Insulin-mediated hypoglycaemia secondary to recurrent clear cell renal carcinoma.

Renal cell carcinoma has previously been associated with hypoglycaemia in the setting of non-islet cell tumours, caused by a paraneoplastic phenomenon relating to the production of insulin-like growth factor type II. We present a case of recurrent clear cell renal cell carcinoma, leading to an insulin-mediated paraneoplastic phenomenon causing severe recurrent hypoglycaemia. Hypoglycaemina was managed successfully using diazoxide therapy, in conjunction with pazopanib and radiotherapy to reduce tumour burden.

Morphine or bupivacaine in controlling postoperative pain in patients subjected to knee joint arthroscopy.

Background. We investigated the efficacy of intra - articular bupivacaine with morphine administration after knee joint arthroscopy.
Material and methods. The present study compared intra- arthicular bupivacaine with intra-arthricular morphine for postoperative analgesia in 56 patients (21 women, 35 men) (age 20-70, mean 39.8) undergoing knee joint arthroscopy.
Intraoperatively, the patients received anaesthesia spinaly (0.5 % Marcaine spinal ASTRA) and immediately following surgery received 10 ml intra-arthricular injection consisting either of 0.5 % bupivacaine (group I), 5 mg morphine + 0.9 % saline (group II).Postoperative analgesia was supporeted by intravenous doses of proefferalgan.
In all patients the visual analogue pain score (VAS), PaO2, systolic blood preassure (SABP), diastolic blood preassure (DABP), heart rate (HR), respiratory rate (f), supplemented analgesia and possible side effects were monitored postoperatively.
Results. Intra-arthricular administration of each solution was well toleratede and non side effects were noted.
There was non significant difference among the two groups in monitored parameters. The mean time of postoperative analgesia was 185,7 +/- 25.3 min for bupivacaine group and 390.3 +/- 35,4 min for morphine group.
Total amount proefferalgan supplamentation was the highest in group I.
Conclusions. Postoperative intra- arthricular injections of bupivacaine and morphine for patients undergoing knee joint arthroscopy can provide a safe and effective analgesia and therefore shound be recommended and widely implamented into the clinical use as a standard procedure.

[Evaluation of late results for surgical treatment of chronic lateral epicondylitis]. / Ocena odleglych wyników leczenia operacyjnego przewleklego zapalenia nadklykcia bocznego kosci ramiennej.

The results of surgical treatment of 25 patients with lateral epicondytilis (tennis elbow) were analysed. The mean time before surgery was 2 years and 4 months. The patients' negative attitude towards surgery and the prolonged conservative treatment by general practitioners were the reasons for such a long period of ineffective conservative procedures. Following Hohmann's surgery the flexion in elbow joint and dorsal flexion in radio-carpal joint limitation were the most common residual impairments. The loss of muscle circumference of the operated extremity was observed in 10 (40%) patients. Pain subsided in 20 (80%) and numbness in 11 (44%) patients. Two third of the patients were satisfied with the surgery outcome This moderately good general outcome was probably due to the prolonged time passed since the onset of symptoms and repeated local steroid injections. The majority of manual workers returned to their work.

[The use of the Richard's dynamic hip screw and hip Zespol fixator in the treatment of proximal femoral fracture]. / Zastosowanie sruboplytki Richardsa i stabilizatora biodrowego Zespol w leczeniu zlaman blizszego konca kosci udowej.

A series of 49 patients (27 females, 22 males) aged 24-82 operated on due to proximal end of the femur fracture between 1990 and 1995 were included in this study. There were 23 femoral neck fractures and 26 trochanteric fractures. DHS was used in 35 patients and Zespol hip fixator in 14 cases. Good results have been achieved in 85.7%. Neither method proved superior to the other. Poor results occurred in subcapital neck fractures. DHS seems to offer advantage in trochanteric fractures and Zespol method in femoral neck fractures.

Maternal IL-11Ralpha function is required for normal decidua and fetoplacental development in mice.

In eutherian mammals, implantation and establishment of the chorioallantoic placenta are essential for embryo development and survival. As a maternal response to implantation, uterine stromal cells proliferate, differentiate, and generate the decidua, which encapsulates the conceptus and forms the maternal part of the placenta. Little is known about decidual functions and the molecular interactions that regulate its development and maintenance. Here we show that the receptor for the cytokine interleukin-11 (IL-11Ralpha) is required specifically for normal establishment of the decidua. Females homozygous for a hypomorphic IL-11Ralpha allele are fertile and their blastocysts implant and elicit the decidual response. Because of reduced cell proliferation, however, only small deciduae form. Mutant deciduae degenerate progressively, and consequently embryo-derived trophoblast cells generate a network of trophoblast giant cells but fail to form a chorioallantoic placenta, indicating that the decidua is essential for normal fetoplacentation. IL-11Ralpha is expressed in the decidua as well as in numerous other tissues and cell types, including the ovary and lymphocytes. The differentiation state and proliferative responses of B and T-lymphocytes in mutant females were normal, and wild-type females carrying IL-11Ralpha mutant ovaries had normal deciduae, suggesting that the decidualization defects do not arise secondarily as a consequence of perturbed IL-11Ralpha signaling defects in lymphoid organs or in the ovary. Therefore, IL-11Ralpha signaling at the implantation site appears to be required for decidua development.

