Reductions in neurotrophin receptor mRNAs in the prefrontal cortex of patients with schizophrenia.

Patients with schizophrenia have reduced neurotrophin levels in their dorsolateral prefrontal cortex (DLPFC) compared to normal unaffected individuals. The tyrosine kinase-containing receptors, trkB and trkC, mediate the growth-promoting effects of neurotrophins and respond to changes in growth factor availability. We hypothesized that trkB and/or trkC expression would be altered in the DLPFC of patients with schizophrenia. We measured mRNA encoding the tyrosine kinase domain (TK+)-containing form of trkB and measured pan trkC mRNA in schizophrenics (N=14) and controls (N=15) using in situ hybridization. TrkB and trkC mRNAs were detected in large and small neurons in multiple cortical layers of the human DLPFC. We found significantly diminished expression of trkB(TK+) mRNA in large neurons in multiple cortical layers of patients as compared to controls, while small neurons also showed reductions in trkB(TK+) mRNA that did not reach statistical significance. In normals, strong positive correlations were found between trkB(TK+) mRNA levels and brain-derived neurotrophic factor (BDNF) mRNA levels among various neurons, while no correlation between BDNF and trkB(TK+) was found in patients with schizophrenia. TrkC mRNA was also reduced in the DLPFC of schizophrenics in large neurons in layers II, III, V and VI and in small neurons in layer IV. Since neurons in the DLPFC integrate and communicate signals to various cortical and subcortical regions, these reductions in growth factor receptors may compromise the function and plasticity of the DLPFC in schizophrenia.

Non-endoscopic diagnosis of multifocal atrophic gastritis; efficacy of serum gastrin-17, pepsinogens and Helicobacter pylori antibodies.

BACKGROUND/AIMS: Infection with H. pylori is an important risk factor for the development of gastric cancer and glandular atrophy is an intermediate stage in gastric carcinogenesis. While screening the patients with atrophic gastritis by endoscopy is unrealistic, a concept of "serological gastric biopsy" based on measurement of gastric secretory proteins and peptides should be further validated. We sought to determine if the laboratory panel composed of serum PGI and protein stimulated gastrin-17 might select patients with MAG, and what is diagnostic significance of H. pylori serology in population of high prevalence of H. pylori infection. MATERIAL AND METHODS: 55 consecutive patients of both sexes (M/F 25/30; range of age 55 -81 years) were referred for gastroscopy with antrum and corpus mucosal biopsies. Patients with histological signs of glandular atrophy at any site of the stomach were considered to have multifocal atrophic gastritis. A first blood sample was collected for measurement of basal gastrin-17, pepsinogens and H. pylori IgG-antibodies, and second was taken 20 minutes after use of protein-rich drink to measure stimulated gastrin-17. RESULTS: Signs of mucosal atrophy were found in 19 patients, while 29 patients showed non-atrophic gastritis and seven H. pylori-negative patients had no histological pathology. Low serum level of stimulated gastrin-17 (< 5 pmol/l) and/or pepsinogen I (< 50 microg/l), were found in 16 of 19 patients (84.2%) with and in 7 of 36 patients (19.4%) without atrophy in the histological study. Combining of H. pylori serology with serum levels of secretory peptides had no significant effect on diagnostic sensitivity of the test panel. CONCLUSION: The test panel composed of pepsinogen I and protein stimulated gastrin-17 may be used as the "serological gastric biopsy" detecting multifocal atrophic gastritis. The diagnostic sensitivity of this test panel is not increased by knowledge of H. pylori status.

Acute biliary pancreatitis in a 9-year-old child treated with endoscopic sphincterotomy.

Acute biliary pancreatitis is a well recognized complication of gallstone disease in adults. Acute pancreatitis in childhood is usually caused by congenital anomalies of the pancreatico-biliary ducts, viral infections, drug toxicity or abdominal trauma. We report the case of a 9-year-old girl with acute biliary pancreatitis and cholangitis. On urgent endoscopic retrograde cholangiopancreatography a bulging papilla with impacted stone was seen. She was treated with endoscopic sphincterotomy without complications. The disease resolved rapidly and uneventfully after the endoscopic treatment.

Alterations in trkB mRNA in the human prefrontal cortex throughout the lifespan.

