.I 90305
.U
88240854
.S
Br J Anaesth 8809; 60(6):627-31
.M
Buprenorphine/AD/AE/*TU; Cesarean Section/*; Comparative Study; Female; Human; Injections, Epidural; Morphine/AD/AE/*TU; Pain, Postoperative/*DT; Pregnancy.
.T
Comparison of extradural buprenorphine and extradural morphine after caesarean section.
.P
JOURNAL ARTICLE.
.W
Fifty-seven women received extradural morphine 3 mg, buprenorphine 0.18 mg or buprenorphine 0.09 mg after elective Caesarean section carried out under extradural bupivacaine. Supplementary sublingual buprenorphine was available on demand. Ten-centimetre visual analogue pain scores were completed regularly; emesis, pruritis and urinary retention were recorded for 24 h. Patients who received buprenorphine 0.09 mg had more pain, and required more supplementary analgesia, than those who received morphine 3 mg. Pain scores and analgesic requirements after buprenorphine 0.18 mg were not significantly different from either of the other two groups. Emesis was not significantly different in the three groups. More itching occurred after morphine 3 mg and buprenorphine 0.18 mg than after buprenorphine 0.09 mg; pruritis of the face, legs and perineum was more common after morphine than buprenorphine. Twenty-eight percent of patients without a urinary catheter developed retention of urine. Seventy-five to 84% of patients were satisfied with analgesia during the first day after operation. Analgesia and adverse effects were similar when morphine 3 mg or buprenorphine 0.18 mg was given extradurally after Caesarean section.
.A
Simpson KH; Madej TH; McDowell JM; MacDonald R; Lyons G.
.I 90306
.U
88240855
.S
Br J Anaesth 8809; 60(6):632-8
.M
Cesarean Section/*; Diacetylmorphine/AD/AE/*TU; Double-Blind Method; Drug Therapy, Combination; Epinephrine/AD/AE/*TU; Female; Human; Injections, Epidural; Morphine/BL; Pain, Postoperative/*DT; Pregnancy; Random Allocation.
.T
Effect of the addition of adrenaline to extradural diamorphine analgesia after caesarean section.
.P
JOURNAL ARTICLE.
.W
In a randomized double-blind study the effect of the addition of adrenaline to extradural diamorphine was assessed in 54 patients after Caesarean section. Patients received extradural diamorphine 5 mg in saline 10 ml with or without adrenaline 1 in 200,000 for postoperative pain relief. Analgesia was profound and of rapid onset in both groups. Duration of analgesia was greater in the adrenaline group (time to next analgesia 12.51 +/- 0.94 h, mean +/- SEM), than in the saline group (9.87 +/- 0.98 h) (P = 0.057). Analgesia was also more consistent in the adrenaline group, with 77% of patients having more than 8 h of good analgesia compared with 48% in the saline group (P less than 0.05). Plasma morphine concentrations, measured in 12 patients, were lower, although not significantly so, in the adrenaline group and mean time to peak concentration markedly delayed. No serious side effects were observed, but there was a higher incidence of vomiting in the adrenaline group.
.A
Semple AJ; Macrae DJ; Munishankarappa S; Burrow LM; Milne MK; Grant IS.
.I 90307
.U
88240856
.S
Br J Anaesth 8809; 60(6):639-44
.M
Adult; Aged; Comparative Study; Heart Surgery/*; Heart Valve Prosthesis; Human; Injections, Intravenous; Injections, Spinal; Male; Middle Age; Morphine/*AD/PD/TU; Myocardial Revascularization; Pain, Postoperative/*DT; Respiration/DE; Support, Non-U.S. Gov't.
.T
Intrathecal morphine in the management of pain following cardiac surgery. A comparison with morphine i.v.
.P
JOURNAL ARTICLE.
.W
Forty-four patients undergoing coronary revascularization received either intrathecal morphine 1 mg (n = 15), intrathecal morphine 2 mg (n = 15), or i.v. morphine 30 mg (n = 14) after the induction of anaesthesia. Morphine 2.5 mg i.v. was given, as required, in the postoperative period and pain score, respiratory rate and PaCO2 measured every 2 h. FVC, FEV1 and PEFR were measured before, and 24 h after, the induction of anaesthesia. Mean overall pain scores in both intrathecal groups were significantly lower than in the i.v. group (P less than 0.01), but did not differ significantly between the intrathecal groups. Consumption of supplementary morphine was significantly lower in both intrathecal groups (P less than 0.01). Mean PaCO2 was significantly higher in patients given intrathecal morphine 2 mg. This was significant at 12, 14 and 16 h after induction of anaesthesia. Respiratory rate did not differ significantly between the groups. Postoperative PEFR was significantly better in patients given intrathecal morphine (P less than 0.01). These results suggest that intrathecal morphine provided better analgesia after cardiac surgery than did a conventional regimen. The lower dose (1 mg) was associated with less respiratory depression as assessed by PaCO2 measurements.
.A
Fitzpatrick GJ; Moriarty DC.
.I 90308
.U
88240857
.S
Br J Anaesth 8809; 60(6):645-50
.M
Absorption; Blood Pressure/DE; Dextrans/*PD; Epinephrine/*PK; Heart Rate/DE; Human; Lidocaine/*PK; Neuroleptanalgesia/*; Norepinephrine/BL; Time Factors.
.T
Influence of dextran on the absorption of adrenaline-containing lignocaine solutions: a protective mechanism in local anaesthesia.
.P
JOURNAL ARTICLE.
.W
The effect of adding 6% dextran to a lignocaine solution containing adrenaline was studied in 27 neurosurgical patients during modified neuroleptanaesthesia. Before trepanation they received infiltration anaesthesia of the scalp at the site of the proposed operation. For a period of 1 h following injection plasma concentrations of adrenaline were measured by high pressure liquid chromatography and serum concentrations of lignocaine by gas chromatography. The addition of dextran caused a significant reduction in the absorption of both adrenaline and lignocaine from the injection site. It is concluded that the dextran adjuvant constitutes a protective mechanism against toxic systemic side effects in local anaesthesia using adrenaline-containing anaesthetic solutions. This effect is particularly significant in patients with pre-existing cardiovascular disease and when local anaesthetic solutions are used in combination with volatile anaesthetics.
.A
Adams HA; Biscoping J; Kafurke H; Muller H; Hoffmann B; Boerner U; Hempelmann G.
.I 90309
.U
88240858
.S
Br J Anaesth 8809; 60(6):651-4
.M
Adolescence; Atracurium/*AD/PD; Body Surface Area; Body Weight; Child; Child, Preschool; Human; Infant; Infant, Newborn; Infusions, Intravenous; Muscle Contraction/DE; Support, Non-U.S. Gov't.
.T
Infusion of atracurium in neonates, infants and children. A study of dose requirements.
.P
JOURNAL ARTICLE.
.W
The doses of atracurium (by infusion) required to maintain steady-state (90-95%) neuromuscular block were assessed in 75 children aged 9 days to 17 yr during balanced anaesthesia. Following the intubating dose of atracurium 0.4 mg kg-1 and after the recovery of single twitch to 5-10% of control (monitored by evoked EMG of hypothenar muscle), an infusion of atracurium 0.5 mg kg-1 h-1 was started. In 22 of the patients this initial rate resulted in the desired steady state; 32 patients required one, and 21 required two or more adjustments in rate. The mean single twitch value at steady-state was 6.6 +/- 0.3% (SEM), which is equal to 93% neuromuscular block. The infusion requirement to maintain the steady state neuromuscular block in all paediatric patients more than 1 month old was constant (0.53 +/- 0.01 mg kg-1 h-1). The infusion requirement of neonates up to 1 month old was 25% less (0.40 +/- 0.02 mg kg-1 h-1; P = 0.003). A significant correlation (n = 75, r = 0.76, P less than 0.001) was found between the infusion rate (mg m-2 h-1) and the logarithm of the body surface area.
.A
Kalli I; Meretoja OA.
.I 90310
.U
88240859
.S
Br J Anaesth 8809; 60(6):655-9
.M
Anesthesia, General/*; Animal; Calcium Chloride/PD; Diltiazem/*PD; Dogs; Electrocardiography; Fentanyl/*; Hemodynamics/*DE; Isoproterenol/PD; Nitrous Oxide/*; Time Factors.
.T
Haemodynamic effects of diltiazem during fentanyl-nitrous oxide anaesthesia. An in vivo study in the dog.
.P
JOURNAL ARTICLE.
.W
The haemodynamic effects of diltiazem were studied in six dogs during fentanyl-nitrous oxide (in oxygen) anaesthesia. A bolus of diltiazem 300 micrograms kg-1 was given, followed by infusions at 30, 60 and 90 micrograms kg-1 min-1 which produced plasma diltiazem concentrations of 392 +/- 30, 908 +/- 54 and 1483 +/- 134 ng ml-1, respectively. Diltiazem significantly reduced systemic vascular resistance index, mean arterial pressure, heart rate and PR interval. The decrease in afterload increased cardiac index, since there was little change in myocardial contractility (LV dP/dt). Five dogs developed second degree atrioventricular (AV) block in association with the highest dose. Administration of calcium chloride 20 mg kg-1 did not reverse the haemodynamic or electrophysiological effects of diltiazem. Isoprenaline increased heart rate and restored sinus rhythm in four dogs with AV block.
.A
Griffin RM; Dimich I; Jurado R; Kaplan JA.
.I 90311
.U
88240861
.S
Br J Anaesth 8809; 60(6):671-9
.M
Anesthesia, General; Animal; Bupivacaine/*PD; Comparative Study; Coronary Circulation/*DE; Dogs; Heart/*DE; Hemodynamics/DE; Lidocaine/*PD; Myocardial Contraction/DE; Support, Non-U.S. Gov't.
.T
Effects of lignocaine and bupivacaine on regional myocardial function and coronary blood flow in anaesthetized dogs.
.P
JOURNAL ARTICLE.
.W
Empirical i.v. doses of lignocaine or bupivacaine of equal local anaesthetic potency were administered to halothane-anaesthetized dogs. Both local anaesthetics caused the expected depression of global haemodynamic function. Regional myocardial systolic shortening was depressed similarly by both agents. Regional myocardial dysfunction, seen as post-systolic shortening, occurred to a similar extent with both lignocaine and bupivacaine. Coronary blood flow and coronary perfusion pressure were significantly correlated during the administration of lignocaine; bupivacaine had erratic effects on coronary blood flow and no correlation between coronary blood flow and coronary perfusion pressure was seen. These results suggest that regional myocardial dysfunction occurs with both local anaesthetics and does not account for the apparent increased cardiotoxicity of bupivacaine. Bupivacaine did, however, cause wider individual variations compared with lignocaine with respect to coronary blood flow.
.A
Leone BJ; Lehot JJ; Runciman WB; Welding RN; Ramsay JG; Arvieux CC; Ryder WA; Foex P.
.I 90312
.U
88240862
.S
Br J Anaesth 8809; 60(6):680-91
.M
Action Potentials/DE; Anesthetics/*PD; Animal; Dose-Response Relationship, Drug; Enflurane/PD; Halothane/PD; Hippocampus/*PH; In Vitro; Isoflurane/PD; Male; Neural Transmission/DE; Neurons/DE; Rats; Rats, Inbred Strains; Support, Non-U.S. Gov't; Synapses/*DE.
.T
Inhalation anaesthetics exhibit pathway-specific and differential actions on hippocampal synaptic responses in vitro.
.P
JOURNAL ARTICLE.
.W
The effects of halothane, isoflurane and enflurane were compared on three CNS excitatory synaptic pathways in vitro, to determine whether selective actions described in vivo result from differential effects on anatomically distinct cortical pathways and neurone populations. Halothane (0.25-1.25 vol%) depressed postsynaptic excitability of CA1 pyramidal neurones in response to activation of stratum radiatum synaptic inputs, and concentration-dependent excitatory (0.25-1.25 vol%) and depressant (1.5-2.0 vol%) actions were observed on dentate granule neurone excitability and perforant path evoked synaptic responses. In contrast, isoflurane increased CA1 neurone excitability (0.25-0.75 vol%) and produced postsynaptic depression of dentate neurones (0.5-4.0 vol%). Enflurane also increased CA1 excitability (0.5-4.0 vol%), but depressed synaptic responses at equivalent concentrations, and produced mixed excitatory (0.25-1.0 vol%) and depressant (1.0-4.0 vol%) effects on dentate synaptic responses. Differential actions were also observed for the three anaesthetics on stratum oriens excitatory inputs to CA1 neurones, and on antidromic responses. A good correlation (r = 0.992) exists between the membrane/buffer partition coefficients of these anaesthetics and their half-maximal concentrations for depression of synaptic responses; however, this correlation does not reflect the different, anaesthetic-specific actions observed. The results indicate that inhalation anaesthetics act at multiple and selective hydrophobic recognition sites which are heterogenously distributed on different synaptic pathways.
.A
MacIver MB; Roth SH.
.I 90313
.U
88240863
.S
Br J Anaesth 8809; 60(6):692-6
.M
Anesthetics/*PD; Animal; Diazepam/*ME; Drug Interactions; Enflurane/PD; Halothane/PD; In Vitro; Isoflurane/PD; Liver/DE/*ME; Male; Protein Binding; Rats; Rats, Inbred Strains; Serum Albumin/ME/*PD; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Trifluoroacetic Acid/PD.
.T
Rat liver slices and diazepam metabolism: in vitro interactions with volatile anaesthetic drugs and albumin.
.P
JOURNAL ARTICLE.
