Effect of selenium on glutathione metabolism. Induction of gamma-glutamylcysteine synthetase and glutathione reductase in the rat liver

The effect of sodium selenite (Na₂SeO₃, Se) on cellular glutathione metabolism was examined, particularly with respect to its ability to alter the activities of γ-glutamylcysteine synthetase and glutathione disulfide (GSSG) reductase. The treatment of rats with Se (5, 10 and 20 μmoles/kg) caused time- and dose-dependent increases in the activities of the synthetase and the reductase in the liver. The activity of γ-glutamylcysteine synthetase, the rate-limiting enzyme of the glutathione (GSH) biosynthesis, was particularly susceptible to Se treatment. The Se-mediated increases in the activities of the above enzymes were inhibited by puromycin and the increases could not be elicited in vitro. Selenium treatment caused time-dependent perturbations in the levels and ratio of GSSG and GSH in the liver. When compared to the control animals, rats treated for 3 hr with 10 and 20 μmoles Se/kg showed increased cellular levels of GSSG; in contrast, 24 hr after Se treatment the concentration of GSH was increased significantly. The activity of γ-glutamyl transpeptidase, which catalyzes the initial reaction in GSH breakdown, was unaltered by Se treatment. Repeated administration of low doses of Se (7.0 μmoles/kg, three times) also increased the activities of the reductase and the synthetase as well as the cellular levels of hepatic GSH and GSSG. It is suggested that the Se-mediated increases in the activities of γ-glutamylcysteine synthetase and GSSG-reductase represent cellular responses to Se-mediated perturbations in the levels and ratio of GSH and GSSG.     

Autotomy following limb denervation: effects of sparing selected afferents

Lesions of the brachial plexus are often followed by inflammation, self-inflicted scratching and autotomy of the denervated extremity. If innervation of the shoulder girdle muscles was spared, this denervation syndrome was decreased in incidence and intensity as compared to a full brachial plexus section. Spared innervation increased the latency between the appearance of inflammation and autotomy, revealing a strong linkage between the site of inflammation and the site of autotomy attack. Plexus lesions, which spared one of the nerves of the distal limb, also decreased the incidence and intensity of autotomy and shifted self-attack from autotomy to scratching wounds. Subsequent section of this nerve produced a two-stage brachial plexus denervation, and the cumulated autotomy was markedly less than that produced by a single-stage brachial plexus denervation. Scratching wounds and autotomy exhibited similar latencies. Scratching was directed towards areas of partial innervation and autotomy towards areas of total denervation. The results are discussed in terms of the possible contributions of dysesthesia inflammation and ischemia in scratching behavior and autotomy.     

World's smallest combined en bloc liver‐pancreas transplantation

We present a case of a 2‐year‐old child who underwent a combined en bloc liver and pancreas transplant following complications of WRS. WRS is characterized clinically through infantile insulin‐dependent diabetes mellitus, neutropenia, recurrent infections, propensity for liver failure following viral infections, bone dysplasia, and developmental delay. Usually, death occurs from fulminant liver and concomitant kidney failure. Few cases with WRS are reported in the literature, mostly from consanguineous parents. To the best of our knowledge, combined en bloc liver and pancreas transplant has not been performed in small children.     

Consultation-Liaison outpatient clinics

This paper describes the history of the provision of psychiatric services to outpatients in general (medical) hospitals in the United States. It also reviews the rationale for the development of consultation-liaison psychiatric clinics that have been created to meet the psychiatric needs of these patients. Results of a random survey of current consultation-liaison psychiatry outpatient clinics are presented and recommendations are made for a model outpatient clinic.     

Acquired Immune Deficiency Syndrome (AIDS) and consultation-liaison psychiatry

Acquired Immune Deficiency Syndrome (AIDS) is a new highly lethal transmissible syndrome that occurs primarily in identified high-risk groups. The number of AIDS cases has been doubling approximately every 6 months in the United States since 1981. A large number of healthy HTLV-III seropositive individuals, and a significant number of individuals with AIDS-related complex (ARC), who are at increased risk for eventual development of AIDS, have been identified. At least one third of AIDS patients develop neurologic disease prior to death. Organic mental disorders are frequent in AIDS and can have devastating consequences. Severe psychologic distress and functional psychiatric syndromes are also common. The psychosocial effects of AIDS for patients, family and friends, and health-care professionals are discussed in relationship to the psychosocial consequences of other serious medical illnesses including cancer. An ideal comprehensive program to meet the needs of “AIDS affected” individuals is presented, as are the authors' views on the tasks of C-L psychiatrists in participating in the comprehensive care of these individuals.     

