CSF somatostatin in affective illness and normal volunteers

Somatostatin is a hypothalamic tetradecapeptide with many central nervous system actions. We investigated a potential role for altered somatostatin activity in affective disorder by measuring somatostatin in the cerebrospinal fluid (CSF) of 47 patients with affective disorder and of 39 normal volunteers. Medication-free depressed patients showed significantly lower levels of CSF somatostatin than normal volunteers (p less than .001) or patients during the improved state (p less than .01). Somatostatin levels were significantly and inversely correlated with duration of sleep on the night of the lumbar puncture (p less than .05). Treatment with carbamazepine reduced CSF somatostatin (p less than .01) in contrast to the absence of effect of imipramine, desmethylimipramine, and lithium carbonate and the significant increase in CSF somatostatin seen in a small group of patients treated with zimelidine. The implications of these findings with respect to attempts to explore the neurobiology of depression are discussed.     

An antagonism between 5-hydroxytryptamine and norepinephrine in thermally responsive units in the rabbit hypothalamus

One hundred and eight single units in the preoptic anterior hypothalamic region were examined in 25 urethan-anesthetized rabbits in this study. When these units were classified by their thermal responsiveness, the proportions of thermallyunresponsive, warm-responsive, and cold-responsive units were 52.8, 38.9, and 8.3%, respectively, of the total units studied. The proportion of the thermally responsive units responding to intraventricular administration of both 5-hydroxytryptamine (5-HT) and norepinephrine (NE) was very high, from 78.6% of the warm-responsive units to 100% of the cold-responsive units. In no case did both 5-HT and NE affect the activity of the thermally unresponsive units tested. In addition, more than 52% of the total population of the warm-responsive units were depressed by NE but excited by 5-HT application. Twenty-six percent of the total population of the warm-responsive units displayed a different pattern; each unit was excited by NE but was depressed by 5-HT. The remainder (21.4%) showed no antagonism between these two amines. Furthermore, 66.7% of the total cold-responsive units showed an excitation in response to NE but an inhibition to 5-HT. The remainder (33.3%) of the cold-responsive untis showed inhibition to NE but excitation to 5-HT application. The data demonstrate that there exists an antagonism between 5-HT and NE in thermally responsive units in the rabbit hypothalamus.     

Pericardiectomy: Current Indications,Concepts, and Results in a University Center

During a 7½-year period, 102 patients underwent pericardiectomy in the Emory University Affiliated Hospitals for a wide variety of pericardial disease. Seventy-six patients had predominantly effusive pericardial disease, and 26 patients had constrictive pericarditis. Nineteen cases of constrictive pericarditis developed in patients who had undergone previous open-heart operations. Hospital mortality at six weeks was 8.8%. The surgical approach was a left anterior thoracotomy in 72 patients; median sternotomy in 26 patients; and a subxiphoid approach in 4 patients. Only 2 patients required cardiopulmonary bypass. A detailed discussion of each subgroup of patients with pericardial disease requiring pericardiectomy is given.     

Dysfunction of sarcoplasmic reticulum in rabbit and human steroid myopathy.

Experimental steroid myopathy was induced in rabbits by injections of triamcinolone acetonide. Sarcoplasmic reticulum was prepared from quadriceps muscle. Calcium-dependent ATPase activity decreased in the steroid-treated group. Calcium uptake and binding of sarcoplasmic reticulum were also reduced in the steroid-treated group. By the same methods, sarcoplasmic reticulum in human steroid myopathy was analysed. Again, decreased calcium-dependent ATPase activity, calcium uptake, and binding were revealed in steroid myopathy. These results are consistent with the view that the effects of glucocorticoid on skeletal muscle are mediated, in part, through its action on the calcium transport system.     

Spontaneous remission of Cushing's disease. A case report and review of the literature.