.W
The influence of the volatile anaesthetic agents enflurane, isoflurane, halothane and the halothane metabolite trifluoroacetic acid was studied on the hepatic elimination of diazepam, by incubating precision-cut slices of rat liver in a closed system. The impact of anaesthetic-induced action on enzyme activity and diazepam binding to human serum albumin (HSA) was assessed in protein free and protein containing buffers, respectively. Human serum albumin reduced the elimination of diazepam by 12 and 50% at concentrations of 1 and 10 mg ml-1, respectively. In the absence of albumin, halothane 1 mmol litre-1 reduced the elimination of diazepam by 13%, whereas enflurane at 1.5 mmol litre-1 caused a reduction of 8%. No effect was seen from isoflurane 1 mmol litre-1 and trifluoroacetic acid 4 mmol litre-1. In the presence of the highest concentration of albumin, however, an increased elimination of diazepam of 24% resulted from exposure to enflurane and trifluoroacetic acid, while no statistically significant changes were seen for isoflurane and halothane. The present work supports the view that volatile anaesthetic agents may cause pharmacokinetic drug interactions by interference with both enzyme activity and drug protein binding.
.A
Dale O; Gandolfi AJ; Brendel K; Schuman S.
.I 90314
.U
88240864
.S
Br J Anaesth 8809; 60(6):697-702
.M
Adult; Aged; Anesthesia, General/*; Auditory Perception/PH; Double-Blind Method; Female; Human; Intraoperative Period/*; Male; Middle Age; Postoperative Complications/*PC; Random Allocation; Sound/*; Suggestion; Support, Non-U.S. Gov't; Surgery, Operative/*.
.T
Effects of sounds presented during general anaesthesia on postoperative course.
.P
JOURNAL ARTICLE.
.W
In a double-blind, randomized study, patients undergoing cholecystectomy were administered one of four different sounds during general anaesthesia: positive suggestions, nonsense suggestions, seaside sounds or sounds from the operating theatre. The effect of these sounds on the postoperative course was examined to assess intraoperative auditory registration. No differences were found between the four groups in postoperative variables.
.A
Boeke S; Bonke B; Bouwhuis-Hoogerwerf ML; Bovill JG; Zwaveling A.
.I 90315
.U
88240865
.S
Br J Anaesth 8809; 60(6):703-8
.M
Aged; Brachial Plexus/*PH; Comparative Study; Female; Galvanic Skin Response/*; Hand/PH; Human; Male; Middle Age; Nerve Block/*MT.
.T
Predicting successful brachial plexus block using changes in skin electrical resistance.
.P
JOURNAL ARTICLE.
.W
Skin electrical resistance is determined by the degree of sweating of the skin which is, in turn, related to sympathetic nervous system activity in the area concerned. It is increased when the nerves supplying the area are damaged or blocked by local anaesthetic agents. We have assessed the temporal and spatial relationship between the onset of sympathetic and sensory loss in the hand following brachial plexus block in 44 patients. Skin electrical resistance, measured using a simple ohm meter, has been shown to increase within 2 min of brachial plexus blockade with 1% lignocaine and adrenaline 1:200,000. This increase is an early and reliable indicator of subsequent, and occasionally delayed, sensory loss.
.A
Smith GB; Wilson GR; Curry CH; May SN; Arthurson GM; Robinson DA; Cross GD.
.I 90316
.U
88240867
.S
Br J Anaesth 8809; 60(6):730-2
.M
Anesthesia, General; Blood Glucose/*ME; Cholecystectomy; Human; Hydrocortisone/*BL; Intercostal Nerves/*; Nerve Block/*; Preoperative Care/*; Thoracic Nerves/*; Time Factors.
.T
Preoperative intercostal nerve block: effect on the endocrine metabolic response to surgery.
.P
JOURNAL ARTICLE.
.W
The plasma cortisol and glucose responses to cholecystectomy were studied in 20 healthy patients. Ten patients received preoperative intercostal nerve blocks of the 6th to 12th nerves bilaterally using 0.5% bupivacaine with adrenaline 250 micrograms. The control group had the same quantity of adrenaline infiltrated into the intercostal space. Both groups had general anaesthesia with endotracheal intubation and controlled ventilation. In the non-blocked group, the mean cortisol concentration increased from a control value of 182.5 nmol litre-1 to a peak of 686.2 nmol litre-1 at 5.5 h after incision. In the blocked group the baseline serum cortisol concentration was 283.8 nmol litre-1 and it increased to a similar peak at 5.5 h. There were no significant differences between groups. The baseline plasma glucose concentration was also higher in the blocked group (4.45 mmol litre-1 compared with 3.94 mmol litre-1), but after a brief increase following the performance of the block decreased to only 14% above control values. The unblocked group exhibited substantial increase following the start of the surgery which continued for the duration of the study period to end at a mean of 6.48 mmol litre-1. These differences were significant (P less than 0.001). It is concluded that bilateral intercostal blocks may inhibit the glucose response to surgery, but have no effect on the cortisol response.
.A
Pither CE; Bridenbaugh LD; Reynolds F.
.I 90317
.U
88240870
.S
Br J Anaesth 8809; 60(6):743-4
.M
Animal; Cardiac Output; Dogs; Flowmeters; High-Frequency Jet Ventilation/*.
.T
High frequency jet ventilation [letter]
.P
LETTER.
.A
Young JD.
.I 90318
.U
88240871
.S
Br J Anaesth 8809; 60(6):744-6
.M
Antidotes/*TU; Cyanides/*BL; Ferricyanides/*PO; Human; Nitroprusside/*PO; Thiosulfates/*TU.
.T
Sodium thiosulphate decreases blood cyanide concentration following sodium nitroprusside [letter]
.P
LETTER.
.A
Ivankovich AD; Braverman B.
.I 90319
.U
88240873
.S
Br J Anaesth 8809; 60(6):746-7
.M
Aged; Hip Fractures/*SU; Human; Postoperative Complications/*MO; Time Factors.
.T
Mortality and morbidity after hip fracture [letter]
.P
LETTER.
.A
Dodds C.
.I 90320
.U
88240874
.S
Br J Anaesth 8809; 60(6):747
.M
Anesthesia, General/*; Anesthesia, Obstetrical/*; Cesarean Section/*; Female; Human; Pregnancy.
.T
General anaesthesia for Caesarean section [letter]
.P
LETTER.
.A
Jenkins JG.
.I 90321
.U
88240875
.S
Br J Anaesth 8809; 60(6):747-8
.M
Autoantibodies/*AN; Halothane/*IM; Hepatitis, Toxic/*DI; Human.
.T
Diagnostic test for halothane hepatitis [letter]
.P
LETTER.
.A
Wark H.
.I 90322
.U
88240903
.S
Br J Dermatol 8809; 118(4):471-4
.M
Antigens, Neoplasm/*AN; Human; Pemphigoid, Bullous/IM; Pemphigus/*IM; Skin/*IM; Skin Diseases/IM.
.T
Increased serum levels of squamous cell carcinoma-related antigen in pemphigus.
.P
JOURNAL ARTICLE.
.W
Serum levels of squamous cell carcinoma-related antigen (SCC-RAG) were measured in five cases of pemphigus, five cases of bullous pemphigoid and 18 cases of benign and malignant dermatoses other than SCC. The SCC-RAG titres were significantly raised in four of five patients with pemphigus, while they remained within the normal range in the other dermatoses except in one case. In three pemphigus cases in whom serial measurements were made, SCC-RAG levels seemed to be related to disease activity. The SCC-RAG levels in blister fluids were much higher than those in serum, suggesting that the skin is a major source of serum SCC-RAG. These results show that SCC-RAG is increased not only in SCC, but also in some cases of pemphigus, and suggest that pemphigus antibodies may cause the production or release of SCC-RAG.
.A
Kudo H; Yamamoto M; Miyachi Y; Danno K; Imamura S.
.I 90323
.U
88240904
.S
Br J Dermatol 8809; 118(4):475-9
.M
Animal; Dermatitis, Contact/ET/*PP; Dinitrofluorobenzene; Disease Models, Animal; Female; Lactones/*PD; Mice; Mice, Inbred BALB C; Platelet Activating Factor/*AI/PH; Skin/DE/PP; Support, Non-U.S. Gov't.
.T
Effect of BN 52021, a platelet activating factor antagonist, on experimental murine contact dermatitis.
.P
JOURNAL ARTICLE.
.W
A specific platelet activating factor (PAF) receptor antagonist, BN 52021, was tested for its efficacy in modulating DNFB-induced allergic and croton oil-induced irritant contact dermatitis in mouse ears. Oral treatment of the animals in the elicitation phase of the dermatitis caused a significant suppression of DNFB-induced ear swelling. The compound was less active in croton oil-induced irritant dermatitis and ineffective when given during the sensitization phase of allergic dermatitis. The results provide indirect evidence for the involvement of PAF in the effector phase of murine contact dermatitis of the allergic type and also the irritant type to a lesser extent.
.A
Csato M; Czarnetzki BM.
.I 90324
.U
88240905
.S
Br J Dermatol 8809; 118(4):481-6
.M
Acquired Immunodeficiency Syndrome/BL/*PA; Adolescence; Adult; Cell Count; Female; Helper Cells; Human; Langerhans Cells/*PA; Leukocyte Count; Male; Middle Age; Prognosis.
.T
Prognostic value of Langerhans cells in the epidermis of HIV patients.
.P
JOURNAL ARTICLE.
.W
We measured the number of Langerhans cells in clinically normal epidermis and the number of T4 lymphocytes in the plasma in 24 patients infected with HIV, and related these to the stage of the disease. A correlation is demonstrated between the numbers of Langerhans cells and T4 lymphocytes. Numbers of Langerhans cells were lower in patients with disease stages III and IV than in those with disease stage II. Thus Langerhans cell numbers could be of prognostic value in this disease.
.A
Dreno B; Milpied B; Bignon JD; Stalder JF; Litoux P.
.I 90325
.U
88240907
.S
Br J Dermatol 8809; 118(4):497-503
.M
Animal; Anoplura/*UL; Microscopy, Electron, Scanning.
.T
A closer look at Pthirus pubis.
.P
JOURNAL ARTICLE.
.A
Burns DA; Sims TA.
.I 90326
.U
88240908
.S
Br J Dermatol 8809; 118(4):505-7
.M
Chronic Disease; Human; Psoriasis/PX/TH; Self-Help Groups/*; Skin Diseases/*PX/TH.
.T
Self help groups for patients with chronic skin diseases.
.P
JOURNAL ARTICLE.
.A
Logan RA.
.I 90327
.U
88240909
.S
Br J Dermatol 8809; 118(4):509-16
.M
Human; In Vitro; Nickel/AN/*PK; Occlusive Dressings; Permeability; Skin/AN/*ME; Skin Absorption/DE; Vehicles/*PD.
.T
Permeation of nickel through human skin in vitro--effect of vehicles.
.P
JOURNAL ARTICLE.
.W
The effect of the vehicle on the permeation rate of nickel ions through excised human skin was evaluated. Different hydrogels were compared with the standard patch test in petrolatum. A hydroxypropyl methylcellulose gel seemed to be the most promising alternative to petrolatum. It gave high bioavailability of the nickel and had good film forming properties leaving the nickel spread across the skin surface as a thin film without microscopically detectable crystals. The content of nickel in the various skin layers after cutaneous application was determined, and nickel was found to accumulate in the epidermis, probably due to epidermal binding. A significant amount of nickel was found also in the dermis. Occlusion and application of higher nickel concentrations increased the transport rate and must be considered in patch testing using this hydrogel. We conclude that nickel permeation is highly dependent of the choice of vehicle and the vehicle should, therefore, be an important consideration in patch testing with nickel.
.A
Fullerton A; Andersen JR; Hoelgaard A.
.I 90328
.U
88240910
.S
Br J Dermatol 8809; 118(4):517-22
.M
Aging/*ME; Child; Child, Preschool; Dermatitis, Atopic/*ME; Female; Human; Hydrocortisone/BL; Hydrocortisone, Topical/*PK; Infant; Male; Seborrhea/*ME; Skin Absorption/*; Support, Non-U.S. Gov't.
.T
Influence of age and severity of dermatitis on the percutaneous absorption of hydrocortisone in children.
.P
JOURNAL ARTICLE.
.W
The results of 55 4-h hydrocortisone absorption tests in 38 children with atopic or seborrhoeic dermatitis were analysed to evaluate the effect of age and severity of the dermatitis on percutaneous absorption of hydrocortisone. The children were divided into three groups on the basis of the severity of the dermatitis. The absorption of hydrocortisone caused a significantly higher mean rise of serum cortisol in 20 children with severe dermatitis (Group A) than in 17 children with moderate dermatitis (Group B). The mean post-application rise of serum cortisol in 18 children with mild dermatitis (Group C) was significantly lower than in the children with moderate dermatitis. There was a significant negative linear correlation between age and the post-application rise of serum cortisol in Groups A and C. In these groups the mean post-application rise of serum cortisol was significantly higher in children aged under 18 months than in children aged 18 months or over. Severe widespread dermatitis and an age under 18 months are two relevant risk factors in the topical use of hydrocortisone.
.A
Turpeinen M.
.I 90329
.U
88240911
.S
Br J Dermatol 8809; 118(4):523-30
.M
Adult; Betamethasone/*AA; Clobetasol/*AA/PK; Human; Male; Models, Biological; Occlusive Dressings; Skin/*DE/ME; Skin Absorption/*DE; Vehicles/*PD.
.T
The effect of the vehicle formulation on the stratum corneum penetration characteristics of clobetasol 17-propionate in vivo.
.P
JOURNAL ARTICLE.
.W
The multiple skin surface biopsy technique to measure stratum corneum (SC) penetration characteristics in vivo has been more accurately quantified and used to provide information on the kinetics of transfer of a topical steroid through the SC. Radiolabelled clobetasol 17-propionate formulated in two different vehicles, consisting primarily of dibutyl adipate or of propylene glycol, was applied and the penetration characteristics compared. Using exponential expressions for radioactivity in skin surface biopsies as a function of SC depth, and total SC radioactivity as a function of time, a mathematical model was developed to calculate the rate of loss of steroid through superficial shedding and the rate of transfer of steroid from the SC into the epidermis. When a topical steroid was applied for 8 h under gauze occlusion, over 80% was recovered from the gauze.
