Low-dose adrenocorticotropin test in patients with the acquired immunodeficiency syndrome.

Adrenocortical insufficiency is a serious complication of AIDS. Usually, integrity of the hypothalamo-pituitary-adrenal (HPA) axis in AIDS patients is assessed by measuring basal cortisol levels and cortisol response to 250 microg of ACTH. Recent studies suggest that a lower ACTH dose increases the sensitivity of the procedure. In the present study, we investigated the prevalence of adrenal hypofunction in AIDS patients using a low-dose ACTH test (1 microg), evaluated the clinical characteristics that might suggest this diagnosis, and the diseases and/or drugs that could be associated with it. We prospectively evaluated 63 very ill AIDS patients and 16 normal controls. A standard examination assessed the presence of signs and symptoms of adrenal insufficiency. Blood samples were collected before and 30 and 40 minutes after an injection of 1 microg 1-24 ACTH. No opportunistic disease, signs, symptoms or drugs were associated with an abnormal cortisol response to ACTH. The lowest stimulated cortisol level in the control group was 18.5 microg/dL; cortisol levels > or = 18 microg/dL were taken to indicate a normal HPA axis. Test results revealed that 12/63 AIDS patients (19%) had an abnormal HPA axis. With these data in mind, we suggest a prospective adrenal function evaluation of all severely ill AIDS patients.

Long-lasting effects of neonatal stimulation on the behavior of rats.

The present study aimed to analyze the effects of neonatal stimulation on species-specific behaviors (defensive reactions to a predator and social interactions) in adult male and female rats. Handling and an unpredictable sequence of aversive stimuli were applied to male and female pups from the 1st to the 10th day after delivery; behavioral inhibition, aggression, and sexual behavior were evaluated in adulthood. Results showed that either neonatal handling or aversive stimulation decreased behavioral inhibition in a novel and potentially harmful situation (open field with a predator) in both male and female rats and increased maternal aggressive behavior. Sexual behavior in both males and females decreased, which could affect reproductive capability. The results could cast doubts on the generalization of beneficial effects of neonatal stimulation on the behavior of adult rats.

Hypothalamic paraventricular nucleus modulates maternal aggression in rats: effects of ibotenic acid lesion and oxytocin antisense.

Central oxytocin (OT) appears to be crucial for maternal behavior. OT, through the parvocellular neurons of the hypothalamic paraventricular nucleus (PVN), can exert its physiological and behavioral effects by acting on OT receptors in nonpituitary projections of the PVN. The purpose of the present study was to analyze the role of the PVN and OT on maternal aggressive behavior in two different periods after delivery: on the fifth day (period of high aggressiveness) and on the eighteenth day postpartum (period of low aggressiveness). In the first experiment, ibotenic acid was injected into the PVN in order to lesion the parvocellular neurons. A second experiment was designed to study more specifically the effects of OT using the antisense technique. On the fifth day postpartum, both the PVN lesion by the ibotenic acid and a possible acute reduction of OT synthesis by the antisense administration in that nucleus increased maternal aggressive behavior, while on the eighteenth day postpartum no effect was recorded. We may conclude that central projections of the PVN modulate maternal aggression during a restricted period after delivery, only when lactating females show naturally high levels of aggressive behaviors.

Aversive stimulation during the stress-hyporesponsive period does not affect the number of corticotroph cells in neonatal male rats

Immunohistochemistry was used to evaluate the effects of neonatal handling and aversive stimulation during the first 10 days of life on the number of corticotrophs in the anterior lobe of the pituitary of 11-day-old male Wistar rats. Since adult rats handled during infancy respond with reduced corticosterone secretion in response to stressors and with less behavior inhibition in novel environments, we assumed that neonatal stimulation could affect pituitary morphology during this critical period of cell differentiation. Three groups of animals were studied: intact (no manipulation, N=5), handled (N=5) and stimulated (submitted to 3 different aversive stimuli, N=5). The percentage of ACTH-immunoreactive cells in the anterior lobe of the pituitary (number of ACTH-stained cells divided by total number of cells) was determined by examining three slices per pituitary in which a minimum of 200 cells were counted by two independent researchers. Although animals during the neonatal period are less reactive to stress-like stimulation in terms of ACTH and corticosterone secretion, results showed that the relative number of ACTH-stained cells of neonatal handled (0.25 + 0.01) and aversive stimulated (0.29 + 0.03) rats was not significantly different from intact (0.30 + 0.03) animals. Neonatal stimulation may have a differential effect on the various subpopulations of corticotroph cells in the anterior pituitary.

Hypothalamic paraventricular nucleus, oxytocin, and maternal aggression in rats.

Both the lesion of the parvocellular region of the PVN (FIG. 1) and the acute reduction of OT synthesis in that nucleus (FIG. 2) increase maternal aggression in rats. Previous work showed that ibotenic acid as well as the OT antisense in the PVN reduced the level of OT in the brainstem, but not in the pituitary. Therefore, the oxytocinergic parvocellular neurons of the PVN appear to exert an inhibitory effect on the aggressive behavior of the lactating female rat against an adult intruder. In a relationship of a different nature, mother-infant, a facilitatory effect of OT has been shown. Previous work showed a significant decrease of OT mRNA levels in the PVN of female rats during the first 10 days after delivery compared to late pregnancy, which is the inverse ratio of the natural temporal evolution of maternal aggressive behavior. Furthermore, in the present work, a functional decrease of OT mRNA was probably the effect of the antisense in the PVN. In conclusion, OT cells in the PVN appear to play different roles on maternal care and maternal aggression.

Sjögren's syndrome and vulvar cancer.

In the vulvar pathology surgery unit we have come across 3 patients with Sjögren's syndrome. Two of them also now show the presence of vulvar carcinoma, and one of them shows the presence of vulvar dystrophy with dysplasia. This has induced us to consider the possible connections between the 2 pathologies. All 3 of the patients, at different times and in different periods have been treated with steroids for the original disorder. The connections between the 2 affections are presumably to be found in the possible autoimmunitary genesis of the original disease and in the concomitant use of steroids.

Proposed classification of vulvar disorders observed most frequently in a vulvar pathology surgery unit.

An adequate and unified classification of vulvar pathology has been difficult and continues to be a problem hard to solve, due to the difficulties in including different clinical aspects in various pathological classes. The causes of this uncertainty, as rather a multiplicity of view points, may be ascribed in particular to the extreme polymorphic nature of vulvar pathology. Our classification, in attempting to overcome arbitrary and absolute distinctions in such a polymorphic and variable field, adopts an etiological and anatomo-histological criterium which distinguishes vulvar pathology in: primary disorders, secondary disorders. It is evidently important to know and distinguish possible vulvar infections, in order to be able to identify those disorders which assume an oncogenous risk, while trying to overcome the problems of differential diagnosis.