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Pregnancy and lactation are metabolically challenging states, where the mother must supply all the energy requirements for the developing fetus and growing pups respectively. The aim of the current study was to characterize many aspects of energy homeostasis before and during pregnancy in the mouse, and to examine the role of voluntary activity on changes in energy expenditure during pregnancy. In a secondary aim, we evaluate measures of energy homeostasis during pregnancy in mice that successfully reared their litter or in mice that went on to abandon their litter, to determine if an impairment in pregnancy-induced adaptation of energy homeostasis might underlie the abandonment of pups soon after birth. During pregnancy, food intake was increased, characterized by increased meal size and duration but not number of meals per day. The duration of time spent inactive, predicted to indicate sleep behaviour, was increased both early and late in pregnancy compared to pre-pregnancy levels. Increased x + y beam breaks, as a measure of activity increased during pregnancy and this reflected an increase in ambulatory behaviour in mid pregnancy and an increase in non-ambulatory movement in late pregnancy. Energy expenditure, as measured by indirect calorimetry, increased across pregnancy, likely due to the growth and development of fetal tissue. There was also a dramatic reduction in voluntary wheel running as soon as the mice became pregnant. Compared with successful pregnancies and lactations, pregnancies where pups were abandoned soon after birth were associated with reduced body weight gain and an increase in running wheel activity at the end of pregnancy, but no difference in food intake or energy expenditure. Overall, during pregnancy there are multiple adaptations to change energy homeostasis, resulting in partitioning of provisions of energy to the developing fetus and storing energy for future metabolic demands.

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(+)- and (-)-Chloroephedrine, and their respective aziridines, cis- and trans-1,2-dimethyl-3-phenylaziridine, have been reported present in clandestinely synthesized methamphetamine. Since methamphetamine and structurally related compounds are potential substrates for human liver CYP2D6, the possible interaction of the chloroephedrines with human liver CYP2D6 was evaluated. Computational methods (using Flexidock and HINT in SYBYL) were used to determine the feasibility of (+)- or (-)-chloroephedrine and cis- or trans-1,2-dimethyl-3-phenylaziridine binding in the active site of a three dimensional CYP2D6 molecular model. Although modeling indicates both (+)- and (-)-chloroephedrine would bind comparably to methamphetamine, the binding energies of cis- or trans-1,2-dimethyl-3-phenylaziridine products indicate a preference for trans-1,2-dimethyl-3-phenylaziridine, the product formed from (-)-chloroephedrine. The effects of (+)- and (-)-chloroephedrine on the metabolism of dextromethorphan in human liver microsomes were then experimentally evaluated. (+)-Chloroephedrine (50 micro M) had no effect on human CYP2D6. (-)-Chloroephedrine appeared to be selective for human CYP2D6 versus CYP1A2 and CYP3A4/5. The inhibition of CYP2D6 was time-dependent, not dependent on metabolic activation, and irreversible. It appeared to bind at the active site of CYP2D6 with an apparent K(i) of 226 micro M, with a k(int) of 0.039 min(-1), and a t(1/2) of 23 min. Due to the irreversible nature of this inhibition, this impurity in clandestinely synthesized methamphetamine may be important and warrant further study.

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BACKGROUND: The risk factors for gallstone disease are well known, but they have not been updated to take the development of better ultrasound technology and the advent of laparoscopic surgery into consideration. METHODS: We compared two groups of patients who underwent ultrasound-one group (n = 100) who underwent cholecystectomy after ultrasound revealed the presence of gallstones and a control group (n = 107) in whom no gallstones were shown on ultrasound. RESULTS: Seven patients in the control group refused to participate in the study; otherwise, the groups are sequential. Age in the surgery group was 51 years (+/- 16) vs 50 (+/- 16) for the control group. The percentage of female patients was 59% and 52%, respectively (p = ns). Body mass index was 32 (+/- 8) and 28 (+/- 6), respectively (p = 0.013). Parity > 2 was 0.49% and 0.37%, respectively (p = 0.000001). The number who breast-fed at least one child was 17 (24%) and eight (12%), respectively (p = 0.03). Oral contraceptive use was 37 (52%) and 17 (22%), respectively (p = 0.0005). Primary relatives who had had gallbladder surgery was 0.68 (+/- 1) and 0.35 (+/- 0.6), respectively (p = 0.02). CONCLUSION: Body mass index, breast-feeding, oral contraceptives, parity > 2, and family history were found to be risk factors for gallstone disease. Age and female sex were not, probably due to selection bias.

