The role of 99mTc-DTPA retrobulbar SPECT in staging and follow-up of Graves' orbitopathy.

The pathogenesis of Graves' orbitopathy (GO) is not completely understood. Coexistent hyperfunction of the thyroid gland is frequent; however, GO may also coexist with hypo- or euthyrodism. The course of GO is largely independent of thyroid function, although elevated serum TSH is known to negatively interfere with GO course. GO is severe in 10% of the cases; sight threatening complications may also develop. A successful therapy of GO requires the assesment of both the severity and activity of orbital inflammation. Based on relevant studies and our own experiences, the possible management choices are reviewed here. For this purpose, we compare the clinical value of imaging techniques for detecting the activity of the disease. During the last 15 years, we used 99mTc-DTPA retrobulbar SPECT routinely in more than 1400 patients to facilitate the right therapeutic decision. This diagnostic utility simplified management decisions compared to previously applied alternative techniques. We recommended the routine use of 99mTc-DTPA retrobulbar SPECT for the evaluation and follow-up of GO.

Marijuana smoke induces severe pulmonary hyperresponsiveness, inflammation, and emphysema in a predictive mouse model not via CB1 receptor activation.

Sporadic clinical reports suggested that marijuana smoking induces spontaneous pneumothorax, but no animal models were available to validate these observations and to study the underlying mechanisms. Therefore, we performed a systematic study in CD1 mice as a predictive animal model and assessed the pathophysiological alterations in response to 4-mo-long whole body marijuana smoke with integrative methodologies in comparison with tobacco smoke. Bronchial responsiveness was measured with unrestrained whole body plethysmography, cell profile in the bronchoalveolar lavage fluid with flow cytometry, myeloperoxidase activity with spectrophotometry, inflammatory cytokines with ELISA, and histopathological alterations with light microscopy. Daily marijuana inhalation evoked severe bronchial hyperreactivity after a week. Characteristic perivascular/peribronchial edema, atelectasis, apical emphysema, and neutrophil and macrophage infiltration developed after 1 mo of marijuana smoking; lymphocyte accumulation after 2 mo; macrophage-like giant cells, irregular or destroyed bronchial mucosa, goblet cell hyperplasia after 3 mo; and severe atelectasis, emphysema, obstructed or damaged bronchioles, and endothelial proliferation at 4 mo. Myeloperoxidase activity, inflammatory cell, and cytokine profile correlated with these changes. Airway hyperresponsiveness and inflammation were not altered in mice lacking the CB1 cannabinoid receptor. In comparison, tobacco smoke induced hyperresponsiveness after 2 mo and significantly later caused inflammatory cell infiltration/activation with only mild emphysema. We provide the first systematic and comparative experimental evidence that marijuana causes severe airway hyperresponsiveness, inflammation, tissue destruction, and emphysema, which are not mediated by the CB1 receptor.

The effect of gabapentin and ketorolac on allodynia and conditioned place preference in antibody-induced inflammation.

BACKGROUND: Glucose-6-phosphate isomerase and collagen type II antibody-induced arthritis models (K/BxN and CAIA, respectively) have an inflammatory and a post-inflammatory phase. Both phases display robust tactile allodynia. In previous work, inflammatory phase allodynia was reversed by gabapentin and ketorolac, whereas in late phase only gabapentin was effective. Here, we sought to determine if the effects of these two drugs during the early and late phases of the two arthritis models were observed in the conditioned place preference (CPP) paradigm, indicating a differential drug effect on the aversive state. METHODS: Male C57BL/6 mice received K/BxN serum intraperitoneally, while male BALB/c mice received collagen type II antibody cocktail intravenously. After onset of inflammation and allodynia, we assessed effects of i.p. gabapentin (100 mg/kg) or ketorolac (15 mg/kg) using a CPP paradigm: 2 days adaptation, 2 days conditioning (vehicle in morning and drug in afternoon), preference testing on day 5. RESULTS: Consistent with the effects upon allodynia, both gabapentin and ketorolac produced a preference for the drug-paired compartment in the early phase of the K/BxN model, while gabapentin, but not ketorolac, resulted in a place preference during late phase. In the CAIA model, consistent with differential effects upon allodynia, gabapentin produced a preference in the early phase and a trend in the late phase, whereas ketorolac was ineffective at either time. CONCLUSIONS: CPP validated the aversive state in the inflammatory and post-inflammatory phases of the K/BxN and CAIA arthritis models and correspondence between the anti-hyperpathic pharmacology as defined by thresholds and CPP.

Spinal release of tumour necrosis factor activates c-Jun N-terminal kinase and mediates inflammation-induced hypersensitivity.

