating glucocorticoid action, but little is known about 11βHSD1 gene expression and enzymatic activity in the rat heart. 2. In the present study rat cardiac 11βHSD1 activity and ontogeny of gene expression have been characterized. The addition of NADP, but not NAD, to heart homogenates resulted in significant increases in the metabolism of both corticosterone and cortisol, with the former substrate displaying far greater metabolism. Both 11βHSD1 gene expression and enzyme activity increased in parallel from low levels at 1 week of age to maximal levels at 8 weeks, with no further change by 16 weeks of age. 3. We also compared theactivity of 11βHSD1 in the hearts of male and female spontaneously hypertensive rats (SHR) with normotensive Wistar-Kyoto (WKY) controls. Enzyme activity in the pooled atria of female SHR was significantly higher than in male SHR atria (7.6±0.6% conversion of corticosterone vs 4.5±0.5%; P < 0.05). The left ventricles of female WKY rats contained significantly less 11βHSD activity than either male WKY rats or female SHR (8.6±0.8% conversion vs 17±1.4 and 13.6±0.5%, respectively; P < 0.05). In the right ventricle, female WKY rats also had significantly less enzyme activity than either female SHR or male WKY rats (4.9±0.7 vs 10.0±1.7 and 10.2±1.4%; P<0.05). 4. These results clearly show that the rat heart contains significant amounts of the 11βHSD1 enzyme and that this activity is sexually dimorphic. Furthermore, significant differences were observed between a normotensive and hypertensive strain of rat. The relevance of these observations to the aetiology and maintenance of hypertension remains to be explored.