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Chloroephedrine is an intermediate and possible contaminant formed when methamphetamine is manufactured using ephedrine or pseudoephedrine as precursors. The purpose of this study was to determine whether this contaminant has biological activity and might contribute to methamphetamine-induced cardiovascular toxicity. In conscious rats, the (-) and (+) isomers of chloroephedrine (0.1 and 1.0 mg/kg, i.v.) dose-dependently increased mean arterial pressure (MAP) and heart rate (HR). The potency of the pressor effects of (-) and (+)-chloroephedrine was between that of ephedrine and pseudoephedrine. The increases in HR elicited by the four stimulants were similar except that the tachycardia elicited by all doses of ephedrine and pseudoephedrine were preceded by a brief decrease in HR. The i.v. administration of 10 mg/kg of (+) or (-)-chloroephedrine produced biphasic (decrease followed by increase) the MAP and HR responses. Ephedrine and pseudoephedrine did not decrease MAP at any dose tested. The initial decrease in HR elicited by (-)-chloroephedrine was significantly reduced and the hypotensive response abolished by atropine, indicating that these components of the MAP and HR responses resulted from vagal activation. The secondary pressor response elicited by (-)-chloroephedrine was significantly reduced and the tachycardia significantly increased by pretreatment with phentolamine (3 mg/kg, i.v.). The increase in HR was reversed by propranolol. These results indicate that (-) and (+)-chloroephedrine have sympathomimetic properties similar to other known sympathomimetic stimulants. In addition, larger doses of chloroephedrine can activate the vagus nerve. The combination of (+)-methamphetamine and (-)-chloroephedrine did not markedly alter the magnitude of the MAP and HR responses of (+)-methamphetamine alone except at high doses of (-)-chloroephedrine (10 mg/kg). Contamination of illicit methamphetamine with chloroephedrine may have toxic consequences.

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In the last decade, laparoscopy has been the most innovative surgical movement in general surgery. Minimally invasive surgery performed through a few small incisions, laparoscopy is the standard of care for the treatment of gallbladder disease and the gold standard for the treatment of reflux disease. The indications for a laparoscopic approach to abdominal disease continue to increase, and many diseases may be treated with laparoscopic techniques. At Ochsner, laparoscopic techniques have demonstrated better cosmetic results, shorter recovery times, and an earlier return to normal activity compared with open surgery.

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Evaluation and management of patients with nipple discharge (ND) aims to identify carcinoma when present, and in benign cases, stop the discharge when bothersome. We reviewed our recent experience with ND to develop a simple and effective algorithm to manage these patients. Records of all patients with ND evaluated from December 1996 through June 1999 were reviewed. Patients were liberally offered duct excision for a clinical suspicion of malignancy (persistent clear or bloody fluid) or to stop bothersome discharge. Patients with breast imaging abnormalities (mammography or ultrasound) related to their ND underwent biopsy and were considered separately. Of 104 patients with ND, 11 underwent biopsy as a result of mammographic findings; three of these cases proved malignant. The remaining 93 patients were evaluated with 55 tests that did not demonstrate malignancy, including ductography, discharge fluid cytology, serum prolactin and thyroid-stimulating hormone levels, and image-guided breast or nipple biopsy. Thirty-nine patients underwent duct excision with only a single patient demonstrating malignancy. Clinical follow-up has not identified malignancy in any patient managed nonoperatively. When diagnostic breast imaging is negative, malignancy related to ND is uncommon. Patients with ND should have diagnostic breast imaging and, if it is negative, should be offered duct excision. There is little role for ductography, cytology, or laboratory studies in evaluating these patients.

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Previous studies in our laboratories have shown that extracts from mainstream or sidestream tobacco smoke nick DNA. These solutions contain the tar semiquinone free radical, and the tar radical becomes associated with cellular DNA. Aged solutions of catechol contain a semiquinone species that has ESR properties similar to those of the radical in cigarette tar extracts, and we have used these catechol solutions as a model for the tar radical. Both the radical in aged catechol solutions and the cigarette tar radical become associated with the DNA in mammalian cells and also nick DNA. The nicking of DNA caused by both tar and aged catechol solutions follows saturation kinetics. Aged catechol solutions thus allow the study of a model for the radical present in cigarette tar, without interference from the other toxic constituents in tar extracts.

