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678 | Effects of milk, prostaglandin, and antacid on experimentally induced duodenitis in the rat. Use of myeloperoxidase as an index of inflammation.
Ulcerogenesis of the duodenal mucosa frequently involves an inflammatory reaction with infiltration of leukocytes.
Measurement of neutrophil myeloperoxidase activity might thus be a sensitive indicator of damage, before visible lesions occur.
To test this possibility, a rat model for duodenal injury was used where fasted animals were treated with indomethacin and histamine-diHCl.
Twenty-four hours after indomethacin treatment, duodenal tissues were collected for histochemical staining and biochemical assay for myeloperoxidase activity.
Indomethacin- and histamine-challenged rats had significantly elevated myeloperoxidase activity compared to unchallenged controls (P less than 0.05) for both histochemistry and biochemistry.
There was also a significant correlation between these two parameters (r = 0.68, P less than 0.001).
The duodenal injury model then was used to test the effectiveness of known gastric protective agents.
Results indicated that milk and buttermilk did not aggravate or protect against duodenal injury, while antacid and prostaglandin did significantly protect against inflammation (P less than 0.02).
We concluded that measurement of myeloperoxidase activity is a sensitive and potentially useful estimate of duodenal injury that can be valuable in assessing ulcerogenesis and healing.
| 5 |
1,495 | Maternal mortality in the United States, 1979-1986.
To understand better the epidemiology and to describe the causes of maternal death, we reviewed all identified maternal deaths in the United States and Puerto Rico for 1979-1986.
The overall maternal mortality ratio for the period was 9.1 deaths per 100,000 live births.
The ratios increased with age and were higher among women of black and other minority races than among white women for all age groups.
The causes of death varied for different outcomes of pregnancy; pulmonary embolism was the leading cause of death after a live birth.
Unmarried women had a higher risk of death than married women.
The risk of death increased with increasing live-birth order, except for primiparas.
In order to develop strategies to reduce the risk of maternal death in the United States, future studies should include expanded information about each death, which will allow better understanding of factors associated with maternal mortality.
| 12 |
2,106 | Hemopump ventricular support for patients undergoing high risk coronary angioplasty.
Prophylactic implantation of a Hemopump (Johnson and Johnson, Skillman, NJ) has been evaluated in nine patients selected for high risk coronary angioplasty.
They were unstable patients, refractory to maximal pharmacology, with indications for revascularization, but contraindications for surgery such as low ejection fraction and lack of material for bypass.
In all, the target lesion was located on the last patent vessel.
The pump was inserted under local anesthesia, without any graft.
A specially designed occluder permitted avoidance of retrograde bleeding during implantation.
The bypass flow ranged from 2.5 to 3.2 L/min, and permitted a rise in cardiac index from 2.05 to 2.55 L/min/m2, with a drop in capillary wedge pressure from 13 (7-18) to 10 (7-13) mmHg.
During balloon inflation, no electrocardiographic changes were observed, because only minor ventricular arrhythmias occurred.
No significant hemolysis was seen (plasma free hemoglobin less than 10 mg/dl in all) after 2 hr of pumping.
The only limitation of the technique appears to be difficulty at the time of implantation from narrow, stenosed, or tortuous iliofemoral arteries (3 patients).
This experience strongly supports the benefit of temporary left ventricular Hemopump support in high-risk situations and clearly shows the need for a smaller pump.
| 13 |
2,320 | Spontaneous rheumatoid-like arthritis in a line of mice sensitive to collagen-induced arthritis.
Twenty-eight percent of 13-month-old male mice of the high antibody responder line of Biozzi's selection I (HI) spontaneously developed a long-lasting inflammatory arthritis.
This disease was clinically and histologically similar to human rheumatoid arthritis.
The synovium of joints and some tendons was hypertrophied, with thickening of the synovial cell layer and infiltration by polymorphonuclear and mononuclear leukocytes.
In some cases, synovial pannus formation led to destructive damage of articular cartilage and bone.
Rheumatoid factor and antinuclear, anti-DNA, and anti-type II collagen (CII) antibodies were often found in the sera of both arthritic mice and clinically normal littermates.
The presence of CII autoantibodies in this line of mice suggests that a potentially harmful anti-CII T cell autoimmunity can also develop spontaneously and lead to joint damage.
Moreover, HI mice are also susceptible to collagen-induced arthritis, while a closely related mouse line (HII) is resistant to both diseases.
These data support the hypothesis that collagen-induced arthritis is pathogenetically related both to this spontaneous arthritis and to rheumatoid arthritis.
| 16 |
2,240 | Intraoperative echocardiography in infants and children with congenital cardiac shunt lesions: transesophageal versus epicardial echocardiography.
To determine the utility and limitations of intraoperative transesophageal echocardiography in infants and children with congenital intracardiac shunts, intraoperative transesophageal (n = 50) and epicardial (n = 49) echocardiograms were performed before and after cardiopulmonary bypass in children from 4 days to 16 years old and 3 to 45 kg in body weight.
A miniaturized transesophageal probe (6.9 mm maximal diameter) was used in 36 patients weighting less than or equal to 20 kg.
Epicardial imaging was performed with a 5 MHz precordial probe.
The intraoperative transesophageal echocardiographic findings before and after cardiopulmonary bypass were correct and complete in 94% of patients.
Transesophageal echocardiography correctly identified atrial septal defects, most types of ventricular septal defects, anomalous pulmonary veins, atrioventricular septal defects, tetralogy of Fallot, truncus arteriosus and double inlet ventricles.
It failed to provide a correct diagnosis in only three patients, all of whom had doubly committed subarterial ventricular septal defects.
Epicardial echocardiography identified all cases that had a doubly committed subarterial ventricular septal defect.
A correct and complete intraoperative diagnosis was obtained with the use of epicardial imaging in 92% before and after cardiopulmonary bypass, but this technique required interruption of surgery and could not be completed in three patients because of induced arrhythmias and hypotension.
These results demonstrated that intraoperative transesophageal echocardiography consistently defined important morphologic, color and pulsed Doppler ultrasound features of most congenital shunt lesions.
Lesions that involved the right ventricular outflow tract are sometimes difficult to image with uniplane transesophageal echocardiography.
There were no complications in any of the 50 subjects.
| 15 |
2,241 | Increased birth prevalence of cardiac defects in Yuma, Arizona
A systematic study was undertaken to estimate the birth prevalence of congenital heart disease because there was a clinical impression that a disproportionate number of cases occurred in Yuma, Arizona.
Control data were obtained from Sierra Vista, Arizona, a region with similar demographic characteristics, and from the Baltimore-Washington Infant Study.
Patients with chromosomal or syndromal associations were excluded.
In the Baltimore-Washington Infant Study only echocardiographic and invasively documented cases were included.
From 1983 to 1988 the birth prevalence was significantly higher in Yuma (10.5/1,000) than in Sierra Vista (5.4/1,000, p less than 0.0001).
As assessed only by invasive or echocardiographic diagnosis, there was a higher birth prevalence of congenital heart disease in the study population (6.7/1,000) compared with both the Baltimore-Washington Infant Study (3.7/1,000, p = 0.0008) and Sierra Vista (4.6/1,000, p = 0.04).
Families were interviewed to exclude cases in which the mother did not spend the month before conception and the first trimester in Yuma or Sierra Vista.
The birth prevalence for Yuma (6.0/1,000) remained significantly greater than that for Sierra Vista (3.8/1,000, p = 0.03).
The exclusion of cases in which the mother resided elsewhere suggests, but does not prove, that an environmental influence may have played a role in the increased birth prevalence of congenital heart disease in this community.
| 15 |
1,658 | Experimental studies of the physiologic properties of technetium-99m isonitriles.
Recently, efforts have been directed at the development of technetium-99m (Tc-99m)-labeled isonitrile compounds for assessment of regional perfusion and viability after experimental myocardial infarction or ischemia.
One of the most promising of these agents, Tc-99m sestamibi, has undergone rather extensive laboratory investigation.
Like thallium-201 (Tl-201), the uptake of Tc-99m sestamibi in myocardial tissue is proportional to myocardial blood flow after intravenous injection.
Similar to other diffusible indicators, Tc-99m sestamibi underestimates blood flow at high flow rates.
In low flow regions, the myocardial uptake of this agent is higher relative to nonischemic uptake than is microsphere-determined blood flow.
This is attributed to increased extraction at low flows.
This first-pass myocardial extraction fraction for Tc-99m sestamibi is less than that for Tl-201.
However, Tc-99m sestamibi has a higher parenchymal cell permeability and higher volume of distribution than T;-201.
Tc-99m sestamibi shows minimal "delayed redistribution" after initial intravenous administration.
Uptake of Tc-99m sestamibi is not altered by myocardial "stunning" or with ischemic dysfunction produced by sustained low coronary flow.
The uptake of the isonitrile is still proportional to blood flow in these situations.
In intact animal models, myocardial uptake of Tc-99m sestamibi during coronary occlusion delineates the in vivo area at risk.
When Tc-99m sestamibi is administered after reperfusion following variable periods of preceding coronary occlusion, Tc-99m sestamibi uptake delineates the area of viable myocardium that is salvaged and not simply the degree of reflow.
This suggests that serial Tc-99m sestamibi imaging might be useful in assessing the efficacy of coronary reperfusion after thrombolytic therapy.
| 13 |
2,787 | Penetrating injuries of the abdominal aorta.
The charts of 56 consecutive patients with penetrating injuries to the abdominal aorta were reviewed in an attempt to identify prognostic factors.
Mechanism of injury was gunshot wound (GSW), 82 per cent (.22 cal: 15.2%; greater than .38 cal: 84.8%); shotgun wound (SGW), 5 per cent; and stab wound (SW), 13 per cent.
Overall mortality was 73 per cent, with GSW 78 per cent (.22 cal: 0%; greater than .38 cal: 92%), 67 per cent with SGW, and 43 per cent with SW.
Average initial systolic blood pressure (ISBP) was 53 (0-130); 87 (0-120) in survivors; and 40 (0-130) in nonsurvivors (NS).
Eighteen patients (32%) had no ISBP, with one survivor.
Thirty (54%) patients had ISBP less than 70, with three survivors.
Six Emergency Department (ED) thoracotomies were performed, with five patients surviving to reach the operating room (OR), and none surviving long-term.
Ten patients died in the ED, 18 during surgical intervention, six within 24 hr, and seven greater than 24 hr postop.
Average time from injury to OR was 75 minutes, with 122 minutes in survivors, and 53 minutes in nonsurvivors (P less than 0.05); 49 minutes in those dying in the OR; and 58 minutes in those surviving the OR but dying postop (NS).
At surgery, six patients had thoracotomy before celiotomy for control of the thoracic aorta, with three surviving the OR and two surviving long-term.
Survivors had 2.53 associated injuries; nonsurvivors had 2.89 (NS).
No significant difference was noted in number or location of associated injuries between survivors and nonsurvivors.
| 20 |
2,890 | Submersion in The Netherlands: prognostic indicators and results of resuscitation.
STUDY OBJECTIVES: To analyze prognostic indicators and the outcome of resuscitation in submersion victims (drowning and near drowning).
DESIGN: Retrospective study.
SETTING: Intensive and Respiratory Care Unit.
Between January 1, 1979, and December 31, 1985, 87 submersion victims were admitted.
The files of 83 victims were available for statistical analysis.
There were 66 male victims and 17 female victims; the average age was 31.4 +/- 25.8 years.
There were ten salt water and 73 fresh water submersions.
MEASUREMENTS AND MAIN RESULTS: Predictors for better survival potentials were a young age, submersion of less than ten minutes, no signs of aspiration, and a central body temperature of less than 35 C at admission.
We did not detect factors that accelerated a decrease in core body temperature at admission and assume that lethal hypoxia had preceded protective hypothermia in our submersion victims.
The Orlowski score had a predictive value but at the same time we found nonindependent indicators in this score.
Neurologic outcome in our patients, who were not treated according to a brain protection protocol, was not worse than the outcome published by authors who have used such a protocol.
Thirty-three percent of the victims with a cardioventilatory arrest (15) and all victims with a ventilatory arrest (11) survived resuscitation and were discharged.
Five nonarrest victims died due to late complications.
CONCLUSION: This study shows that no indicator at the rescue site and in the hospital is absolutely reliable with respect to death or survival.
| 20 |
2,796 | Estimation of the amount of alcohol ingested from a single blood alcohol concentration.
Capillary blood alcohol concentrations (BAL) measured in 22 young adult male volunteers each of whom received three different treatments of alcohol (total N = 66) have been related quantitatively to the dose of alcohol ingested.
Linear regression with reasonably homogeneous variances have been found when the BAL at 2, 2.5 and 3 hr are divided by the person's body weight and plotted versus the g/kg (D/W) dose.
Error analysis indicated that the least error in the predicted dose (D/W) was obtained for BAL measured at 2 hr post dosing.
In the latter case the mean absolute error was 6.23%, 59% of the errors were within +/- 5% and 88% of the errors were within +/- 10%.
| 20 |
1,919 | Predictive value of lipoprotein (a) and other serum lipoproteins in the angiographic diagnosis of coronary artery disease.
To determine the relation among lipids in predicting coronary artery disease (CAD), 213 patients undergoing diagnostic angiography for suspected CAD were prospectively studied.
Twenty-one patients had normal coronary arteries and 192 had CAD in 1 to 3 arteries at arteriography with measurements obtained with digital calipers.
Lipoproteins were measured and lipoprotein (a) [Lp(a)] was also assayed in a subset of 98 patients with CAD.
Statistical analysis was performed using uni- and multivariate techniques to test the association among age, gender, systemic hypertension, diabetes mellitus, cigarette smoking, family history, total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, very low density lipoprotein cholesterol, apolipoproteins (apo) A-I and apo B, ratio of apo A-I to apo B, and ratio of HDL cholesterol to total cholesterol, to Lp(a) and to CAD.
All factors except gender, systemic hypertension, diabetes mellitus and cigarette smoking were univariate predictors of CAD.
Multivariate predictors were, in decreasing order of significance, family history, age, HDL/total cholesterol ratio and apo B.
When Lp(a) was included, multivariate predictors were age, family history, apo B and Lp(a), in that order.
