Recurrent pulmonary embolism associated with Klippel-Trenaunay-Weber syndrome.

Klippel-Trenaunay-Weber syndrome (KTWS) is a rare, congenital disorder characterized by the triad of varicose veins, cutaneous hemangiomas, and hypertrophy of soft tissue and bone. We present the case of a woman with KTWS, cor pulmonale, and death due to recurrent pulmonary embolism (PE). The risk of deep venous thrombosis and PE in patients with KTWS is evaluated, and treatment recommendations are made with emphasis on the role of early, aggressive management in the subset of patients with KTWS known to have thromboembolic disease.

The changing radiographic presentation of bronchogenic carcinoma with reference to cell types.

OBJECTIVE: To analyze chest radiographic patterns of lung cancer at presentation by cell type. This current series is compared with historic published data. DESIGN: Retrospective, using a tumor registry. SETTING: Large, rural multispecialty clinic. PATIENTS: Three hundred forty-five patients with newly diagnosed lung cancers presenting between October 1990 and August 1992. METHODS: Radiographs were interpreted by two radiologists blinded to cell type. Our results were compared statistically to published data from Mayo Clinic patients in the 1950s and 1960s. RESULTS: (1) Adenocarcinoma: Decreased presentation as a peripheral tumor in current series (49%) compared with historic control at Mayo (72%); (2) squamous cell: increased presentation as peripheral tumor in current series (43%) compared with historic control (31%); and (3) no statistically significant difference between adenocarcinoma (49%) and squamous (43%) for a presentation as a peripheral mass, or between adenocarcinoma (46%) and squamous (52%) for central origin in the current series of cases. CONCLUSION: As adenocarcinoma has increased in relative frequency among lung cancers, the percent of cases with peripheral primary tumors is decreased while central tumors have increased. Squamous carcinoma has had a relative increase in peripheral mass presentation. There is now no significant difference between these two cell types in percent presenting as a peripheral mass or central tumor on chest radiograph.

Chronic use of benzodiazepines and cognitive deficit complaints: a risk factor study.

Benzodiazepines produce an anterograde amnesia after acute administration but whether their chronic use is hazardous to memory processes remains unclear. The present study analyses the risk of increasing cognitive complaints with chronic benzodiazepine use. Subjects seeking medical assistance at the General Internal Medicine Outpatient Clinic of Hospital de Clinicas de Porto Alegre, were interviewed before seeing physicians. They were asked about use of benzodiazepines, history of neurological and psychiatric diseases, use of alcohol, and deficits in remembering and learning as well as age, sex and level of education. Age (over 51 years), low level of education, a history of neurological and psychiatric diseases and use of benzodiazepines showed significant associations with cognitive complaints. After a conditional logistic regression analysis, benzodiazepine use lost its association with memory complaints. These data support the hypothesis that the chronic use of benzodiazepines does not carry a risk for cognitive deficits complaints.

Effect of atropine and propranolol on retrieval enhancement by a novel experience or by injection of beta-endorphin prior to testing in rats.

Wistar rats were trained in step-down inhibitory avoidance and tested 24 h later. One h prior to testing they were exposed to an open field or to an open field with flashing light (OFL) for 2 min. The OFL-exposed group showed retrieval enhancement for the avoidance task. This effect was mimicked by an injection of beta-endorphin (2.0 micrograms/kg) 1 h prior to testing, and both effects were blocked by the concomitant administration of naloxone (0.8 mg/kg, ip). Propranolol (2.0 mg/kg, ip) and atropine (0.5 mg/kg, ip) injected 6 min before the test completely blocked the retrieval-enhancing effect of both beta-endorphin and OFL. These results suggest that: 1) in rats, novel experiences may induce retrieval enhancement provided they are alerting; 2) the retrieval-enhancing effect of pre-testing exposure to OFL is probably due to activation of the brain beta-endorphin system which triggers late beta-noradrenergic and cholinergic mechanisms acting at the moment of retrieval.

Beta-endorphin and electroconvulsive shock alter the retrieval of two avoidance tasks when given after the first, but not the second, training session.

1. Rats were submitted to three consecutive sessions, one session per day, of two-way active avoidance or of step-down inhibitory avoidance, and received 1 microgram/kg beta-endorphin intraperitoneally or an electroconvulsive shock immediately after the first or after the second training session. 2. Administration of either treatment after the first session caused a reduction of performance in the second session in both tasks. There was no impairment of performance in the third session. 3. Administration of either treatment after the second session did not affect performance during the third session. 4. Therefore the effect of beta-endorphin and of electroconvulsive shock on active and inhibitory avoidance performance was expressed only when treatments were administered after the first, i.e., novel, training experience. We suggest this effect is on mechanisms acting on retrieval, since the retention performances of all groups for the third session were identical.

ß-endorphin and electroconvulsive shock alter the retrieval of two avoidance tasks when given after the first, but not the second, training session

1. Rats were submitted to three consecutive sessions, one sessions per day, of two-way active avoidance or of step-down inhibitory avoidance, and received 1 µg/Kgß-endorphin intraperitoneally or an electroconvulsive shock immediately aftere the first or after the second training session. 2. Administration of either treatment after the first session caused a reduction of performance in the second session in both tasks. There was no impairment of performance in the third session. 3. Administration of either treatment after the second session did not affect performance during the third session. 4. Therefore the effect of ß- endorphin and of electroconvulsive shock on active and inhibitory avoidance performance was expressed only when treatments were administered after the first, i.e., novel, training experience. We suggest this effect is on mechanisms acting on retrieval, since the retention performance of all groups for the third session were identical

Pre-test administration of beta-endorphin, or of electroconvulsive shock reverses the memory disruptive effect of posttraining electroconvulsive shock.

Memory disruption by posttraining electroconvulsive shock was studied in adult Wistar rats using three different tasks: step-down inhibitory avoidance, two-way active avoidance, and habituation of rearing to an open field. The animals were given training and test sessions 24 hours apart in each of these tasks. Immediate posttraining transcorneal, 15 mA, 60 Hz, 2 sec electroconvulsive shock disrupted memory of the three tasks. The effect was completely reversed by the IP administration of beta-endorphin (2.0 micrograms/kg), 6 min prior to testing, or of another electroconvulsive shock, 30 min prior to testing. These findings indicate that the posttraining electroconvulsive shock did not affect memory storage. In view of the fact that electroconvulsive shock has been previously shown to cause a pronounced decrease of brain beta-endorphin immunoreactivity, attributable to a release of the peptide, the present findings can be interpreted as showing that memory disruption by posttraining electroconvulsive shock results from the induction of state dependency on beta-endorphin.