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This study demonstrates the ability of tar isolated from environmental tobacco smoke (ETS) to nick DNA in mammalian cells. Solutions of ETS tar behave similarly to aqueous solutions of cigarette tar from mainstream smoke. Both solutions contain the tar semiquinone radical, and this radical associates with the DNA in viable rat alveolar macrophages. Solutions of tar from ETS cause single-strand DNA breaks in rat thymocytes in proportion to the amount of tar present, until a plateau is reached. ETS tar solutions, like mainstream tar solutions, produce hydrogen peroxide. Hydrogen peroxide appears to be an essential component of the mechanism by which both ETS tar and mainstream tar cause DNA damage in rat thymocytes, as catalase substantially protects against DNA damage. Glutathione also protects against DNA nicking by both ETS and mainstream tar solutions by scavenging radicals and/or oxidants. The chelator diethylenetriamine pentaacetic acid also provides partial (40%) protection. The studies demonstrate that the water-soluble components of ETS tar can enter cells, associate with, and then nick DNA.

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Cortisol resistance is a rare condition due to abnormal glucocorticoid receptor function. Stimulation of aromatase activity by dexamethasone (DEX) in cultured human skin fibroblasts provides a model for studying the biological activity of glucocorticoid receptors in cells. Skin fibroblasts derived from an affected father and his less severely affected son with cortisol resistance were used for this study. Saturation analysis of DEX receptor binding was performed after incubation of cells with various DEX concentrations (1-50 nmol/L). In normal cells, the mean maximal binding capacity (Bmax) and dissociation constant (Kd) were 24 +/- 3 pmol/mg DNA and 14 +/- 3 nmol/L, respectively. Although the Bmax in cells of the father (33 +/- 2 pmol/mg DNA) was normal, the Kd (31 +/- 7 nmol/L) was abnormally elevated. By contrast, both the Bmax and Kd in cells of the son were normal. The dose response of aromatase activity to DEX stimulation was determined by assay of aromatase activity after incubation of cells in the absence or presence of DEX (0.25-500 nmol/L) for 14 h. In three strains of normal fibroblasts, the mean concentration of DEX that produced a half-maximal response was 6 +/- 1 nmol/L). In cells from the father, the mean concentration of DEX that produced half-maximal stimulation of aromatase (27 +/- 4 nmol/L) was abnormally elevated. By contrast, the concentration of DEX that half-maximally stimulated aromatase activity (6.0 and 5.9 nmol/L) was normal in cells from the son. These data provide additional evidence of abnormal glucocorticoid action in the father, but not in his son, and demonstrate the potential usefulness of determining aromatase induction by DEX as a means of assessing the biological activity of the glucocorticoid receptor.

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The cytochrome P-450-dependent aromatase pathway utilizes the androgens testosterone (T) and androstenedione, as substrates for estrogen formation. In addition, androgens have been shown to influence the level of aromatase activity in various tissues. In cultured human skin fibroblasts, incubation with T for 14 h resulted in a dose-dependent decline in aromatase activity, the concentration of T producing a half-maximal decline being 6 nM. In the presence of T (50 nM), aromatase activity declined in a time-dependent fashion with maximal reduction occurring by 9 h. When aromatase kinetics were determined after preincubation of cells with T, there was a significant decline in the calculated Vmax with no significant change in the apparent Km, suggesting that incubation of cells with T reduced the number of active enzyme sites. Aromatase activity was unaffected by preincubation of cells with the synthetic androgen methyltrienolone. In addition, the decline in aromatase activity following preincubation with T was observed in cells derived from patients with complete androgen insensitivity demonstrating that the effect of T was not mediated by androgen receptors. Furthermore, new protein synthesis was not necessary for the T-mediated effect as the presence of cycloheximide (50 micrograms/ml) did not prevent it. When cells were incubated at low oxygen tension, the inhibition of aromatase activity by T was diminished. Testosterone is rapidly metabolized in genital skin fibroblasts to dihydrotestosterone, androstanedione, androsterone, 3 alpha-androstanediol, 3 beta-androstanediol and estradiol. To determine if a metabolite of T might be responsible for the repression of aromatase activity, aromatase activity was determined in cells following preincubation with various metabolites of T. Preincubation of cells with androstenedione, androstanedione or 3 alpha-androstanediol produced a small but significant decline in aromatase activity, whereas preincubation of cells with dihydrotestosterone, androsterone, or 3 beta-androstanediol did not have a significant effect. Aromatase activity was also unaffected by preincubation of cells with estradiol or diethylstilbestrol. When aromatase activity was assayed in microsomal preparations from cells preincubated with T, activity was reduced. Although cells preincubated with 50 nM [3H]T contained between 0.25 and 0.51 pmol of residual steroid/mg microsomal protein, the amount of [1-3H]androstenedione and T was insufficient to account for the observed decline in aromatase activity on the basis of competitive inhibition.(ABSTRACT TRUNCATED AT 400 WORDS)