The mouse Gtl2 gene is differentially expressed during embryonic development, encodes multiple alternatively spliced transcripts, and may act as an RNA.

We have isolated a novel mouse gene (Gtl2) from the site of a gene trap integration (Gtl2lacZ) that gave rise to developmentally regulated lacZ expression, and a dominant parental-origin-dependent phenotype. Heterozygous Gtl2lacZ mice that inherited the transgene from the father showed a proportionate dwarfism phenotype, whereas the penetrance and expressivity of the phenotype was strongly reduced in Gtl2lacZ mice that inherited the transgene from the mother. Gtl2 expression is highly similar to the beta-galactosidase staining pattern, and is down-regulated but not abolished in mice carrying the Gtl2lacZ insertion. In early postimplantation embryos, Gtl2 is expressed in the visceral yolk sac and embryonic ectoderm. During subsequent development and organogenesis, Gtl2 transcripts are abundant in the paraxial mesoderm closely correlated with myogenic differentiation, in parts of the central nervous system, and in the epithelial ducts of developing excretory organs. The Gtl2 gene gives rise to various differentially spliced transcripts, which contain multiple small open reading frames (ORF). However, none of the ATG codons of these ORFs is in the context of a strong Kozak consensus sequence for initiation of translation, suggesting that Gtl2 might function as an RNA. Nuclear Gtl2 RNA was detected in a temporally and spatially regulated manner, and partially processed Gtl2 transcripts were readily detected in Northern blot hybridizations of polyadenylated RNA, suggesting that primary Gtl2 transcripts are differently processed in various cell types during development. Gtl2 transcript levels are present in parthenogenic embryos but may be reduced, consistent with the pattern of inheritance of the Gtl2lacZ phenotype.

Two differentially expressed interleukin-11 receptor genes in the mouse genome.

Interleukin-11 (IL-11) is a multifunctional cytokine involved in the regulation of cell proliferation and differentiation in a variety of cell types and tissues in vitro and in vivo. The effects of IL-11 were shown to be mediated by the IL-11 receptor (hereafter referred to as IL-11 R alpha), which is a ligand-binding subunit and provides ligand specificity in a functional multimeric signal-transduction complex with gp130. Here we show that the mouse genome contains a second gene encoding an IL-11-binding protein, referred to as IL-11R beta. The structure of the IL-11R beta gene is highly similar to that of IL-11R alpha, and IL-11R beta exhibits 99% sequence identity with IL-11R alpha at the amino acid level. IL-11R beta is co-expressed with IL-11R alpha, albeit at lower levels, in embryos and in various adult tissues. IL-11R beta transcripts are abundant in testis, and, in contrast with IL-11R alpha, absent from skeletal muscle. IL-11R beta expressed in vitro binds IL-11 with high affinity, suggesting that the mouse genome contains a second functional IL-11R.

Molecular cloning and characterization of the human interleukin-11 receptor alpha-chain gene, IL11RA, located on chromosome 9p13.

The human gene coding for the interleukin-11 receptor (IL11RA) was cloned and its structure analyzed. The gene is composed of 13 exons comprising nearly 10 kb of DNA that was completely sequenced. The intron-exon boundaries were determined based on the mouse Etl2 and interleukin-11 receptor cDNAs that were recently cloned. The protein sequence predicted by the human gene was over 83% identical with its murine counterpart, with very strict conservation of functionally important domains and signatures. Fluorescence in situ hybridization showed the gene to be located on human chromosome 9p13, syntenic with the mouse etl2 gene on chromosome 4. The coding exons of the Interleukin-11 gene were sequenced in a patient with the cartilage-hair hypoplasia syndrome, which has been linked to a gene on chromosome 9, but no functional mutations were detected.

Interactions between atrial natriuretic factor (ANF) and thyrotropin or somatostatin in their effects on thyroid growth processes; studies in vitro and ex vivo in vitro.