.A
Watson WS; Finlay AY.
.I 90330
.U
88240913
.S
Br J Dermatol 8809; 118(4):537-43
.M
Acetic Acids/*AD; Administration, Topical; Adolescence; Adult; Child; Female; Foot Diseases/*DT; Human; Irritants/*AD; Male; Salicylic Acids/*AD/TU; Warts/*DT.
.T
Monochloroacetic acid and 60% salicylic acid as a treatment for simple plantar warts: effectiveness and mode of action.
.P
JOURNAL ARTICLE.
.W
Monochloroacetic acid crystals and 60% salicylic acid ointment was found to be more effective than placebo as a treatment for simple plantar warts in a double blind study on 57 patients. Nineteen (66%) patients in the active treatment group compared with five (18%) patients in the placebo group were cured after 6 weeks (P = 0.002). The active treatment was associated with a significantly higher cure rate 6 months after entry (P = 0.04). Treatments were well tolerated. IgG or IgM antibodies or both to human papilloma virus (HPV) types 1 or 2 or both were detected significantly more frequently in the actively treated group 6 weeks after entry (P = 0.0005). Twelve (50%) patients considered to be cured had no detectable secondary immune response. Our results suggest that cure does not depend primarily on the humoral system but rather on mechanical destruction of wart tissue, or occurs as a result of cell mediated immunity.
.A
Steele K; Shirodaria P; O'Hare M; Merrett JD; Irwin WG; Simpson DI; Pfister H.
.I 90331
.U
88240914
.S
Br J Dermatol 8809; 118(4):545-52
.M
Adult; Aged; Anticonvulsants/AE; Case Report; Dermatitis Medicamentosa/*DI/ET/PA; Diagnosis, Differential; Female; Human; Lymphoma/*DI/PA; Male; Middle Age; Prospective Studies; Skin/PA; Skin Diseases/*DI/PA.
.T
Drug-induced pseudolymphomatous skin reactions.
.P
JOURNAL ARTICLE.
.W
We present two patients with generalized and three with localized skin eruptions due to various non-anticonvulsant drugs, with a histological picture of a pseudolymphoma of the skin. Cessation of the causative drugs resulted in disappearance of the lesions in all cases.
.A
Kardaun SH; Scheffer E; Vermeer BJ.
.I 90332
.U
88240916
.S
Br J Dermatol 8809; 118(4):559-61
.M
Acute Disease; Aged; Case Report; Female; Human; Infant; Psoriasis/*MI; Skin Diseases, Infectious/*MI; Streptococcal Infections/*MI.
.T
Acute psoriasis associated with Lancefield Group C and Group G cutaneous streptococcal infections.
.P
JOURNAL ARTICLE.
.W
Involvement of Streptococcus pyogenes (beta haemolytic streptococcus, Lancefield Group A) infection, usually of the throat, in acute exacerbations of psoriasis is well known. We report here two cases of an acute psoriatic eruption associated in one patient with Group C streptococcal cellulitis and in another with Group G streptococcal intertrigo.
.A
Henderson CA; Highet AS.
.I 90333
.U
88240917
.S
Br J Dermatol 8809; 118(4):563-6
.M
Adult; Case Report; Genital Neoplasms, Male/*PA; Human; Male; Neoplasm Recurrence, Local/*PA; Scrotum; Skin Neoplasms/*PA.
.T
Recurrent solitary giant trichoepithelioma located in the perianal area; a case report.
.P
JOURNAL ARTICLE.
.W
A case of giant solitary trichoepithelioma of the perianal region is described. Following excision the lesion recurred with a similar histological appearance. This is the first report, to our knowledge, of recurrence of such a lesion.
.A
Beck S; Cotton DW.
.I 90334
.U
88240920
.S
Br J Dermatol 8809; 118(4):581-2
.M
Disposable Equipment/*; Electrocoagulation/*IS.
.T
A disposable tip for the Birtcher Hyfrector [letter]
.P
LETTER.
.A
Motley RJ.
.I 90335
.U
88240921
.S
Br J Dermatol 8809; 118(4):582-3
.M
Carcinoma, Squamous Cell/*PA; Flow Cytometry; Human; Keratoacanthoma/*PA.
.T
Flow cytometric comparison of keratoacanthoma and squamous cell carcinoma [letter]
.P
LETTER.
.A
Stephenson TJ; Cotton DW.
.I 90336
.U
88240922
.S
Br J Dermatol 8809; 118(4):584-5
.M
Female; Fingers/*AH; Human; Male; Sweat Glands/*AH.
.T
Sweat pores on fingertips [letter]
.P
LETTER.
.I 90337
.U
88240923
.S
Br J Dermatol 8809; 118(4):585-6
.M
Adenoma/*ME; Human; Protein Precursors/*ME; Sweat Gland Neoplasms/*ME.
.T
Expression of involucrin in skin appendage tumours [letter]
.P
LETTER.
.A
Kanitakis J.
.I 90338
.U
88240924
.S
Br J Dermatol 8809; 118(4):586-8
.M
Cell Movement; Human; Neutrophils/*PH; Psoriasis/*PA.
.T
PMN migration in psoriasis [letter]
.P
LETTER.
.A
Christophers E; Langer A.
.I 90339
.U
88240925
.S
Br J Dermatol 8809; 118(4):588-9
.M
Adult; Case Report; Human; Hyperhidrosis/*ET; Male; Thromboangiitis Obliterans/*CO; Time Factors.
.T
Unilateral hyperhidrosis [letter]
.P
LETTER.
.A
Baker H.
.I 90340
.U
88240980
.S
Br J Ophthalmol 8809; 72(4):244-5
.M
Aged; Aged, 80 and over; Case Report; Choroid Neoplasms/*/RT/SU; Female; Human; Male; Melanoma/*/RT/SU; Sweden.
.T
Two cases of primary bilateral malignant melanoma of the choroid.
.P
JOURNAL ARTICLE.
.W
The first two Swedish cases of primary bilateral malignant melanoma of the choroid are presented. In one case bilateral histological confirmation was obtained as both eyes were enucleated. In the other case one eye was enucleated and the other irradiated with an episcleral ruthenium plaque. Sweden has a population of 8.38 millions, so that bilateral choroidal melanomas may be less rare than previously thought.
.A
Seregard S; Daunius C; Kock E; Popovic V.
.I 90341
.U
88240981
.S
Br J Ophthalmol 8809; 72(4):246-7
.M
Aged; Brain Neoplasms/PA/RA/*SC; Case Report; Eye Neoplasms/*PA; Female; Human; Melanoma/*PA; Neoplasm Invasiveness; Optic Nerve/PA; Tomography, X-Ray Computed.
.T
Intracerebral metastases from ocular melanoma.
.P
JOURNAL ARTICLE.
.W
A blind painful eye may harbour an unsuspected malignant melanoma. We report a case of ocular melanoma that presented with confusion owing to direct extension via the optic nerve into the anterior cranial fossa.
.A
Jones DR; Scobie IN; Sarkies NJ.
.I 90342
.U
88240983
.S
Br J Ophthalmol 8809; 72(4):253-7
.M
Adult; Arterioles/AH; Blood Pressure/*; Female; Homeostasis; Human; Male; Ophthalmic Artery/*PH; Posture/*; Retinal Vessels/*PH; Support, Non-U.S. Gov't; Vasodilation.
.T
Postural changes in perfusion pressure and retinal arteriolar calibre.
.P
JOURNAL ARTICLE.
.W
Ophthalmic artery perfusion pressures and retinal arteriolar calibres were studied in 10 human subjects when sitting, standing, and lying. Differing responses in perfusion pressure were found; autoregulatory responses were found in 13 of the 18 significant calibre changes on moving from sitting to standing and 13 of 22 significant calibre changes on moving from standing to lying. The remaining significant calibre changes were non-autoregulatory, the arterioles dilating with perfusion pressure increase and constricting with decrease.
.A
Hague S; Hill DW.
.I 90343
.U
88240984
.S
Br J Ophthalmol 8809; 72(4):258-62
.M
Adult; Aged; Aged, 80 and over; Comparative Study; Eye Movements; Female; Glaucoma/*PP; Human; Male; Middle Age; Perimetry/*MT; Support, Non-U.S. Gov't; Visual Fields/*.
.T
Comparative evaluation of oculokinetic perimetry and conventional perimetry in glaucoma.
.P
JOURNAL ARTICLE.
.W
Oculokinetic perimetry is a new method of visual field assessment in which the patient moves the eye around a central static target to look sequentially at an array of numbers. When fixation on a number is accompanied by disappearance of the central target, that number is deleted from a recording chart. Inversion of the recording chart gives a plot of the central visual field. In this study we have shown that in 64 eyes of 37 patients, with unequivocal field loss attending a glaucoma clinic, the test is efficient and reliable when compared with conventional static (Dicon 3000) and kinetic (Tubingen Oculus) field tests. The results were identical in 88% of eyes tested and approximately comparable in another 6%. Quantitative equivalent targets for the different methods are described. Oculokinetic perimetry was carried out by a previously untrained person, and it is suggested that this new method merits further study as a screening device for glaucoma in the community.
.A
Alvarez E; Damato BE; Jay JL; McClure E.
.I 90344
.U
88240985
.S
Br J Ophthalmol 8809; 72(4):263-9
.M
Aged; Aged, 80 and over; Carbonic Anhydrase Inhibitors/TU; Female; Glaucoma, Open-Angle/DT/PP/*SU; Human; Intraocular Pressure; Laser Surgery/*; Male; Middle Age; Time Factors; Trabeculectomy/*.
.T
Therapeutic limitations of argon laser trabeculoplasty.
.P
JOURNAL ARTICLE.
.W
Sixty-one patients (82 eyes) were studied after argon laser trabeculoplasty (ALT) to determine the lasting efficacy of such treatment. This investigation, now in its fourth year, was prospective, and the information derived was analysed with the aid of a computer. Success was defined as intraocular pressure (IOP) below baseline (22 mmHg). The mean follow-up time was 24.5 months, when the success rate was 74% compared with 75% at three months. Success declined to 45% at 42 months. No significant difference was noted when (a) first lasered eyes of all patients and those fellow eyes treated were analysed separately, (b) when right and left eyes were analysed separately, nor (c) when patients were divided into two treatment groups, (I) 100 burns at 1 W, and (II) 65 burns at 850 mW. Eight of 11 eyes showed progressive postlaser field loss despite below-baseline intraocular pressures. ALT is an alternative to carbonic anhydrase inhibitor therapy, with a success rate of 66.7% at two years. However, repeat ALT was successful in only 25% of patients seven months after treatment.
.A
Fink AI; Jordan AJ; Lao PN; Fong DA.
.I 90345
.U
88240987
.S
Br J Ophthalmol 8809; 72(4):274-7
.M
Adult; Aqueous Humor/PH; Cell Membrane Permeability; Comparative Study; Endothelium, Corneal/*ME; Female; Fluorometry; Human; Intraocular Pressure; Keratotomy, Radial/*; Male; Middle Age; Myopia/SU; Postoperative Complications/*; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Time Factors.
.T
The evaluation of corneal endothelial permeability in PERK study patients.
.P
JOURNAL ARTICLE.
.W
Sixteen patients enrolled in the PERK study were evaluated by fluorophotometry 24 hours or six months following radial keratotomy. A comparison of eyes operated and not operated upon showed that endothelial permeability was not significantly altered 24 hours and six months after surgery. Aqueous humour flow rates and anterior chamber elimination coefficients were significantly higher 24 hours after surgery in the eyes operated on than in those not operated on. Six months after surgery there was no longer a significant difference in these factors. The increase in aqueous humour flow rates 24 hours after surgery may represent a subclinical breakdown in the blood-aqueous barrier.
.A
Serle JB; Asbell PA; Obstbaum SA; Podos SM; Anh-Le N.
.I 90346
.U
88240988
.S
Br J Ophthalmol 8809; 72(4):278-83
.M
Animal; Choroid/PA/SU; Macrophages; Pigment Epithelium of Eye/PA; Polyurethanes/*; Rabbits; Retina/PA; Retinal Detachment/PA/*SU.
.T
Experimental suprachoroidal plombage with a urethane based hydrophilic polymer.
.P
JOURNAL ARTICLE.
.W
Small portions of dehydrated hydrophilic polymer (HPU 90, Smith and Nephew) have been inserted into the suprachoroidal space in rabbits to investigate the possible use of suprachoroidal plombage in retinal detachment surgery. As it hydrates, the material causes a pronounced elevation of choroid and retina, and the implants have been well tolerated for periods of up to one year in experimental animals. The implant slowly breaks down and stimulates a simple macrophagic reaction: fibrosis in the overlying choroid is associated with ischaemic gliosis and chorioretinal fusion.
.A
Foulds WS; Aitken D; Lee WR.
.I 90347
.U
88240989
.S
Br J Ophthalmol 8809; 72(4):284-5
.M
Eye/*SU; Head; Human; Immobilization; Surgical Equipment/*.
.T
A new surgical head rest.
.P
JOURNAL ARTICLE.
.W
A surgical head rest is described that gives good wrist support, provides space to place instruments, and allows drainage of irrigation fluid.
.A
Halliday BL.
.I 90348
.U
88240990
.S
Br J Ophthalmol 8809; 72(4):286-8
.M
Case Report; Child; Child, Preschool; Choroid Neoplasms/CO/*RT; Female; Fluorescein Angiography; Hemangioma/CO/*RT; Human; Retinal Detachment/CO.
.T
Radiotherapy in benign orbital disease. I: Complicated ocular angiomas.
.P
JOURNAL ARTICLE.