Lipid parameters alone showed that the HDL/total cholesterol ratio and that Lp(a) provide the best predictive tests for the detection of CAD in this referral population and may ultimately become important screening tests for CAD.
| 13 |
2,761 | Alcohol and trauma. An endemic syndrome.
Injuries are a pervasive and costly problem, and alcohol use appears to be an important risk factor for injury.
We examined the blood alcohol levels and selected demographic and epidemiologic variables recorded on trauma patients by 1 trauma center for a 28-month period.
A total of 2,262 trauma patients were admitted to the trauma center during this period, of whom 75% were male and 72% were injured in vehicle-related incidents.
Blood alcohol levels of 2,095 patients (93%) were measured, and alcohol was present in the blood of 855 (41%).
Of those patients with a blood alcohol level done, 32% had a level higher than 100 mg per dl.
We conclude that the level of alcohol involvement in trauma is high and that this involvement must be addressed by the medical community and the health care system.
| 20 |
67 | Percutaneous central venous catheterization. Three years' experience in a neonatal intensive care unit.
Prolonged venous access is desirable in very-low-birth-weight infants and infants for whom feedings are contraindicated.
We prospectively evaluated 481 small-diameter venous catheters placed percutaneously in 317 patients over 3 years.
Of 478 catheters, 241 (50%) were placed in infants weighing 1 kg or less.
Mean catheter stay was 13 days (range, less than 1 to 77 days).
Almost half (49%) of the central and thoracic catheters (91% of placements) were removed nonelectively: 43% due to problems such as leaking or clotting and 6% to suspicion of sepsis or venous occlusion.
Of the 23 episodes of possible sepsis in the 478 catheter stays, six (1.3%) were confirmed catheter-related sepsis; 12 (2.5%) were confirmed alternate locus sepsis.
Three factors specific to percutaneous central venous catheter-related sepsis were prolonged catheter stay (3 to 5 weeks), Staphylococcus epidermidis, and weight less than or equal to 1 kg.
Four factors specific to alternate locus sepsis were presence of an alternate infection site, earlier infection (1 to 2 weeks), extremely low birth weight, and prolonged clinical instability.
Percutaneous central venous catheterizations reduced the need for the stress of repeated venipuncture, resulting in lower complication rates than those reported with surgically placed central venous catheters, and leading to identification of risk factors specific to catheter sepsis and alternate locus sepsis.
| 0 |
334 | Alternating cisplatinum and VAC ineffective in end stage squamous cell carcinoma of the head and neck.
Sixteen patients with end stage squamous cell carcinoma of the head and neck were admitted to a phase II study of alternating courses of cisplatinum (100 mg/m2) and VAC (vincristine 1.4 mg/m2, adriamycin 50 mg/m2, cyclophosphamide 750 mg/m2) given at three weekly intervals.
Only two patients achieved a response (12 per cent).
The median survival time was 62 days which is much the same as that of a similar group of patients who received no chemotherapy in a previous trial (70 days).
| 3 |
39 | Bioaerosols: prevalence and health effects in the indoor environment.
Assessing the role of bioaerosols in residence-related symptoms involves (1) determining that symptoms are related to the residence by medical examination and careful questioning, (2) connecting reported symptoms with known or hypothesized effects of bioaerosols, (3) examining the residence for bioaerosol risk factors such as overcrowding/poor ventilation, inappropriate outdoor air intrusion, and dampness/standing water, (4) and finally, if no obvious risk factors are present, air sampling.
Air sampling should always be a last resort and should use a reliable volumetric method.
Particulate samplers, such as the Burkard personal spore trap, are inexpensive alternatives to viable particle samplers and will provide data on most organisms implicated in hypersensitivity diseases.
Interpretation of residential bioaerosol sample data requires both qualitative and quantitative comparison with adjacent outdoor air and examination of aerosol changes related to domestic activities.
Recommendations that should lead to a decrease in indoor bioaerosols include the use of air conditioning to allow limitation of outdoor aerosols, prevention of dampness or moisture intrusion, and discouraging the use of humidifying devices other than steam.
Bioaerosol assessment in the workplace is often more complex than for residences.
Because the symptomatic subjects are not in charge of the environment, such situations often lead to difficult employee/management relations and occasionally to litigation.
It is essential that each step in workplace bioaerosol assessment be defensible and that the best possible methods are used.
The approach is similar to the approach used for residences, but on a larger scale.
Symptom assessment must include stress and ergonomic factors.
Air sampling, if this is necessary, must usually be extensive with controls for ventilation rates, occupancy, and spatial variation.
| 0 |
1,312 | Digital rectal examination in the early detection of prostate cancer.
Screening using digital rectal examination improves the clinical stage distribution of prostate cancer and prolongs survival.
Unfortunately, digital rectal examination may not be sensitive enough to detect the small-volume tumors that are most amenable to cure.
In several studies, approximately 50 per cent of cancers detected through screening had already spread beyond the prostate.
Regardless, the key to demonstrating overall benefit from screening is a diminished disease-specific mortality rate.
To date, this has not been shown.
Lower mortality rates from prostate cancer can be demonstrated only through a randomized study comparing screened and unscreened populations.
Such a study, which has recently been approved and funded by the National Institutes of Health, will require 10 to 15 years to complete.
Until that time, the value of screening for prostate cancer by digital rectal examination or any other method will be unknown.
Beyond a lack of proved benefit, screening for prostate cancer may be harmful because of the variable natural history of the disease and the morbidity and mortality rates associated with treatment.
There exists a large population of patients with pathologically detectable prostate cancer who will never have clinical disease.
The detection of some of these tumors may expose those patients to the risks of unnecessary treatment.
Large-scale prostate cancer screening studies may ultimately be shown to be advantageous.
The sooner this occurs, the earlier aggressive screening can be advocated, similar to screening for breast cancer.
However, the temptation to embark on such screening programs without first demonstrating clear benefit should be resisted.
| 11 |
3,281 | Hemorrhage in mice produces alterations in pulmonary B cell repertoires.
Nosocomial pneumonia occurs frequently after hemorrhage and trauma and contributes to the increased incidence of morbidity and mortality after severe injury.
The production of secretory antibodies by mucosally associated B cells is an important component of pulmonary host defense mechanisms.
To determine the effects of hemorrhage on pulmonary B cell function, we examined hemorrhage induced alterations in pulmonary B cell repertoires.
There were no changes in the relative distribution of T or B cells among intraparenchymal pulmonary lymphocytes after blood loss.
Hemorrhage induced decreases of between 5- and 10-fold in the frequencies and numbers of pulmonary B cell clonal precursors specific for the bacterial Ag levan and Pseudomonas aeruginosa polysaccharide.
These decreases in numbers and frequencies of bacterial Ag-specific pulmonary B cell clonal precursors were present between 3 and 10 days after blood loss.
Similar decreases in numbers and frequencies were found among pulmonary clonal precursors specific for the autoantigen mouse transferrin, but not for the autoantigen dsDNA or the external antigens OVA and keyhole limpet hemocyanin.
These results demonstrate that hemorrhage produces marked alterations in pulmonary B cell repertoires, which may contribute to postinjury abnormalities in host defenses.
| 22 |
1,779 | Hormones regulating cardiovascular function in patients with severe congestive heart failure and their relation to mortality. CONSENSUS Trial Study Group.
There is a varying hormonal activation in heart failure.
To be able to evaluate this activation and relate it to prognosis, we took blood samples at baseline and after 6 weeks from 239 patients with severe heart failure (all in New York Heart Association class IV) randomized to additional treatment with enalapril or placebo.
In this study (CONSENSUS), which has previously been reported, there was a significant reduction in mortality among patients treated with enalapril.
The present data show in the placebo group a significant positive relation between mortality and levels of angiotensin II (p less than 0.05), aldosterone (p = 0.003), noradrenaline (p less than 0.001), adrenaline (p = 0.001), and atrial natriuretic factor (p = 0.003).
A similar relation was not observed among the patients treated with enalapril.
Significant reductions in mortality in the groups of patients treated with enalapril were consistently found among patients with baseline hormone levels above median values.
There were significant reductions in hormone levels from baseline to 6 weeks in the group of patients treated with enalapril for all hormones except adrenaline.
There were no correlations between these changes in hormone levels.
Summarily, there is a pronounced but variable neurohormonal activation in heart failure even in patients with similar clinical findings.
This activation is reduced by enalapril therapy.
The results suggest that the effect of enalapril on mortality is related to hormonal activation in general and the renin-angiotensin system in particular.
| 13 |
1,407 | Transrectal sonographic cystourethrography: studies in stress urinary incontinence.
Transrectal ultrasonic sagittal transducer is an excellent modality to image the bladder and urethra in dynamic change.
In female patients, we found it is also helpful for the diagnosis of urinary stress incontinence.
The posterior urethrovesical (PUV) angle is measured with the transrectal sonoprobe under strain and non-strain conditions.
We compared the results of sonographic cystourethrogram with the radiographic chain cystourethrogram.
The sonographic cystourethrography is superior to the radiography.
The former may estimate the PUV angle accurately and differentiate between the patients with and without stress urinary incontinence.
Furthermore, we also use the transrectal sagittal probe intraoperatively to adjust the suspension force as well as PUV angle in patients who underwent vesical neck suspension for stress urinary incontinence (SUI).
| 11 |
2,194 | Right ventricular growth after transventricular pulmonary valvotomy and central aortopulmonary shunt for pulmonary atresia and intact ventricular septum.
We performed transventricular pulmonary valvotomy as initial surgery in 22 consecutive patients with pulmonary atresia and intact ventricular septum who had a patent infundibulum.
Nineteen patients also had placement of a central aortopulmonary shunt.
All patients survived surgery, and 16 patients have had preoperative and later postoperative catheterizations.
The purpose of this study was to determine the response of the right ventricle to transventricular pulmonary valvotomy with regard to relief of right ventricular hypertension and growth of the entire right ventricle, including tricuspid valve, right ventricular volume, and right ventricular outflow tract.
Right ventricular systolic pressure decreased from 111.3 +/- 31.7 mm Hg before initial surgery to 65.6 +/- 26.2 mm Hg.
Right ventricular end-diastolic volume increased from 59.1 +/- 39.3% of predicted normal before initial surgery to 114.6 +/- 63.2% at late follow-up catheterization.
Tricuspid valve anulus circumference also increased in size from 73.2 +/- 21.3% of predicted normal before initial surgery to 90.4 +/- 22.8% at late follow-up catheterization.
Only one patient (6%) required a transanular right ventricular outflow tract patch at the time of biventricular repair.
Twenty of 22 patients (91%) either have had or are awaiting biventricular repair.
We conclude that transventricular pulmonary valvotomy and central aortopulmonary shunt can be performed safely in newborn infants with pulmonary atresia and intact ventricular septum who have a patent infundibulum.
Effective valvotomy relieves right ventricular hypertension, allows for excellent right ventricular and tricuspid valve growth, and optimizes potential for biventricular repair.
| 15 |
2,122 | Hemodynamic efficacy of rapid saline infusion and dobutamine versus saline infusion alone in a model of cardiac rupture.
Despite recent reports describing survival after cardiac rupture, the effectiveness of circulatory support while awaiting definitive surgical treatment is controversial.
To assess the efficacy of volume expansion and pharmacologic support in cardiac tamponade due to cardiac rupture, a model of hemorrhagic cardiac tamponade was developed and treatment with rapid saline infusion and dobutamine was compared with rapid saline infusion alone in 15 closed chest dogs.
A right ventricular wound of reproducible size was produced by deflating an aortic valvuloplasty balloon that had previously been passed by way of the internal jugular vein into the pericardial space and through a stab wound in the right ventricular free wall.
Hemodynamic values were compared at baseline, during tamponade and after a rapid infusion (1 liter at 100 ml/min) of either saline solution alone or saline solution plus dobutamine (20 micrograms/kg per min).
Atrial and pericardial pressures increased significantly in both groups.
Mean arterial pressure, cardiac output and stroke volume increased with combined saline and dobutamine infusion to values similar to those at baseline (91 +/- 19%, 114 +/- 43% and 94 +/- 37% of baseline, respectively).
In contrast, saline infusion alone caused a small increase in cardiac output but failed to significantly increase mean arterial pressure or stroke volume (76.8 +/- 14.2%, 55 +/- 18% and 51 +/- 17% of baseline, respectively).
Combined rapid infusion of saline solution and dobutamine infusion has a more beneficial hemodynamic effect and may be more effective than rapid saline infusion alone in resuscitating patients with hemorrhagic cardiac tamponade due to cardiac rupture.
| 13 |
1,395 | Adult minimal change glomerulopathy with acute renal failure.
Oliguric acute renal failure occurs in some adult patients with minimal change glomerulopathy.
To look for clinical and pathologic factors that increase the risk for developing acute renal failure, 21 adults with minimal change glomerulopathy and a serum creatinine greater than 177 mumol/L (mean, 486 mumol/L; range, 194 to 1,344 mumol/L) (greater than 2.0 mg/dL [mean, 5.5 mg/dL; range, 2.2 to 15.2 mg/dL]) were compared with 50 adults with minimal change glomerulopathy and a serum creatinine less than 133 mumol/L (mean, 88 mumol/L; range, 53 to 124 mumol/L) (less than 1.5 mg/dL [mean, 1.0 mg/dL; range, 0.6 to 1.4 mg/dL]).
Minimal change glomerulopathy patients with acute renal failure were older (59.5 v 40.3 years, P less than 0.001), and had higher systolic blood pressure (158 v 138 mm Hg, P = 0.001), more proteinuria (13.5 v 7.9 g/24 h, P = 0.01), and more arteriosclerosis in the renal biopsy specimen (1.7 + v 0.7 + on a scale of 0 to 4+, P = 0.005).
Tubular epithelial simplification identical to that observed with ischemic acute renal failure (acute tubular necrosis) was observed in 71% of the patients with serum creatinine greater than 177 mumol/L (greater than 2.0 mg/dL) and 0% of those with less than 133 mumol/L (less than 1.5 mg/dL).
All 18 patients with renal failure for whom follow-up data were available had recovery of function (mean creatinine, 539 +/- 301 mumol/L [6.1 +/- 3.4 mg/dL] at the time of biopsy and 106 +/- 27 mumol/L [1.2 +/- 0.3 mg/dL] at last follow-up), but sometimes only after weeks of dialysis support.
| 11 |
3,202 | Mechanisms of edema formation in experimental autoimmune encephalomyelitis. The contribution of inflammatory cells.