A 70 year old man whose severe Cushing's disease remitted spontaneously is described. Medical therapy was instituted as a temporary measure prior to planned adrenalectomy. The patient showed dramatic improvement during medication and has remained well for two and a half years following the discontinuation of drug therapy. The literature is reviewed for other cases of spontaneous resolution of Cushing's.     

Effects of cholinergic and dopaminergic agents on pain and morphine analgesia measured by three pain tests

The effects of several cholinergic and dopaminergic agents on pain and morphine analgesia were assessed using three pain tests. These tests--tail-flick, hot-plate, and Formalin--allow comparison of the effects of different noxious stimuli and different motor responses. Each pain test yielded a unique constellation of cholinergic and dopaminergic influences, suggesting that variation of stimulus and response parameters can change the functional expression of cholinergic and dopaminergic systems related to pain processing. Significant analgesia was observed in the Formalin test, compared with the saline control, after administration of choline (30 or 60 mg/kg), atropine (2 mg/kg), mecamylamine (2 mg/kg or 10 mg/kg), or apomorphine (0.3 or 8 mg/kg). No analgesic effects in this test were observed after atropine (10 mg/kg) or pimozide (0.125 or 0.5 mg/kg). In contrast, there was no evidence of analgesia produced by any of these drugs, in the doses given, in the hot-plate test, and only apomorphine (8 mg/kg) produced analgesia in the tail-flick test. When these cholinergic and dopaminergic agents were administered to rats after an injection of 2.5 mg/kg morphine, which by itself has been shown not to produce analgesia in any of the tests, a general pattern of facilitation was observed in the Formalin test but not in the tail-flick or hot-plate tests. Facilitation was produced by choline, atropine, mecamylamine, apomorphine, and pimozide (at 0.5 mg/kg but not 0.125 mg/kg). The data suggest that differences in the type of noxious stimulation and in the motor responses required in various pain tests are crucial in determining the observed pharmacologic profile of pain and opiate analgesia.     

Second laparotomy for proximal colon cancer. Sites of recurrence and implications for adjuvant therapy

Sixty-four patients with primary adenocarcinomas of the colon proximal to the peritoneal reflection underwent exploratory laparotomy at the time of first recurrence of their cancers. Local recurrence, retroperitoneal lymph node metastases, parenchymal liver metastases, and diffuse peritoneal seeding were identified as frequent components of the overall pattern of recurrence. The significance of these findings has been discussed herein, relative to refinements of operative technique and selection of appropriate adjuvant therapy.     

New criteria for computer interpretation of exercise electrocardiograms in a largely asymptomatic population

We developed new discriminant functions for analyzing treadmill ECGs from a largely asymptomatic population. Treadmill ECG data were gathered from two patient groups: 70 patients with coronary artery disease with occlusions ? 30% by angiography, and 138 patients without coronary artery disease. The group without coronary artery disease consisted of 76 false positive responders to treadmill testing using standard ST segment criteria, 22 supraventricular tachycardia patients (both groups free of coronary artery disease by angiography), and 40 patients at very low risk for having coronary artery disease. ECG leads CC5, CM5, V5, Yh and Z were recorded before, during and after exercise protocol conditions. Computer-averaged ECGs were processed to provide Q, R, S and T-wave amplitudes, ST amplitudes and slope, and QS and RT intervals. Each patient provided over 100 variables per lead for analysis. Stepwise statistical procedures yielded lead-specific linear discriminant functions containing four to six variables/lead. Application of these functions provided sensitivity and specificity in the range 70–84%. When compared with other standard interpretive criteria, these results provided improved diagnostic accuracy for the largely asymptomatic population.     

Low serum IgA in a familial ovarian cancer aggregate

Low serum IgA levels were found to segregate in a sufficient number of individuals from a familial ovarian carcinoma aggregate to suggest that this may be a genetically determined immune defect etiologically integral to cancer susceptibility in this family. The putative role of IgA in pathogenesis remains elusive. Cancer-prone families should be thoroughly investigated for further elucidation of these phenomena.