Abnormally persistent latent inhibition induced by MK801 is reversed by risperidone and by positive modulators of NMDA receptor function: differential efficacy depending on the stage of the task at which they are administered.

RATIONALE: Latent inhibition (LI) is the poorer conditioning to a stimulus resulting from its nonreinforced preexposure. LI indexes the ability to ignore irrelevant stimuli and is used extensively to model attentional impairments in schizophrenia (SZ). We showed that rats and mice treated with the N-methyl-D-aspartic acid (NMDA) receptor antagonist MK801 expressed LI under conditions preventing LI expression in controls. This abnormally persistent LI was reversed by the atypical antipsychotic drug (APD) clozapine and by compounds enhancing NMDA transmission via the glycineB site, but not by the typical APD haloperidol, lending the MK801 LI model predictive validity for negative/cognitive symptoms. OBJECTIVE: To test additional representatives from the two classes of drugs and show that the model can dissociate between atypical APDs and glycinergic drugs are the objectives of the study. MATERIALS AND METHODS: LI was measured in a conditional emotional response procedure. Atypical APD risperidone, selective 5HT2A antagonist M100907, and three glycinergic drugs were administered in preexposure or conditioning. RESULTS: Rats treated with MK801 (0.05 mg/kg) exhibited LI under conditions that disrupted LI in controls. This abnormality was reversed by risperidone (0.25 and 0.067 mg/kg) and M100907 (1 mg/kg) given in preexposure. Glycine (0.8 g/kg), D-cycloserine (DCS;15 and 30 mg/kg), and glycyldodecylamide (GDA; 0.05 and 0.1 g/kg.) counteracted MK801-induced LI persistence when given in conditioning. CONCLUSIONS: These results support the validity of MK801-induced persistent LI as a model of negative/cognitive symptoms in SZ and indicate that this model may have a unique capacity to discriminate between typical APDs, atypical APDs, and glycinergic compounds, and thus, foster the identification of novel treatments for SZ.

Cervical rib--preliminary data on diagnosis by ultrasound.

AIM: To determine whether ultrasound is useful in detecting cervical rib. Ultrasound was used to diagnose cervical rib in five patients with neck pain and the findings were compared to those from plain radiography. MATERIALS AND METHODS: Ultrasound was used in 34 patients with pain and stiffness in the neck region. The area concerned was scanned sonographically in both longitudinal and transverse planes. In the sitting position, plain radiographs were obtained after ultrasound examination for comparison and verification. The contralateral side of the neck was used as control. RESULTS: Sonography revealed abnormalities in five patients. Sonography and X-ray confirmed the diagnosis of cervical rib in six patients, whereas one patient had a lipoma of the neck. CONCLUSION: Sonography is an additional and easily available diagnostic modality for the detection of cervical rib in cases of pain and stiffness in the neck region.

Prevençäo de malformações congênitas / Congenital malformations prevention

A idéia de escrever este artigo surgiu a partir da experiência didática, durante os últimos 22 anos, sobre temas referentes à embriologia geral (formaçäo do zigoto humano até o início do período embrionário) e embriologia especial (diferenciaçäo dos sistemas orgânicos), de um simpósio interno CAMU I - Unesa-2001 e, finalmente, da VIII Semana Científica da FMP, em 2002, sobre "Medicina: uma preocupaçäo com a saúde ou com a doença". Segundo a OMS (1999), o nível primário representa evitar que aconteça o modelo genético, o secundário representa evitar a recorrência das doenças entre as famílias e o terciário representa a reabilitaçäo dos problemas decorrentes destas doenças. A prevençäo das malformações congênitas, sobretudo, se faz mais essencial na saúde pública preventiva, ou seja, no nível primário, tendo como objetivo final proporcionar uma boa qualidade de vida ao portador da malformaçäo

Ultrasonography as a diagnostic modality in Osgood-Schlatter disease. A clinical study and review of the literature.