BACKGROUND: Mounting evidence points to individual contributions of tumour necrosis factor-alpha (TNF) and the c-Jun N-terminal kinase (JNK) pathway to the induction and maintenance of various pain states. Here we explore the role of spinal TNF and JNK in carrageenan-induced hypersensitivity. As links between TNF and JNK have been demonstrated in vitro, we investigated if TNF regulates spinal JNK activity in vivo. METHODS: TNF levels in lumbar cerebrospinal fluid (CSF) were measured by enzyme-linked immunosorbent assay, spinal TNF gene expression by real-time polymerase chain reaction and TNF protein expression, JNK and c-Jun phosphorylation by western blotting. The role of spinal TNF and JNK in inflammation-induced mechanical and thermal hypersensitivity was assessed by injecting the TNF inhibitor etanercept and the JNK inhibitors SP600125 and JIP-1 intrathecally (i.t.). TNF-mediated regulation of JNK activity was examined by assessing the effect of i.t. etanercept on inflammation-induced spinal JNK activity. RESULTS: TNF levels were increased in CSF and spinal cord following carrageenan-induced inflammation. While JNK phosphorylation followed the same temporal pattern as TNF, c-jun was only activated at later time points. Intrathecal injection of TNF and JNK inhibitors attenuated carrageenan-induced mechanical and thermal hypersensitivity. TNF stimulation induced JNK phosphorylation in cultured spinal astrocytes and blocking the spinal actions of TNF in vivo by i.t. injection of etanercept reduced inflammation-induced spinal JNK activity. CONCLUSIONS: Here we show that spinal JNK activity is dependent on TNF and that both TNF and the JNK signalling pathways modulate pain-like behaviour induced by peripheral inflammation.

Comparison of ractopamine residue depletion from internal tissues.

The aim of the study was to compare residue depletion of ractopamine HCl as a ß-adrenergic agonist that promotes muscle growth of animals, from internal tissues on days after its repeat administration to animals. The experiment was carried out in 38 albino guinea pigs. Treated animals (n = 30) were orally administered ractopamine HCl in a dose of 3.5 mg/kg body mass per day for 7 consecutive days. On days 1, 10, 20 and 30 of drug discontinuation, animals were randomly sacrificed and the liver, kidney, lung, heart, muscle, spleen and fat samples were collected. In all matrices, ractopamine concentration was determined using validated enzyme-linked immunosorbent assay (ELISA) as a quantitative screening method. The highest ractopamine concentration was recorded on day 1 in the lungs (55.80 ± 15.62 µg/kg), followed by the kidney (21.85 ± 3.91 µg/kg), spleen (12.59 ± 1.95 µg/kg), fat (10.17 ± 5.02 µg/kg), heart (9.73 ± 0.22 µg/kg), liver (5.58 ± 2.09 µg/kg), and lowest in muscle (2.21 ± 1.02 µg/kg). Ractopamine residues were detected in the lungs in the period of 30 days after withdrawal in significantly higher concentrations in comparison to other investigated matrices, suggesting that depletion of ractopamine from the lungs occurs at a much slower rate than its depletion from other internal tissues.

Impaired nocifensive behaviours and mechanical hyperalgesia, but enhanced thermal allodynia in pituitary adenylate cyclase-activating polypeptide deficient mice.

Pituitary adenylate cyclase-activating polypeptide-38 (PACAP-38) and its receptors (PAC1 and VPAC) have been shown in the spinal dorsal horn, dorsal root ganglia and sensory nerve terminals. Data concerning the role of PACAP in central pain transmission are controversial and we have recently published its divergent peripheral effects on nociceptive processes. The aim of the present study was to investigate acute somatic and visceral nocifensive behaviours, partial sciatic nerve ligation-evoked chronic neuropathic, as well as resiniferatoxin-induced inflammatory thermal and mechanical hyperalgesia in PACAP deficient (PACAP(-/-)) mice to elucidate its overall function in pain transmission. Neuronal activation was investigated with c-Fos immunohistochemistry. Paw lickings in the early (0-5 min) and late (20-45 min) phases of the formalin test were markedly reduced in PACAP(-/-) mice. Acetic acid-evoked abdominal contractions referring to acute visceral chemonociception was also significantly attenuated in PACAP knockout animals. In both models, the excitatory role of PACAP was supported by markedly greater c-Fos expression in the periaqueductal grey and the somatosensory cortex. In PACAP-deficient animals neuropathic mechanical hyperalgesia was absent, while c-Fos immunopositivity 20 days after the operation was significantly higher. In this chronic model, these neurons are likely to indicate the activation of secondary inhibitory pathways. Intraplantarly injected resiniferatoxin-evoked mechanical hyperalgesia involving both peripheral and central processes was decreased, but thermal allodynia mediated by only peripheral mechanisms was increased in PACAP(-/-) mice. These data clearly demonstrate an overall excitatory role of PACAP in pain transmission originating from both exteroceptive and interoceptive areas, it is also involved in central sensitization. This can be explained by the signal transduction mechanisms of its identified receptors, both PAC1 and VPAC activation leads to neuronal excitation. In contrast, it is an inhibitory mediator at the level of the peripheral sensory nerve endings and decreases their sensitization to heat with presently unknown mechanisms.

