Minimal immunoreactive plasma beta-endorphin and decrease of cortisol at standard analgesia or different acupuncture techniques.

BACKGROUND AND OBJECTIVE: Acupuncture has been claimed to be associated with activation of the endogenous antinociceptive system. The analgesic effects of acupuncture have been ascribed to beta-endorphin interacting with opioid receptors. However, firstly, the release of beta-endorphin into the blood has been proven to be induced by stress, i.e. under dysphoric conditions, and, secondly, if released under stress, beta-endorphin has been shown not to be analgesic. Our aim was to test whether beta-endorphin immunoreactive material is released into the cardiovascular compartment during acupuncture comparing the most frequently used types of acupuncture with standard pain treatment under apparently low stress conditions. METHODS: This prospective study included 15 male patients suffering from chronic low back pain. beta-Endorphin immunoreactive material and cortisol were measured in the plasma of patients who underwent, in random order, therapy according to a standard pain treatment, traditional Chinese acupuncture, sham acupuncture, electro acupuncture and electro acupuncture at non-acupuncture points before, at and after the treatment. Statistical analysis was performed using two-way ANOVA with repeated measures. RESULTS: A decrease in plasma cortisol concentration measured over the five treatment protocols was highly significant (P < 0.001). The beta-endorphin immunoreactive material concentrations in plasma were minimal at all times and in all treatment conditions. The influence of treatments by various acupuncture procedures on cortisol and beta-endorphin immunoreactive material plasma concentrations over the three time points was not significantly different. CONCLUSIONS: beta-endorphin immunoreactive material in blood is not released by any type of acupuncture as tested under low stress conditions.

Olfactory function in patients with olfactory groove meningioma.

OBJECTIVES: Olfactory meningiomas are rare benign tumours and represent about 12% of all basal meningiomas. Anosmia is thought to be among the first symptoms, even though patients often present with headaches or visual problems. However, so far no detailed psychophysical tests of olfactory function have been performed in a large number of those patients. METHODS: Twelve patients (five men, seven women; mean age 52 years) with olfactory meningiomas were examined. In all patients extensive preoperative and postoperative lateralised olfactory testing was performed using the "Sniffin' Sticks" test battery, a psychometric testing tool. In eight cases the meningioma was lateralised (five left, three right), in four patients a bilateral meningioma was found. In addition to a detailed ear, nose, and throat examination MRI was performed in all patients. RESULTS: In preoperative testing six patients were found to be anosmic on the side of the tumour, two were hyposmic. Four patients were normosmic. Postoperative investigations showed lateralised anosmia in four patients on the operated side, three were normosmic on the contralateral side and one hyposmic. The remaining eight patients were completely anosmic postoperatively. CONCLUSIONS: (1) Contrary to expectations, olfactory testing seems to be of little help in detecting olfactory meningiomas. (2) The likelihood of normal postoperative olfactory function contralateral to the tumour was high when the tumour was less than 3 cm in diameter and preoperative normosmia had been established. (3) Preservation of olfactory function ipsilateral to the tumour seems to be extremely difficult, irrespective of tumour size or surgical approach.

[Anosmia caused by inhaled hazardous substances. Significance for expert assessment general practice]. / Riechstörungen durch inhalative Schadstoffexposition. Bedeutung für die gutachterliche Praxis.

BACKGROUND: Both environmental and occupational pollutants can affect the functional integrity of the olfactory epithelium or even destroy olfactory tissue. However, occupational hyposmia and anosmia have not been included into the list of occupational diseases. Therefore, compensation of occupationally induced smell disorders is difficult. OBJECTIVE: To evaluate patients with toxic hyposmia for the pollutants involved and to discuss consequences for occupational and environmental medicine. METHODS: A total of 19 patients were evaluated in our departments between 1993 and 1997 for olfactory disorders related to environmental or occupational pollutants. The charts of these patients were retrospectically analyzed and the causative pollutants compared with the literature. RESULTS: A chronical exposure to mixtures of metal dusts and steam, volatile organic substances, and anorganic gases were the most common pollutants involved in occupational dysosmia. Only one case of acute development of an anosmia due to exposure to CO and combustion gases was documented. CONCLUSIONS: Olfactory disorders are underestimated in occupational and environmental medicine. Relevance of olfactotoxic substances for occupational medicine can be postulated in metal and chemical workers, in welding and disinfection. The list of occupational diseases should be completed by olfactory hyposmia and anosmia.