Most of the central nervous system (CNS) endothelium regulates the passage of solutes and functions as a blood-brain barrier (BBB).
During experimental autoimmune encephalomyelitis (EAE), an inflammatory demyelinating disease of the CNS, loss of BBB function occurs.
The authors have previously shown an increase in endothelial transcytotic activity associated with decreased mitochondrial content as evidence of BBB dysfunction in EAE.
These changes occurred in the capillary bed and correlated with CNS edema and clinical signs.
In the present report, a fixation procedure before infusion of the intravascular tracer horseradish peroxidase (HRP) in rats at the height of clinical EAE has been used.
In these animals, tracer leakage was only noted in inflamed venules with diameters of 12 to 19 mu.
The authors detected several mechanisms of passive leakage: 1) increased junctional permeability; 2) increased interendothelial space; 3) leakage alongside migrating inflammatory cells.
Some small capillaries showed necrotic changes with minimal tracer leakage.
This report demonstrates that BBB disruption also occurs via nonendocytic mechanisms that may be induced by inflammatory cells.
| 22 |
464 | Rhabdomyosarcomas in the head and neck: MR imaging evaluation.
To determine the typical magnetic resonance (MR) signal intensity characteristics of rhabdomyosarcomas, short repetition time (TR)/short echo time (TE) (T1-weighted) and long TR (proton density and T2-weighted) images of 13 patients with rhabdomyosarcomas of the head and neck were retrospectively reviewed.
Seven patients received gadopentetate dimeglumine injections.
The most common MR appearance was that of a homogeneous mass, hyperintense to both muscle and fat on long TR/long TE images and isointense or minimally hyperintense to muscle on short TR/short TE images.
All lesions of the patients who received gadopentetate dimeglumine enhanced markedly.
Two lesions had intratumoral hemorrhage, and six were markedly heterogeneous in signal intensity.
Similar MR signal intensity patterns have been described for lymphomas and nasopharyngeal carcinomas.
The forte of MR imaging lies in its ability to delineate precisely the extent of the rhabdomyosarcoma.
| 3 |
2,859 | Agreement between two dietary methods in the measurement of alcohol consumption.
This study compares estimates of alcohol consumption from two dietary methods: a self-reported diet diary and a quantitative food frequency questionnaire.
In the 1984-85 University of Michigan Food Frequency Study, 228 black and white, male and female respondents, ages 23-51 years, kept diet diaries covering 16 days during a 1-year period.
At the end of the year, the same respondents completed a dietary quantity-frequency questionnaire that included alcoholic beverages.
The two methods showed excellent agreement in estimated group mean ethanol consumption and good agreement in the ranking of individual respondents.
Respondents described alcohol consumption in abstract terms on the questionnaire in a way that was consistent with the consumption recorded in the diary.
However, the two methods showed only poor to moderate agreement in classifying individuals as infrequent, moderate or heavier drinkers, suggesting that such classifications should be used cautiously.
These results suggest that in general population studies a dietary quantity-frequency questionnaire and a diet diary covering several weeks can measure moderate levels of alcohol consumption similarly.
The degree of consistency suggests that, for moderate levels of intake, measures of alcohol consumption derived from the two methods are equally valid.
| 20 |
494 | Abnormal vitamin B6 status in childhood leukemia.
Vitamin B6 is involved in many biological processes of potential relevance to carcinogenesis and tumor growth, including DNA synthesis and maintenance of immunocompetence, yet very little information exists on B6 nutritional status in childhood leukemia.
Using a radioenzymatic assay, the authors measured plasma pyridoxal 5'-phosphate (PLP), the biologically active form of B6, in 11 newly diagnosed untreated children with leukemia and 11 age-matched controls.
The children with leukemia had significantly lower PLP levels than the controls.
In 26 additional leukemia patients and 26 additional controls, a high-performance liquid chromatography assay also demonstrated lower plasma PLP levels in childhood leukemia compared with controls.
These differences were significant for both acute lymphoblastic leukemia (ALL) and for acute nonlymphoblastic leukemia (ANLL).
The PLP values did not correlate with indices of leukemia cell burden, but did correlate with reported B6 intake, suggesting that illness-related diet changes are at least partially responsible for the low PLP levels.
Before any chemotherapy, overall nutritional status was suboptimal in 53% of ALL cases and 57% of ANLL cases.
Newly diagnosed children with leukemia have suboptimal overall nutrition as well as suboptimal vitamin B6 status.
| 3 |
1,731 | Studies of salt intake in hypertension. What can epidemiology teach us?
It has been suggested that small changes in population blood pressure will have a major impact upon the incidence of cardiovascular disease caused by blood pressure elevation.
Early reports indicated a close correlation between intercultural differences in salt intake and blood pressure.
Before such epidemiological associations can be translated into population advice, certain conditions have to be met.
The association has to be validated scientifically, and persuasive evidence has to be produced that the relationship is causal and reversible by changes in salt intake.
Further, risk-benefit analysis should indicate that net harm is unlikely.
Finally it has to be demonstrated that the population measures being advocated will produce an adequate change in dietary salt intake.
The small individual effects upon blood pressure being examined, and the prevailing changes in blood pressure and cardiovascular mortality suggest that data will always fall short of the ideal and therefore that extrapolation will always be necessary.
Nevertheless, a review of the present evidence indicates the inadequacies of the available data as a basis for population advice.
| 13 |
1,691 | Digitalis-like activity in human plasma: relation to blood pressure and sodium balance.
PURPOSE: On the assumption that renal tubular cells are more important as the target cells for a natriuretic factor than blood cells, we used a well-characterized cultured renal tubular cell line, Madin-Darby canine kidney (MDCK), cells to monitor the circulating digitalis-like factor in human plasma and examine its role in the regulation of blood pressure and sodium balance.
SUBJECTS AND METHODS: We investigated the effects of plasma on binding of radioactive ouabain to monolayered MDCK cells in order to determine the level of a circulating digitalis-like factor.
First, we measured specific 3H-ouabain binding to MDCK cells in the presence of plasma from 71 outpatients (34 normotensive subjects and 37 hypertensive patients) after incubation for 4 hours.
Second, we measured specific 3H-ouabain binding after incubation of cells with plasma from 16 hospitalized subjects (eight normotensive subjects and eight hypertensive patients) receiving low and high sodium diets.
RESULTS: In Study 1, ouabain binding was lower by 30% with plasma from hypertensive patients than with plasma from normotensive subjects (p less than 0.01).
There was a significant negative correlation between individual subject's systolic or mean blood pressure and ouabain binding (r = -0.34, p less than 0.01 or r = -0.29, p less than 0.01).
In Study 2, ouabain binding was also significantly reduced by 25% in the presence of plasma from hypertensive subjects as compared with plasma from normotensive subjects irrespective of sodium intake (p less than 0.01).
A significant negative correlation was also found for all subjects between either systolic, diastolic, or mean blood pressure and ouabain binding (r = -0.58, p less than 0.01, r = -0.51, p less than 0.01, or r = -0.55, p less than 0.01, respectively).
With the changes from low to high sodium intake, there was a corresponding decrease in ouabain binding (p less than 0.01) and an increase in sodium excretion (p less than 0.01).
A significant negative correlation was observed between these two parameters (r = -0.47, p less than 0.05).
CONCLUSIONS: These findings suggest that a circulating digitalis-like factor, which may act on renal tubular cells as the ouabain-displacing compound, is increased in patients with essential hypertension and also demonstrate that plasma levels may be influenced by changes in dietary sodium intake.
| 13 |
2,186 | Chromosomal region of the cystic fibrosis gene in yeast artificial chromosomes: a model for human genome mapping.
A general strategy for cloning and mapping large regions of human DNA with yeast artificial chromosomes (YAC's) is described.
It relies on the use of the polymerase chain reaction to detect DNA landmarks called sequence-tagged sites (STS's) within YAC clones.
The method was applied to the region of human chromosome 7 containing the cystic fibrosis (CF) gene.
Thirty YAC clones from this region were analyzed, and a contig map that spans more than 1,500,000 base pairs was assembled.
Individual YAC's as large as 790 kilobase pairs and containing the entire CF gene were constructed in vivo by meiotic recombination in yeast between pairs of overlapping YAC's.
| 15 |
1,500 | Serum estradiol as an aid in the diagnosis of ectopic pregnancy.
The value of serum beta-hCG measurement in the diagnosis of ectopic pregnancy is well established, and there have been recent studies on the use of serum progesterone levels.
However, we have been unable to find any reports on the potential application of serum estradiol (E2) assays in the diagnosis of ectopic pregnancy.
We therefore concurrently measured serum E2, progesterone, and beta-hCG in 100 women with ectopic pregnancies, as well as in 69 controls with normal intrauterine pregnancies and 36 women with threatened abortion.
The mean (+/- standard deviation) E2 levels for ectopic-pregnancy patients, the normal controls, and the women with threatened abortion were 281.1 +/- 115.6, 788.2 +/- 45.5, and 788.8 +/- 40.6 pg/mL, respectively; the mean levels in the ectopic group were significantly different (P less than .0001) from those of the other two groups.
All but one of the ectopic pregnancies had values below 650 pg/mL for E2 and 23 ng/mL for progesterone, and all but one of the normal intrauterine pregnancies had values above these levels.
Our data suggest that the addition of the estradiol assay, with or without progesterone, to the early evaluation of patients suspected of having an ectopic pregnancy may be helpful in diagnosis.
| 12 |
919 | Mortality from pulmonary embolism in the United States: 1962 to 1984.
To examine the effect of advances in the prevention of and therapy for PE, we reviewed mortality for PE in the United States from 1962 to 1984.
Age-adjusted PE mortality increased by 67 to 100 percent between 1962 and 1974 for white and non-white men and women.
From 1975 to 1984, these rates declined by 20 to 28 percent.
Non-white PE mortality was greater than white PE mortality; men had a greater risk of PE death than women.
Age-specific patterns (more than 40 years of age) of PE mortality followed those of the age-adjusted death rates, with increases noted in all groups between 1962 and 1974 and declines during the 1975-1984 period.
These patterns might reflect improved ascertainment of cases and better prevention of disease.
The magnitude of the rates suggests that the list of indications for prophylactic anticoagulation should be re-examined for possible expansion.
| 7 |
1,257 | Cytopathology of adenovirus keratitis by replica technique.
Corneal replicas were made from the severely affected eyes of 12 patients presenting with typical signs and symptoms of epidemic keratoconjunctivitis.
Adenovirus was isolated from the eyes.
Histopathological study of the replicas and cytology of diseased cells removed with the replica showed diffuse mild oedema of the epithelium, with scattered moderately swollen and deformed cells.
The clinically observed punctate lesions histologically consisted of markedly swollen cells that had become oval or rounded.
Fusion of these cells led to small syncytial formations, and the development of pseudopodia-like processes was occasionally observed.
Loss of cell contents resulted in the formation of plicae on the surface of many cells.
Two types of inclusion bodies were detected in the epithelial cells.
The first type, intranuclear vacuolar inclusions, contained homogeneous material.
The second type of inclusions were round, dense bodies, that developed in the homogeneous material of intranuclear vacuolar inclusions.
The dense bodies contained the replicating and maturing virus particles.
After cell degeneration the dense bodies become extracellular.
Making a corneal replica had a beneficial effect on the clinical course of adenovirus keratitis.
| 10 |
352 | Radioimmunoscintigraphy using iodine-131-anti-CEA monoclonal antibodies and thallium-201 scintigraphy in medullary thyroid carcinoma: a case report.
This case report demonstrates the use of thallium-201 (201Tl) scans versus iodine-131- (131l) anti-CEA F(ab')2 scans in a patient with high serum CEA levels due to metastases of medullary thyroid carcinoma in the suprarenal region and sacroiliacal region.
Scintigraphy using monoclonal antibodies directed against CEA showed a higher tumor uptake (0.26% dose and 0.64% dose, respectively) than a thallium scan and is believed to be promising for future radiotherapeutic applications.
| 3 |
2,680 | Effect of procaterol on arterial blood gas in asthmatic children.
We determined changes in arterial blood gas after the inhalation of procaterol, a highly beta 2-selective and long-acting adrenergic agonist, in 11 asthmatic children.
Seven of the patients, with a maximum fall of 14 mmHg (63.6%), showed a decrease in PaO2 (mean +/- SD = -7.1 +/- 4.0 mmHg) and had poorer pulmonary function with a lower initial PaO2 than four subjects who had an increase in PaO2 after inhalation.
There was a statistically significant correlation between values of the PaO2 before and after inhalation (P less than .05).
| 19 |
2,654 | Hodgkin's disease and CD30-positive anaplastic large cell lymphomas--a continuous spectrum of malignant disorders. A quantitative morphometric and immunohistologic study.
The authors have examined cellular areas of lymphoma tissue in 28 cases of Hodgkin's disease (HD) or anaplastic large cell lymphoma (ALCL, 'Ki-1 cell lymphoma') to evaluate the boundaries between the two entities.
Methods applied included conventional histology; test point analysis; semiautomated morphometry of nuclear profile features of Reed-Sternberg and other atypical large cells (RSALCs); and immunohistochemistry of these elements on all paraffin sections and, in 15 cases, on frozen sections.
Mean nuclear profile morphotypes of RSALCs per case varied independently of immunophenotype and histologic diagnosis.
Conversely, immunohistochemistry demonstrated significant, although not consistent, preferential positivities of these CD30+ elements for CD15 in HD, and for epithelial membrane antigen (EMA) and CD43 in ALCLs.
In the latter, RSALCs also exhibited a tendency for CD45 and CD45RO positivity and for the expression of T-cell-associated antigens.
However, there were considerable overlaps.
This continuous spectrum of RSALC nuclear profile morphotypes and immunophenotypes, ranging from HD over questionable cases, intermediate between HD and ALCL, to ALCLs, was paralleled by differences in the reactive component of lymphomas.
Lymphocytes and granulocytes were significantly deficient in ALCLs.
| 19 |
3,062 | Percutaneous transluminal coronary angioplasty of gastroepiploic artery graft.