Circannual variations in the B cell/T cell ratio in normal human peripheral blood

In previous studies we have shown that B cells and subpopulations of T cells can be identified in blood smears with bacteria used as markers that bind spontaneously to lymphocytes. We have also identified Ig-bearing cells by using an Escherichia coli coated with anti-human Ig antibody. Here we determined the absolute values and the percentage of B cells and of other lymphocyte subpopulations in the peripheral blood of six normal donors every 2 mo for 1 yr. We found that the total leukocyte counts and the total number of lymphocytes remained unchanged throughout the year, whereas the percentage of B cells in the coldest month was at almost twice the level observed in summer. The percentage of cells that bind Arizona hinshawii and Salmonella schottmülleri remained practically unchanged during the entire year. A variation was noted in the ratio between T₁ and T₂ cells, which also appears to be seasonally related. We speculate that hormonal factors, probably corticosteroids, are responsible for changes in the traffic of some lymphocyte subpopulations.     

Autotomy following limb denervation: Effects of previous exposure to neurectomy

Neurectomy, dorsal rhizotomy or spinal cord lesions can evoke self-attack and autotomy of portions of insensate limbs. This behavior has been attributed to dysesthesia and/or pain. However, the majority of animals subjected to these lesions do not exhibit self-mutilation. This study was designed to test for individual predisposition to self-mutilative behaviors by effecting two sequential limb denervations.In susceptible animals, denervation of the first limb induced circulatory, trophic and inflammatory reactions and/or autotomy. Inflammation developed slowly in one or two digits of some animals and then spontaneously resolved. Other animals attacked the tips of inflamed digits effecting local autotomy. Still other animals aggressively attacked multiple digits, rapidly developed diffuse inflammation and produced extensive autotomy.Denervation of a second limb, following complete healing of all tissue injury, induced by the first denervation, produced several dramatic responses. Nearly 90% of those responding with autotomy to the first denervation responded with autotomy to the second denervation. In contrast, only 11% of the non-attackers showed autotomy following the second denervation. The inflammatory and autotomy responses to the second denervation were markedly reduced in latency and increased in intensity. The pattern of autotomy was stereotyped, initiated at the digit tips, progressed proximally, lead by advancing inflammation. It is suggested that a strong host-response component is involved in the autotomy response.     

Hypoalgesia induced by the local injection of phentolamine in the nucleus raphe magnus: blockade by depletion of spinal cord monoamines

Blockade of the noradrenergic input to the nucleus raphe magnus (NRM) by the injection of alpha-adrenergic antagonists produces hypoalgesia. Previous studies show that this hypoalgesia is blocked by the intrathecal injection of either phentolamine or methysergide. The present study demonstrates that depletion of spinal cord serotonin, norepinephrine, or both also blocks this hypoalgesia. Together these studies suggest that the hypoalgesia produced by microinjection of noradrenergic antagonists in the NRM is mediated by the activation of both raphe-spinal serotonergic neurons and bulbospinal noradrenergic neurons.     

Wide local excision in the treatment of vulvar carcinoma in situ: a reappraisal

A retrospective study of 56 patients treated for carcinoma in situ of the vulva over a 24-year period has shown a relative increase in the occurrence of this neoplasm. Only 6.7% of patients in the first 14 years of the study period were less than 35 years of age, as compared with 29.3% in the last decade. In the earlier years of the study, simple vulvectomy was the primary treatment, and 81.3% of the patients were disease-free at 5 years. Wide local excision, used in the later years, resulted in a rate of 46.2% with no evidence of disease. Involvement of surgical margins played a significant role in this increased incidence of recurrence. Only one patient, originally treated by simple vulvectomy, later developed early stromal invasion. A wide local excision technique should be strongly considered as initial management of this multifocal neoplasm. Close follow-up is mandatory. Recurrence of disease may be treated with appropriate wide excision.     

The role of adenoviruses in the pertussis syndrome.

To define the role of adenoviruses in the pertussis syndrome, a study was done of a group of 134 children with clinical pertussis and a healthy control population of similar age, race, sex, and socioeconomic status. Adenovirus infections occurred in 30 (22.4%) of 134 patients with the pertussis syndrome and 5 (4.9%) of 101 control subjects (p smaller than 0.001). B. pertussis was recovered from 46 (34.3%) patients, and from 18 (39.1%) of these patients adenoviruses were also isolated. Although adenovirus infections also occurred in patients with the pertussis syndrome with negative cultures for B. pertussis, the rate, 12 of 88 patients (13.6%), was significantly lower (p smaller than 0.001). The clinical course was similar irrespective of the results of bacterial or viral cultures. These data substantiate the frequent association of adenoviruses with the pertussis syndrome, It would appear that adenoviruses do not usually have an independent role in the pathogenesis of the pertussis syndrome since we found them so commonly to be one agent in a mixed infection.