.W
Radiotherapy has been successful in the management of complicated ocular and orbital angiomas, but late morbidity (particularly radiation induced cataract) has been a problem. With modern radiotherapy techniques it is possible to minimise the morbidity to other tissues. By means of a recently developed method of lens-sparing ocular radiotherapy (initially adopted for retinoblastoma therapy) two cases of diffuse ocular haemangioma complicated by retinal detachment have been treated, with evidence of regression.
.A
Plowman PN; Harnett AN.
.I 90349
.U
88240993
.S
Br J Ophthalmol 8809; 72(4):299-302
.M
Case Report; Dexamethasone/TU; Evoked Potentials, Visual; Human; Magnetic Resonance Imaging; Male; Middle Age; Ophthalmoplegia/*DI/DT/RA; Tomography, X-Ray Computed.
.T
Computerised axial tomography and magnetic resonance scanning in the Tolosa-Hunt syndrome.
.P
JOURNAL ARTICLE.
.W
A 50-year-old Asian male presented with a left sixth nerve palsy, left temporal pain, and rapidly deteriorating visual acuity in the left eye. A high resolution CT scan and magnetic resonance scan showed a left retro-orbital enhancing lesion extending from the lateral margin of the cavernous sinus on to the greater wing of the sphenoid and into the left orbit. Arteriography was normal. On high dose steroid therapy there was total resolution of the lesion. The value of imaging techniques in this condition is discussed.
.A
Thomas DJ; Charlesworth MC; Afshar F; Galton DJ.
.I 90350
.U
88240994
.S
Br J Ophthalmol 8809; 72(4):303-4
.M
Adult; Angioid Streaks/*CO/PA; Case Report; Female; Fluorescein Angiography; Human; Retina/PA; Thalassemia/*CO/PA.
.T
Angioid streaks in beta thalassaemia minor.
.P
JOURNAL ARTICLE.
.W
We report what we believe to be the first recorded case of angioid streaks in a patient with beta thalassaemia minor. The occurrence of angioid streaks in a patient with a relatively normal iron balance and only very mild haemolysis may be explained by the combination of pregnancy with associated multiple transfusions in a myopic patient where an inherent defect in Bruch's membrane may exist.
.A
Kinsella FP; Mooney DJ.
.I 90351
.U
88240995
.S
Br J Ophthalmol 8809; 72(4):305-8
.M
Adult; Aphakia/*CO/ET; Case Report; Esotropia/*CO/SU; Eye Foreign Bodies/CO; Human; Lenses, Intraocular; Male; Periodicity; Strabismus/*CO; Visual Acuity.
.T
Cyclic esotropia in a patient with unilateral traumatic aphakia: case report.
.P
JOURNAL ARTICLE.
.W
Cyclic esotropia is a rare and poorly understood condition normally treated by correcting the deviation measured on the squinting day. Control in some patients with this condition can be gained by correcting their refractive errors, thereby improving acuity. We report on an adult patient who developed cyclic esotropia after unilateral traumatic aphakia with failed contact lens wear whose squint was corrected by secondary intraocular lens implantation. This may be explained by the reduction in the degree of aneisokonia which subsequently improved steropsis.
.A
Cole MD; Hay A; Eagling EM.
.I 90352
.U
88240998
.S
Br J Ophthalmol 8809; 72(4):317-20
.M
Choroid Neoplasms/*RT; Human; Melanoma/*RT; Neoplasm Metastasis.
.T
Is radiation a justifiable treatment of choroidal melanoma? [letter]
.P
LETTER.
.A
Oosterhuis JA; Lommatsch PK; Wessing A.
.I 90353
.U
88241202
.S
Br J Rheumatol 8809; 27(3):169-70
.M
Arthritis, Juvenile Rheumatoid/*ET/MI; Chronic Disease; Human; Virus Diseases/*CO/MI.
.T
A viral aetiology for juvenile chronic arthritis? [editorial]
.P
EDITORIAL.
.A
Denman AM.
.I 90354
.U
88241204
.S
Br J Rheumatol 8809; 27(3):176-80
.M
Adolescence; Antibodies, Viral/*AN; Arthritis, Juvenile Rheumatoid/EP/ET/*IM; Chronic Disease; Comparative Study; Female; Great Britain; Hemagglutination Inhibition Tests; Human; Male; Orthomyxovirus Type A, Human/*IM; Space-Time Clustering.
.T
Antibodies to influenza A in a cluster of children with juvenile chronic arthritis.
.P
JOURNAL ARTICLE.
.W
In this study of 41 patients with progressive juvenile chronic arthritis (JCA), born between 1946 and 1970, it was noticed that 14 were born in the same year (1963). The possibility of a common environmental factor was therefore investigated. Records showed that an epidemic of influenza A H2N2 was present in that year, and the study shows that JCA patients born in 1963 still have a higher level of antibody to influenza A H2N2 than JCA patients born in other years or age-matched controls. This elevation is not seen in a survey of three control viruses. Since this group developed their clinical JCA after the appearance of influenza A H3N2 in 1977, it is suggested that these patients developed a progressive arthropathy because they had been pre-sensitized to influenza A by contact with an earlier strain when in utero.
.A
Pritchard MH; Matthews N; Munro J.
.I 90355
.U
88241207
.S
Br J Rheumatol 8809; 27(3):191-7
.M
Agranulocytosis/*ET; Bacterial Infections/BL/*ET; Bone Marrow/CY/DE; Bone Marrow Examination/MT; Candidiasis/BL/*ET; Cell Cycle/DE; Disease Susceptibility; Epinephrine/DU; Felty's Syndrome/BL/*CO; Human; Hydrocortisone/DU; Leukocyte Count/DE; Neutropenia/BL/*ET; Neutrophils/CY/DE; Prospective Studies; Risk Factors; Time Factors.
.T
Neutropenia and infections in Felty's syndrome.
.P
JOURNAL ARTICLE.
.W
Fifteen patients with Felty's syndrome (FS) were studied prospectively during a 3-year period to determine the influence of multiple haematologic parameters on the incidence of infections. An increased risk of recurrent major and minor infections was primarily related to peripheral blood polymorphonuclear cell (PMN) counts of less than 0.1 x 10(9)/l. Bone marrow lymphocytosis, a decreased percentage of PMN in bone marrow differential counts and an impaired in vitro growth of colony-forming unit-PMN macrophage were also related to an increased incidence of infection but were predominantly present in patients with less than 0.1 x 10(9)/l circulating PMN. The maximal response in the number of circulating PMN measured after injection of epinephrine and hydrocortisone varied substantially within patients, but those with less than 0.1 x 10(9)/l PMN always had lower responses than those with greater than 0.1 x 10(9)/l PMN. These variables did not therefore contribute to the identification of FS patients at risk of infection.
.A
Breedveld FC; Fibbe WE; Cats A.
.I 90356
.U
88241208
.S
Br J Rheumatol 8809; 27(3):198-201
.M
Amylases/*BL; Comparative Study; Human; Isoenzymes/BL; Lupus Erythematosus, Systemic/*EN; Macromolecular Systems; Methods.
.T
Serum amylase and macroamylase in patients with systemic lupus erythematosus.
.P
JOURNAL ARTICLE.
.W
We measured serum amylase and macroamylase activity in 25 patients with systemic lupus erythematosus (SLE) and 15 controls. The mean (+/- SD) for SLE was greater than for the controls (161 +/- 71.8 versus 116 +/- 38.8 units/dl). Five patients (20%) had elevated amylase and 6 (25%) had a macroamylase present. None of the controls had amylase elevation or macroamylase. None of the patients had abdominal pain and there was no observable correlation of amylase activity with disease activity, drugs, or renal function. Elevation of serum amylase in SLE without pancreatitis is frequent, as is the presence of macroamylase. Autoantibodies to this serum enzyme may be frequent in SLE.
.A
Hasselbacher P; Myers AR; Passero FC.
.I 90357
.U
88241209
.S
Br J Rheumatol 8809; 27(3):202-5
.M
Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid/BL/*CO; Biopsy; Bone and Bones/PA; Female; Hospitalization/*; Human; Male; Middle Age; Osteomalacia/BL/DI/*EP; Risk Factors; Scotland.
.T
High prevalence of unrecognized osteomalacia in hospital patients with rheumatoid arthritis.
.P
JOURNAL ARTICLE.
.W
A consecutive series of 31 patients with rheumatoid arthritis (RA) admitted over a 6-month period to the rheumatology unit of a District General Hospital were screened for possible osteomalacia. Transiliac bone biopsies were performed in 14 patients where the above diagnosis was suspected, yielding four (12.9%) cases of osteomalacia. All affected patients were elderly women who had a poor diet and were virtually housebound. Additional risk factors in two cases were partial gastrectomy and occult coeliac disease. Biochemical screening was of limited value in differential diagnosis, since elevated serum alkaline phosphatase levels were noted in both osteomalacic and non-osteomalacic patients. This study indicates that, in the West of Scotland at least, osteomalacia is a common, easily overlooked and treatable cause of morbidity in elderly patients with RA.
.A
Ralston SH; Willocks L; Pitkeathly DA; Morton R; Smith GD.
.I 90358
.U
88241212
.S
Br J Rheumatol 8809; 27(3):215-9
.M
Adult; Aged; Aged, 80 and over; Alkaline Phosphatase/BL; Arthritis, Rheumatoid/DT/*ME; Bone and Bones/DE/*ME; Calcitriol/BL; Calcium/AN/*ME; Chronic Disease; Creatinine/UR; Female; Human; Hydroxyproline/UR; Male; Methylprednisolone/AD/*AE; Middle Age; Parathyroid Hormones/BL; Time Factors.
.T
Acute changes in calcium and bone metabolism during methylprednisolone pulse therapy in rheumatoid arthritis.
.P
JOURNAL ARTICLE.
.W
Corticosteroids (CS) decrease bone formation and enhance bone resorption and this can lead to osteopenia. Bone metabolism was studied during the administration of huge amounts of CS (1000 mg methylprednisolone) over a short period of time in 10 patients with persistently active rheumatoid arthritis. The effects could be divided into those occurring within 24 h: (a) a decrease in bone resorption (urinary excretion of calcium and hydroxyproline) and bone formation (alkaline phosphatase); (b) a decrease in renal excretion of calcium; (c) an increase in concentration of serum 1,25-dihydroxy-cholecalciferol and those secondary effects arising after 24 h; (d) a decrease in serum calcium due to the decrease in intestinal Ca absorption and the decrease in renal tubular reabsorption of Ca; (e) an increase in serum PTH concentrations. In a previous study it was found that these changes normalized within a few days after completion of the CS treatment.
.A
Bijlsma JW; Duursma SA; Bosch R; Raymakers JA; Huber-Bruning O.
.I 90359
.U
88241216
.S
Br J Rheumatol 8809; 27(3):233-5
.M
Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid/DI/*ME; Chronic Disease; Comparative Study; Creatine/*BL/UR; Diagnostic Errors; Female; Human; Male; Metabolic Clearance Rate; Middle Age; Prognosis.
.T
Errors in the prediction of creatinine clearance in patients with rheumatoid arthritis.
.P
JOURNAL ARTICLE.
.W
The accuracy of two equations used to predict creatinine clearance was assessed in 27 patients with rheumatoid arthritis (RA) and 34 controls. Both equations were accurate in controls, but overestimated the clearance in RA patients. The degree of overestimation was not related to patient characteristics. Uncritical use of these equations in RA patients may lead to serious error.
.A
Boers M; Dijkmans BA; Breedveld FC; Mattie H.
.I 90360
.U
88241217
.S
Br J Rheumatol 8809; 27(3):236-8
.M
Aged; Case Report; Female; Human; Intestinal Perforation/*ET/PA; Intestine, Small/*/PA; Mesenteric Arteries/PA; Mesenteric Vascular Occlusion/*CO/PA; Temporal Arteritis/*CO/PA.
.T
Small-intestinal perforation secondary to localized giant-cell arteritis of the mesenteric vessels.
.P
JOURNAL ARTICLE.
.W
This report describes small-bowel perforation caused by giant-cell arteritis of the regional mesenteric vessels. No evidence of giant-cell arteritis at other sites was discovered and 18 months after presentation the patient remains well and symptom-free.
.A
Smith JA; O'Sullivan M; Gough J; Williams BD.
.I 90361
.U
88241218
.S
Br J Rheumatol 8809; 27(3):239-40
.M
Aneurysm/*ET/PA; Arthritis, Rheumatoid/*CO/PA; Case Report; Celiac Artery/*/PA; Chronic Disease; Human; Male; Middle Age; Renal Artery/*/PA; Vasculitis/ET/PA.
.T
Abdominal microaneurysms in rheumatoid arthritis.
.P
JOURNAL ARTICLE.
.W
A 55-year-old man presented with systemic vasculitis complicating long-standing classical rheumatoid arthritis (RA). Digital and cutaneous vasculitis, together with widespread microaneurysms on both renal and coeliac arteries, were found. The simultaneous presence of these different patterns of vasculitic lesions in a single patient, affecting small as well as medium size vessels with aneurysm formation, emphasizes the value of angiographic studies in evaluating RA.
.A
Hitter E; Williame L; Chappel R; Mahler CH.
.I 90362
.U
88241219
.S
Br J Rheumatol 8809; 27(3):241
.M
Acute Disease; Adult; Case Report; Human; Lung Diseases/*PA; Male; Sarcoidosis/*PA; Spondylitis, Ankylosing/*PA.
.T
Sarcoidosis and spondarthritis [letter]
.P
LETTER.
.A
Kirkham B; Jobanputra P.
.I 90363
.U
88241220
.S
Br J Rheumatol 8809; 27(3):241-2
.M
Comparative Study; Female; Human; Joint Instability/*DI; Male; Spondylitis, Ankylosing/*DI.
.T
Joint laxity and ankylosing spondylitis [letter]
.P
LETTER.
.A
Hordon LD; Bird HA.
.I 90364
.U
88241221
.S
Br J Rheumatol 8809; 27(3):242-3
.M
Acromegaly/DI/*ME; Arthritis, Rheumatoid/DI/*ME; Case Report; Female; Growth Substances/*ME; Human; Middle Age.
