Clinical presentation, diagnosis and management of autoimmune pancreatitis.

Autoimmune pancreatitis (AIP) is a relatively rare but clinically important form of chronic pancreatitis that has typical clinical, serologic, histologic, and radiologic findings. Patients frequently present with jaundice and cholestatic serum liver function tests. The serum IgG4 level is typically elevated with a lymphoplasmacytic infiltrate in affected tissue that stains by immunohistochemistry for IgG4-containing cells. Characteristic radiologic features include pancreatomegally and pancreatobiliary duct strictures. Extrapancreatic manifestations are increasingly being recognized. AIP typically rapidly responds to corticosteroid therapy and possibly other immunosuppressive medications. A missed diagnosis can result in unnecessary pancreatic surgery with unnecessary morbidity and mortality. Although significant progress in disease pathophysiology has occurred during the past decade, there is still much to learn regarding disease pathogenesis and management. With further research, the diagnostic algorithm, treatment strategy, follow-up protocol, and long-term prognosis should become better defined.

The relationship between agricultural environments and olfactory dysfunction.

OBJECTIVES: To examine the olfactory ability of farmers and identify exposures in agricultural environments associated with olfactory loss. STUDY DESIGN: Cross-sectional. METHODS: 405 individuals (214 males and 191 females) completed a questionnaire assessing agricultural exposures, health status, and olfactory history. Participants then completed a scratch-and-sniff 12-item odor identification test. Data analysis was conducted using the method of least squares to fit general linear models. Equality of outcome measures (the number of correctly identified odorants) between groups was evaluated using the Wilcoxon rank sum test. Differences were considered to be significant at the 0.05 level. RESULTS: Approximately 80% of participants reported active participation in farm work. Farmers correctly identified an average of 9.3 of 12 odorants, compared to 10.1 of 12 correctly identified by non-farmers, a difference that was not statistically significant (p = 0.2). Participants reporting sneezing after handling soybeans, wheat, or oats scored significantly lower than those without symptoms. There were suggestive associations between olfactory ability and exposure to anhydrous ammonia, history of wheezing and asthma, and a history of flu-like illness after farm work. CONCLUSIONS: Results indicate that, in general, farming is not associated with olfactory loss. However, we identified certain groups of farmers with inflammatory-type reactions who appeared to be susceptible to olfactory loss. The association between inflammatory reactions or conditions and olfactory loss is a novel finding.

Susceptibility to estrogen-induced mammary cancer segregates as an incompletely dominant phenotype in reciprocal crosses between the ACI and Copenhagen rat strains.

Estrogens have been inextricably linked to the etiology of breast cancer. We have demonstrated that the female ACI rat exhibits a unique propensity to develop mammary cancers when treated continuously with physiological levels of 17 beta-estradiol (E2). The E2-induced mammary cancers are estrogen dependent and exhibit genomic instability. In contrast, the genetically related Copenhagen (COP) rat strain is relatively resistant to E2-induced mammary cancers. In this study we evaluated susceptibility to E2-induced mammary cancers in first filial (F(1)), second filial (F(2)), and backcross (BC) progeny generated from reciprocal intercrosses between the ACI and COP strains. F(1) progeny resembled the parental ACI strain with respect to incidence of E2-induced mammary cancers. However, latency was significantly prolonged in the F(1) populations. These data indicate that susceptibility behaves as an incompletely dominant phenotype in these crosses. Analysis of phenotypes exhibited by the F(1), F(2), and BC populations suggests that mammary cancer susceptibility is modified by one or two genetic loci in the reciprocal intercrosses between the ACI and COP strains. Susceptibility to E2-induced mammary cancers did not correlate with E2-induced pituitary growth in the genetically diverse F(2) and BC populations, suggesting that the genetic bases for susceptibility to E2-induced mammary cancers differ from those for E2-induced lactotroph hyperplasia.

Early versus late gold weight implantation for rehabilitation of the paralyzed eyelid.

OBJECTIVES/HYPOTHESIS: The purpose of this study is to evaluate the outcomes and complications associated with early gold weight implantation for management of the paralyzed eyelid. STUDY DESIGN: A retrospective review of clinical charts was conducted to analyze results and complications in patients who underwent gold weight implantation within 30 days of onset of facial nerve paralysis and to compare these outcomes with those of patients who received gold weights after a traditional waiting period. METHODS: The charts of 67 patients who underwent gold weight implantation during the time period of this study were reviewed. Patients were categorized into "early" or "late" groups based on whether gold weights were implanted before or after 30 days following onset of facial nerve paralysis. Etiology of facial nerve paralysis, degree of paralysis, timing of surgery, and outcomes of the procedure, including degree of lid closure and complication rates, were compared between the two groups. RESULTS: Of the 67 patients, 49.3% underwent gold weight implantation within 30 days of onset of paralysis and 50.7% received gold weights after 30 days. A total of 89.2% of all patients who underwent implantation in this study achieved satisfactory lid closure after the initial procedure. Both early and late implantation groups had statistically similar lid closure and complication rates. CONCLUSIONS: Implantation of gold weights within 30 days of paralysis is as effective for the management of paralytic lagophthalmos as delayed implantation and is not associated with higher complication rates. Early implantation of gold weights should be considered in all patients with paralytic lagophthalmos.