Signalling through tyrosine kinase receptor B (trkB) influences neuronal survival, differentiation and synaptogenesis. trkB exists in a full-length form (trkB(TK+)), which contains a catalytic tyrosine kinase (TK) domain, and a truncated form (trkB(TK-)), which lacks this domain. In the rodent brain, expression of trkB(TK+) decreases and trkBTK- increases during postnatal life. We hypothesized that both forms of trkB receptor mRNA would be present in the human neocortex and that the developmental profile of trkB gene expression in human may be distinct from that in rodent. We detected both trkB(TK+) and trkB(TK-) mRNA in RNA extracted from multiple human brain regions by Northern blot. Using in situ hybridization, we found trkB(TK+) mRNA in all cortical layers, with highest expression in layer IV and intermediate-to-high expression in layers III and V of the human dorsolateral prefrontal cortex. trkB(TK+) mRNA was present in neurons with both pyramidal and nonpyramidal shapes in the dorsolateral prefrontal cortex. trkB(TK+) mRNA levels were significantly increased in layer III in young adults as compared with infants and the elderly. In the elderly, trkB(TK+) mRNA levels were reduced markedly in all cortical layers. Unlike the mRNA encoding the full-length form of trkB, trkB(TK-) mRNA was distributed homogeneously across the grey matter, and trkB(TK-) mRNA levels increased only slightly during postnatal life. The results suggest that neurons in the human dorsolateral prefrontal cortex are responsive to neurotrophins throughout postnatal life and that this responsiveness may be modulated during the human lifespan.

[Vascular changes of colonic mucosa as a cause of lower gastrointestinal bleeding in patients with liver cirrhosis]. / Zmiany naczyniowe blony sluzowej jelita grubego jako przyczyna krwawienia z dolnego odcinka przewodu pokarmowego u chorego z marskoscia watroby.

Gastrointestinal bleeding is the common complication of the portal hypertension. Endoscopy is the most accessible diagnostic technique, but the investigation is often limited to the endoscopy of upper gastrointestinal tract. Colonoscopy in the case of bleeding from the colon is often limited by the possibility of good bowel preparation to that procedure. However diagnostic colonoscopy in these cases increases chances for correct diagnosis and application of adequate treatment. Increasing number of gastrointestinal bleeding cases in the last decade causes the necessity of focusing on this problem.

[Endoscopic ultrasonography in the preoperative localization of a pancreatic tumor producing insulin (insulinoma)]. / Ultrasonografia endoskopowa w przedoperacyjnej lokalizacji guza trzustki produkujacego insuline (insulinoma).

Pancreatic endocrine tumors include insulinomas, gastrinomas and some other less frequent neoplasms produce different GI hormones. Preoperative localization of the tumor in patients with evident clinical and biochemical features is usually difficult to obtain in conventional imaging methods. This is due to typically small size of these tumors. Non-invasive methods (conventional ultrasound, computerized tomography, nuclear magnetic resonance, positron emission tomography) and invasive methods (visceral angiography, portal veins catheterization) are often of no use in such condition, as their sensitivity is low. Preoperative localization is of importance for the surgeon, as he can plan his operation for reducing the length of the procedure with obvious consequences. This paper describes for the first time on Polish literature the usefulness of endoscopic ultrasonography in preoperative assessment of insulinoma in one patient. This finding was confirmed during surgery. The operation led to enucleation of two small insulinomas in the head of the pancreas and resulting in complete healing of the patient as found in one year follow up.

Short-term effects of variceal sclerotherapy on portal hypertensive gastropathy.

BACKGROUND AND STUDY AIMS: Obliteration of esophageal varices may modify the mucosal perfusion of the stomach. The relationship between short-term injection variceal sclerotherapy (IVS) and the evolution of portal hypertensive gastropathy (PHG) is insufficiently recognized. PATIENTS AND METHODS: Forty-one cirrhotic patients were treated with hemostatic or secondary preventive IVS. They underwent sclerotherapy at intervals of four to five days until esophageal ulceration, stricture, or a reduction in variceal size developed. On admission and on completing the IVS schedule, an endoscopy score was calculated using a system assigning 0 points for a normal mucosal image, 1 point for reddened, 2 points for a mosaic-like mucosal pattern, and 3 points for a mosaic-like pattern plus red marks in the stomach. All patients received propranolol after the first sclerotherapy session. RESULTS: The total score before IVS was 45 points (1.1 points per patient). After 188 sclerotherapy sessions (2-8 per patient), the score significantly increased to 73 points (1.8 points per patient, P = 0.04). This effect was particularly marked in Child-Pugh class B patients (mean individual rise from 0.7 to 1.9 points, P = 0.01), and negligible in patients with either less or more advanced cirrhosis (Child-Pugh classes A and C). CONCLUSIONS: In patients with cirrhosis, short-term IVS may contribute to the mechanisms of progressive PHG.

Metal stents for palliation of rectal carcinoma: a preliminary report on 12 patients.