Comparison of olfactory function in patients with seasonal and perennial allergic rhinitis.

Hyposmia is a common symptom in allergic rhinitis. However, little is known about differences in the olfactory function of patients with seasonal or perennial allergy. A prospective controlled study was performed on 28 patients with allergic rhinitis to grass pollen and on 47 patients with allergic rhinitis to mites. Sixty-six healthy volunteers served as a control. Olfactory function was evaluated by a modified Connecticut Chemosensory Clinical Research Center testing procedure for threshold, identification, and discrimination. The grass pollen-allergic patients were tested preseasonally and after 3 weeks of intraseasonal grass pollen exposure; the mite-allergic patients and the volunteers were tested once. In the mite allergics, olfactory threshold, identification, and discrimination tests were significantly worse than in the volunteers (all P < 0.0001). In the grass pollen allergics, the results in olfactory identification and discrimination tests were not different from the controls if tested out of the season (both P > 0.05). However, in threshold testing (P = 0.0139), the results were worse. Intraseasonally, the grass pollen allergics showed a significant decrease in threshold, identification (both P < 0.0001), and discrimination testing (P = 0.0029). If the intraseasonal pollen allergics were compared to the mite allergics, they showed better results in identification (P = 0.0087) and threshold (P < 0.0001) tests, but worse results in discrimination testing (P = 0.0002). Therefore, the different kind of allergen exposure seems to result in a different pattern of allergic olfactory dysfunction.

Lateralized and bilateral olfactory function in patients with chronic sinusitis compared with healthy control subjects.

Results of this study demonstrated that a new olfactory test, the "Sniffin' Sticks," can be used to distinguish hyposmic patients with chronic sinusitis (n = 63) from control subjects. Dirhinic testing yielded improved olfactory sensitivity compared with monorhinic testing. However, dirhinic results were not significantly different from results obtained for the best nostril.

Olfactory function after microscopic endonasal surgery in patients with nasal polyps.

A controlled prospective study on 31 patients with nasal polyps was performed to evaluate the time course of olfactory function after endonasal surgery. A modified Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory function test was used to measure olfactory threshold, odor identification ability, and odor discrimination ability. The test was performed in all patients 1-3 days before surgery (V1), 7-10 days after surgery (V2), and after 1 (V3), 2 (V4), 3 (V5), and 6 (V6) months. Mean olfactory threshold in the CCCRC butanol test was 4.19 at V1 (= moderate hyposmia). At V2, it decreased to 3.46 (= severe hyposmia), before increasing to 5.16 at V3 and 5.22 at V4 (= mild hyposmia). After the second postoperative month, olfactory threshold decreased again until the end of the study: 5.13 at V5 and 4.87 at V6 (= moderate hyposmia). The time course for odor identification ability and odor discrimination ability showed comparable results. This study demonstrates that olfactory function is impaired in patients with nasal polyps. Endonasal sinus surgery might improve olfactory function with best results within 3 months after surgery.

Storage artifact increases helper T lymphocytes and helper-to-suppressor T lymphocyte ratio to normal levels in a patient with acquired immune deficiency related complex.