Sonographic examination of the knee has been proposed by several authors in the past as a simple and reliable method to diagnose Osgood-Schlatter disease (OSD). Ultrasound was used to compare the knees of 25 boys and 10 girls with typical OSD with 35 symptom-free knees of an aged-matched group of children. Based on recorded data, patients were categorized (one affected knee in each individual) according to the classification system proposed by De Flaviis et al. in 1989. The results included the following pathological findings: pretibial swelling, fragmentation of the ossification center, insertional thickening of the patellar tendon, and excessive fluid collection in the infrapatellar bursa. Of our patients, 26% fell into the type 1 category, 43% were type 2, 20% type 3, and 11% type 4. This distribution of cases was found to be statistically similar to the initial findings reported by De Flaviis and colleagues. This study therefore supports the validity and reproducibility of their classification method for the ultrasonographic evaluation of children with OSD. This is only the first step, and further assessment of this classification is still required to elucidate its clinical as well as its prognostic value.

Achilles tendon pain and related pathologies: diagnosis by ultrasonography.

BACKGROUND: When encountering complaints of pain in the area of the Achilles tendon, the clinician seldom reaches a correct and precise diagnosis based solely on the grounds of physical examination and standard X-rays. OBJECTIVES: To assess the usefulness of ultrasound in diagnosing pathologies of the Achilles tendon. METHODS: We conducted a retrospective review of patients presenting at our orthopedic clinics. RESULTS: Sonography was used to evaluate 41 patients with achillodynia. This modality enabled the diagnoses of 19 abnormal tendons (46%), peritendinous and other lesions; a complete rupture in two patients (5%); a partial rupture of the Achilles tendon in 3 (7%); various degrees of calcification of the tendon in 7 (17%); and peritendinous lesions discerned by the tendon's hypoechoic regions with disorganized arrangement of collagen fibrils in 4 patients (10%). Other lesions included tendonitis (3 patients, 7%), retrocalcaneal bursitis (3 patients, 7%), lipoma (1 patient, 2%), and foreign bodies (2 patients, 5%). The mean diameter of the pathological tendons was 10.4 +/- 2.7 mm, while normal tendons measured 5.2 +/- 0.8 mm (P < 0.001). CONCLUSION: As in many other soft tissue lesions, ultrasonography is a useful tool in the evaluation of the underlying pathology in patients presenting with achillodynia.

Ultrasonography: an imaging modality enabling the diagnosis of bipartite patella.

Ultrasound was used to diagnose bipartite patella in seven adolescents with anterior knee pain, and the findings were compared to those from plain radiography and to those of a group of asymptomatic subjects. In all affected individuals the quadriceps and patellar tendons appeared normal on ultrasound. Sonographic examination of the patella demonstrated an irregularity of the bony contour with occurrence of a cleft between the main part of the patellar body and the large superolateral accessory ossicle. The signal detected in the interface between bones was less echogenic than bone reflecting its fibrocartilaginous nature. The correlation with conventional radiography was absolute, as was the inter- and intraobserver reliability. Ultrasound is thus proposed as a simple and reliable imaging modality in bipartite patella. We do not believe that it should replace the initial radiographic, but it can be used to evaluate the contralateral knee for bilaterality and as an adjunct to therapeutic procedures such as local injections to increase the accuracy of treatment.

Ultrasonography as a diagnostic modality and therapeutic adjuvant in the management of soft tissue foreign bodies in the lower extremities.

BACKGROUND: Foreign bodies are sometimes overlooked in the initial evaluation of soft tissue wounds in the emergency room setting. The physical examination identifies foreign bodies that are superficial enough to be seen or palpated, while radiographs reveal those that are radio-opaque. If these two criteria are not met, however, the foreign body may remain undetected. These patients present later with long-standing pain in the area of penetration sometimes associated with localized tenderness. OBJECTIVES: To assess the role of ultrasonography in the diagnosis and management of patients with a suspected retained foreign body. METHODS: Ultrasound was used in 21 patients with suspected retained foreign bodies and the diagnosis was positive in 19. Fifteen underwent a surgical exploration in which the ultrasound was used as an adjunctive modality either pre- or intraoperatively to assist in the localization of the foreign body. RESULTS: All procedures were successful. No postoperative complications were recorded at an average follow-up of 2 years. Three patients gradually became asymptomatic and were left untreated. One patient was lost to follow-up. CONCLUSION: Sonography is an extremely effective tool for the late diagnosis of retained foreign bodies in the soft tissues. We suggest that its availability in the emergency room may decrease the rate of misdiagnosis and avoid these unfortunate cases, although this remains to be proven.