BACKGROUND AND STUDY AIMS: Laser therapy is often the only alternative to palliative surgery for elderly patients with advanced rectal carcinoma. In order to reduce the number of laser sessions required, we tried to insert metal stents after initial relief of the obstruction. PATIENTS AND METHODS: In 12 patients (seven female, five male, aged 77-91 years) with rectal or rectosigmoid carcinomas, metallic self-expanding stents (length 5-10 cm, internal diameter 1-2 cm) were introduced. Initial treatments were performed with Nd:YAG laser (mean number of sessions 3.1) in order to allow free passage of an adult colonoscope. Endoscopic and clinical follow-up was carried out at regular intervals. RESULTS: Stent insertion was possible in 11 of the 12 patients. Failure occurred in one patient with sigmoid carcinoma with a distorted loop and diverticulosis. In three patients, the prostheses migrated due to the opening of the lumen being too large; after stent removal, a second stent was successfully placed. Seven patients have died since the beginning of the study, all from the initial disease, without symptoms of stent occlusion. Stenting allowed the number of laser sessions to be reduced. The interval between the laser sessions was extended from 5.1 weeks in a historical control group of 65 patients to the 9.7 weeks in these 11 patients with additional stenting. CONCLUSION: Stenting for rectal carcinoma is technically feasible and safe, and probably reduces the number of laser sessions required. However, better materials are required.

[Does hyperthyroidism promote drug hepatotoxicity]. / Czy nadczynnosc tarczycy zwieksza toksycznosc watrobowa leków?

Mechanisms and circumstances in which drugs injure hepatocytes are not clear. It is known that thyroid gland hormones sensitize the liver to hepatic toxins, but not to commonly used drugs. We report two cases of liver injury mediated by acetaminophen and oestrogens which occurred during hepatic exposure to increased plasma level of thyroid hormones. We suggest that hyperthyroidism might promote drug hepatotoxicity.

[Effect of bismuth salts in elimination of Helicobacter pylori from gastric mucosa in patients with duodenal ulcer]. / Wplyw soli bizmutu na eliminacje Helicobacter pylori z blony sluzowej zoladka u chorych z wrzodem dwunastnicy.

Bismuth salts belong do basic drugs used for elimination of Helicobacter pylori (HP), a microorganism which is postulated to participate in etiopathogenesis of duodenal ulcer. The study was aimed at evaluation of effectiveness of application of tripotassium bismuth citrate (Ventrisol-Polfa) in elimination of HP and its influence on treatment of the ulcer. In 30 patients with diagnosed endoscopically duodenal ulcer, Ventrisol in tablets was applied (2 x 2); it was also used in its fluid form (4 x 5 ml). The time of treatment amounted to 28 days. During endoscopy, samples from various parts of the stomach were taken for microbiological inspection and they were studied in direct smear and in culture. HP was isolated from 20 out of 30 patients (37%) before treatment. After application of Ventrisol, the bacteria were present in 11/30 (34%) treated patients (p < 0.05). There was no influence of the form of drug for elimination of HP. No dependence was also found between elimination of HP and healing of the ulcer.

[Occurrence of Helicobacter pylori in mucous membrane of stomach in patients with duodenal ulcer and inflammation of stomach mucous membrane]. / Wystepowanie Helicobacter pylori w blonie sluzowej zoladka u chorych z wrzodem dwunastnicy i zapaleniem blony sluzowej zoladka.

In 1990-1991 microbiological studies were performed aimed at determination of frequency of occurrence of Helicobacter pylori in patients treated because of peptic ulcer in Department of Gastroenterology in Katowice. Studies were performed in 112 patients. Out of these, in 73 duodenal ulcer was detected endoscopically (group I), in 26--inflammation of stomach mucous membrane with erosion (group II), and in 13--both duodenal ulcer and erosion of stomach membrane (group III). Samples from mucous membrane of pylorus and of stomach taken endoscopically were tested microscopically and in culture. Helicobacter pylori was found in 74 patients (66.1%). Frequency of isolation was different in individual groups. Helicobacter pylori was found in 51 patients (70%) of group I, 15 (58%) of group II and in 8 (61%) of group III. Helicobacter pylori was most frequently isolated from patients with duodenal and stomach ulcer (81.3%).

The theophylline disposition after caffeine administration in liver cirrhosis: an index of liver function.

Six blood samples covering a 24 hr post caffeine dosage were drawn in 8 healthy subjects and 18 patients with liver cirrhosis. Caffeine and theophylline concentration were assayed by gas-chromatography and fluorescent polarization immunoassay, respectively. In normals the maximum theophylline levels were found between 3 and 8 hrs (62.5% at 8 hrs) and ranged 50-420 ng/ml, whereas these levels in cirrhotic patients were noted between 3 and 12 hrs (61.1% at 8 hrs) and ranged 40-670 ng/ml. The largest difference in mean theophylline concentration between normals and cirrhotics was found at 6 hrs (348 +/- 103.7 ng/ml vs 217.1 +/- 140.8 ng/ml; p less than 0.02) and 24 hrs (101.6 +/- 57.3 ng/ml vs 172.2 +/- 119.6 ng/ml; p = 0.075) after caffeine dosing. Theophylline formation rate (theo6) differentiated controls from cirrhotics in the initial stage of the disease (Child-Pugh A), however it failed to discriminate between initial and late cirrhosis. In contrast, the ability of liver to remove theophylline (theo24) differentiated effectively these groups of patients. Theo6 to theo24 ratio was a valuable index of liver function, although its capacity to detect early cirrhosis was unsatisfactory.