.T
Rheumatoid arthritis and acromegaly--effect of growth factors on RA? [letter]
.P
LETTER.
.A
Read RC; Watt I; Dieppe PA.
.I 90365
.U
88241222
.S
Br J Rheumatol 8809; 27(3):243-4
.M
Backache/*TH; Human; Sciatica/*TH.
.T
Back pain and sciatica [letter]
.P
LETTER.
.A
Helliwell PS.
.I 90366
.U
88241223
.S
Br J Rheumatol 8809; 27(3):244-6
.M
Case Report; Dose-Response Relationship, Drug; Drug Evaluation; Human; Male; Middle Age; Raynaud's Disease/*DT; Triiodothyronine/*AD.
.T
Tri-iodothyronine in Raynaud's phenomenon: further objective evidence of its beneficial effect [letter]
.P
LETTER.
.A
Dessein PH; Gledhill RF.
.I 90367
.U
88241224
.S
Br J Rheumatol 8809; 27(3):246-7
.M
Colonoscopy/*; Human; Ileum/*; Spondylitis, Ankylosing/*DI.
.T
Ileocolonoscopy and spondarthritis [letter]
.P
LETTER.
.A
Dequeker J; Grillet B; De Clerck L; Rutgeerts P; Geboes K.
.I 90368
.U
88241225
.S
Br J Rheumatol 8809; 27(3):247-8
.M
Anemia/*CI; Anti-Inflammatory Agents, Non-Steroidal/*AE; Human.
.T
Anaemia and nonsteroidal anti-inflammatory drugs [letter]
.P
LETTER.
.A
Doube A.
.I 90369
.U
88241240
.S
Br Med J (Clin Res Ed) 8809; 296(6629):1108
.M
Consumer Satisfaction; Drug Therapy/*AE; England; Female; Human; Malpractice/*LJ.
.T
Dr Gee cleared of serious professional misconduct [published erratum appears in Br Med J (Clin Res Ed) 1988 May 14;296(6633):1388]
.P
JOURNAL ARTICLE.
.A
Dyer C.
.I 90370
.U
88241296
.S
Br Med J (Clin Res Ed) 8809; 296(6634):1421-2
.M
Employee Discipline/*MT; Great Britain; Human; Personnel Management/*MT; Physicians/*; State Medicine/*OG.
.T
Disciplining doctors: the need for better methods [editorial] [published erratum appears in Br Med J (Clin Res Ed) 1988 May 28;296(6635):1488]
.P
EDITORIAL.
.A
Forsythe M.
.I 90371
.U
88241335
.S
Brain 8809; 111 ( Pt 2):223-44
.M
Adult; Aged; Basal Ganglia/*PH; Cerebral Cortex/PP; Evoked Potentials, Somatosensory; Female; Human; Huntington Chorea/*CO/PP; Male; Middle Age; Movement/*; Movement Disorders/*CO/PP; Muscle Contraction; Reflex, Stretch; Support, Non-U.S. Gov't; Volition; Wrist/PP.
.T
The coexistence of bradykinesia and chorea in Huntington's disease and its implications for theories of basal ganglia control of movement.
.P
JOURNAL ARTICLE.
.W
Investigation of motor function in a group of 17 patients with Huntington's disease reveals that, in addition to the chorea that many patients exhibit, defects in voluntary motor performance also are evident. Fast simple wrist flexion movements to 15 degrees or 60 degrees were slower, and individual movements showed greater variability than seen in normal subjects. This bradykinesia was most pronounced in those patients who were akinetic and rigid, but also was seen in those with chorea alone; bradykinesia was independent of the drug treatment that the patients were receiving (and was therefore not due to drug-induced parkinsonism). The electromyographic activity of the agonist muscles during such simple but slow movement differed from that seen in Parkinson's disease. The performance of complex movements revealed further deficits. Some patients were unable to combine two movements in a simultaneous or sequential movement task of squeezing the hand and flexing the elbow. Those who could perform these complex movements exhibited slowing of the velocity of the movement and prolongation of the interval between movements. These abnormalities were present in patients with chorea who were not taking neuroleptic drugs. It is argued that they represent an abnormality of motor programming of complex movements, over and above the defect in executing simple movements. The long latency stretch reflexes in wrist flexor muscles and flexor pollicis longus were reduced or absent, but this did not correlate with changes in motor performance, or with the reduced size of the early components of cortical sensory evoked potentials. Bradykinesia is thus shown to be an integral component of the motor disorder of Huntington's disease, in addition to the chorea. The coexistence of bradykinesia and chorea in this illness is compatible with current theories of the role of the basal ganglia in the control of movement.
.A
Thompson PD; Berardelli A; Rothwell JC; Day BL; Dick JP; Benecke R; Marsden CD.
.I 90372
.U
88241337
.S
Brain 8809; 111 ( Pt 2):267-80
.M
Aged; Analysis of Variance; Attention/*; Cues; Female; Human; Male; Orientation/*; Supranuclear Palsy, Progressive/*PX; Vision/*.
.T
Orienting of visual attention in progressive supranuclear palsy.
.P
JOURNAL ARTICLE.
.W
Orienting of visual attention was studied in 8 patients with progressive supranuclear palsy (PSP) and 8 parkinsonian control subjects. While maintaining fixation on the centre of a visual display, subjects made simple reaction time (RT) key press responses on detecting visual targets which appeared above, below, to the left or right, equidistant from fixation. On each trial the target was preceded by a preparatory cue, either a peripheral luminance change or a central arrow, to summon attention to one of the four locations. The orienting of attention was measured as a facilitation in detection RT at the cued location. For the parkinsonian controls, this facilitation was equal for horizontal and vertical directions, whereas for both types of cues, PSP patients were slower moving attention in the vertical than in the horizontal plane. Midbrain retinotectal pathways are important not only for controlling eye movements, but also for orienting attention.
.A
Rafal RD; Posner MI; Friedman JH; Inhoff AW; Bernstein E.
.I 90373
.U
88241338
.S
Brain 8809; 111 ( Pt 2):281-97
.M
Adolescence; Adult; Female; Human; Male; Orientation/*; Perceptual Masking; Posture/*; Proprioception/*; Self Concept/*; Support, U.S. Gov't, Non-P.H.S.; Vibration.
.T
Some proprioceptive influences on the perceptual representation of body shape and orientation.
.P
JOURNAL ARTICLE.
.W
Perception of the surface contour of the body is generally thought to depend on topographically organized neural maps of somatosensation in the thalamus and cortex. Recent neurophysiological studies indicate that these maps are potentially modifiable through alterations in their sensory input. We present evidence that the apparent shape and orientation of the body can be changed within seconds by using muscle vibration to generate proprioceptive misinformation about limb position. Depending on the position of the hands or feet in relation to the rest of the body and to the test chamber, it is possible to generate systematic perceptual distortions of the body and changes in the apparent orientation of the body. Some implications of these observations for the maintenance of an accurate body schema, for spatial orientation, and for the encoding of ocular position are described.
.A
Lackner JR.
.I 90374
.U
88241339
.S
Brain 8809; 111 ( Pt 2):299-321
.M
Aged; Cognition/*; Comparative Study; Female; Frontal Lobe/*PP; Human; Levodopa/*TU; Male; Middle Age; Neuropsychological Tests; Parkinson Disease/DT/*PP/PX; Support, Non-U.S. Gov't.
.T
'Frontal' cognitive function in patients with Parkinson's disease 'on' and 'off' levodopa.
.P
JOURNAL ARTICLE.
.W
A wide range of cognitive impairments can be observed in patients with Parkinson's disease. A close parallel exists between these deficits and those found following damage to prefrontal cortex. Anatomical evidence is reviewed which reveals a complex pattern of neuronal circuits connecting the frontal cortex and basal ganglia. All these circuits are in some way dependent upon dopamine, suggesting that changes in the levels of dopamine stimulation may alter performance on 'frontal' tests. To test this hypothesis, a group of patients with Parkinson's disease were assessed both on and off levodopa treatment, on a range of tests selected from the human and animal experimental literature as being sensitive to disruption of prefrontal cortex. A variable pattern of results was obtained. On one test, a measure of verbal fluency, patients were impaired, compared with normal controls, only when off levodopa. On two measures, associative conditional learning and subject-ordered pointing, patients were impaired only when on levodopa, while on the final measures, the Wisconsin Card Sorting Test, patients were impaired both on and off levodopa. Two mechanisms are discussed to explain these results, one based on the effects of dopamine depletion, and the other based on the adverse effects of dopamine overstimulation. The results suggest that different areas of prefrontal cortex are involved in the tasks employed, and that functional levels of dopamine in separate areas of cortex and caudate may differ crucially in Parkinson's disease.
.A
Gotham AM; Brown RG; Marsden CD.
.I 90375
.U
88241340
.S
Brain 8809; 111 ( Pt 2):323-45
.M
Attention/*; Cues/*; Human; Neuropsychological Tests; Parkinson Disease/*PX; Reaction Time.
.T
Internal versus external cues and the control of attention in Parkinson's disease.
.P
JOURNAL ARTICLE.
.W
In recent years, several attempts have been made to characterize the nature of the cognitive deficits shown by patients with Parkinson's disease. It has been suggested variously that they have difficulty in switching cognitive set, in performing effortful (or controlled) as opposed to automatic tasks, or that their impairment is found in tasks which maximize the amount of 'self-directed task specific planning'. It is proposed that this latter distinction may be reformulated in terms of the degree of internal versus external attentional control which is required by the task. An experiment is described which attempted to manipulate this parameter. A version of the Stroop colour-word test was used, in which the words 'red' and 'green' were presented in the complementary coloured 'ink'. Subjects responded either to the colour of the ink in which the word was written or the colour named by the word. The relevant attribute changed at intervals during the course of the experiment. In one condition, the relevant stimulus attribute was cued before each trial. In another condition, subjects had to remember which attribute was currently relevant. Results revealed that patients with Parkinson's disease were impaired mainly on the second version of the task which required internal attentional control. The results are discussed in relation to the models of Working Memory (Baddeley, 1986), and attentional control (Norman and Shallice, 1980). Exploration of these models leads to the formulation of a theory in which the crucial determinant of cognitive impairment in Parkinson's disease is reduced resources in the Supervisory Attentional System. Provided the demands of the task are within the patient's available attentional resources the patient may not show any deficit. If, however, the attentional demands exceed available resources, as in tasks which depend upon internal cues, then deficits will be observed.
.A
Brown RG; Marsden CD.
.I 90376
.U
88241341
.S
Brain 8809; 111 ( Pt 2):347-73
.M
Adult; Aged; Diencephalon/PH/SU; Female; Fixation, Ocular; Hemianopsia/PP/PX; Human; Male; Middle Age; Optic Disk/*; Support, Non-U.S. Gov't; Telencephalon/PH/SU; Visual Fields/*; Visual Perception/*PH.
.T
An investigation into perceptual completion in blind areas of the visual field.
.P
JOURNAL ARTICLE.
.W
The perceptual completion phenomenon refers to seeing a figure as complete when part of it falls in a blind area of the visual field. This phenomenon and the conditions for its occurrence were examined in three different situations: over the retinal blind spot, across the midline of the visual field in commissurotomized patients, and in the blind visual field in hemianopic patients. Responses of complete perception were obtained in each of the three conditions, but they were not all the result of a genuine perceptual completion process. Reports of vision over the retinal blind spot qualified as genuine perceptual completion. In the other two situations, reports suggestive of completion could be entirely eliminated in all but one hemianopic patient by manipulating parameters inherently involved in the evaluation of perceptual completion. The nature of perception, the characteristics and properties of the experimental task and stimuli, the mode of response, the patient's mental status, and eccentric eye fixation, all contributed towards reports of complete perception for reasons other than a process of completing the missing information. Evidence of completion was found in one patient who could see more distinctly in his affected field with bilateral stimulation than with stimulation of the affected field alone. The results suggest that perceptual completion in the hemianopic field is not a common phenomenon and that reports of complete perception are determined by many factors, not all related to seeing more than is objectively available. The results also indicate that the hemianopic defect does not function as an extended blind spot. Possible mechanisms underlying perceptual completion over the blind spot and the hemianopic field are suggested.
.A
Sergent J.
.I 90377
.U
88241342
.S
Brain 8809; 111 ( Pt 2):375-87
.M
Cerebral Arteries; Cerebral Infarction/CL/*CO/PA; Cognition Disorders/ET; Depressive Disorder/DI/*ET/PP; Disability Evaluation; Hospitalization; Human; Male; Middle Age; Neurologic Examination; Social Adjustment; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Time Factors.
.T
Depressive disorders following posterior circulation as compared with middle cerebral artery infarcts.
.P
JOURNAL ARTICLE.
.W
Patients with cerebrovascular lesions in the posterior circulation territory (PC) were compared with patients having middle cerebral artery territory (MCA) strokes for the presence of mood disorders. Both groups showed a similar profile of clinical symptoms of depression during the acute evaluation in hospital. Patients with posterior circulation lesions involving the brainstem and/or cerebellum demonstrated a significantly lower frequency of depression than patients with MCA lesions or patients with posterior circulation lesions involving the left cerebral hemisphere. Moreover, depression following brainstem and/or cellebellar infarcts was of significantly shorter duration than depression following MCA lesions. These differences in the frequency and duration of depression following brainstem/cerebellar as compared with MCA lesions were not explained by differences in lesion volume, physical impairment, cognitive deficits or quality of social support. They suggest that PC and MCA induced depression may have different aetiologies.
.A
Starkstein SE; Robinson RG; Berthier ML; Price TR.