Dosagem e aspectos dinamicos de 25-hidroxivitamina D em pacientes portadores de hiperparatiroidismo primario. / Dosage and dynamic aspects of 25-hydroxyvitamin D in patients with primary hyperparathyroidism

Os niveis de 25-OHD sericos, encontrados em pacientes com hiperparatiroidismo primario, foram muito baixos (15,8 +/- 10,3 ng/ml) e quando analisados mais de 6 memeses apos exerese de adenoma de seis meses apos exerese de adenoma de paratiroide apresentaram uma acentuada elevacao (48,3 +/- 16,7ng/ml), embora continuassem significativamente mais baixos que em individuos normais. A administracao oral de colecalciferol a pacientes com hiperparatiroidismo primario demonstrou que a absorcao e a 25-hidroxilacao hepatica da vitamina D estavam normais, desde que a ascensao dos niveis de 25-OHD e os valores maximos atingidos foram equivalentes aos observados em individuos normais.O decaimento dos niveis sericos do metabolito pareceu, entretanto, estar acelerado, o que seria explicado por um aumento de sua conversao renal a 1,25-(OH)2D

Dosagem do AMP ciclico urinario na avaliacao da atividade das glandulas paratiroides. / Dosage of cyclic urinary AMP in the evaluation of parathyroid glands function

Foram estudados 11 pacientes com hiperparatiroidismo primario (posteriormente confirmado cirurgicamente) e 10 pacientes com hipercalciuria e calculose recidivante.Quando o AMPc urinario (AMPcU) total foi expresso em nmol/mg de creatinina (11,8 +/ - 6,4), permitiu o diagnostico de hiperparatiroidismo nos 11 pacientes estudados ao passo que apenas 8 hiperparatiroidianos apresentaram valores elevados de AMPcU total, quando este foi expresso en nmol/dl FG (7,8 +/- 5,1).Os valores utilizados como normais para o AMPcU total foram os publicados por Broadus e cols. Todos os pacientes com hipercalciuria e calculose recidivante apresentaram valores normais de AMPcU total, tanto em nmol/mg de creatinina (3,2 +/- 1,1) quanto em nmol/dl FG (2,4 +/- 0,8). O AMPcU total foi uma dosagem importante na avaliacao da funcao paratiroidiana, tendo colaborado para que pacientes com calcemias e calciurias repetidamente normais fossem encaminhados para cirurgia exploradora do pescoco

Padronizacao de um metodo rapido de dosagem para a 25-hidroxivitamina D e valores obtidos em individuos normais na cidade de Sao Paulo. / Standardization of a rapid assay for 25-hydroxyvitamin D and normal values in subjects in the city of Sao Paulo

Os autores padronizaram um metodo rapido de dosagem para a 25-OHD, baseado em ligacao proteica competitiva, e dosaram amostras de soro de criancas e adultos jovens normais, obtendo valores mais altos que os referidos nos trabalhos europeus e norte-americanos anteriormente publicados

Obtencao de proteina ligadora para o ensaio de 25-OH vitamina D. / Binding protein obtention for the 25-OH vitamin D assay

Dez ratos Sprague-Dawley, recem-desmamados foram mantidos em escuridao completa e receberam dietas raquitogenicas por 6 semanas. Apos este periodo, foi retirado sangue e rins destes animais e realizado o "teste de linha" nos animais que receberam dieta raquitogenica e em ratos controle, mostrando que todos os animais que receberam dieta raquitogenica ficaram raquiticos O plasma separado e a fracao pos-microssomal do rim foram congelados imediatamente e empregados posteriormente como proteina ligadora no ensaio de competicao proteica de 25-OH vitamina D. permitindo a obtencao de curvas-padrao superponiveis

The acromegaly syndrome. Relation between clinical features, growth hormone values and radiological characteristics of the pituitary tumours.