The right gastroepiploic artery is being used as a third arterial conduit for coronary artery bypass surgery.
Presented here is a case demonstrating successful percutaneous transluminal coronary angioplasty of the gastroepiploic artery graft.
This successful accomplishment may avoid repeat surgical revascularization in case of failure of the gastroepiploic artery graft, hence may encourage people to use it more often.
| 22 |
887 | Mechanical disruption of pulmonary emboli in dogs with a flexible rotating-tip catheter (Kensey catheter).
Pulmonary embolism was induced in 11 dogs by the injection of three- to four-day-old allogeneic blood clots.
The clots were made radiopaque by soaking them in contrast material.
The resulting clots were firm, 3 to 4 cm long, and 1 cm in diameter.
Injection of the clots into the external jugular vein consistently produced occlusion of at least one of the lobar pulmonary arteries.
In every instance in which the tip of the catheter could be positioned at the clot embolus (six dogs), the clots were readily fragmented with a number 8 French (2.67 mm OD) flexible rotating tip catheter (Kensey catheter) activated at 80,000 rpm.
Overall perfusion was shown by posttreatment angiograms to be markedly improved.
These studies show that catheter-tip fragmentation of pulmonary emboli with a Kensey catheter has excellent potential for therapeutic application in patients with pulmonary embolism.
| 7 |
998 | An adherent subline of a unique small-cell lung cancer cell line downregulates antigens of the neural cell adhesion molecule.
Small-cell lung cancer (SCLC) lines are distinguished from non-small-cell lung cancer (NSCLC) lines by their growth in floating aggregates, in contrast to the adherent monolayers formed by NSCLC cells in culture.
Of 50 well-characterized SCLC lines recently described by the National Cancer Institute (NCI)-Navy Medical Oncology Branch, only four variant cell lines (SCLC-v) grew as adherent monolayers.
One line, NCI-H446, was unique in growing long-term with coexisting floating and surface adherent subpopulations.
We have physically segregated these two populations over many passages in vitro to enrich for relatively pure cultures of floating and adherent cells.
No differences in c-myc expression, keratin pattern, or cytogenetic appearance were found between the adherent and floating sublines.
However, expression of the neuroendocrine marker neuron-specific enolase in the floating cells was three times that found in the adherent cells.
The floating subline also had much greater surface expression of neuroendocrine tumor antigens detected by monoclonal antibodies UJ13A and HNK-1, which have been recently shown to detect the neural cell adhesion molecule (NCAM) on SCLC cells.
Two other adherent SCLC-v lines were also found to be unreactive with UJ13A and HNK-1, generalizing the association between NCAM expression and the growth of most SCLC cultures as floating aggregates.
In conclusion, we have an interesting model to study expression of NCAM as related to the adhesive properties of SCLC cells.
| 7 |
2,081 | Spectrum of hemodynamic changes in cardiac tamponade.
To investigate the pathophysiology of cardiac tamponade, the hemodynamics of 77 consecutive patients with greater than 150 ml of pericardial effusion were studied.
Patients were classified into 3 groups based on the equilibration of intrapericardial with right atrial and pulmonary arterial wedge pressures (mm Hg): group I (n = 16), intrapericardial pressure was less than right atrial and pulmonary arterial wedge pressures; group II (n = 13), intrapericardial pressure was equilibrated with right atrial but not pulmonary arterial wedge pressures; group III (n = 48), intrapericardial pressure was equilibrated with right atrial and pulmonary arterial wedge pressures.
Pericardiocentesis produced the following changes: group I--significant (p less than 0.03) decreases in intrapericardial pressure (7 +/- 2 mm Hg), right atrial pressure (3 +/- 2 mm Hg), pulmonary arterial wedge pressure (2 +/- 2 mm Hg), and the inspiratory decrease in arterial systolic pressure (3 +/- 4 mm Hg) but no significant change in cardiac output; group II--significant (p less than 0.02) decreases in intrapericardial pressure (11 +/- 5 mm Hg), right atrial pressure (6 +/- 4 mm Hg), pulmonary arterial wedge pressure (4 +/- 5 mm Hg), and inspiratory decrease in arterial systolic pressure (8 +/- 7 mm Hg), and increase in cardiac output (1.1 +/- 1.2 liters/min); group III--significant (p less than 0.001) decreases in intrapericardial pressure (16 +/- 7 mm Hg), right atrial pressure (9 +/- 4 mm Hg), pulmonary arterial wedge pressure (8 +/- 5 mm Hg), inspiratory decrease in arterial systolic pressure (17 +/- 11 mm Hg), and increase in cardiac output (2.8 +/- 1.5 liters/min).
The changes after pericardiocentesis in all parameters were significantly (p less than 0.05) greater in group III than in groups I or II except for the change in right atrial pressure, which was not significantly different in groups II versus III.
The changes after pericardiocentesis indicate pericardial effusion caused the greatest abnormalities in group III but also caused significant abnormalities of pressure and flow in group II and of pressure alone in group I.
| 13 |
1,988 | Inferior vena caval filter thrombi: evaluation with intravascular US.
A 20-MHz intravascular ultrasound (US) transducer inside a percutaneously inserted catheter was used to evaluate inferior vena caval (IVC) filters for thrombi in vitro and in vivo.
Six different IVC filters were studied with intravascular US in a saline-filled model.
Each filter had a characteristic, recognizable US pattern.
Experimental thrombi as small as 0.5 cm3 were easily detected.
Intravascular US was used clinically 25 times to evaluate the IVC in 23 patients with 24 IVC filters.
Positive-contrast cavograms were available for comparison in all 25 cases.
In 13 cases, no thrombi were identified in the filter or IVC with either intravascular US or cavography; in five of 12 cases with thrombi, intravascular US and cavography demonstrated the thrombi equally well.
In six cases, intravascular US was superior to cavography in detection or delineation of thrombus in the IVC or filter.
Intravascular US was considered superior to external duplex US in evaluation of caval thrombi in all 21 cases available for comparison.
No complications from intravascular US were noted.
| 13 |
2,029 | Similar frequencies of renin gene restriction fragment length polymorphisms in hypertensive and normotensive subjects.
A prospective study was conducted to compare the frequency of renin gene polymorphisms in normotensive and hypertensive subjects.
Hypertensive (n = 102, blood pressure 168 +/- 17/103 +/- 9 mm Hg) and normotensive (n = 120, blood pressure 122 +/- 10/75 +/- 9 mm Hg) subjects were white, had similar age and sex distributions (hypertensive group, 45 +/- 10 years old and 52% female; normotensive group, 44 +/- 9 years old and 55% female) and similar body mass index (hypertensive group, 23.2 +/- 2.6; normotensive group, 22.5 +/- 2.4 kg/m2, p = 0.048).
The familial susceptibility to hypertension was defined as at least one parent and one sibling who were hypertensive before age 65; subjects in the normotensive group had no familial history of hypertension.
Renin gene polymorphisms located throughout the renin gene were identified by using three restriction enzymes (Taq I, HinfI, HindIII).
For each polymorphic restriction site, allele frequencies were similar in the hypertensive and the normotensive groups.
In the absence of parental genotypes, the haplotype frequencies combining the three restriction fragment length polymorphisms were estimated by using maximum likelihood techniques and were similar in both groups (hypertensive group, 0.429, 0.277, and 0.177; normotensive group, 0.453, 0.245, and 0.195 for the three most common haplotypes).
A rare haplotype detected by Taq I/Hind III was apparently more frequent in the hypertensive than in the normotensive group (hypertensive group, tH 0.086, th 0.022; normotensive group, tH 0.038, th 0.050), but the difference was not statistically significant.
In conclusion, no association between renin gene polymorphisms and essential hypertension was demonstrated in the present study.
| 13 |
1,949 | Effect of intravenous streptokinase on early mortality in patients with suspected acute myocardial infarction. A meta-analysis by anatomic location of infarction [published erratum appears in Ann Intern Med 1991 Mar 15;114(6):522]
PURPOSE: To determine the effect of intravenous streptokinase on early mortality in patients with suspected acute anterior and acute inferior myocardial infarctions.
DATA IDENTIFICATION: A literature search of English-language studies on the use of intravenous streptokinase in the treatment of suspected acute myocardial infarction for the period 1966 to 1989 using Medlars II and the bibliographies of relevant articles.
In a number of instances, additional details on early mortality by location of myocardial infarction were provided by the authors.
STUDY SELECTION: Of 140 originally identified articles, 6 that specifically met our inclusion criteria were selected: randomized trials that used intravenous streptokinase in a dose of 1.5 million units, with or without additional agents, compared with a group that differed only by the absence of streptokinase.
Trials were selected by review of the methods section without regard for the results.
DATA EXTRACTION: Data were extracted independently by two observers using specific methodologic criteria for infarct location and early mortality.
After they conferred, the observers agreed completely on the data.
RESULTS OF DATA SYNTHESIS: Among the 9155 patients with suspected acute anterior myocardial infarction, the mortality rate in the control group was 17.4%.
In contrast, patients treated with streptokinase had a 12.5% mortality.
The mean risk difference was -4.8% (95% CI, -7.5% to -2.1%) and the summary risk ratio was 0.72 (CI, 0.65 to 0.79).
A total of 9650 patients with suspected inferior infarction had a mortality rate in the control group of 7.6% [corrected].
The mortality for streptokinase-treated patients was 6.6%.
The mean risk difference was -0.8% (CI, -1.8% to 0.2%) and the summary risk ratio was 0.87 (CI, 0.76 to 1.01).
CONCLUSIONS: Intravenous streptokinase clearly confers a protective effect against early mortality in patients with suspected acute anterior myocardial infarction.
The magnitude of this effect is on the order of a 5% absolute reduction in risk of death by 21 to 35 days.
For these patients, 21 need to be treated to save 1 additional life.
For patients with suspected acute inferior infarction, the benefit of treatment on reducing early mortality is of smaller magnitude and less certain.
These patients have an estimated absolute reduction of early mortality of approximately 1%, which would require treating 125 patients to save 1 additional life.
| 13 |
1,836 | Dynamic positron tomographic imaging with nitrogen-13 glutamate in patients with coronary artery disease: comparison with nitrogen-13 ammonia and fluorine-18 fluorodeoxyglucose imaging.
This study was designed to test the usefulness of nitrogen-13 (N-13) glutamate imaging with positron emission tomography in defining myocardial ischemia in humans.
Seventeen patients who had undergone coronary arteriography were studied with N-13 glutamate at peak supine exercise using a bicycle ergometer, as well as with the flow tracer N-13 ammonia at peak exercise during a second similar exercise test.
Six of the patients also underwent imaging with N-13 glutamate at rest before exercise testing; in the remaining 11 patients imaging with fluorine-18 (F-18) fluorodeoxyglucose was performed to assess glucose metabolism after the second exercise test.
Seven patients had classic metabolism-flow mismatches consistent with ischemia (that is, decreased N-13 ammonia uptake in a region with relatively increased F-18 fluorodeoxyglucose uptake).
There was no evidence of increased N-13 glutamate uptake in the ischemic mismatched regions in any of these patients.
In all 17 patients, the uptake of N-13 glutamate during exercise paralleled the uptake of N-13 ammonia during exercise, suggesting that N-13 glutamate behaves as a flow tracer rather than as a metabolic marker of ischemia in humans.
| 13 |
1,884 | Regression of intracardiac thrombus after embolic stroke.
Using two-dimensional echocardiography, we studied the pathophysiology of intracardiac thrombus regression accompanied by anticoagulant therapy in 82 consecutive patients with acute cardiogenic cerebral embolism.
We noted intracardiac thrombus in 15 patients; nine of the 15 were started on anticoagulant therapy with warfarin potassium to maintain the prothrombin time between 2.5 and 3.5 (international normalized ratio).
Serial two-dimensional echocardiograms were obtained for these nine patients before and after anticoagulation, with the plasma levels of fibrinopeptide A, fibrinopeptide B beta 15-42, and D-dimer measured at the same time.
In eight of the nine patients the intracardiac thrombi gradually decreased in size while the plasma level of fibrinopeptide A fell to within the normal range and the plasma levels of fibrinopeptide B beta 15-42 and D-dimer remained above the normal ranges.
In the other patient the thrombus disappeared, with embolization to the right arm immediately after starting anticoagulant therapy.
Mobile or small thrombi regressed earlier than nonmobile or large ones.
We conclude that regression of intracardiac thrombi after anticoagulation may be based on the relative predominance of plasma fibrinolytic activity over anticoagulation-inhibited thrombin activity.
| 13 |
1,915 | Reduction of mortality, sudden death and non-fatal reinfarction with beta-adrenergic blockers in survivors of acute myocardial infarction: a new hypothesis regarding the cardioprotective action of beta-adrenergic blockade.
Beta-adrenergic blockers have been shown definitely to reduce the incidence of total mortality, cardiovascular mortality, sudden death and nonfatal reinfarction in survivors of an acute myocardial infarction.
The mechanisms to explain this protective action of beta blockers have never been elucidated conclusively, and include the antiarrhythmic and myocardial oxygen demand-reducing effects of the drugs.
An antithrombotic mechanism has also been suggested.
However, beta blockers have relatively weak antiplatelet activity, suggesting that their antithrombotic effects may be related to prevention of coronary artery plaque rupture and the subsequent propagation of an occlusive arterial thrombus rather than direct anticoagulant action.
The therapeutic ability of beta blockers to attenuate the hemodynamic consequences of catecholamine surges, may protect a vulnerable atherosclerotic plaque from fracture, thereby reducing risk of coronary thrombosis, myocardial infarction and death.
| 13 |
2,568 | Modulation of interleukin-1 beta RNA in monocytic cells infected with human immunodeficiency virus-1.
The effect of HIV-1 infection on cytokine levels was studied in monocytic cells by using Northern blotting analysis.
Monoblasts (THP-1, U937) did not express IL-1 beta RNA even if the cells were infected with HIV-1.
After exposure to LPS (10 micrograms/ml) and 12-O-tetradecanoylphorbol-13-acetate (TPA, 100 nM) for 12 h, these HIV-1-infected monoblasts accumulated 8-15-fold greater levels of IL-1 beta RNA as compared with their HIV-1-uninfected counterparts that were similarly stimulated.