Seasonal patterns of carbohydrate reserves in red spruce seedlings.

We studied seasonal dynamics of carbohydrate storage in red spruce (Picea rubens Sarg.) seedlings by measuring starch and sugar concentrations of old needles (>/= one year old), new needles (< one year old), stems, and roots in two stands in the Green Mountains of Vermont. Although the two stands differed in many site characteristics including percent slope, aspect, soil type, drainage, and 564 m in elevation, concentrations and seasonal patterns of carbohydrates were similar for the two stands. For all tissues, starch concentrations peaked in late spring, declined through summer, and reached a minimum in winter. Sugar concentrations were greater than starch concentrations in all months except May and June. Sugar concentrations peaked in winter, and old needles showed a significant increase in sugar concentration between February and March. This increase in sugar concentration occurred without any reduction in localized starch concentrations or reductions in sugar or starch concentrations in new needles, stems or roots. Because March measurements were made toward the end of a prolonged thaw, a time when increases in photosynthesis have been documented for red spruce, it is likely that the March increase in sugar concentrations resulted from photosynthesis during the thaw. Compared with stems and roots, needles generally contained the highest concentration of carbohydrates and exhibited the greatest seasonal change in carbohydrate concentration. Needles were also the largest reservoir of carbohydrates throughout the year, especially during winter. Because of the critical roles of needles in photosynthesis and storage of carbohydrates, we conclude that any factors that disrupt the accumulation or availability of carbohydrates in red spruce needles will greatly alter plant carbon relations.

Keratocytes: no more the quiet cells.

BACKGROUND: In the past, the keratocytes of the adult cornea have been characterized as quiescent cells populating the stroma. Recent research and the introduction of laser refractive procedures have forced us to reassess this notion. METHODS: By reviewing recent, pertinent papers, an attempt was made to give an overview of the new information the scientific community is learning about keratocytes. This overview assesses the heightened interest in the keratocytes, while maintaining a clinical perspective. Where applicable, this information was tied in with our own laboratory observations. RESULTS: It is becoming increasingly clear that keratocytes may play a vital role in regulating the stromal constituents, while also providing structural stability in maintaining the interlamellar organization and, thus, promote corneal transparency. Keratocytes form a communicating network of cells linked in a anterior-posterior fashion, as well as laterally. This ability to communicate appears instrumental in triggering and orchestrating the corneal response in wound healing. External corneal injury, such as epithelial debridement and excimer laser exposure, can cause profound anterior keratocyte loss. These cells are replaced by aggressive stromal cells, which may play an important role in the formation of scar tissue and corneal haze. CONCLUSION: Keratocytes play an important role in both the healthy and the injured cornea. It appears that the improved outcomes of laser refractive procedures will--to a large extent--depend on our ability to maintain keratocyte health, while also controlling the negative effects of cells replacing injured or dead keratocytes.

Estrogen-induced tumorigenesis in the Copenhagen rat: disparate susceptibilities to development of prolactin-producing pituitary tumors and mammary carcinomas.

The Copenhagen (COP) rat is unique among inbred rat strains in its high degree of resistance to spontaneously arising and induced mammary cancers. Hyperprolactinemia resulting from tumors of the anterior pituitary gland has been suggested to be the causative factor in the etiology of estrogen-induced mammary cancer in rats. Therefore, we have examined the ability of administered estrogens to induce development of PRL-producing pituitary tumors and mammary carcinomas in COP rats. Diethylstilbestrol (DES), administered to male COP rats for 12 weeks, beginning when the animals were 9 weeks of age, induced development of PRL-producing pituitary tumors, defined as grossly enlarged pituitary masses displaying lactotroph hyperplasia and associated hyperprolactinemia. When treated with 17beta-estradiol (E2), female COP rats developed pituitary tumors and hyperprolactinemia, but displayed a high degree of resistance to development of mammary carcinomas. These data indicate that E2-induced hyperprolactinemia is insufficient to induce development of mammary carcinomas in the female COP rat.

Teaching secondary students with learning disabilities to self-manage classroom survival skills.