An increase in both the helper/suppressor T lymphocyte ratio and the absolute number of helper T lymphocytes from subnormal to normal values was observed on overnight storage of a lymphocyte preparation from a patient with acquired immune deficiency related complex. Storage of lymphocyte preparations did not significantly alter the helper/suppressor ratio for four additional patients with acquired immune deficiency related complex but produced increases for one patient with Crohn's disease and two patients with sickle cell disease. Overnight storage of heparinized blood at room temperature did not alter the helper/suppressor ratio for one healthy volunteer and one patient with acquired immune deficiency related complex but produced increases for one patient with Crohn's disease and one patient with acute infectious mononucleosis, resulting in a change from a subnormal to a normal value in the latter patient. We suggest that physicians and laboratory directors consider storage artifacts when evaluating results of tests for absolute numbers of helper T lymphocytes or helper/suppressor T lymphocyte ratios performed on patients.

Phosphorylation of Thylakoid Proteins of Oryza sativa: In Vitro Characterization and Effects of Chilling Temperatures.

The phosphorylation of thylakoid proteins of rice (Oryza sativa L.) was studied in vitro using [gamma-(32)P]ATP. Several thylakoid proteins are labeled, including the light-harvesting complex of photosystem II. Protein phosphorylation is sensitive to temperature, pH, and ADP, ATP, and divalent cation concentrations. In the range pH 7 to 8.2, phosphorylation of the light-harvesting polypeptides declines above pH 7.5, whereas labeling of several other thylakoid polypeptides increases. Increasing divalent cation concentration from 3 to 20 millimolar results in a decrease in phosphorylation of the 26 kilodalton light-harvesting complex polypeptide and increased phosphorylation of several other polypeptides. ADP has an inhibitory effect on the phosphorylation of the light-harvesting complex polypeptides. Phosphorylation of the 26 kilodalton light-harvesting polypeptide requires 0.45 millimolar ATP for half-maximal phosphorylation, compared to 0.3 millimolar for the 32 kilodalton phosphoprotein. Low temperature inhibits the phosphorylation of thylakoid proteins in chilling-sensitive rice. However, phosphorylation of histones by thylakoid-bound kinase(s) is independent of temperature in the range of 25 to 5 degrees C, suggesting that the effect of low temperature is on accessibility of the substrate, rather than on the activity of the kinase.

Serologic, immunologic, and clinical features of parenteral drug users from contrasting populations.

We screened inpatient and outpatient parenteral drug users with no clinical evidence of AIDS for immunodeficiency and antibodies to HTLV-III by ELISA. Among 20 outpatient drug users, 5 (25%) were seropositive. Three of these (and 2 who were seronegative) had low T-cell ratios. Over 6 months, 1 seropositive patient with a low ratio developed oral thrush and weight loss. We also studied 13 parenteral drug users hospitalized for conditions other than AIDS. Eight had low T-cell ratios, and at least 6 of these developed AIDS or ARC within 4 months. Serum from 8 of 13 inpatients was available for HTLV-III testing: 6/8 were seropositive and 3 of these 6 were among those developing AIDS or ARC. Abnormal T-cell ratios among all patients were associated with abnormal HTLV-III serology (p = .02). Of the 7 patients who developed AIDS or ARC, 4 were tested for both antibodies and T-cell ratios: all 4 were seropositive and had low ratios. A low ratio (p = .0004), a positive ELISA (p = .014), and abnormalities of both tests (p = .001) were associated with the development of AIDS or ARC. Of the 26 patients without AIDS or ARC, 3 were lost to follow-up and 23 did not develop AIDS or ARC. Six of these 26 had abnormal ratios. Of the 21 patients who did not develop AIDS or ARC and who were tested for HTLV antibodies, 2 were lost to follow-up. Seven of 21 were seropositive and 2/21 were both seropositive and had a low ratio. One of these 2 seropositive patients with low ratios also had lymphadenopathy, but he was lost to follow-up. The other had no adenopathy and remained well until her death from trauma a year later. This study found two populations with very different risks. Six of 13 hospitalized parenteral drug users and only 1 of 20 healthy outpatients developed AIDS or ARC.