The goal of our present study has been to examine the effects of the atrial natriuretic factor (ANF) on the growth processes in rat thyroid lobes. In the initial in vitro experiment, thyroid lobes were preincubated with rat ANF (Sigma) for 30 min in RPMI 1640 medium with 3H-thymidine (2 microCi/ml), and later on 15% fetal calf serum (FCS), Hepes buffer and the remaining tested substances [TSH 20 mIU/ml, somatostatin (SS) 10(-7)M] were added. Preincubations with ANF were not conducted in the controls and in the group exposed to TSH alone. Incubations of all the examined groups (controls, TSH alone, ANF alone, ANF together with TSH or ANF together with SS) with 3H-thymidine were carried out for 4 hours. We obtained the following results: at none of the examined concentrations (10(-5)M, 10(-7)M, 10(-9)M), did ANF significantly affect the rate of 3H-thymidine incorporation in vitro. Neither did TSH alone nor ANF with TSH jointly significantly influence the process in question. However, we observed increased rates of the 3H-thymidine uptake, following the joint exposure of thyroid lobes to ANF (10(-7)M or 10(-9)M) and SS (10(-7)M), when compared to ANF alone. In the ex vivo in vitro experiment, direct intrathyroidal microinjections of ANF alone or jointly with TSH or SS, were carried out. Twenty four (24) hours after the microinjections, all the animals were sacrificed by decapitation, the thyroid lobes being collected and incubated for 4 hours with 3H-thymidine (2 microCi/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Etl2, a novel putative type-I cytokine receptor expressed during mouse embryogenesis at high levels in skin and cells with skeletogenic potential.

The regulatory effects of signaling proteins like hormones, growth factors, and cytokines are mediated by specific cell surface receptors which are grouped into distinct families on the basis of structural criteria. Here we report on the isolation and embryonic expression of a novel mouse gene, Etl2 (enhancer trap locus 2) which, based on its deduced amino acid sequence, constitutes a new member of the cytokine type-I receptor family. Among type-I receptors Etl2 is most similar to the alpha subunits of the human ciliary neurotrophic factor (CNTF) receptor and the mouse interleukin-6 (IL6) receptor with 32 and 30% identical amino acids, respectively. From Day 9 p.c. (postcoitum) onward low levels of Etl2 mRNA were detected in mesenchymal cells throughout the embryo and in parts of the nervous system, in particular in the ependymal linings of the spinal cord and the developing brain vesicles and in the neuronal layer of the retina. Highest levels of Etl2 expression were found on Day 12.5 p.c. in the craniofacial mesenchyme and during subsequent development in mesenchymal cells around all developing cartilages. At later stages, Etl2 transcripts were abundant in the dental papilla, the dermis, and hair follicles, as well as in the perichondrium and periost, i.e., in regions containing chondro and osteo progenitor cells. Etl2 mRNA was not detected, however, in mature odontoblasts, chondroblasts, osteoblasts, chondrocytes, and osteocytes. Our results suggest that Etl2 is a new orphan receptor belonging to the type-I cytokine receptor family and that Etl2 might have regulatory functions, particularly in the control of proliferation and/or differentiation of skeletogenic progenitor and other mesenchymal cells.

Occurrence of goitre in relation to iodine deficiency in school children in Lódz City, the Lódz metropolitan area and in Piotrków, Sieradz, Plock, Wloclawek, Radom and Skierniewice Voivodships (Lódz coordinating center).

This paper presents the results of studies performed within the Applied Project of the Ministry of Health and Social Welfare and of the Committee for Scientific Research: "Studies on Iodine Deficiency in Poland", including the school children in Lódz City and seven voivodships of the Central Poland. According to the results, the analyzed regions can be regarded as areas of goitrous endemia of a moderate degree (the goitre was found in 32.7% of examined population); the same regions can also be classified among the regions of mild iodine deficiency (the mean iodide concentration in urine was 64.0 micrograms/l). The obtained results prove the to-date's iodine prophylaxis to be not entirely efficient in the areas of interest, demanding an effective model of iodine complementation in diet to be designed.

[Axial spondylometer--a device for measurement of the configuration and mobility of the spine in three planes]. / Spondylometr osiowy--przyrzad do pomiaru uksztaltowania i sprawnosci ruchowej kregoslupa w trzech plaszczyznach.

A method of triplanar assessment of the configuration and mobility of the spine with the use of the original axial spondylometer is described. The device allows to present mobility in the plane of two perpendicular axes X and Y in new categories: elasticity, susceptibility and deshaping of the spine.

[Spondylometric assessment of the configuration and flexion-extension mobility of the spine in students]. / Spondylometryczna ocena uksztaltowania i gibkosci zgieciowo-przeprostnej kregoslupa studentów.

An original method of assessment of the configuration and mobility of the spine in the sagittal plane with the use of axial spondylometer allowed reproducible and more objective evaluation of the spinal movement then previously employed methods. A qualitatively new assessment of the spinal mobility was achieved due to the introduction of mathematical indicators of elasticity, susceptibility and reshaping of the spine. The evaluation of the spinal range of motion in 167 students indicated prominent sexual dimorphism. The elasticity and flexion reshaping indicators in males exceeded of 17.6% and 21.6% respectively the females ones. The circular mobility of the spine greater then its distensibility is characteristic for males. In both sexes flexion surpasses extension of the spine from 157% to 215%.