.I 90378
.U
88241343
.S
Brain 8809; 111 ( Pt 2):389-403
.M
Afferent Pathways/PH; Brain Mapping; Cerebral Cortex/*PH; Electric Stimulation; Electrophysiology; Extremities/*IR; Human; Individuality; Muscles/*IR; Nerve Fibers/PH; Nervous System/PH; Neural Transmission/*; Reaction Time; Support, Non-U.S. Gov't.
.T
Projection to the cerebral cortex from proximal and distal muscles in the human upper limb.
.P
JOURNAL ARTICLE.
.W
Motor-point stimulation using insulated microelectrodes has been used to assess the cerebral projection from a number of single muscles in the human upper limb. Previous studies with intrafascicular neural stimulation have revealed a short-latency cortical projection from group I muscle afferents of intrinsic muscles of the hand but this technique is unsuitable to study the projection of afferents from proximal muscles. In 6 subjects, stimuli were delivered to the motor point of the following muscles: anterior deltoid, biceps brachii (short head), flexor carpi radialis, extensor digitorum communis, abductor pollicis brevis and first dorsal interosseous. The mean latency of the early cortical negativity was 15.0 ms for deltoid, 16.4 ms for biceps, 18.8 ms for flexor carpi radialis, 18.8 ms for extensor digitorum communis, 21.9 ms for abductor pollicis brevis and 25.0 ms for first dorsal interosseous. The amplitude of cerebral potentials from individual muscles was smaller than that produced by stimulation of the digital nerves of the index or little finger and did not vary systematically between proximal and distal muscles. This study provides direct evidence for a short-latency cortical projection from proximal muscles of the upper limb. The results are consistent with psychophysical studies which have proposed a role for intramuscular receptors in kinaesthesia at both proximal and distal joints.
.A
Gandevia SC; Burke D.
.I 90379
.U
88241344
.S
Brain 8809; 111 ( Pt 2):405-16
.M
Action Potentials; Adult; Child; Electromyography; Human; Muscles/PP; Neural Conduction/*; Polyradiculoneuritis/*PP; Sensation/PH.
.T
Patterns of conduction failure in the Guillain-Barre syndrome.
.P
JOURNAL ARTICLE.
.W
Within the limits of the Guillain-Barre syndrome, the pattern of clinical deficit is variable. Motor deficit may begin proximally or distally in the extremities and sensory deficit is sometimes, but not always present. Longitudinal studies were performed in 13 patients, starting during the progressive phase. The severity of the clinical deficit was related to the amplitude of the compound muscle action potentials (CMAPs) and sensory nerve action potentials (SNAPs). Two patterns were detected, but could only be reliably distinguished during the progressive phase of the disease. (1) A length-dependent reduction of the CMAP, i.e., a progressive decrease of the CMAP on moving the stimulating electrode to more proximal stimulation sites. This could often be attributed to conduction block. In this pattern (Group A), the sensory potentials were spared with only 1 exception. These patients had motor involvement without sensory deficit and the myotatic reflexes could be preserved up to MRC grade 3 paresis. (2) A simple reduction of the CMAP, i.e., the amplitude decreased during clinical deterioration, but during a single investigation remained similar for stimulation at all levels of the nerve. In this pattern (Group B), motor and sensory fibres were similarly involved. These patients showed both motor and sensory deficit and early myotatic areflexia. The second pattern might be explained by an immunological mechanism with a predilection for those regions of the peripheral nervous system where the blood-nerve barrier is naturally deficient. In the first pattern the discrepancy between the involvement of motor and sensory fibres raises new questions, the solution of which might be of importance for the understanding of the Guillain-Barre syndrome.
.A
van der Meche FG; Meulstee J; Vermeulen M; Kievit A.
.I 90380
.U
88241345
.S
Brain 8809; 111 ( Pt 2):417-37
.M
Adult; H-Reflex; Human; Leg; Middle Age; Motor Neurons/PH; Nerve Fibers/*PH; Neural Inhibition/*; Posture/*; Support, Non-U.S. Gov't; Synapses/*PH; Volition.
.T
Changes in presynaptic inhibition of Ia fibres in man while standing.
.P
JOURNAL ARTICLE.
.W
Presynaptic inhibition of homonymous Ia afferent terminals to soleus, quadriceps and tibialis anterior motoneurons and of heteronymous Ia fibres from quadriceps to soleus was compared in the same subjects when standing without support and during a control situation (sitting or standing with back support). Changes in presynaptic inhibition of Ia fibres were indirectly deduced from alterations in the amount of monosynaptic Ia facilitation elicited in motoneurons by a constant conditioning stimulation. Facilitation was measured during the first 0.5 ms when the monosynaptic Ia excitatory postsynaptic potential (EPSP) was not yet contaminated by polysynaptic effects evoked by the conditioning stimulation. Two indirect methods were used to provide an estimate of the size of the conditioning Ia EPSP: (1) the resulting H reflex facilitation; and (2) the peak of increased firing probability elicited in voluntarily activated motoneurons by stimulation of homonymous and heteronymous Ia fibres (poststimulus time histogram PSTH method). Only those PSTH experiments in which the 'spontaneous' firing rate of the motor unit was identical in the different positions, thus ensuring an identical net synaptic drive to the motoneuron, were considered. Under these conditions it is assumed that changes in the size of the peak of facilitation elicited by the monosynaptic Ia volley are likely to be caused by changes in presynaptic inhibition of Ia fibres. It is argued that the substantial changes in monosynaptic Ia excitation observed when standing without support probably reflect changes in presynaptic inhibition of Ia fibres. Under this interpretation, presynaptic inhibition of Ia fibres to soleus motoneurons is increased while standing without support, whereas presynaptic inhibition of homonymous Ia fibres to quadriceps motoneurons is decreased. There is no evidence for a change in presynaptic inhibition of Ia fibres to tibialis anterior motoneurons. The resulting alterations in the gain of the monosynaptic reflex of these muscles are discussed in relation to the possible role of the monosynaptic stretch reflex in human gait.
.A
Katz R; Meunier S; Pierrot-Deseilligny E.
.I 90381
.U
88241346
.S
Brain 8809; 111 ( Pt 2):439-56
.M
Adult; Human; Male; Mouth/*; Movement/*; Speech/*; Speech Articulation Tests; Stuttering/*PP; Support, U.S. Gov't, P.H.S..
.T
Kinematic analysis of multiple movement coordination during speech in stutterers.
.P
JOURNAL ARTICLE.
.W
This study addresses the long-standing claim that stuttering reflects an impairment in the neuromotor coordination of multiple speech movements. Upper lip (UL), lower lip (LL), and jaw (J) kinematics for nonstuttered speech behaviours in stutterers and normal speakers were examined using quantitative indices of normal multiple movement coordination reported in recent studies of gait, reaching, grasping, and speech. While two measures of coordination--dynamic movement composition and intermovement motor equivalence--did not distinguish between stutterers and normals, stutterers manifested striking differences from normal on a third measure, the sequencing of UL, LL, and J movement onsets and velocity peaks. These findings suggest that, contrary to previous hypotheses, stutterers do not manifest general problems of coordination of speech movement. Instead, stuttering appears to be associated with a specific impairment in multiple movement coordination associated with sequencing of those movements.
.A
Caruso AJ; Abbs JH; Gracco VL.
.I 90382
.U
88241347
.S
Brain 8809; 111 ( Pt 2):457-66
.M
Acoustic Stimulation; Adult; Agnosia/ET/PP/*PX; Arabia; Audiometry, Pure-Tone; Case Report; Cerebral Cortex/PP; Cerebral Infarction/CO/RA; Electroencephalography; Evoked Potentials, Auditory; Hearing Tests; Human; Language; Male; Myocardial Infarction/CO/PP; Speech Perception/*PH; Tomography, X-Ray Computed.
.T
Pure word deafness (acquired verbal auditory agnosia) in an Arabic speaking patient.
.P
JOURNAL ARTICLE.
.W
A 38-year-old, right-handed Arabic-speaking male developed pure word deafness three days after myocardial infarction. He could recognize Arabic music and instruments but not words of songs; a radio broadcast from the Koran, but not the individual words; a male as opposed to female voice; Arabic and non-Arabic languages; and whether sentences were questions, exclamations, or imperatives. He discerned whether the speaker was emotionally neutral, happy, angry or sad. Contextual cues and reducing the rate of speaking aided verbal comprehension. Pure tone threshhold audiometry revealed mild bilateral sensorineural loss up to 2000 Hz and a moderate high frequency loss. Brainstem auditory evoked potentials were normal, cortical auditory evoked potentials abnormal. CT scan revealed bilateral infarcts subcortically just posterior to the left superior temporal gyrus and the right posterior superior and midtemporal regions. Neurolinguistic tests indicated that the deficit is prephonemic and not due to impairment of linguistic discrimination.
.A
Yaqub BA; Gascon GG; Al-Nosha M; Whitaker H.
.I 90383
.U
88242118
.S
Clin Perinatol 8809; 15(2):163-419
.M
Female; Human; Pregnancy; Pregnancy Complications, Infectious/*.
.T
Infectious complications of pregnancy.
.P
JOURNAL ARTICLE.
.I 90384
.U
88242132
.S
Clin Pharmacol Ther 8809; 43(6):599-604
.M
Adult; Alcohol, Ethyl/*PD; Alcoholic Intoxication/DT; Human; Hydrocortisone/*SE; Male; Naloxone/*AI/PK/TU; Support, Non-U.S. Gov't.
.T
Alcohol antagonism of hypercortisolism induced by naloxone.
.P
JOURNAL ARTICLE.
.W
The reversal of acute alcohol intoxication by naloxone is controversial. Naloxone increases cortisol secretion but there are no reports of this effect during acute alcohol intoxication. This study examines the effect of 20 mg naloxone on alcohol-induced intoxication using a balanced placebo design to investigate the role of cortisol, participant expectancy of treatment, and possible pharmacokinetic interactions during intoxication. Our results show differences in the time course of subjective self-evaluation of drunkenness in the presence of naloxone. Also, changes are observed in naloxone pharmacokinetic parameters with the ingestion of alcohol, specifically a decrease in plasma clearance. Whereas the cortisol response induced by naloxone was greater in the subgroup of participants with positive expectancy, in the presence of alcohol the naloxone effect on cortisol response was not observed. These observations may help explain the observed reversal of alcohol-induced coma by naloxone in a subgroup of patients.
.A
Cami J; de la Torre R; Garcia-Sevilla L; Ugena B; Knobel H; Segura J.
.I 90385
.U
88242133
.S
Clin Pharmacol Ther 8809; 43(6):605-9
.M
Adult; Female; Human; Migraine/*CI/ET; Piperazines/BL/*PD; Receptors, Serotonin/*DE.
.T
Induction of migrainelike headaches by the serotonin agonist m-chlorophenylpiperazine.
.P
JOURNAL ARTICLE.
.W
In a study of serotonin (5-HT) function in patients with eating disorders and healthy control subjects, severe headaches with features of common migraine occurred unexpectedly in 28 of 52 subjects (54%) 8 to 12 hours after receiving a single oral dose of the 5-HT receptor agonist m-chlorophenylpiperazine (m-CPP), 0.5 mg/kg. None of the same subjects developed similar late-occurring headaches after placebo or the 5-HT precursor, L-tryptophan, 100 mg/kg given intravenously. The frequency of these migrainelike headaches was not significantly different between patients with bulimia or anorexia nervosa and control subjects, but incidence of headaches was significantly greater in subjects with a personal or family history of migraine, with almost all predisposed individuals (18 of 20, 90%) developing severe symptoms. Headache ratings were also significantly correlated (rho = 0.70; p less than 0.0001) with peak concentrations of m-CPP in plasma. These observations indicate that m-CPP may provide a novel probe for studies of the pathophysiology of migraine headaches.
.A
Brewerton TD; Murphy DL; Mueller EA; Jimerson DC.
.I 90386
.U
88242136
.S
Clin Pharmacol Ther 8809; 43(6):623-9
.M
Dose-Response Relationship, Drug; Heroin Dependence/*RH; Human; Methadone/AD/*BL; Substance Withdrawal Syndrome.
.T
The use of serum methadone levels in patients receiving methadone maintenance.
.P
JOURNAL ARTICLE.
.W
Trough serum methadone concentration was measured in 43 patients under treatment for heroin addiction and complaining of withdrawal symptoms. Low serum levels were noted only in patients taking very low doses and in 10 patients who were concomitantly using enzyme-inducing drugs. The 27 patients in the maintenance program who had trough levels greater than 100 ng/ml were given no dose increase and were followed up prospectively. Alternate explanations for the patient's symptoms were well accepted in almost all cases, and subsequent performance in the treatment program appeared to be independent of serum level. We conclude that a trough serum level of 100 ng/ml is adequate for effective methadone maintenance. Measurement of serum levels can be a valuable intervention in patients with difficulties.
.A
Bell J; Seres V; Bowron P; Lewis J; Batey R.
.I 90387
.U
88242137
.S
Clin Pharmacol Ther 8809; 43(6):630-5
.M
Cyclosporins/*ME; Cytochrome P-450/*GE/IM; Drug Interactions; Human; Isoenzymes/*GE/IM; Microsomes, Liver/*ME; Substrate Specificity; Support, Non-U.S. Gov't.
.T
Cyclosporine metabolism in human liver: identification of a cytochrome P-450III gene family as the major cyclosporine-metabolizing enzyme explains interactions of cyclosporine with other drugs.
.P
JOURNAL ARTICLE.
.W
The rate of formation of the three initial metabolites of cyclosporine metabolism has been determined in liver microsomes of 15 kidney transplant donors. Interindividual variation in metabolite formation was considerable but all three metabolites varied in parallel. An antiserum raised against a steroid-inducible rat cytochrome P-450 (P-450 PCN) strongly inhibited the formation of these metabolites. Immunoquantitation of the protein recognized by a monoclonal antibody reacting with human cytochromes P-450 of the P-450III gene family, homologues of rat P-450 PCN and rabbit P-4503C, revealed a high degree of correlation with microsomal cyclosporine metabolism. The data suggest that this cytochrome P-450 is the major cyclosporine-metabolizing enzyme in human liver. The substrate specificity and the known inducers and inhibitors of this cytochrome P-450 explain several clinically observed drug interactions with cyclosporine.