In contrast, levels of RNAs coding for monocyte-colony-stimulating factor (M-CSF) and tumor necrosis factor-alpha (TNF alpha) were elevated less than twofold in the HIV-1-infected cells as compared with HIV-1-uninfected cells after their stimulation with LPS and TPA.
Inhibition of new protein synthesis did not block the marked accumulation of IL-1 beta RNA produced by exposure to LPS and TPA in the HIV-1-infected cells.
Time-course experiments showed that the maximal levels of IL-1 beta RNA occurred at 12 and 24 h after LPS and TPA stimulation of the HIV-1-infected and uninfected U937 cells, respectively.
Studies of stability of RNA using actinomycin D showed that IL-1 beta RNA was equally stable in infected and uninfected U937 cells after their stimulation with TPA and LPS.
Taken together, our data show that HIV-1 infection markedly augments IL-1 beta RNA accumulation in stimulated monocytic cells, probably through increasing rate of transcription of IL-1 beta.
| 19 |
1,612 | Evolution of deep venous thrombosis: a prospective evaluation with US.
Forty-six patients with a diagnosis of acute deep venous thrombosis (DVT) established by means of duplex ultrasound (US) were prospectively followed up with serial duplex US examinations during a 6-month period to assess the persistence of venous abnormalities.
All patients were asymptomatic.
Isolated popliteal DVT was found to be more likely to revert to normal at duplex compression US than thrombosis involving both the femoral and popliteal systems (P less than .05).
Increased venous diameter was a sign of acute clot (P less than .005).
Clot echogenicity did not help to enable distinction of acute DVT and chronic DVT.
At compression US, 10 of 21 patients (48%) who initially had occlusive thrombosis had persistent abnormalities that mimicked findings consistent with acute DVT.
Chronic venous changes that persisted after 6 months consisted of either lumen recanalization (with resultant intimal thickening) or persistent venous occlusion.
Both of these conditions can result in incomplete compression, the major US indication of acute DVT.
This appearance should not be confused with that of acute DVT.
Follow-up examinations to establish a baseline appearance can be obtained as early as 6 months after an acute episode of DVT.
| 13 |
2,175 | A constitutive antibody in normal human serum directed against rabbit bone marrow cells: lack in parturients, neonates, and hematologic disorders.
Normal human serum effectively inhibits a bioassay for erythropoietin based on DNA synthesis by rabbit erythroid precursors.
This heat-sensitive inhibitory activity is readily lost on dilution of serum, revealing the presence of erythropoietin-potentiating activity.
Inhibitory activity is caused by a rapid cytotoxic effect on rabbit bone marrow cells; mouse cells are less sensitive.
Cytotoxic activity is removed from serum by adsorption to protein A, is not expressed at 4 degrees C, and is neutralized by anti-C3c complement antibody.
Cytotoxicity is inhibited by EGTA; the effect of EGTA is reversed by addition of Ca2+ ions.
These findings show that cytotoxicity is exerted through an antibody via the classical pathway of complement-dependent cell lysis.
Although serum from healthy, adult human donors consistently contains cytotoxic activity, no such activity is observed in most serum samples from neonates, parturients, and patients with severe anemia.
Patients with polycythemia or chronic renal failure occasionally lack cytotoxic activity in their serum.
Serum samples lacking cytotoxic activity were found to be deficient in the antibody component in 34 out of 35 cases examined.
These results show that an antibody directed against rabbit cells is constitutively present in normal human serum but is absent in a number of pathologic situations as well as being absent in neonates and parturients.
| 14 |
3,279 | Cup containment and orientation in cemented total hip arthroplasties.
We reviewed the radiographs of 864 Charnley and STH (Zimmer) cemented total hip arthroplasties with a mean follow-up of seven years (maximum 16 years).
Survivorship analysis was used to assess the correlation between radiographic performance and the bony containment or the coronal orientation of the acetabular cup.
The cup orientation and containment were interrelated; all vertically oriented cups were completely contained, whereas 25% of more horizontal cups were only partially contained.
Completely contained cups had significantly lower incidences of complete cement-bone radiolucency (p = 0.02) and of wear (p = 0.09).
Vertically oriented cups had a lower incidence of continuous radiolucency than neutrally oriented cups, but this was not statistically significant (p = 0.25).
Our results confirm the importance of complete bony containment, and also indicate that it is better to accept vertical orientation and obtain full bony coverage than to have a more horizontal orientation with partial containment.
| 22 |
1,954 | Tension pneumopericardium as a complication of single-lung transplantation.
Tension pneumopericardium is distinctly uncommon in the adult population.
We present a case of tension pneumopericardium as a complication of lung transplantation in a 54-year-old woman with thromboembolic pulmonary hypertension who underwent single-lung transplantation.
| 13 |
2,987 | Influence of postmortem time and temperature on osteoinductive activity of demineralized microperforated ethylene oxide-sterilized syngeneic bone implant in the rat.
Bone morphogenetic protein is labile and easily inactivated by many extracorporeal factors.
It is crucial to establish whether delay in retrieval of donor bone and ambient holding temperature of the donor body influence osteoinductivity of bone left in situ.
Of ten adult rats that were killed, five were kept at 4 degrees and five at room temperature.
Femurs were harvested at 24, 36, 48, 72, and 168 hours.
After processing, segments were implanted in 20 four-week-old syngeneic rats for 14 days.
The level of osteoinduction was evaluated histologically.
It was excellent in the 4 degrees group in the 24-, 36-, and 48-hour specimens but less advanced at 72 hours.
Bone taken from the room temperature group showed findings identical to those kept at 4 degrees through 36 hours, but osteoinduction was less advanced at 48 hours and absent at 72 hours.
No bone formed at 168 hours in either temperature group.
The following observations were made.
(1) Osteoinductivity of demineralized bone left in situ after death was unexpectedly stable.
(2) Retrieval time was extended by donor cooling.
(3) Microperforated demineralized bone actively induced new bone formation.
(4) Ethylene oxide does not inhibit osteoinduction when correctly applied for sterilization.
If confirmed in humans, retrieval of bone to be used for osteoinduction could be delayed for some hours, particularly if the donor was immediately refrigerated.
This would increase the effective number of bone tissue donors and utilize an undeveloped resource.
| 22 |
2,827 | The osteogenic response to distant skeletal injury.
We tested the hypothesis that when one bone of the skeleton is injured, others experience an osteogenic response.
Although similar or related phenomena have been observed previously, the purposes of the study were to determine if this response was reproducible, to characterize it in terms of its magnitude and duration, and to show how it is related to the type of injury sustained.
To obtain this information, a model was used in which an intramedullary nail was implanted in the femur and a standard closed fracture was subsequently produced.
The osteogenic response was measured by histomorphometry.
Eight-four nine-week-old male Sprague-Dawley rats were divided into seven groups of twelve animals each.
Groups I and II consisted of control animals in which no injury was produced.
In Group-III rats, cortical drilling of the intercondylar notch and piriformis fossa of the right femur was performed, without intramedullary nailing.
In Groups IV through VII, half of each group received intramedullary nails only, and in the other half intramedullary nailing was done and a closed transverse diaphyseal fracture was produced.
With two different fluorochrome labels, rates of mineral apposition were measured in the left and right tibiae of all animals.
The labeling periods differed in each group and were designed to determine when the peak response occurred, how long it lasted, and whether aging during the course of the experiment affected the response.
| 20 |
254 | Soft tissue sarcomas of the head and neck in adults.
We reviewed the clinical records and pathologic material of 176 adults with primary soft tissue sarcomas treated at Memorial Sloan-Kettering Cancer Center between 1950 and 1985.
Seventy-two patients (41%) had low-grade sarcomas and 104 (59%) had high-grade sarcomas.
All but 18 patients underwent some form of excision as initial therapy.
Adjuvant radiotherapy and chemotherapy combined with surgical excision showed no significant effect.
A significantly increased risk of treatment failure was associated with large tumor size, positive surgical margins, bone involvement, local recurrence, metastatic spread, and high histologic grade.
Except for recurrence, the p value by univariate analysis in the log-rank test for comparison of survival according to these clinical and pathologic characteristics was p less than 0.0001.
Although the overall survival was 75% at 2 years, 55% at 5 years, and 46% at 10 years, only 20% of the patients with high-grade sarcomas were alive 10 years after treatment.
Most patients with rhabdomyosarcoma, high-grade peripheral nerve tumor, and high-grade fibrous histiocytoma and all patients with high-grade angiosarcoma died of disease less than 5 years after diagnosis.
New therapeutic strategies are needed to improve the survival of adult patients with high-grade soft tissue sarcomas of the head and neck.
| 3 |
2,231 | Effects of newborn screening of cystic fibrosis on reported maternal behaviour.
Screening for cystic fibrosis is highly controversial.
Concerns have been expressed that newborn screening may cause mothers, who had considered their child to be healthy before diagnosis, to overprotect their child.
Some critics of screening also suggest that a period of delay from onset of symptoms to diagnosis may help a mother adjust to the reality of the child's lethal condition.
This study compared the strength of overprotective child rearing attitudes of 29 mothers whose children were screened (13 had symptomatic children and 16 asymptomatic children) with the attitudes of 29 mothers whose children were diagnosed after the onset of symptoms.
Results indicate that newborn screening had not increased a mother's tendency to overprotect her child with cystic fibrosis and in some cases the tendency had decreased.
Further, delay in diagnosis when screening was not conducted usually caused mothers considerable personal distress.
| 15 |
2,874 | Hair dryer burns in children.
Three children with burn injuries caused by home hair dryers are described.
In one patient the injury was believed to be accidental, and in the other two cases the injuries were deliberately caused by a caretaker.
The lack of prior experience with hair dryer burns initially led to suspicion of other causes.
The characteristics of each case aided in the final determination of accidental vs nonaccidental injury.
These cases prompted testing of home hair dryers to determine their heat output.
At the highest heat settings, the dryers rapidly generated temperatures in excess of 110 degrees C.
After the dryers were turned off, the protective grills maintained sufficient temperatures to cause full-thickness burns for up to 2 minutes.
These cases and the results of testing demonstrate that hair dryers must be added to the list of known causes of accidental and nonaccidental burns in children.
| 20 |
28 | Intraocular pressure changes and postural changes of intraocular pressure in experimentally induced Hansen's disease of rhesus, mangabey, and African green monkeys.
In our long term evaluation of patients with Hansen's disease we have frequently found reduction of their intraocular pressure.
Furthermore, we noted changes in their intraocular pressure on change of posture.
To determine if these changes have any significance we measured the intraocular pressures of 24 experimentally infected and 39 control monkeys in both sitting and reclining positions.
We found significant reduction of intraocular pressure in 66.7% compared with controls in the sitting position, and a significant increase in intraocular pressure in 79% when checked first in the sitting then in the reclining position.
We offer a possible pathophysiological explanation as to why the changes occur.
| 0 |
1,908 | Timing and triggers of transient myocardial ischemia.
Use of exercise tolerance testing and new techniques of ambulatory electrocardiographic monitoring to more objectively measure myocardial ischemia have enabled clinicians to better recognize the magnitude, timing and variable characteristics of transient ischemic events.
These commonly occurring events in patients with coronary artery disease have a diurnal pattern strikingly similar to that reported for catastrophic cardiovascular events such as myocardial infarction, sudden cardiac death and stroke.
Whether those factors that contribute to reversible ischemic events are similar to those causing infarction and sudden death has not been resolved.
However, the parallel increase in morning activity for these related phenomena suggests that a better understanding of the triggers of reversible myocardial ischemia may help improve understanding of the causes of myocardial infarction and sudden cardiac death.
| 13 |
1,850 | Plaque morphology and pathologic changes in arteries from patients dying after coronary balloon angioplasty
Morphologic correlates of pathologic success or failure were studied at autopsy in 28 patients with 40 coronary arteries that had been subjected to balloon angioplasty.
The presence of the following histologic features was evaluated: plaque concentricity or eccentricity, calcification, fibrous or fibropultaceous plaque, medial disruption, luminal thrombus and inflammation.
Angioplasty was considered successful (residual cross-sectional luminal area greater than 25%) on pathologic examination in 14 arteries and unsuccessful in 26 arteries.
Eccentric plaques were more likely to be successfully dilated than were concentric lesions (p less than 0.05).
Six (50%) of 12 fibropultaceous plaques were successfully dilated compared with only 8 (29%) of 28 fibrous plaques.
Moderate to severe calcification did not preclude morphologic success.
Medial stretching or dissection, or both, was more often associated with a successful result.
Thus, plaque morphology may be an important determinant of pathologic outcome after coronary angioplasty.
| 13 |
578 | Basic studies on a new material for inducing antitumor immune cells.
Recently, adoptive immunotherapy for cancer with lymphokine activated killer (LAK) cells has been widely used experimentally.
The therapy has several problems, including difficulty in handling, sterilization, and time consumption.
To solve these problems, new materials able to induce antitumor immune cells were investigated.
Pokeweed mitogen (PWM) and PWM-conjugated materials (CMC-1) could induce strong killer cells by short-term stimulation of human peripheral blood lymphocytes (PBL).
The induced killer cells showed a wide killing spectrum in vitro against human tumor cell lines (MKK-1, PRMI4788, NBT-2, ZR-7530, H-1, Hela, KB, HMV-1, PC-10, C-1).
Human PBL stimulated for a short time by CMC-1 also showed a tumoricidal effect on tumor bearing (MKN-1, MKN-45) nude mice.
These results suggest that CMC-1 may solve the problems with currently used LAK therapy and may provide easily applicable extracorporeal immunotherapy for cancer.
| 3 |
2,962 | Case report: severe ethylene glycol intoxication with normal osmolal gap--"a chilling thought".
This is a case of a 23-year-old male presenting with altered sensorium, vomiting, and right flank pain.
Despite a normal osmolal gap, he was found to be suffering from ethylene glycol intoxication.
This little-described presentation can result in the clinician failing to consider ethylene glycol as a causative agent.
| 20 |
1,335 | Ionized calcium, parathormone, and mortality in critically ill surgical patients.
A prospective study measured ionized calcium and parathormone sequentially at 48- to 72-hour intervals in 25 surgical intensive care unit patients.
Twelve patients (48%) died at mean day 40 and median day 26.