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Skin is an important site of estrogen production in men. Although the aromatase complex in these cells appears to be similar to that of other human cells, the regulation of aromatase by glucocorticoids in cultured human skin fibroblasts is unique. We examined aromatase activity in microsomal-enriched fractions of cultured human skin fibroblasts in order to characterize better the factors that regulate the aromatase in these cells. The optimum pH for aromatase activity in microsomal preparations ranged between 7.0 and 7.5. When androstenedione was the substrate, the mean Vmax was 0.58 pmol/mg protein/h (range: 0.09-1.26 pmol/mg protein/h) and the mean Km was 27 nM (range: 9-50 nM). When aromatase activity was determined as a function of NADPH concentration, the mean Vmax was 0.39 pmol/mg protein/h (range 0.11-0.82 pmol/mg protein/h) and the mean Km was 180 microM (range: 86-300 microM). For skin fibroblasts exposed to DEX, aromatase activity in isolated microsomes and intact cells was stimulated demonstrating a typical time course with peak levels at 14h and a decline toward baseline with prolonged (48-60 h) exposure. Cytosol from DEX-stimulated cells did not stimulate the aromatase activity in microsomal-enriched preparations from untreated cells. In addition, cytosol from cells incubated with DEX for a prolonged period (60 h) did not inhibit the higher aromatase activity of microsomes from cells incubated with DEX for only 14 h. We previously demonstrated that skin fibroblasts incubated with DEX and CHX produced a superinduction phenomenon for aromatase activity. This superinduction of enzyme activity also occurred in the microsomal-enriched fraction and was unaffected by the cytosol of these cells. These studies exclude the possibility that the unique effects of DEX on the aromatase in human skin fibroblasts are due to the production of either inhibitory or stimulatory soluble factors within cytosol.

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Human genital skin fibroblasts grown in cell culture contain aromatase activity and glucocorticoid receptors, providing a model for studying the relationship between changes in levels of dexamethasone (DEX) receptor binding and changes in the response of aromatase to DEX. Incubation of cells with media containing DEX produced a time-dependent decline in receptor number, with a nadir at 18-24 h. When DEX was removed from the media, only 40-60% of the lost receptor content was recovered. Binding of DEX to its receptor declined in a dose-dependent fashion after 24-h exposure to this glucocorticoid; the concentration of DEX that produced a half-maximal decline (2.2 nmol/L) was in the same range as the Kd for the receptor-DEX complex (14 nmol/L). Incubation of cells with DEX for 20 h also reduced the level of DEX receptor binding in purified nuclei and nuclear matrix by 76% and 89%, respectively. When subcellular fractions were prepared after incubation of cells with DEX for 1-24 h, whole cell, cytosolic and nuclear DEX receptor binding declined in parallel with time. Incubation of skin fibroblasts with DEX resulted in progressive stimulation of aromatase activity, with a peak at 24 h followed by a return to baseline at 72 h. The initial stimulation of aromatase was mediated by DEX receptors. However, the decline in aromatase activity after prolonged DEX exposure did not appear to be due to a decline in the level of DEX receptor binding. The data supporting this last conclusion included the following. When cells were washed free of DEX after 48 h, DEX receptor binding recovered within 24 h, whereas aromatase activity could not be maximally restimulated until 36 h; when cells were incubated with media containing DEX and cycloheximide for 1-48 h, DEX receptor binding declined to a nadir by 24 h, whereas aromatase activity rose continuously up to 48 h. These findings are consistent with the concept that the aromatase gene in skin fibroblasts is subject to both positive and negative regulation.

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The amplitude of human, antidromic, sensory compound action potentials (CAP) recorded from median and ulnar digital nerves is greater in females than males. This sex difference is probably due entirely to females having digits of smaller circumference, resulting in digital nerves being closer to the recording ring electrode enclosing the digit. The negative linear correlation between CAP amplitude and circumference holds true for persons of the same sex.

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The effects of furosemide on renal function and hemodynamics were evaluated in 54 critically ill surgical patients. Standard clearance techniques were used to measure glomerular filtration rate (GFR), renal plasma flow (RPF), osmolar clearance (COsm), sodium clearance (CNa), and renal blood flow (RBF). RBF distribution to outer cortex, inner cortex-outer medulla, and inner medulla was measured by the radioactive xenon disappearance technique. Furosemide produced a marked rise in urine output, COsm, and CNa; it produced no change in GFR, RPF, RBF, and RBF distribution. Twelve of the 54 patients received furosemide for therapy not related to the study; six patients developed renal failure and five became hypotensive 2 to 10 hours after administration of furosemide. These data demonstrate that furosemide does not protect against renal failure by altering or increasing RBF but may cause renal failure by producing hypovolemia.

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