.A
Kronbach T; Fischer V; Meyer UA.
.I 90388
.U
88242138
.S
Clin Pharmacol Ther 8809; 43(6):636-42
.M
Human; Protein Binding; Quinidine/*AA/AE/BL/*ME; Support, U.S. Gov't, P.H.S.; Tachycardia/*CI/ME.
.T
Plasma concentrations of quinidine, its major metabolites, and dihydroquinidine in patients with torsades de pointes.
.P
JOURNAL ARTICLE.
.W
We examined the hypothesis that excess accumulation of major quinidine metabolites or the commercial impurity dihydroquinidine contributes to the development of polymorphic ventricular tachycardia (torsades de pointes, [TdP]) in patients taking quinidine. Total and free plasma concentrations of these compounds were measured by reverse-phase HPLC with fluorescence detection and equilibrium dialysis in 19 patients with TdP and 38 control patients tolerating quinidine therapy without toxicity. No significant differences were found between the two groups of patients. Ratios of metabolite or dihydroquinidine to quinidine varied up to tenfold among patients but were similarly distributed in the TdP and control groups. Only the metabolite 3-hydroxyquinidine was present at free plasma concentrations that exceeded free concentrations of quinidine. We conclude that although quinidine metabolism is highly variable, there does not appear to be any correlation between the plasma concentrations of quinidine, its metabolites or dihydroquinidine, and the subsequent development of TdP.
.A
Thompson KA; Murray JJ; Blair IA; Woosley RL; Roden DM.
.I 90389
.U
88242139
.S
Clin Pharmacol Ther 8809; 43(6):643-7
.M
Adult; Aged; Drug Administration Schedule; Duodenal Ulcer/*BL/DT; Female; Gastrins/*BL; Human; Male; Middle Age; Omeprazole/*AD/TU.
.T
Effect of intermittent weekend therapy with omeprazole on basal and postprandial serum gastrin concentrations in patients with duodenal ulcer.
.P
JOURNAL ARTICLE.
.W
We have studied the effect on serum gastrin concentrations of weekly 3-day courses of 20 mg/day omeprazole followed by a 4-day period without medication (weekend therapy) for 4 weeks in 10 patients with duodenal ulcer. Basal and postprandial serum gastrin concentrations were measured in week 1, before (day 1) and immediately after the 3-day omeprazole course (day 4), and further on day 6 and day 8, immediately before the next course, and at similar intervals in week 4 (days 22, 25, 27, and 29). Basal serum gastrin concentrations were not significantly different from day 1, but postprandial peak gastrin concentrations on days 6, 8, 22, 25, 27, and 29 and integrated postprandial gastrin secretion on days 25 and 27 were significantly increased (p less than 0.01 to p less than 0.05). However, the increases in serum gastrin concentration were modest and clinically irrelevant. It is concluded that this intermittent weekend schedule of omeprazole therapy does not induce marked hypergastrinemia and may therefore be suitable for long-term therapy with this drug.
.A
Crobach LF; Jansen JB; Lamers CB.
.I 90390
.U
88242140
.S
Clin Pharmacol Ther 8809; 43(6):648-54
.M
Administration, Oral; Adrenergic Alpha Receptor Agonists/*PD; Adult; Aged; Antihypertensive Agents/*PD; Clonidine/AE/*PD; Heart Conduction System/*DE; Hemodynamics/*DE; Human; Hypertension/*DT/PP; Middle Age; Refractory Period, Neurologic/DE; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Thiophenes/AE/*PD.
.T
Electrophysiologic and hemodynamic effects of chronic oral therapy with the alpha 2-agonists clonidine and tiamenidine in hypertensive volunteers.
.P
JOURNAL ARTICLE.
.W
Clonidine can produce symptomatic sinus bradycardia or atrioventricular (AV) block in some patients. Electrophysiologic studies have been performed after intravenous clonidine in patients showing such side effects; these have demonstrated variable depression of sinus and AV nodal function. We have evaluated the electrophysiologic and hemodynamic effects of chronic oral treatment with either clonidine (0.2 to 0.5 mg every 12 hours; n = 7) or another centrally active alpha 2-agonist, tiamenidine (0.5 to 1.5 mg every 12 hours; n = 7), in otherwise healthy hypertensive human volunteers. At dosages that modestly lowered diastolic blood pressure, both agents significantly slowed sinus rate and increased the atrial pacing rate producing AV nodal Wenckebach. Clonidine also significantly increased corrected sinus node recovery time and lowered cardiac output while similar (but statistically insignificant) trends were seen with tiamenidine. We conclude that chronic oral treatment with these alpha 2-agonists depresses sinus and AV nodal function in virtually all subjects, including those without manifest conduction system disease.
.A
Roden DM; Nadeau JH; Primm RK.
.I 90391
.U
88242141
.S
Clin Pharmacol Ther 8809; 43(6):655-62
.M
Adult; Blood Pressure/*DE; Female; Human; Male; Middle Age; Nadolol/*PD; Sleep/*DE; Sleep Stages/*DE; Support, Non-U.S. Gov't; Time Factors.
.T
Effects of nadolol on blood pressure, sleep efficiency, and sleep stages.
.P
JOURNAL ARTICLE.
.W
The effects of nadolol (20 and 80 mg) on blood pressure and sleep parameters were assessed in six patients with mild hypertension. A 32-night experimental protocol in the sleep laboratory was instituted consisting of four placebo-baseline nights followed by 4 weeks of drug administration. Both doses of nadolol had a clear-cut and consistent lowering effect on blood pressure throughout the night and during the day, with a greater reduction noted with the 80 mg dose. In fact, blood pressure values were reduced to normotensive levels. Neither dose had a disrupting effect on sleep, whereas the 80 mg dose improved sleep efficiency and also had a rapid eye movement-enhancing effect. This absence of sleep-disrupting effects is attributed to nadolol's low level of lipophilicity and lack of intrinsic sympathomimetic activity. The clinical significance of the lack of sleep disruption and possible improvement of sleep with nadolol is discussed in light of the well-recognized sleep disturbances produced by other beta-blockers.
.A
Kales A; Bixler EO; Vela-Bueno A; Cadieux RJ; Manfredi RL; Bitzer S; Kantner T.
.I 90392
.U
88242144
.S
Clin Pharmacol Ther 8809; 43(6):673-80
.M
Adult; Blood Pressure/DE; Cimetidine/*PD; Drug Interactions; Female; Heart Rate/DE; Human; Male; Nifedipine/PD/*PK; Ranitidine/*PD; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Effect of cimetidine or ranitidine administration on nifedipine pharmacokinetics and pharmacodynamics.
.P
JOURNAL ARTICLE.
.W
The effect of cimetidine or ranitidine administration on responses to single and multiple doses of nifedipine were studied in 11 subjects who received cimetidine (300 mg q.i.d.) and 12 who received ranitidine (150 mg b.i.d.) in combination with nifedipine. After single doses of nifedipine, cimetidine decreased apparent oral clearance (dose/AUC) from 66 +/- 32 L/hr to 33 +/- 14 L/hr (p less than 0.01); elimination half-life increased from 4.0 +/- 2.2 to 4.9 +/- 2.9 hours (p less than 0.07). Increases in heart rate were greater (26 +/- 13 vs 13 +/- 11 beats/min standing; 19 +/- 11 vs 9 +/- 9 beats/min supine) and lasted longer than after nifedipine alone. Hypotensive effects were similar (10 +/- 7 mm Hg decrease vs 9 +/- 9 mm Hg). During nifedipine multiple-dose administration, cimetidine decreased the apparent oral clearance from 76 +/- 39 to 43 +/- 20 L/hr (p less than 0.01). Blood pressure responses were not altered by cimetidine but heart rate increased more (18 +/- 9 vs 9 +/- 9 beats/min supine; 18 +/- 13 vs 13 +/- 14 beats/min standing). Ranitidine coadministration did not alter nifedipine elimination or dynamic responses. During administration of nifedipine alone, the ratio of oral clearances (multiple to single doses) was 1.1 +/- 0.5. Thus (1) cimetidine but not ranitidine alters responses to nifedipine and (2) nifedipine kinetics do not differ between single- vs multiple-dose conditions.
.A
Schwartz JB; Upton RA; Lin ET; Williams RL; Benet LZ.
.I 90393
.U
88242145
.S
Clin Pharmacol Ther 8809; 43(6):681-7
.M
Adult; Dietary Proteins/*AD; Glomerular Filtration Rate; Human; Hydrogen-Ion Concentration; Inulin/*PK; Kidney/*ME; Metabolic Clearance Rate; Oxypurinol/*PK; Pyrimidines/*PK; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Time Factors; Uric Acid/PK.
.T
Renal clearances of oxypurinol and inulin on an isocaloric, low-protein diet.
.P
JOURNAL ARTICLE.
.W
In previous studies a low-calorie, low-protein diet caused a sustained reduction in both oxypurinol and uric acid renal clearances (CLR). With the hypothesis that the decrease in CLR was due to the low-protein and not the low-caloric content of the diet, we studied the CLR of oxypurinol, uric acid, creatinine, and inulin in normal subjects during isocaloric (2600 calories per 70 kg per day), normal-protein (150 gm per day), and low-protein (19 gm per day) diets. There were three major findings: (1) the CLR of oxypurinol declined from 26.6 +/- 1.8 ml/min on the normal-protein diet to 13.5 +/- 1.4 ml/min on the isocaloric low-protein diet (p less than 0.05); (2) the CLR of inulin and creatinine fell 14% and 20%, respectively, on the low-protein diet compared with the normal-protein diet (both p less than 0.05); and (3) there was a diurnal variation in the CLR of oxypurinol. We conclude that the decreased CLR of oxypurinol was the result of the reduced protein content of the diet and the CLR of both inulin and creatinine were decreased on the low-protein diet.
.A
Kitt TM; Park GD; Spector R; Lawton W; Tsalikian E.
.I 90394
.U
88242148
.S
Clin Pharmacol Ther 8809; 43(6):701
.M
Certification/*ST; Education, Graduate; Pharmacology, Clinical/*ED; United States.
.T
Criteria for certification in clinical pharmacology [letter]
.P
LETTER.
.A
Burris JF.
.I 90395
.U
88242215
.S
Contact Dermatitis 8809; 18(4):197-201
.M
Cosmetics/AE; Dermatitis, Contact/DI/*ET; Formaldehyde/AE/*IM; Human; Hydantoins/AE/*IM; Patch Tests; Photosensitivity Disorders/CI/EP; Preservatives, Pharmaceutical/AE.
.T
Patch test reactivity to DMDM hydantoin. Relationship to formaldehyde allergy.
.P
JOURNAL ARTICLE.
.W
The relationship between contact allergy to formaldehyde and positive patch test reactions to DMDM hydantoin was investigated. 35 formaldehyde-allergic patients were patch tested with serial dilutions of formaldehyde (0.1%-0.3%-1.0% aq.) and DM hydantoin (the non-formaldehyde-containing parent compound of DMDM hydantoin). 21 were also patch tested with MDM hydantoin (1 molecule formaldehyde) in serial dilutions: 7 (33%) reacted to 1 or more concentrations. The other 14 were also tested with DMDM hydantoin (2 molecules formaldehyde) in serial dilutions: 8 (57%) reacted to 1 or more concentrations. Patients patch-test-positive to formaldehyde 0.1% and/or 0.3% tended to show more patch test reactivity to (D)MDM hydantoin than those who reacted only to 1%. Aqueous solutions of (D)MDM hydantoin in concentrations as used in cosmetic products therefore contain enough free formaldehyde to cause dermatitis in a patch test system in some formaldehyde-allergic patients: 12 such patients applied a cream containing 1% DMDM hydantoin to the flexor aspect of the lower arm twice daily for 1 week; 4 (33%) developed dermatitis. The use of a cream containing 0.25% DMDM hydantoin in these 4 patients still caused dermatitis in 1 and provoked itching in another. An increase in the use of DMDM hydantoin in cosmetic products will also inevitable increase the risk of cosmetic dermatitis in consumers allergic to formaldehyde.
.A
de Groot AC; van Joost T; Bos JD; van der Meeren HL; Weyland JW.
.I 90396
.U
88242216
.S
Contact Dermatitis 8809; 18(4):202-5
.M
Adult; Case Report; Cosmetics/*IM; Cross Reactions; Dermatitis, Contact/DI/*ET; Female; Formaldehyde/IM; Human; Middle Age; Netherlands; Patch Tests; Preservatives, Pharmaceutical/AE; Urea/*AA/IM.
.T
Contact allergy to diazolidinyl urea (Germall II).
.P
JOURNAL ARTICLE.
.W
4 cases of contact allergy to diazolidinyl urea (Germall II) in a "hypoallergenic" brand of cosmetics are described. 2 patients sensitized by these cosmetics were not allergic to formaldehyde. 2 other patients already sensitive to formaldehyde had exacerbations of dermatitis due to diazolidinyl urea. The following tentative conclusions were drawn. (i) Contact allergy to diazolidinyl urea may or may not be due to formaldehyde sensitivity. (ii) Patients allergic to formaldehyde may suffer contact allergic reactions from the use of cosmetics containing diazolidinyl urea. (iii) Patients sensitized to diazolidinyl urea may cross-react to imidazolidinyl urea and vice-versa. (iv) It is suggested that the sensitizing potential of diazolidinyl urea is greater than that of imidazolidinyl urea. (v) Aq. solutions may be preferable to pet. for patch testing with diazolidinyl urea.
.A
de Groot AC; Bruynzeel DP; Jagtman BA; Weyland JW.