Levels of ionized calcium, parathormone, blood urea nitrogen, creatinine, albumin, magnesium, and phosphate for patients who lived were compared with levels for patients who died.
The incidence of hypotension, renal failure (creatinine greater than or equal to 3.0), and bacteremia, as well as the amount of red cell, crystalloid, and colloid administration for the two groups was compared.
Hypotension, bacteremia, red cells, crystalloid, and colloid were no different.
On days 1 and 2 ionized calcium levels were significantly lower and parathormone levels significantly higher in nonsurviving patients; this difference persisted through days 3 and 4.
Blood urea nitrogen and creatinine levels increased early in nonsurviving patients but renal failure, which occurred in nine nonsurviving patients, did not develop until mean day 14, median day 18.
The phosphate level was slightly higher but still within normal range in nonsurviving patients.
By days 5 and 6 ionized calcium and parathormone levels were no different in nonsurviving patients, despite there being no improvement in renal function.
Magnesium and albumin levels were no different between groups.
Ionized calcium levels are lower and parathormone levels higher early in nonsurviving patients.
This difference is not readily explained by associated clinical conditions, including renal dysfunction.
Although etiology remains unclear, low ionized calcium and elevated parathormone are early predictors of mortality in critically ill surgical patients.
| 11 |
3,055 | Muscle relaxation rates in individuals susceptible to malignant hyperthermia.
Muscle relaxation rate following a tetanic stimulus of adductor pollicis muscle was measured prospectively in 26 patients potentially susceptible to malignant hyperthermia (MH) the day before a muscle biopsy was obtained for MH in vitro screening.
Eleven subjects were found to be MH susceptible (MHS) and 15 subjects MH-negative (MHN).
In all patients, relaxation rate was recorded at three different temperatures of the skin overlying adductor pollicis (30, 34 and 38 degrees C) achieved by a small surface heating unit placed over the thenar eminence.
The MHS group exhibited slightly higher relaxation rate at 34 and 38 degrees C compared with the MHN group and this difference was accentuated with increasing temperature, but was not statistically different.
The results of the present study suggest that relaxation rates are normal in MHS individuals under physiological conditions and cannot be used diagnostically for MH screening.
| 22 |
3,120 | Porcelain and resin veneers clinically evaluated: 2-year results.
A clinical comparison of two different types of dental veneers--baked porcelain veneer and heat-and-pressure processed urethane resin veneer--was made after 2 years.
Although the esthetic appearance and gingival response were equal for both systems, the resin veneers had a greater tendency to chip and fracture.
By the end of 2 years, 20% of the resin veneers had failed, whereas all of the porcelain veneers remained.
| 22 |
627 | Quantitative electromyography in polymyositis: a reappraisal.
Manual analysis of motor unit action potentials (MUAPs) was performed in 33 patients with polymyositis of whom 16 were studied in the acute stage and 17 in the chronic stage.
Contrary to common description of "myopathic potentials" as being of low amplitude, short duration, and polyphasic shape, the quantitated study revealed no difference as to amplitude of short duration MUAPs in patients and normal subjects though short-duration MUAP and short duration polyphasic potentials were 4 and 3 times, respectively, more common in patients than in controls.
Although the mean duration of MUAPs usually was significantly shorter in polymyositis than in controls, the average scatter of MUAPs duration was the same in the 2 groups.
The average incidence of polyphasic MUAPs was 4 times higher in patients than in controls, as was the incidence of those of long duration.
To avoid misinterpretation of EMG findings due to an excess of polyphasic MUAPs, a greater number of individual potentials than usually recommended should be collected allowing a valid estimate of the mean duration of MUAPs of simple configuration.
| 4 |
2,532 | Tumor necrosis factor: a putative mediator of the sick euthyroid syndrome in man.
Tumor necrosis factor-alpha (TNF) is believed to be an important mediator in many diseases that are associated with the sick euthyroid syndrome.
To investigate the effect of TNF on thyroid hormone metabolism, we performed a controlled study in six healthy postabsorptive males, in whom plasma thyroid hormones and TSH were sequentially measured after iv bolus injections of recombinant human TNF (50 micrograms/m2) and isotonic saline.
During the 10.5-h study TNF produced the characteristic changes in circulating thyroid hormones and TSH observed in the sick euthyroid syndrome.
Compared with the control experiment, TNF induced significant decreases in T3 (-36 +/- 2%; saline, -20 +/- 3%; P less than 0.05) and TSH levels (-68 +/- 3%; saline, -44 +/- 8%; P less than 0.05) and a significant increase in rT3 values (+48 +/- 11%; saline, -12 +/- 7%; P less than 0.05).
T4 and free T4 index were not affected by TNF.
Free T4 showed a mean transient increase of 18% in five subjects (nonsignificant), which occurred synchronically with a transient 3.5-fold rise in circulating FFA levels.
Our results suggest that TNF is involved, either directly or indirectly, in the pathogenesis of the sick euthyroid syndrome.
| 18 |
1,961 | Prevalence of symptoms of Raynaud's phenomenon in general practice.
OBJECTIVE--To investigate the prevalence of Raynaud's phenomenon in the populations of five general practices.
DESIGN--Two populations studied.
A questionnaire was given to all new patients attending five general practices over four weeks, and the same questionnaire was sent by post to a random sample of adults from two of the practices.
SETTING--General practices in inner London, Merseyside, and Cheshire.
SUBJECTS--1532 Patients who completed questionnaires (1119 who attended the surgeries (response rate unknown) and 413 respondents to the postal survey (response rate 69%)).
MAIN OUTCOME MEASURES--Response to questionnaire on symptoms of Raynaud's phenomenon: patients were regarded as having the disease if they had episodes of blanching of the fingers that were precipitated by cold and accompanied by sensory symptoms (pins and needles or numbness).
Subsequent interview and clinical appraisal of patients with the disease according to their responses to the questionnaire.
RESULTS--The prevalence of Raynaud's phenomenon was 11% (26/231) and 19% (34/182) respectively in men and women who completed the postal questionnaire and 16% (56/357) and 21% (157/762) respectively in those who completed the questionnaire when attending their general practice.
Thus the overall rates were slightly higher in women, but there was no effect of age even after adjustment of the rates for practice and method of survey.
CONCLUSION--The prevalence of Raynaud's phenomenon is high compared with the low number of patients who seek treatment for the disease.
| 13 |
1,885 | Ultrasonic evaluation of early carotid atherosclerosis.
We investigated the prevalence of carotid atherosclerosis, including mild early lesions, and its association with cervical bruits and various risk factors (age, male sex, hypertension, hyperlipidemia, diabetes mellitus, obesity, and cigarette smoking) in 232 consecutive Japanese patients.
High-resolution real-time B-mode ultrasonography was performed to determine the extent of atherosclerosis, and it was quantified by using a scoring system.
The prevalence of carotid atherosclerosis was 49%, 59%, and 41% in all 232 patients, the 100 symptomatic patients, and the 132 asymptomatic patients, respectively.
Although carotid lesions were detected frequently (87%) in the 30 patients with cervical bruits, bruits were noted in only 30% of the 88 examined patients with carotid atherosclerosis.
Independent risk factors for carotid atherosclerosis in these patients were found to be age, male sex, and hyperlipidemia; diabetes mellitus was a possible risk factor for carotid atherosclerosis.
Our study did not show a close association between hypertension and carotid atherosclerosis, and this might be caused by the high prevalence of hypertension in our patients.
Our findings suggest an increasing prevalence of carotid atherosclerosis in the Japanese, though this should be confirmed in a population-based study.
Our study demonstrates the clinical usefulness of high-resolution B-mode ultrasonography for the evaluation of early carotid atherosclerosis.
| 13 |
446 | Lipiodol computerized tomography: how sensitive and specific is the technique in the diagnosis of hepatocellular carcinoma?
Computerized tomography (CT) following the intra-arterial injection of Lipiodol (Lipiodol-CT) was performed on 60 patients suspected of having a hepatocellular carcinoma (HCC).
Four main patterns of uptake of the Lipiodol within the liver were seen on CT.
Of the 14 well circumscribed lesions with dense homogeneous uptake of Lipiodol, 13 were confirmed to be HCCs.
Of the 25 lesions with dense patchy uptake of Lipiodol at the periphery and/or in the centre, 19 were confirmed to be HCCs.
In 18 patients, in whom only ill defined faint patchy uptake of Lipiodol was present in the liver, or in whom no hepatic uptake was present at all, only one patient was found later to have an HCC.
Of the three hypodense lesions in the liver with no Lipiodol uptake, one was found to be necrotic HCC, one a cholangiocarcinoma and one a regenerative nodule.
In the diagnosis of HCC, Lipiodol-CT had an overall sensitivity of 97.1%, an accuracy of 88.3% and a specificity of 76.9%.
Of the 34 patients with HCC, only 23 were solitary at diagnosis.
The size of the HCCs ranged from 0.8 cm to 11 cm in diameter with the median size at 2.2 cm.
Eleven of 34 HCCs (32.3%) were resectable.
We conclude that, as part of a screening programme for high risk patients.
Lipiodol-CT is useful in the early detection of HCCs.
The technique also plays an important role in determining whether the tumour should be resected or managed with chemotherapy.
By detecting HCCs while still small, the resectability rate can also be improved.
| 3 |
2,258 | Treatment of hirsutism with the pure antiandrogen flutamide.
The effectiveness of the antiandrogen flutamide in combination with an oral contraceptive was studied in 20 patients with moderate to severe hirsutism.
Eight patients had no previous therapy, whereas 12 had failed to respond to oral contraceptives, spironolactone, or dexamethasone therapy.
Treatment with the antiandrogen flutamide (250 mg twice daily) and an oral contraceptive (Ortho 1/35) resulted in a particularly rapid and marked decrease in the total hirsutism score, which reached the normal range at 7 months.
Seborrhea, acne, and hair loss score were also rapidly corrected.
Treatment was associated with a decrease in plasma luteinizing hormone, progesterone, and estradiol levels.
Plasma sex hormone-binding globulin levels were initially low in 18 to 20 patients but increased significantly during therapy.
No clinically significant side effects were observed.
| 16 |
57 | Safety evaluation of PRP-D Haemophilus influenzae type b conjugate vaccine in children immunized at 18 months of age and older: follow-up study of 30,000 children.
We evaluated the safety of the PRP-D conjugate Hib vaccine (ProHIBit, Connaught) in 29,309 children vaccinated at 18-60 months of age in the Southern California Kaiser Permanente medical clinics during the period April 1, 1988, to July 31, 1989.
Surveillance for potential reactions involved postcard questionnaires, telephone surveys, reports of Kaiser staff and review of hospitalizations and covered two periods following immunization: (1) the first 48 hours and (2) days 2 through 30.
Surveillance for invasive Hib disease involved the above methods in addition to systematic reviews of laboratory and hospital records through January 31, 1990.
Rates of local and systemic reactions within 48 hours of vaccination with PRP-D alone were low (less than or equal to 2% for fever greater than 102 degrees F, local redness or swelling) and similar to those previously reported after vaccination with PRP.
Hospitalization and seizures (0.15% and 0.09% of vaccinated children, respectively) occurring within 1 month of immunization appeared to be unrelated to vaccination.
One 29-month-old child had onset of a fatal episode of Hib sepsis/meningitis within 48 hours of vaccination.
Also, a 30-month-old child developed Hib meningitis 10 months after PRP-D vaccination.
We conclude that PRP-D is safe when given alone or in combination with other childhood vaccines between 18 and 60 months of age.
| 0 |
3,255 | Cytomegalovirus infections in pediatric liver transplantation.
From 1986 to 1989, 26 consecutive pediatric liver transplant recipients were followed up at The Hospital for Sick Children, Toronto, Canada.
The patients were reviewed to assess the incidence of infection with cytomegalovirus, the severity of disease, and the relationship of recipient and donor serostatus to cytomegalovirus disease.
Overall, the incidence of infection was 54% (14/26).
Over 90% of patients who were seropositive or whose donors were seropositive developed evidence of cytomegalovirus infection after transplantation.
Forty-three percent (6/14) of those with cytomegalovirus infections developed severe, fatal cytomegalovirus disease, despite treatment with immunoglobulins and ganciclovir (Syntex Laboratories Inc, Palo Alto, Calif) or foscarnet sodium (Astra, Pharmaceutical Products Inc, Westborough, Mass).
Of all posttransplant deaths, two thirds were associated with severe cytomegalovirus infection.
Cytomegalovirus-related deaths occurred in three of four seronegative patients with seropositive donors and three of six seropositive patients with seropositive donors.
Therefore, a seropositive donor appeared to be a major risk factor for severe cytomegalovirus disease.
| 22 |
590 | Intertrochanteric corrective osteotomy in slipped capital femoral epiphysis. A long-term follow-up study of 26 patients.
The results of intertrochanteric corrective osteotomy in a series of 26 hips with moderate to severe chronic slipped capital femoral epiphysis are reported from follow-up studies in 1976 and 1986.
In hips with a slippage of less than 40 degrees (ten hips), arthrosis was present in one hip.
In the remaining 16 cases in which slippage exceeded 40 degrees, osteoarthrosis was present in 15, even though correction was adequate.
From these observations it can be concluded that intertrochanteric corrective osteotomy does not prevent degeneration in cases with the most severe slip.
On the basis of the present observations on treated and untreated cases, the authors advocate treatment by fixation without realignment, accepting the deformity in moderate and severe chronic slips.
Rotational osteotomy may be considered in the event of hip joint contracture.
| 4 |
1,538 | The use of rectus abdominis myocutaneous flaps following excision of vulvar cancer.
Rectus abdominis myocutaneous flaps have been used in 16 women following radical excision of extensive vulvar cancer.
In two women the procedure was part of the primary surgery, in 11 for recurrence of vulvar cancer and in three for symptomatic palliation.
Fifteen (94%) of the grafts took with primary healing.
Thirteen of the 16 patients are alive 6-60 months (median 29 months) after surgery and the three who died benefited from symptomatic palliation.
Simultaneous vulvar reconstruction allows good cosmetic rehabilitation and is an important part of the armamentarium for the management of patients with advanced primary or recurrent vulvar carcinoma.