Involvement of transient receptor potential vanilloid 1 receptors in protease-activated receptor-2-induced joint inflammation and nociception.

Protease-activated receptor-2 (PAR-2) is a G-protein-coupled receptor activated through proteolytic cleavage. It is localized on epithelial, endothelial and inflammatory cells, as well as on transient receptor potential vanilloid 1 (TRPV1) receptor-expressing neurones. It plays an important role in inflammatory/nociceptive processes. Since there are few reports concerning PAR-2 function in joints, the effects of intraarticular PAR-2 activation on joint pain and inflammation were studied. Secondary hyperalgesia/allodynia, spontaneous weight distribution, swelling and inflammatory cytokine production were measured and the involvement of TRPV1 ion channels was investigated in rats and mice. Injection of the PAR-2 receptor agonist SLIGRL-NH(2) into the knee decreased touch sensitivity and weight bearing of the ipsilateral hindlimb in both species. Secondary mechanical allodynia/hyperalgesia and impaired weight distribution were significantly reduced by the TRPV1 antagonist SB366791 in rats and by the genetic deletion of this receptor in mice. PAR-2 activation did not cause significant joint swelling, but increased IL-1beta concentration which was not influenced by the lack of the TRPV1 channel. For comparison, intraplantar SLIGRL-NH(2) evoked similar primary mechanical hyperalgesia and impaired weight distribution in both WT and TRPV1 deficient mice, but oedema was smaller in the knockouts. The inactive peptide, LRGILS-NH(2), injected into either site did not induce any inflammatory or nociceptive changes. These data provide evidence for a significant role of TRPV1 receptors in secondary mechanical hyperalgesia/allodynia and spontaneous pain induced by PAR-2 receptor activation in the knee joint. Although intraplantar PAR-2 activation-induced oedema is also TRPV1 receptor-mediated, primary mechanical hyperalgesia, impaired weight distribution and IL-1beta production are independent of this channel.

Topical acetone treatment induces neurogenic oedema on the sensitized mouse ear: an in vivo study using transient receptor potential vanilloid 1 (TRPV1) receptor knockout mice.

OBJECTIVE: The participation of sensory neurons and transient receptor potential vanilloid 1 (TRPV1) receptors in phorbol 12-myristate 13-acetate (PMA)-induced nerve-sensitizing effect was examined. MATERIALS AND METHODS: PMA dissolved in acetone and acetone were applied to the ears of TRPV1 receptor knockout and wild-type mice. Different groups of animals received ibuprofen, anti-interleukin-1 beta (IL-1beta) antibody, resiniferatoxin (RTX) or capsaicin pretreatment. Ear thickness, myeloperoxidase activity and IL-1beta content of the ears were determined. Histological evaluation was performed. RESULTS: PMA exerted potentiating action on contralateral acetone-induced ear oedema, which was inhibited by ibuprofen, topical capsaicin desensitization of the acetone-treated ear as well as by systemic RTX pretreatment. Neither the lack of TRPV1 receptors nor anti-IL-1beta antibody prevented sensitizing effect. CONCLUSIONS: The TRPV1 receptor-independent potentiating action of PMA on contralateral acetone-induced ear oedema is mediated via capsaicin-sensitive afferents and prostanoids are involved. IL-1beta is not essential in this process.

Effects of the somatostatin receptor subtype 4 selective agonist J-2156 on sensory neuropeptide release and inflammatory reactions in rodents.

BACKGROUND AND PURPOSE: Substance P (SP) and calcitonin gene-related peptide (CGRP) released from capsaicin-sensitive sensory nerves induce local neurogenic inflammation; somatostatin exerts systemic anti-inflammatory actions presumably via sst4/sst1 receptors. This study investigates the effects of a high affinity, sst4-selective, synthetic agonist, J-2156, on sensory neuropeptide release in vitro and inflammatory processes in vivo. EXPERIMENTAL APPROACH: Electrically-induced SP, CGRP and somatostatin release from isolated rat tracheae was measured with radioimmunoassay. Mustard oil-induced neurogenic inflammation in rat hindpaw skin was determined by Evans blue leakage and in the mouse ear with micrometry. Dextran-, carrageenan- or bradykinin-induced non-neurogenic inflammation was examined with plethysmometry or Evans blue, respectively. Adjuvant-induced chronic arthritis was assessed by plethysmometry and histological scoring. Granulocyte accumulation was determined with myeloperoxidase assay and IL-1beta with ELISA. KEY RESULTS: J-2156 (10-2000 nM) diminished electrically-evoked neuropeptide release in a concentration-dependent manner. EC50 for the inhibition of substance P, CGRP and somatostatin release were 11.6 nM, 14.3 nM and 110.7 nM, respectively. J-2156 (1-100 microg kg(-1) i.p.) significantly, but not dose-dependently, inhibited neurogenic and non-neurogenic acute inflammatory processes and adjuvant-induced chronic oedema and arthritic changes. Endotoxin-evoked myeloperoxidase activity and IL-1beta production in the lung, but not IL-1beta- or zymosan-induced leukocyte accumulation in the skin were significantly diminished by J-2156. CONCLUSIONS AND IMPLICATIONS: J-2156 acting on sst4 receptors inhibits neuropeptide release, vascular components of acute inflammatory processes, endotoxin-induced granulocyte accumulation and IL-1beta synthesis in the lung and synovial and inflammatory cells in chronic arthritis. Therefore it might be a promising lead for the development of novel anti-inflammatory drugs.