Chilling Sensitivity in Oryza sativa: The Role of Protein Phosphorylation in Protection against Photoinhibition.

The effects of exposure to low temperature on photosynthesis and protein phosphorylation in chilling-sensitive and cold-tolerant plant species were compared. Chilling temperatures resulted in light-dependent loss of photosynthetic electron transport in chilling-sensitive rice (Oryza sativa L.) but not in cold-tolerant barley (Hordeum vulgare L.). Brief exposure to chilling temperatures (0-15 degrees C, 10 min) did not cause a significant difference in photosynthetic O(2) evolution capacity in vivo between rice and barley. Analysis of in vivo chlorophyll fluorescence in chilling-sensitive rice suggests that low temperatures cause an increased reduction of the plastoquinone pool that could result in photoinhibitory damage to the photosystem II reaction centers. Analysis of (32)P incorporation into thylakoid proteins both in vivo and in vitro demonstrated that chilling temperature inhibited protein phosphorylation in rice, but not in barley. Low temperature (77 K) fluorescence analysis of isolated thylakoid membranes indicated that state I to state II transitions occurred in barley, but not in rice subjected to chilling temperatures. These observations suggest that protein phosphorylation may play an important role in protection against photoinhibition caused by exposure to chilling temperatures.

Intravenous drug abusers and the acquired immunodeficiency syndrome (AIDS). Demographic, drug use, and needle-sharing patterns.

We studied the demographic characteristics, drug use patterns, and sexual habits of intravenous (IV) drug abusers to further define this population at risk for acquired immunodeficiency syndrome (AIDS). Sixteen IV drug abuser patients with AIDS, 24 IV drug abuser patients with AIDS-related complex (ARC), and 14 IV drug abuser controls without evidence of AIDS or ARC were evaluated. The subjects in each group were similar demographically, in drug use practice, and in sexual orientation and experience. Of the AIDS and ARC patients, 34 (88%) of 40, including all seven homosexual men, shared needles, as did all drug abusers without AIDS or ARC. Seventy-four percent of patients, including all homosexual men, attended "shooting galleries," where anonymous multiple-partner needle sharing took place. Needle sharing supports the hypothesis of AIDS transmission by a blood-borne route, can explain the spread of AIDS and the high rate of seropositivity to the putative AIDS agent among IV drug abusers, and is a logical link between IV drug abusers and male homosexuals, the two largest groups with AIDS.

Oral candidiasis in high-risk patients as the initial manifestation of the acquired immunodeficiency syndrome.

We studied the frequency with which unexplained oral candidiasis led to unequivocal acquired immunodeficiency syndrome (AIDS) in patients at risk. Twenty-two previously healthy adults with unexplained oral candidiasis, of whom the 19 tested had a reversed T4/T8 ratio and 20 had generalized lymphadenopathy, were compared with 20 similar patients with a reversed T4/T8 ratio and generalized lymphadenopathy who did not have oral candidiasis. All were intravenous-drug abusers, homosexual or bisexual men, or both. Thirteen of the 22 patients with oral candidiasis (59 per cent) acquired a major opportunistic infection or Kaposi's sarcoma at a median of three months (range, 1 to 23) as compared with none of 20 patients with generalized lymphadenopathy and immunodeficiency but without candidiasis who were followed for a median of 12 months (range, 5 to 21) (P less than 0.001). AIDS developed in 12 of 15 patients with candidiasis and T4/T8 ratios less than or equal to 0.51, as compared with none of four with ratios equal to or greater than 0.60 (P less than 0.01). We conclude that in patients at high risk for AIDS, the presence of unexplained oral candidiasis predicts the development of serious opportunistic infections more than 50 per cent of the time. Whether the remainder will have AIDS is not yet known.

Immunodeficiency in female sexual partners of men with the acquired immunodeficiency syndrome.