This technique offers excellent surgical clearance of massive offensive and painful vulvar tumors.
| 12 |
357 | The impact of the U.S. Preventive Services Task Force guidelines on cancer screening: perspective from the National Cancer Institute.
The U.S.
Preventive Services Task Force evaluated the medical literature, utilizing strict criteria to judge the merits of experimental trials designed to show benefit in screening for cancer.
For individuals at normal risk, the task force was not able to make recommendations for or against screening for colorectal, prostate, skin, oral, or testicular cancers.
Only one physical-examination cancer-screening procedure has ever been tested in a randomized trial.
During the past 27 years, the National Cancer Institute (NCI) has funded six randomized screening trials.
Thus far, only one has shown a decrease in mortality.
Recognizing the limitations of such trials, the NCI published "Working Guidelines for Early Cancer Detection." Designed for the practicing physician, these guidelines were based upon the best available evidence and on the judgment of representatives of medical professional organizations.
| 3 |
2,270 | Diminished incidence of severe rheumatoid arthritis associated with oral contraceptive use.
It has been suggested that the negative association between rheumatoid arthritis (RA) and oral contraceptive (OC) use might be limited to the more severe forms of RA.
To investigate this further, we studied 121 consecutive female patients with definite RA, 52 female patients with probable RA, and 378 female controls.
All patients had RA symptoms of recent onset.
After a mean followup period of 6 years, patients with definite RA were classified as having either a severe disease course (n = 76) or a mild disease course (n = 45).
The negative association between OC use prior to the onset of RA symptoms and the development of RA was limited to those patients with definite RA who had a severe disease course.
We therefore conclude that OC use prior to the onset of RA symptoms is only associated with a reduction in the incidence of severe RA.
This may explain the divergent results of previous studies.
| 16 |
845 | Crohn's disease in the city of Derby, 1951-85.
An epidemiological survey of Crohn's disease in the city of Derby showed that the incidence of the condition increased from 0.7/10(5) per year between 1951 and 1955 to 6.67/10(5) per year between 1981 and 1985 but seemed to reach a plateau between 1976 and 1985.
Large bowel Crohn's disease was more common in patients presenting aged 60-79 years than in those aged 20-39 years.
The increase in incidence was not solely due to the detection of milder disease.
There was no evidence that the Asian (Indian subcontinent) population of Derby was resistant to the development of Crohn's disease.
| 5 |
3,139 | The detubularized right colonic segment as urinary reservoir: evolution of technique for continent diversion.
Continent diversion of urine via a cecal-right colonic reservoir has been performed at our university hospital since 1977.
Several modifications of surgical technique have been devised to prevent problems of urinary leakage and difficulties in catheterization.
The current technique, used during the last 3 years on 14 patients, involves use of a detubularized right colonic segment as a reservoir, ileal mesenteric exclusion, fashioning the intussuscepted ileal nipple valve with staples and anchoring of a fascia strip sling around the nipple base to the anterior rectus sheath.
Complication from the reservoir outlet occurred in only 1 patient.
| 22 |
2,726 | Search for epitope-specific antibody responses to the human immunodeficiency virus (HIV-1) envelope glycoproteins signifying resistance to disease development.
It is essential for the development of strategies for prevention and therapy of human immunodeficiency virus (HIV-1) infections to define host factors playing a dominant role in determining the clinical outcome of infection.
Antibodies directed against restricted regions of the HIV-1 glycoproteins gp120 and gp41 are likely to represent important factors involved in host defense against HIV-1.
Definition of qualitative and quantitative differences in the spectrum of anti-gp120 and anti-gp41 antibodies between two vastly different groups of HIV-1-infected individuals, long-term asymptomatic carriers, and individuals with acquired immunodeficiency syndrome (AIDS) who died, might reveal the epitope specificity of antibodies contributing to prevention of clinical disease.
To accomplish this goal, sera from both groups were assayed for antibodies recognizing synthetic peptides from gp120/gp41 which were shown in earlier experiments to mimic epitopes on the two HIV-1 glycoproteins.
None of the sera recognized all of the distinct 27 peptides from gp120 and gp41.
The spectrum of antibodies was distinct for each of the sera from both groups of HIV-1-infected individuals.
Nevertheless, antibody responses distinguishing the two groups from each other were discerned.
In particular, it was possible to predict the unfavorable outcome of disease by comparative measurements of levels of antibodies to a peptide (303-338), corresponding to the entire V3 hypervariable loop of gp120 and/or by providing evidence for declining levels of these antibodies during the course of infection.
Antibodies recognizing additional peptides [(219-245), (280-306), (425-452), (658-682), (729-758), (808-845), and (845-862)] were significantly less prevalent in AIDS patients than in asymptomatic carriers.
It appears possible that maintenance of high levels of the respective antibodies would contribute to preventing AIDS in HIV-1-infected individuals.
Active immunization with antigens containing epitopes defined by the respective peptides and/or administration of the corresponding antibodies may be considered as a modality for therapy of HIV-1 infections.
| 19 |
2,586 | The effect of repetitive exercise on airway temperatures
To determine if a relationship exists between intra-airway thermal events and the reduction in pulmonary mechanics that occur in asthmatics when they perform repetitive exercise, we recorded intrathoracic airstream temperatures in seven subjects during and after two identical bouts of cycle ergometry performed 30 min apart.
From these data, global and regional thermal energy exchanges were calculated.
Inspired air conditions, work loads, and minute ventilations were held constant for both trials.
Pulmonary mechanics were measured prior to and serially after each challenge.
As expected, the second provocation produced a smaller response than did the first.
In association with these mechanical changes, the second challenge also produced less airway cooling and slower rewarming in the central airways.
Hence, repetitive exercise trials performed over short intervals attenuate the essential thermal gradients necessary to produce obstruction.
To the extent that these differences in intra-airway temperature reflect changes in perfusion, our data raise the possibility that the responsivity of the bronchial microcirculation of asthmatics may be altered by repetitive exercise.
| 19 |
530 | Intraoperative radiation of canine carotid artery, internal jugular vein, and vagus nerve. Therapeutic applications in the management of advanced head and neck cancers.
As a step in the application of intraoperative radiotherapy (IORT) for treating advanced head and neck cancers, preliminary information was obtained on the radiation tolerance of the canine common carotid artery, internal jugular vein, and vagus nerve to a single, high-dose electron beam.
Both sides of the neck of eight mongrel dogs were operated on to expose an 8-cm segment of common carotid artery, internal jugular vein, and vagus nerve.
One side of the neck was irradiated, using escalating doses of 2500, 3500, 4500, and 5500 cGy.
The contralateral side of the neck served as the unirradiated control.
At 3 and 6 months after IORT, one dog at each dose level was killed.
None of the dogs developed carotid bleeding at any time after IORT.
Light microscopic investigations using hematoxylin-eosin staining on the common carotid artery and internal jugular vein showed no consistent changes that suggested radiation damage; however, the Masson trichrome stain and hydroxyproline concentration of irradiated common carotid artery indicated an increase in the collagen content of the tunica media.
Marked changes in the irradiated vagus nerve were seen, indicating severe demyelination and loss of nerve fibers, which appeared to be radiation-dose dependent.
Four patients with advanced recurrent head and neck cancer were treated with surgical resection and IORT without any acute or subacute complications.
The role of IORT as a supplement to surgery, external beam irradiation, and chemotherapy in selected patients with advanced head and neck cancer needs further exploration.
| 3 |
44 | Cefuroxime treatment failure of nontypable Haemophilus influenzae meningitis associated with alteration of penicillin-binding proteins.
A 10-year-old boy presented with nuchal rigidity and cerebrospinal fluid (CSF) leukocytosis initially and again on day 6 of intravenous cefuroxime therapy (200 mg/kg/day).
Both CSF specimens yielded nontypable beta-lactamase-negative Haemophilus influenzae that were susceptible by disk tests but relatively resistant to cefuroxime (MIC, 8- to 16-fold greater than that of control isolates).
To define the mechanism of resistance, the cefuroxime resistance marker was transformed to a susceptible H.
influenzae recipient; inactivation and permeability of beta-lactam substrate were tested and the penicillin-binding protein (PBP) profiles were examined.
Inactivation of beta-lactam substrate was not detected and reduced permeability was not found.
However, reduced beta-lactam binding to PBPs 4 and 5 was observed; 18- to 27-fold more penicillin and 2.5-to 4-fold more cefuroxime was required to saturate or block 50% of the binding sites of these PBPs, respectively.
Thus, reduced affinity of PBPs 4 and 5 for beta-lactam substrate appears to be the mechanism of cefuroxime resistance in this strain.
The reduced affinity of these targets appears to have contributed to the bacteriologic and clinical failure in this patient.
| 0 |
3,299 | Functional and metabolic effects of bupivacaine and lignocaine in the rat heart-lung preparation.
We have examined the effects of bupivacaine and lignocaine on myocardial metabolism in the rat isolated heart-lung preparation.
Bupivacaine 1, 5 or 25 micrograms ml-1 or lignocaine 4, 20 or 100 micrograms ml-1 was administered 5 min after the start of perfusion.
Both bupivacaine 25 micrograms ml-1 and lignocaine 100 micrograms ml-1 reduced heart rate significantly.
Bupivacaine 25 micrograms ml-1 was associated with a higher incidence of arrhythmias than the other groups.
Three hearts in the bupivacaine 25 micrograms ml-1 group (n = 8) and two hearts in the lignocaine 100 micrograms ml-1 group (n = 8) failed (zero cardiac output) at the end of the experiment.
Although there were no significant differences in myocardial lactate and glycogen concentrations between groups, ATP content in the bupivacaine 25 micrograms ml-1 and lignocaine 100 micrograms ml-1 groups was significantly less than that in the control group.
The results suggest that myocardial depression and subsequent metabolic deterioration occurred with both the high doses of local anaesthetics; these findings do not account for the apparent increased cardiotoxicity of bupivacaine.
| 22 |
1,515 | Experience with a 'physiological' steroid replacement regimen for the establishment of a receptive endometrium in women with premature ovarian failure.
Eighteen women with a premature menopause underwent assessment of serial serum oestradiol (E2) and progesterone levels and endometrial histology and function.
Patients received continuous transdermal E2, and progesterone either orally or vaginally for 14 days.
Physiological levels of E2 were attained.
Significantly higher levels of progesterone were achieved with vaginal progesterone (P less than 0.01).
Endometrial biopsies obtained during E2 replacement demonstrated normal proliferative features.
Expression of an oestrogen related antigen (ER-Ag) was localized in the cytoplasm of the epithelium.
After 3 days of progesterone replacement the endometrium showed normal secretory features and expression of ER-Ag in the stroma as well as in the glands.
After 7 days of progesterone supplementation, vaginal administration produced a more consistent physiological appearance than oral administration.
Thus transdermal E2 combined with vaginal progesterone is a highly satisfactory combination for establishing a physiological endometrium in women with premature ovarian failure.
| 12 |
1,148 | Platelet-activating factor. A putative mediator in central nervous system injury?
Platelet-activating factor (1-O-hexadecyl-2-acetyl-sn-glycero-3-phosphorylcholine) is a potent lipid autacoid produced by many cell types.
Platelet-activating factor is produced by cerebellar granule cells in culture and has been extracted from brain tissue.
Multiple platelet-activating factor receptors have been demonstrated in brain tissue.
Activation of platelet-activating factor receptors in transformed neuronal cell lines involved increases in intracellular calcium.
Platelet-activating factor has potent actions on cerebral vessels and cerebral metabolism when administered in vivo, but may not have direct effects on brain microvessels.
Excessive platelet-activating factor production in pathological states of the nervous system such as neurotrauma and stroke has been shown in only a few models (e.g., spinal cord ischemia and reperfusion or focal repercussion brain injury).
In multiple studies using highly specific and potent platelet-activating factor antagonists, reversal or prevention of key consequences of brain injury such as hypoperfusion following ischemia, reperfusion and edema, inflammatory cell accumulation, neurologic/motor deficits, and neuronal salvage were demonstrated.
This review provides and analyzes evidence in support of the role that platelet-activating factor might have in modulation of brain function and pathophysiological processes in brain ischemia and trauma.
| 9 |
1,812 | Short-term effect of hepatic arterial versus portal venous reperfusion on energy levels of liver tissue.
The hepatic artery and the portal vein blood vary in flow, oxygenation, and hormonal content.
It was uncertain which blood supply has a greater effect on the recuperative process of the hepatocytes in the ischemic liver during the initial reperfusion.
The ability of the liver cells to restore its energy phosphates is related to the viability of the liver.
This study was designed to determine the differences of the high energy phosphate in the liver predicated upon whether reflow was first provided by either the hepatic artery or the portal vein followed by subsequent reperfusion from both vessels.
The recovery of ATP upon 10 min of only hepatic arterial reperfusion after 15 min of total ischemia was much slower compared to the portal venous reperfusion only.
It may be undesirable, therefore, to reperfuse the liver with hepatic arterial blood first immediately after warm liver ischemia.
| 13 |
579 | Fine needle aspiration biopsy in the diagnosis and management of fibroadenoma of the breast.
Cytological and histological biopsies were obtained on 75 breast lumps clinically diagnosed as fibroadenomas.
Of these, 95 per cent of lesions were benign.
In 51 (68 per cent) confirmed as fibroadenomas histologically, cytology was benign in 78 per cent, but inadequate for diagnosis in 16 per cent.
The remaining 24 lesions included three breast cancers and one lymph node with Hodgkin's disease.
In this group cytology was inadequate for diagnosis in 54 per cent, including one breast cancer.
No lesion with benign cytology was subsequently shown to be malignant.
The study supports the view that clinical diagnosis and cytology are accurate in the diagnosis of benign breast disease of this type.
Breast cancer may rarely present with the clinical features of a fibroadenoma and too few lesions have been studied to assess fully the performance of cytological biopsy in detecting these small mobile lesions.
A non-excisional policy should therefore include prolonged follow-up and repeat biopsy.
| 3 |
1,299 | Myxoid malignant fibrous histiocytoma of the bladder.
Although the most common soft tissue sarcoma of adulthood, malignant fibrous histiocytoma (MFH) is an extremely rare tumor of the urinary bladder.
Only three well-documented cases have been reported in the world literature.
The patient presented in this report represents the first case of the myxoid variant to develop in the urinary bladder.