Three generations of alpha,gamma-diaminobutyric acid modified poly(propyleneimine) dendrimers and their cisplatin-type platinum complexes.

Three generations of alpha,gamma-diaminobutyric acid modified poly(propyleneimine) dendrimers [DAB(AM)n, n = 4, 8, 16] containing 4, 8, 16 free amino groups were coupled with Boc-protected alpha,gamma-diaminobutyric acid (DABA) moieties in high yields. These modified dendrimers were deprotected and the chiral dendritic amines with 8, 16 and 32 amino groups on the surface were isolated in excellent yields. Dendrimers with cisplatin moieties at the periphery were obtained in the reaction of the free amine dendrimers and potassium tetrachloroplatinate(II). The highly insoluble complexes were isolated as hydrates and characterized by means of IR, TGA and elemental analysis.

[Causes of recurrence after laparoscopic hiatal reconstruction]. / Laparoszkópos hiatus rekonstrukciók után fellépó recidívák okai.

The authors report our recurrent hiatal hernias occurred after laparoscopic hiatal reconstruction. The situation found during laparoscopic re-operations are illustrated on pictures. The show the methods against the recurrence.

[Laparoscopic cardiomyotomy in the treatment of achalasia]. / Laparoszkópos cardiomyotomia az achalasia kezelésében.

The laparoscopic cardiomyotomy (Heller) with Dor type anterior fundoplication is accepted for treatment of esophageal achalasia. Between December 1994 and December 1998, 21 patients with esophageal achalasia underwent laparoscopic Heller's operation with Dor's antireflux procedures after preoperative assessment which involved radiological, endoscopic and manometric investigations. Results were evaluated on the basis of our experiences and postoperative investigations. There were no intraoperative complications. Operating time was 40-90' (mean 65'). Conversion to laparotomy was not required. One patient had postoperative stenosis, and another had esophageal perforation which was treated. Postoperative manometry in all patients showed a decreased lower esophageal sphincter pressure. Based on the obtained results it could be concluded that cardiomyotomy with Dor fundoplication through a laparoscopic approach leeds to good functional results and seems effective and safe procedure in the treatment of esophageal achalasia.

[Treatment of injuries of the penis and scrotum complicated by total skin loss]. / A penis és a scrotum teljes börhiánnyal járó sérülésének ellátása

In connection with two healed cases the free transplantation of semi-thick skin is recommended by the authors for the treatment of the above-mentioned injuries, on the basis of the following reasons: 1. The most ideal results may be expected from this method. 2. The objective conditions (dermatome, Humbey's knife, sponge etc.) age generally given. 3. The semi-thick skin plasty is one of the mostly used and well-known methods. 4. In the case of failure the method may be repeated or other method may be chosen. 5. Semi-thick skin plasty is the easiest way to observe the principle: "Nil nocere".

[Permeability of post-ischemic aortic wall in rats]. / Postischaemiás patkány-aorták permeabilitásának vizsgálata

Examinations were carried out in order to reveal details of process of the permeability damage, its degrea and fate of the plasma-substances getting into the vessel all. Abdominal aorta has been cross-clapped for one hour by the aid of a double ligature. In a recirculatory period from 1 hour to 10 days material serving for labeling of the plasma has been determined in the vessel using histochemical and microchemical methods. Colloidal iron was administered to animals one hour before removing the aorta. The highest quantity of colloidal iron in the aortic wall could be revealed after 24--48 hours of recirculation. By the 10th day the vessel wall contained physiological iron quantity. Colloidal iron administered on the second day of recirculation--when damage to permeability is most marked--in the early phase could be seen in the whole aortic wall. By the 7th day it could be detected only in the outer part of media and in the adventitia. Endothelium inhibits the flow of plasma-substances into the vessel wall, when they got through it, only elastic lamina form a temporary mechanical obstacle for transfusion.