This multiple baseline study investigated the effectiveness of a cognitive-behavioral self-management training package on the consistent use of specific classroom survival skills. Participants were three adolescent males with learning disabilities in Grades 7 and 8. The training package involved a multicomponent strategy focused on the improvement, maintenance, and cross-classroom generalization of targeted classroom preparedness skills. Following intervention, the training procedures were systematically faded. Results demonstrated more consistent use of targeted classroom survival skills by all three students in both learning support and mainstream generalization settings. Long-term maintenance of the intervention effects was observed for two students in both settings. Three social validity measures revealed positive results. Implications for self-management in secondary education settings are discussed.

Ovary-intact, but not ovariectomized female ACI rats treated with 17beta-estradiol rapidly develop mammary carcinoma.

We have examined the ability of 17beta-estradiol (E2) to induce development of mammary cancers in the female ACI rat. Continuous treatment with E2, delivered through release from s.c. Silastic tubing implants containing 27.5 mg crystalline hormone, resulted in rapid development of palpable mammary tumors in ovary-intact ACI rats. In a population of 21 E2-treated rats, palpable tumors were first observed following 99 days treatment and 100% of the treated population developed tumors within 197 days. The median and mean times to appearance of first palpable tumor were 143 and 145 days respectively. All mammary tumors were classified as carcinomas and invasive features were observed. Circulating E2 levels in the treated animals at the time of sacrifice averaged 185 pg/ml serum. Mammary tumors were not observed in ovary-intact female ACI rats that were not treated with E2. This is the first report indicating that this naturally occurring estrogen is capable of inducing mammary cancers in the ACI rat strain. Mammary carcinoma did not develop in a population of 11 ovariectomized female ACI rats treated with E2 for a period of 140 days. Circulating E2 levels in the treated ovariectomized animals averaged 207 pg/ml. These data indicate that the ovary modulates estrogen-mediated mammary carcinogenesis in this rat strain. Both ovary-intact and ovariectomized female ACI rats displayed similar susceptibilities to E2-induced pituitary tumors and hyperprolactinemia. Pituitary weight was increased 6.0-fold in ovary-intact ACI rats and 5.3-fold in ovariectomized female rats. Circulating prolactin levels averaged 2318 ng/ml in E2-treated, ovary-intact rats and 2285 ng/ml in E2-treated, ovariectomized ACI rats. These data indicate that estrogen-induced hyperprolactinemia is not the sole factor leading to development of mammary cancers in the E2-treated ACI rat.

Developmental aspects of excitation contraction coupling of rabbit bladder smooth muscle.

There is growing evidence that smooth muscle function changes with normal development. In this study a Scatchard analysis revealed that the binding of 3H-ryanodine changed from 6.6 fmol./mg. protein in 3-day-old rabbits to 44 fmol./mg. protein in 8-week-old rabbits (p < 0.05) with no associated developmental changes in the dissociation constants. The physiological findings using muscle strip techniques correlate well with these findings in that the neonatal bladders are far less sensitive to ryanodine than their mature counterparts. In contrast, nifedipine inhibited contractility in the neonatal group to a much greater degree than the mature group. These biochemical and physiological findings support our contention that the mechanism for excitation contraction coupling changes with normal development. Contraction in neonatal rabbit bladder smooth muscle is more dependent upon the influx of extracellular calcium and with normal maturation mechanisms for intracellular calcium storage and release begin to predominate.

Reliability of Q-wave formation and QRS score in predicting regional and global left ventricular performance in acute myocardial infarction with successful reperfusion.

The frequency of electrocardiographic Q-wave formation and the relation of Q wave and QRS score to regional and global left ventricular (LV) performance were determined in 131 patients with acute myocardial infarction (AMI) receiving thrombolytic therapy. Thrombolytic therapy was successful in reperfusing the occluded infarct artery in 100 patients and was unsuccessful in 31. The number of patients who had 1 or more Q waves (88 vs 87%) and 2 or more Q waves (70 vs 74%) was similar. In contrast, normal wall motion was significantly more common in the infarct area in patients in whom reperfusion was successful (42 vs 15%, p less than 0.05). Total QRS scores were similar in patients in whom reperfusion was successful and in those in whom it was not (6.0 +/- 3.2 vs 6.4 +/- 4.2). Despite similar QRS scores, successfully treated patients had significantly higher LV ejection fraction (53 +/- 13% vs 46 +/- 15%, p less than 0.05). Thus, Q-wave formation after successful thrombolytic therapy for AMI is common but does not faithfully reflect regional or global LV performance. Electrocardiographic analysis alone is not a reliable method to assess efficacy of reperfusion therapy.