Whereas all previous patients with MFH of the bladder had intermittent hematuria, this patient's chief complaint was bladder outlet obstruction due to extension of the tumor into the prostate.
He was managed with radical cystoprostatectomy, postoperative radiation therapy to the tumor bed, and adjuvant chemotherapy using doxorubicin.
The patient tolerated the therapy well and was disease-free at the 3-year follow-up visit.
The histogenesis, clinical features, pathologic characteristics, and treatment considerations of this rare bladder tumor are discussed in detail.
| 11 |
421 | Primary malignant melanoma of the lower respiratory tract. Report of a case and literature review.
The authors report a case of primary bronchial malignant melanoma, occurring in a 34-year-old woman presenting with persistent cough.
At bronchoscopic examination, a polypoid mass was found to occlude the left mainstem bronchus.
Biopsies showed a malignant epithelioid tumor resembling an atypical carcinoid.
Histochemistry, electron microscopic study, and immunohistochemistry confirmed the diagnosis of melanoma.
Physical examination and additional clinical history to exclude other possible primary sites were negative.
The patient underwent thoracotomy with left pneumonectomy.
Nineteen months after resection she was found to have a histologically similar tumor involving her left adrenal gland.
Review of the literature shows that melanoma of the lower respiratory tract has been reported only in adults and has a tendency to present as a central polypoid growth that may be responsive to surgical resection.
| 3 |
1,064 | Childhood stroke after minor neck trauma: case report.
Cerebral infarction after minor trauma to the neck has rarely been reported.
A case is presented of a child with trauma to the vertebrobasilar artery resulting in stroke.
Computerized tomography scan and angiography results are presented.
Despite two subsequent, separate transient episodes of vertigo, the child had good functional recovery with complete restoration of language and cognitive function.
After 28 months, residual impairments identified were a mild right-sided ataxia and hemiparesis.
| 9 |
853 | Using periodontal plastic surgery techniques.
In the 1980s, mucogingival surgery evolved into periodontal plastic surgery with various techniques designed to produce root coverage in areas of marginal tissue recession, to augment deficient ridges, and to lengthen crowns in cases of excessive gingival display.
Periodontal plastic surgery not only enables the dentist to reconstruct but also to regenerate lost tissues.
| 6 |
2,857 | Alcohol consumption by college undergraduates: current use and 10-year trends.
In a carefully executed study with a high response rate, a random sample of 10% of the undergraduate student body at a rural New England university was surveyed as to the subjects' use of alcohol in 1987.
Over 87% of the surveyed students returned questionnaires.
The results were compared to similar studies conducted on the campus in 1977 and 1983.
"Daily or almost daily" use of alcohol was registered by 4.7% of the respondents, which represents a continuing decrease in daily consumption from earlier studies.
One-fourth of the sample indicated drinking only one drink or fewer per week, contrary to the common perception on the campus.
Nevertheless, 25.5% recorded a hangover, 7.5% recorded vomiting from drinking too much and 4.4% recorded a blackout, all "in the last week." Compared to the U.S.
population, alcohol consumption appears to be more evenly distributed in the college sample but, still, most of the drinking is done by one-fifth of both groups.
| 20 |
3,339 | Development of a small caliber biologic vascular graft: evaluation of its antithrombogenicity and the early healing process.
The authors previously showed that a small caliber xenograft using our crosslinking technique was applicable to aortocoronary bypass grafting.
In this study of the graft, the antithrombogenicity and healing process was evaluated at an early stage after implantation.
Fresh sheep carotid artery (3mm ID) was obtained and cross-linked with polyepoxy compounds, and then used as a small caliber vascular graft.
The graft was white and soft.
Six cm segments of the graft were implanted into the carotid arteries bilaterally in nine dogs.
Sodium heparin was given during the surgery, but no anticoagulant was used postoperatively.
Fifteen grafts from eight dogs were removed from 1 hr to 30 days after implantation, and 13 of 15 grafts were found to be patent.
Two grafts, one at 3 days, and the other at 14 days, were occluded.
The anastomotic area of the occluded grafts felt hard when touched from the outside.
In one dog, the grafts were shown angiographically to be patent at 14 days after implantation, and this dog was kept for long-term observation.
Macroscopically, no thrombus was observed on any of the patent grafts.
Microscopically, the inner surface near the anastomotic lines was covered with endothelial cells, and infiltration of fibroblasts was observed from the outside 7 days after implantation.
No foreign body reactions were seen around the graft.
After 30 days of implantation, a thin layer of plasma protein at the middle of the graft was observed by scanning electron microscopy (SEM).
From these observations, it was concluded that the grafts exhibited satisfactory early antithrombogenicity and healing after implantation.
| 22 |
2,541 | Interrelationships between age, thyroid volume, thyroid nodularity, and thyroid function in patients with sporadic nontoxic goiter.
PURPOSE: To test the hypothesis that during the natural history of sporadic nontoxic goiter (SNG), a diffuse goiter precedes a multinodular goiter with gradual development of autonomous thyroid function.
PATIENTS AND METHODS: A cross-sectional survey of 102 consecutive patients with SNG (seven male, 95 female) was performed.
Thyroid volume was measured by ultrasonography, and plasma thyroid-stimulating hormone (TSH) by a sensitive assay (TSH immunoradiometric assay).
RESULTS: Patients with a multinodular goiter were older and had a larger thyroid volume than patients with a diffuse or uninodular goiter.
Plasma free thyroxine (T4) and total triiodothyronine (T3) were higher and plasma TSH was lower in patients than in normal subjects.
Free T4 was higher in the subgroup of patients with a multinodular goiter and a decreased TSH response to thyrotropin-releasing hormone.
Plasma TSH (y, in mU/L) was negatively related to thyroid volume (x, in mL): y = 8.2x-0.667 (r = 0.578, p less than 0.001).
Thyroid volume (y, in mL) was positively related to age (x, in years): y = -21.8 + 2.0x (r = 0.455, p less than 0.001); and to duration of goiter (x, in years): y = 40.6 + 2.1x (r = 0.505, p less than 0.001).
The annual increase in thyroid volume was calculated at 4.5%.
CONCLUSION: The data suggest a continuous growth of SNG and provide support for the concept of increasing thyroid nodularity and autonomy of thyroid function--related to increasing thyroid volume--during the natural history of this disorder.
| 18 |
2,749 | Chilblains (perniosis).
Unfamiliarity of physicians with chilblains (perniosis) gives rise to unnecessary hospital admissions with expensive laboratory and radiologic evaluations and, at times, hazardous therapy.
Seven cases of chilblains were seen in San Francisco from November 1986 through January 1987.
The patients presented with pruritic, at times painful, purple acral patches or plaques on the fingers, toes, and nose after exposure to a cool or a cold, damp environment.
Histologic examination in two cases revealed a perivascular lymphocytic infiltrate with endothelial swelling of the subcutaneous fat and of the upper and lower dermal plexus.
| 20 |
599 | The restorative and surgical technique for the full maxillary subperiosteal implant.
The edentulous atrophic maxilla represents one of the most challenging implant restorative opportunities.
When prescribed within the appropriate diagnostic range and performed by a highly skilled and experienced practitioner, the full maxillary subperiosteal implant is a predictable solution for the patient with an edentulous atrophic maxilla.
| 4 |
823 | Primary sclerosing cholangitis.
Primary sclerosing cholangitis is a rare disease of unknown etiology.
Sclerosis of the bile ducts may actually be the final result of multiple factors such as autoimmune, bacterial, congenital, drug, or viral injury.
The most commonly associated diseases are ulcerative colitis and chronic pancreatitis.
Except in the earliest stages of the disease, liver histologic findings are not specific.
Most patients present with jaundice, pain, and pruritus, although an increasing number of asymptomatic patients with inflammatory bowel disease and abnormal liver function are being identified.
Cholangiography is key to the diagnosis and is usually pathognomonic except in the unusual case where primary sclerosing cholangitis is confused with cholangiocarcinoma.
Many forms of medical therapy have been tried, including antibiotics, azathioprine, cholestyramine, colchicine, cyclosporine, D-penicillamine, steroids, and ursodeoxycholic acid.
To date, none of these medications has been proved to alter the course of this disease.
Recent reports of ursodeoxycholic acid trials have been encouraging, but long-term results of ongoing randomized trials have yet to be published.
In recent years, balloon dilatation of biliary strictures has been accomplished via endoscopic and percutaneous transhepatic approaches.
However, in patients with primary sclerosing cholangitis, these nonoperative manipulations must be done repeatedly, may entail multiple general anesthetics, and are difficult to perform.
We believe that a direct surgical approach to the biliary tree with long-term transhepatic stenting is indicated in selected patients with severe hilar or extrahepatic stricturing, persistent jaundice or recurrent cholangitis, and no evidence of cirrhosis.
Hepatic transplantation should be reserved for patients with primary sclerosing cholangitis who have well-established cirrhosis and have not responded to other therapeutic measures.
| 5 |
1,799 | Effects of low perfusate Ca2+ concentration on newborn myocardial function after ischemia.
A greater dependence on transsarcolemmal Ca2+ flux and immaturity of Ca2+ sequestration capacity may potentiate Ca2(+)-mediated reperfusion injury in the newborn myocardium.
The effect of serum ionized Ca2+ concentration on left ventricular systolic and diastolic function after ischemia was studied in 5-7-day-old piglets undergoing a 90-minute period of cold-blood cardioplegic arrest.
In the control group, Ca2+ was maintained at 1.2 mM (Group A [n = 6]).
The cardioplegic solution and bypass perfusate were modified to achieve a low Ca2+ concentration, 0.25 mM, in Group B (n = 6).
Left ventricular pressure-volume loops were acquired by using high-fidelity pressure-sensor-tipped and volume-conductance catheters.
Ventricular function was assessed from the slope of end-systolic (Ees) and end-diastolic (k) pressure-volume relations during transient caval occlusion.
Both groups showed a significant reduction in Ees after ischemia (p less than 0.05).
Intergroup comparison of Ees after ischemia demonstrated a better recovery of the systolic function in the low Ca2+ group, 64 +/- 7% versus 49 +/- 6% in the normal Ca2+ group (p = 0.05).
There was a significant increase in chamber stiffness index in group A (k, 0.48 +/- 0.06 to 0.65 +/- 0.05 ml-1, p less than 0.01) versus no significant change in group B.
This study shows 1) the feasibility of acquiring continuous pressure-volume data in neonatal hearts by using a conductance catheter system, and 2) better preservation of systolic function and diastolic compliance in normal newborn myocardium by low Ca2+ concentration in the peri-ischemic period.
| 13 |
2,633 | Anaphylaxis following ingestion of a psyllium-containing cereal.
Recently, psyllium hydrophilic mucilloid, a bulk-forming laxative, has been added to breakfast cereals for cholesterol-lowering effects.
We report a case of a 60-year-old woman with no prior history of psyllium ingestion who developed anaphylactic symptoms after eating a psyllium-containing cereal.
Her only previous exposure was dispensing a psyllium-containing laxative as a nurse.
Immunoglobulin E-mediated sensitization was documented by skin testing and basophil histamine release.
The literature is reviewed regarding allergic reactions to psyllium.
Health care workers and pharmaceutical workers handling psyllium may be at increased risk due to sensitization from inhalation.
Physicians and consumers should be aware of potential serious reactions from eating psyllium-containing cereals even without prior history of ingestion of psyllium.
| 19 |
2,247 | Effects of haem arginate on variegate porphyria.
Four patients with variegate porphyria (VP) were treated with repeated haem arginate infusions daily for 4 days and then weekly for 4 weeks.
After the initial four daily doses of haem arginate (haem 3 mg/kg), the excretion of faecal protoporphyrin (mean 579 nmol/g dry wt) fell to an almost normal level (mean 123 nmol/g dry wt), and that of coproporphyrin (mean 162 nmol/g dry wt) to the normal level (mean 21 nmol/g dry wt) in all patients.
However, during the period of the four weekly infusions of haem the excretion of porphyrins increased almost to the pretreatment level.
Phototesting showed no changes in the photoreactivity of the skin, and no improvement in skin lesions was seen during the treatment.
Except for one case of thrombophlebitis no side-effects occurred.
In a child with homozygous VP, four daily infusions of haem arginate (2 mg/kg) normalized the faecal protoporphyrin content, but had no effect on the increased erythrocyte protoporphyrin concentration.
| 16 |
2,073 | Determinants and significance of diltiazem plasma concentrations after acute myocardial infarction. The Multicenter Diltiazem Postinfarction Trial Research Group.
A total of 1,975 plasma diltiazem concentrations were obtained from 1,067 patients enrolled in a multicenter secondary intervention study of diltiazem after acute myocardial infarction.
To evaluate the determinants and significance of diltiazem concentrations in this patient population, we related drug concentrations to a variety of clinical variables recorded on the case history forms.
Multiple linear regression analysis showed that (1) time from the last drug dose, (2) drug dose taken, (3) patient height (an index of lean body weight), and (4) patient age were important determinants of plasma concentration.
For an equivalent dose, plasma diltiazem concentrations in a 75-year-old patient were about double those of a 25-year-old patient.
Total weight and drug dose prescribed did not significantly affect plasma concentrations.
Whereas drug concentrations were higher (p = 0.01) among patients with left-sided heart failure, they were not altered by renal dysfunction, hepatic disease or beta blockers.
Diltiazem concentrations were a significant determinant of diastolic arterial pressure (p less than 10(-9), but neither systolic pressure nor heart rate were significantly related to diltiazem concentration.
The overall incidence of adverse experiences was not related to drug concentrations, but the occurrence of second- and third-degree atrioventricular block in the coronary care unit and the need for a temporary pacemaker were substantially higher among patients with a drug concentration greater than 150 ng/ml (7.4 and 1.9%, respectively) than among patients with lower concentrations (2.6% for atrioventricular block, 0.3% for pacemaker; p = 0.02 for each).
The risk of atrioventricular block was particularly increased by high diltiazem concentrations in the face of acute inferior infarction.
These results suggest that diltiazem's pharmacologic and clinical effects in a large population are concentration-related, and that the consideration of patient size, age, and left ventricular function in selecting a diltiazem dose may allow for effective drug therapy with a reduced likelihood of adverse effects.
| 13 |
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