Because the current outbreak of acquired immunodeficiency syndrome (AIDS) among previously healthy adults may be caused by a transmissible biologic agent, and because it may be preceded by immunologic abnormalities with or without a prodromal illness, we studied seven female sexual partners of male patients with the syndrome. The male patients were all drug abusers. One of the seven women was found to have the full-blown syndrome, a second had an illness consistent with the prodrome of AIDS (generalized lymphadenopathy, lymphopenia, and a decreased ratio of helper to suppressor T cells), and four others had generalized lymphadenopathy or lymphopenia, with or without a decreased ratio of helper to suppressor T cells. Only one woman had no abnormalities. These findings suggest that AIDS may be transmitted between heterosexual men and women.

Community-acquired opportunistic infections and defective cellular immunity in heterosexual drug abusers and homosexual men.

Fourteen previously healthy young patients with unusual community-acquired opportunistic infections were seen over a period of three years. They differ from patients previously described in that 11 were heterosexual drug abusers (including two women) and only three were homosexual men. There were eight Puerto Ricans, five blacks, and one white. Infections included Pneumocystis carinii pneumonia (seven), disseminated Mycobacterium intracellulare infection, histoplasmosis, cryptococcosis, and cytomegalovirus infection (one each), oral thrush (13), and Candida esophagitis (two). All patients had impaired cellular immunity manifested by cutaneous anergy and lymphopenia, and all 11 tested had a markedly decreased ratio of T helper/inducer cells to T suppressor/cytotoxic cells. Twelve had evidence of associated viral infection (Epstein-Barr virus in nine, cytomegalovirus in five, Herpes simplex type 2 in two). Clinical presentation was with a severe opportunistic infection or with a prodrome consisting of oral thrush and nonspecific findings including malaise, fever, lymphadenopathy, or cough. The syndrome of immunodeficiency and opportunistic infection occurs in nonwhite heterosexual drug abusers, not exclusively in white homosexual men, and patients may present for medical care before the onset of a severe opportunistic infection.

Alpha-amylase secretion by single barley aleurone layers.

The secretion of alpha-amylase from single isolated (Hordeum vulgare L. cv Himalaya) aleurone layers was studied in an automated flow-through apparatus. The apparatus, consisting of a modified sample analyzer linked to a chart recorder, automatically samples the flow-through medium at 1 minute intervals and assays for the presence of alpha-amylase. The release of alpha-amylase from aleurone layers begins after 5 to 6 hours of exposure to gibberellic acid and reaches a maximum rate after 10 to 12 hours. The release of alpha-amylase shows a marked dependence on Ca(2+), and in the absence of Ca(2+) it is only 20% of that in the presence of 10 millimolar Ca(2+). Withdrawal of Ca(2+) from the flow-through medium results in the immediate cessation of enzyme release and addition of Ca(2+) causes immediate resumption of the release process. The effect of Ca(2+) is concentration-dependent, being half-maximal at 1 millimolar Ca(2+) and saturated at 10 millimolar Ca(2+). Ruthenium red, which blocks Ca(2+) but not Mg(2+) efflux from barley aleurone layers, renders alpha-amylase release insensitive to Ca(2+) withdrawal. Inhibitors of respiratory metabolism cause a burst of alpha-amylase release which lasts for 0.5 to 5 hours. Following this phase of enhanced alpha-amylase release, the rate of release declines to zero. Pretreatment of aleurone layers with HCl prior to incubation in HCN also causes a burst of alpha-amylase release, indicating that the inhibitor is affecting the secretion of alpha-amylase and not its movement through the cell wall. The rapid inhibition of alpha-amylase release upon incubation of aleurone layers at low temperature (5 degrees C) or in 0.5 molar mannitol also indicates that enzyme release is dependent on a metabolically linked process and is not diffusion-limited. This conclusion is supported by cytochemical observations which show that, although the cell wall matrix of aleurone layers undergoes extensive digestion after gibberellin treatment, the innermost part of the cell wall is not degraded and could influence enzyme release.