Recent Publications by CFE Educators

We report a case of a primary right ventricular leiomyosarcoma in a 58-year-old woman diagnosed by endomyocardial biopsy. Clinical findings included a 5-year history of atypical chest pain and atrial fibrillation as well as a 30-lb weight loss. A ventricular mass was identified by echocardiography and magnetic resonance imaging, and an endomyocardial biopsy was performed. Biopsy was guided by right ventriculography, which revealed a mobile mass in the cavity of the right ventricle. Light microscopy revealed a fasciculated, spindle cell sarcoma, most consistent with leiomyosarcoma, and immunohistochemical staining for muscle-specific actin was strongly positive in nearly all tumor cells, confirming its myogenous differentiation. Endomyocardial biopsy provided a definitive tissue diagnosis of this rare primary malignant cardiac neoplasm without the need for a surgical procedure.

In this study, the effect of intracerebroventricular (icv) administration of (5R)-(5 alpha, 7 alpha, 8 beta)-N-methyl-N-[7-(1-pyrrolindinyl)-1- oxaspiro[4,5]dec-8-yl]-4-benzofurnacetamide monohydrochloride (Cl-977) on pain behaviors and on spinal cord fos-like immunoreactivity (FLI) evoked by unilateral formalin injection into the hindpaw of rats was examined. Intracerebroventricular administration of Cl-977 (0.13-13.00 nmol) produced a dose-dependent inhibition of formalin-evoked pain behaviors, with significant inhibition after 1.30, 4.40 and 13.00 nmol. The estimated ED50 for icv Cl-977 inhibition of formalin-evoked behaviors was 0.95 nmol and the Emax was 53%. The inhibitory effect of 4.40 nmol of icv Cl-977 on formalin-evoked behaviors was prevented by either pretreatment with the kappa selective antagonist nor-binaltorphimine (10 or 100 nmol) or coadministration of the opiate receptor antagonist, naloxone (30 nmol). The lowest dose of icv Cl-977 tested (0.13 nmol) produced a 50% reduction in FLI in the superficial laminae but did not inhibit the expression of FLI in any other regions of the spinal cord. The fos-inhibitory effect of low-dose icv Cl-977 in the superficial cord was reversed by coadministration of naloxone (30 nmol). Higher doses of icv Cl-977 that suppressed formalin-evoked behaviors did not inhibit the expression of FLI in any region of the spinal cord. Finally, neither the inhibitory effect of 4.40 nmol Cl-977 on formalin-evoked behaviors nor the formalin-evoked pattern of FLI expression in the spinal cord of rats treated with this dose of Cl-977 was affected by lesions of the dorsolateral funiculus. These results provide the first evidence that supraspinal kappa receptor-mediated antinociception is not dependent on the integrity of the dorsolateral funiculus and may be mediated exclusively at the supraspinal level, suggesting that there are multiple mechanisms through which opioids can evoke antinociceptive effects.

Numerous studies have implicated the primary afferent derived neuropeptide, substance P, which exerts its effects via the neurokinin-1/substance P receptor, in the transmission of nociceptive messages at the level of the spinal cord. Immunocytochemical studies demonstrate that the substance P receptor is concentrated in neurons of lamina I of the superficial dorsal horn. Since alterations in the number and distribution of the receptor may underlie persistent pain conditions, we have used immunocytochemistry to study the distribution of the receptor in two very different rat models of persistent pain: chronic inflammation, which is associated with increased levels of substance P, and sciatic nerve section, which is associated with decreased levels of substance P in the dorsal horn. Inflammation was produced by unilateral hindpaw injection of complete Freund's adjuvant. We report that there is an up-regulation of substance P receptor immunoreactivity in the superficial laminae of the dorsal horn in both injury models. The increase was found at all time points studied (up to one week after induction of inflammation and up to two weeks after sciatic nerve section). The increase in substance P receptor immunoreactivity was not only present in the medial part of the dorsal horn at segment L4, which is the region of input of the afferents from the hindpaw, but also in the lateral parts of the dorsal horn, and at segments rostral (L1) and caudal (S1) to the afferent input from the hindpaw. These results indicate that the up-regulation of the receptor is not predictable merely by the change in the concentration of substance P in the dorsal horn. Furthermore, the non-topographic up-regulation of substance P receptor in these different conditions may contribute to the central sensitization of dorsal horn nociceptors under conditions of persistent pain.