One hundred and fifty-five acromegalics, 76 males (mean age 44 +/- 1.3 years) and 79 females (45 +/- 1.4 years) were studied. The frequency of clinical features were: acral enlargement 100 per cent, hyperhidrosis 65 per cent, headache 55 per cent, paraesthesiae 49 per cent, cardiac problems 34 per cent, hypertension 32 per cent, diabetes mellitus (clinical and chemical) 27 per cent, and visual field defects 6 per cent. Signs and symptoms, and particularly headache, did not show any relation with the size or shape of pituitary tumours, nor with growth hormone (GH) values, age, sex or weight. Mean of GH values at 60, 90 and 120 minutes during a GTT averaged 135 mIU/l, range 8-1833. Diabetes mellitus was more frequent and severe in patients with higher GH values, occurring in 32 per cent of patients with mean GH values greater than or equal to 50 mIU/l and only in 16 per cent of the rest (p less than 0.05). GH values correlated positively with size of tumours. Forty-nine per cent of patients presented with entirely intrasellar tumours, 27 per cent with suprasellar extensions and 23 per cent with partially empty sellae. The mean GH (238 mIU/l) of patients with suprasellar extensions was significantly higher (p less than 0.004) than those of the others. Younger acromegalics showed a tendency to larger tumours. Early treatment of acromegaly, particularly in young patients and those presenting with high GH values, is recommended.

Renal handling of homologous radioiodinated thyrotrophin in the rat.

Previously, TSH metabolism and tissue distribution in the rat were studied using heterologous hormone and/or unphysiological doses. We injected iv [131I]rTSH (S.A. 100 micronCi/microgram) in physiological doses (10 ng) to KI blocked male rats. Two to 180 min after which TCA precipitable 131I was measured in the kidney, liver, muscle, fat and testis. The highest TCA precipitable radioactivity concentration, peak value 12% at 30 min; organ/blood ratio, 16, was found in the kidney. With the kidney validated as the major site of localization of TSH, the renal localization and handling of [125I]rTSH was studied by autoradiography. Radioactivity was confined to the cortex. Two to 30 min samples showed 125I in Bowman's space and luminal parts of the proximal tubular cells while samples from 60 to 180 min revealed activity in contraluminal areas, suggesting glomerular filtration and tubular re-absorption. Gel-filtration of supernatants of kidney homogenates revealed progressive diminution of the TSH peak and the appearance of a smaller MW peak. We conclude that (1) the kidney is the major site of localization and metabolism of homologous TSH, (2) the renal handling of TSH involves both glomerular filtration and tubular re-absorption.

Production and storage of (125-I) thyroxine and (125-I) triiodothyronine of high specific activity.

High specific activity [125-I] triiodothyronine and [125-I] thyroxine have been produced regularly by the chloramine T radioiodination method. Simultaneous production of [125-I] triiodothyronine and [125-I] thyroxine is usual when diiodothyronine or triiodothyronine are employed as the starting materials. Specific activities reached vary with the starting compound (diiodothyronine, triiodothyronine, thyroxine) used, as both substitution and, less readily, exchange of iodine atoms take place. Starting with diiodothyronine specific activities of approximately 2400 and 5200 Ci/g were achieved for [125-I]triidothyronine and [125I] thyroxine, respectively, and, similarly, specific activities of approximately 1200 and 4000 Ci/g for [125I] triiodothyronine and [125I]-thyroxine, respectively, were reached when triiodothyronine was the starting material. [125-I] Triiodoacetic acid and [125I] tetraiodoacetic acid have been produced in the same way from triiodoacetic acid. By column chromatography on Sephadex G-25 (fine), eluting with alkaline phosphate buffer, good separation of the radioiodinated products has been readily achieved. Studies on the stability of the radioiodinated hormones showed that 50% methanol, ethanol, propanol and propylene glycol were all equivalent as preserving agents and, further, that the stability of the radioiodinated hormones was linearly related to the concentration of these preserving agents.