.I 90397
.U
88242217
.S
Contact Dermatitis 8809; 18(4):206-9
.M
Chromium/*AN/IM; Dermatitis, Contact/*ET; Household Products/*AN; Human; Hypochlorous Acids/*AN; Intradermal Tests; Patch Tests; Potassium Dichromate/AN/IM; United States.
.T
Chromium in US household bleach.
.P
JOURNAL ARTICLE.
.W
Spectrophotometric analysis for chromium in hypochlorite bleach sampled at random throughout the USA shows that the highest level found in those products is of the order of 0.1 ppm (2/20). This probably does not represent a significant risk factor for chromate sensitization of the consumer population.
.A
Hostynek JJ; Maibach HI.
.I 90398
.U
88242218
.S
Contact Dermatitis 8809; 18(4):210-2
.M
Administration, Cutaneous; Balsams/IM/TU; Cross Reactions; Czechoslovakia; Dermatitis, Contact/*ET; Human; Patch Tests; Propolis/*IM/TU; Resins/*IM.
.T
The incidence of allergy to propolis in 605 consecutive patients patch tested in Prague.
.P
JOURNAL ARTICLE.
.W
605 consecutive patients were patch tested with the standard CDRG test series and with a 10% alcoholic solution of propolis. Positive allergic reactions to propolis were observed in 25 patients (4.2%); thirteen of them exhibited a simultaneous positive patch test to balsam of Peru. In view of the relatively high incidence of allergic reactions and the appearance of pseudo-cross-sensitivity to another common allergen, balsam of Peru, propolis should not be used in topical medicaments or as a component of cosmetic preparations.
.A
Machackova J.
.I 90399
.U
88242219
.S
Contact Dermatitis 8809; 18(4):213-8
.M
Administration, Cutaneous; Adolescence; Adult; Aged; Amphibian Venoms/AE; Case Report; Child; Dermatitis, Contact/DI/DT/*ET; Drugs, Chinese Herbal/*AE; Female; Fluocinolone Acetonide/TU; Human; Irritants; Male; Patch Tests/MT.
.T
Irritant contact dermatitis due to a Chinese herbal medicine lu-shen-wan.
.P
JOURNAL ARTICLE.
.W
A Chinese herbal medicine Lu-Shen-Wan, which contains 6 ingredients, is sometimes applied topically to treat boils, carbuncles and other skin infections. 2 elderly women developed a rash after applying Lu-Shen-Wan. Patch tests showed positive reactions to Lu-Shen-Wan and to one of its 6 ingredients, Venenum Bufonis. A study in 15 control patients showed that 13 had positive reactions to 50% Lu-Shen-Wan and 50% Venenum Bufonis but that only 2 showed mild reactions when the concentration of the latter was reduced to 5%. The results suggest that Venenum Bufonis in Lu-Shen-Wan can cause irritant contact dermatitis. The present paper demonstrates that a Western dermatological investigative method, the patch test, is applicable to traditional medicine in confirming the cause of contact dermatitis from a Chinese herbal preparation and in identifying the causative ingredient. Such knowledge is very useful for the improvement of the preparation by reducing the concentration of the irritant, by removing it or by substituting it with an alternative non-irritant substance.
.A
Lee TY; Lam TH.
.I 90400
.U
88242220
.S
Contact Dermatitis 8809; 18(4):219-25
.M
Alkyl Sulfonates/*IM; Animal; Antigenic Determinants/*IM; Carrier Proteins/ME; Cross Reactions; Erythema/IM; Eugenol/AA/IM; Guinea Pigs; Haptens/IM; Skin/*IM.
.T
Methyl groups as antigenic determinants in skin sensitisation.
.P
JOURNAL ARTICLE.
.W
The methylating agents, methyl dodecane sulphonate, methyl hexadecane sulphonate and methyl hexadec-3-ene sulphonate are strong skin sensitisers, cross-reactive with one another, in guinea pig adjuvant tests. Differences in potency are observed among these 3 compounds, and the possible reasons for this are discussed. Isoeugenol fails to elicit a sensitisation response when challenged onto guinea pigs sensitised to methyl dodecane sulphonate, indicating that the mechanism of isoeugenol sensitisation is not based on methyl transfer. It is proposed that, in skin sensitisation involving small haptenic groups, antigenic specificity is directed not against the haptenic groups but against portions of the carrier protein whose configuration has been modified as a result of the carrier-hapten reaction. This concept is supported by published data on cross-reactivity patterns with enantiomeric pairs of alpha-methylene-gamma-butyrolactone derivatives.
.A
Roberts DW; Goodwin BF; Basketter D.
.I 90401
.U
88242221
.S
Contact Dermatitis 8809; 18(4):226-8
.M
Case Report; Chromatography, Gas; Dermatitis, Contact/DI/*ET; Formaldehyde/IM; Human; Male; Methenamine/AE/*IM; Middle Age; Occupational Dermatitis/DI/*ET; Patch Tests/MT.
.T
Allergic contact dermatitis due to hexamethylenetetramine in core molding.
.P
JOURNAL ARTICLE.
.W
Hexamethylenetetramine is an odorless powder and slowly liberates formaldehyde in an acid medium or when heated. It is usually used in the manufacture of formaldehyde resins, rubber and the explosive, cyclonite. It is also used as a hardener in core molding processes. It was reported as one of the formaldehyde releasers and as a cause of formaldehyde contact dermatitis. We report an allergic contact dermatitis due to hexamethylenetetramine, with a positive patch test reaction to hexamethylenetetramine (1% pet.) but not to formaldehyde (2% aq.). We concluded that this case was an allergic contact dermatitis from hexamethylenetetramine itself.
.A
Hayakawa R; Arima Y; Hirose O; Takeuchi Y.
.I 90402
.U
88242222
.S
Contact Dermatitis 8809; 18(4):229-33
.M
Adolescence; Adult; Age Factors; Aged; Child; Cross Reactions; Dermatitis, Contact/*ET; Ethylmercury Compounds/*IM; Female; Human; Hypersensitivity, Delayed/*CI/EP; Male; Middle Age; Patch Tests; Preservatives, Pharmaceutical/IM; Retrospective Studies; Sex Factors; Thimerosal/*IM; Vaccines/*AE.
.T
Thiomersal allergy and vaccination reactions.
.P
JOURNAL ARTICLE.
.W
Thiomersal is the preservative in all toxoid vaccines routinely administered to children in the UK, but exposure from other sources is uncommon. Delayed hypersensitivity to thiomersal was demonstrated in 1% of individuals attending the Contact Dermatitis Investigation Unit, and 50 of these patients with positive patch tests to thiomersal were studied. Cross-reaction with other mercurials occurred in 17 of 29 patients tested (59%). 31 of the patients replied to a questionnaire regarding vaccination reactions, and were compared with case-controls matched for age, sex, and site of dermatitis. 4 patients in each group reported reactions to vaccines which contained thiomersal, suggesting that thiomersal hypersensitivity was not associated with an increased risk of vaccination reactions. However, individual cases of severe reactions to thiomersal demonstrate a need for vaccines with an alternative preservative.
.A
Cox NH; Forsyth A.
.I 90403
.U
88242223
.S
Contact Dermatitis 8809; 18(4):234-6
.M
Alcohol, Ethyl/PD; Allergens/*AD/IM; Human; Patch Tests/*MT; Pressure; Skin Tests/*MT; Vehicles; Water/PD.
.T
Ring-shaped positive allergic patch test reactions to allergens in liquid vehicles.
.P
JOURNAL ARTICLE.
.W
In recent years, we have observed several "ring-shaped" positive allergic patch test reactions to allergens dissolved in a liquid vehicle, a more intense response at the periphery of the site of application than in the central part. The occurrence of such reactions was evaluated for formaldehyde, Kathon CG, hydrocortisone and hexamidine diisethionate. Possible explanations for such reactions include pressure and/or a capillary effect.
.A
Lachapelle JM; Tennstedt D; Fyad A; Masmoudi ML; Nouaigui H.
.I 90404
.U
88242224
.S
Contact Dermatitis 8809; 18(4):237-9
.M
Dermatitis, Contact/EP/*ET; Europe; Female; Follow-Up Studies; Human; Nickel/*IM; Occupational Dermatitis/EP/ET; Patch Tests.
.T
Epidemiology of nickel allergy: results of a follow-up analysis of patients with positive patch tests to nickel.
.P
JOURNAL ARTICLE.
.W
In a previous paper, we reported on nickel sensitivity in 2400 consecutive patients in 5 countries. 3 years later, we reassessed 104 of the 157 nickel-positive patients of this former study and found 13 now to be negative to nickel sulphate. Nearly all the others can no longer tolerate nickel contact. 68 patients were free from nickel dermatitis, 16 showed a very mild eczema or dyshidrosis, and 13 were suffering from chronic hand dermatitis. 42 of 104 patients had changed their occupation, 36 successfully, with clearance of skin lesions. Rehabilitation by avoidance of nickel-containing costume jewelry, wrist-watches and clothing buckles, and by change of occupation, is possible and necessary.
.A
Schubert H; Kohanka V; Korossy S; Nebenfuhrer L; Prater E; Rothe A; Szarmach H; Temesvari E; Ziegler V.
.I 90405
.U
88242225
.S
Contact Dermatitis 8809; 18(4):240
.M
Adult; Case Report; Dermatitis, Contact/DI/*ET; Human; Male; Pantothenic Acid/*AA/AE/IM; Patch Tests; Sunscreening Agents/*AE.
.T
Contact allergy to dexpanthenol in sunscreens.
.P
JOURNAL ARTICLE.
.A
Jeanmougin M; Manciet JR; Moulin JP; Blanc P; Pons A; Civatte J.
.I 90406
.U
88242226
.S
Contact Dermatitis 8809; 18(4):240-2
.M
Aged; Case Report; Cosmetics/*AE; Dermatitis, Contact/*ET; Hay Fever/*IM; Human; Lichens/*IM; Male; Patch Tests; Perfume/*IM; Photosensitivity Disorders/*IM; Seasons.
.T
Oakmoss photosensitivity in a ragweed-allergic patient.
.P
JOURNAL ARTICLE.
.A
Guin JD; Jackson DB.
.I 90407
.U
88242227
.S
Contact Dermatitis 8809; 18(4):242-3
.M
Case Report; Dermatitis, Contact/DI/ET/*TH; Desensitization, Immunologic/*MT; Female; Human; Middle Age; Plants/*IM.
.T
Oral hyposensitization in Parthenium dermatitis.
.P
JOURNAL ARTICLE.
.A
Srinivas CR; Krupashankar DS; Singh KK; Balachandran C; Shenoi SD.
.I 90408
.U
88242228
.S
Contact Dermatitis 8809; 18(4):243-4
.M
Aged; Case Report; Dermatitis, Contact/*DI/ET; Female; Human; Male; Middle Age; Patch Tests; Phenyl Ethers/*IM; Triclosan/AE/*IM.
.T
Contact dermatitis from triclosan (Irgasan DP 300).
.P
JOURNAL ARTICLE.
.A
Steinkjer B; Braathen LR.
.I 90409
.U
88242229
.S
Contact Dermatitis 8809; 18(4):244-5
.M
Case Report; Chronic Disease; Dermatitis, Contact/DI/*ET; Glucocorticoids, Topical/*AE; Human; Male; Middle Age; Patch Tests.
.T
Allergic contact dermatitis from multiple topical corticosteroids.
.P
JOURNAL ARTICLE.
.A
Lozinski AZ; Mitchell JC.
.I 90410
.U
88242230
.S
Contact Dermatitis 8809; 18(4):246
.M
Adult; Case Report; Cross Reactions; Dermatitis, Contact/DI/*ET; Female; Human; Occupational Dermatitis/DI/*ET; Patch Tests; Plants/*IM.
.T
Occupational airborne contact dermatitis in a florist.
.P
JOURNAL ARTICLE.
.A
Illuminati R; Russo R; Guerra L; Melino M.
.I 90411
.U
88242231
.S
Contact Dermatitis 8809; 18(4):247-8
.M
Case Report; Child, Preschool; Dermatitis, Contact/DI/*ET; Human; Male; Patch Tests; Plants/*IM; Sunlight/AE; Sweating.
.T
Contact dermatitis from variegated ivy (Hedera helix subsp. canariensis Willd.).
.P
JOURNAL ARTICLE.
.A
Massmanian A; Valcuende Cavero F; Ramirez Bosca A; Castells Rodellas A.
.I 90412
.U
88242232
.S
Contact Dermatitis 8809; 18(4):248-9
.M
Adult; Case Report; Dermatitis, Contact/*DI/ET; Female; Gold/*IM; Human; Middle Age; Nickel/*IM; Patch Tests/MT; Skin/IM.
.T
Snags in gold patch testing.
.P
JOURNAL ARTICLE.
.A
Walton S; Gandhi MM; Wyatt EH.
.I 90413
.U
88242233
.S
Contact Dermatitis 8809; 18(4):249-50
.M
Adult; Case Report; Cosmetics/AE; Dermatitis, Contact/DI/*ET; Emulsions; Ethers/*AE; Female; Human; Middle Age; Palmitates/*AE; Palmitic Acids/*AE; Patch Tests; Pharmaceutic Aids/*AE.
.T
Contact allergy to an emulsifier in a cosmetic lotion.
.P
JOURNAL ARTICLE.
.A
Dooms-Goossens A; Debusschere K; Gladys K; Degreef H.
.I 90414
.U
88242234
.S
Contact Dermatitis 8809; 18(4):250
.M
Adult; Aviation; Case Report; Female; Human; Patch Tests/*IS; Security Measures/*; Skin Tests/*IS.
.T
Patch testing and airport security.
.P
JOURNAL ARTICLE.
.A
Rycroft RJ.
.I 90415
.U
88242235
.S
Contact Dermatitis 8809; 18(4):250-2
.M
Algae/*IM; Algae, Brown/*IM; Case Report; Dermatitis, Contact/DI/*ET; Human; Iodine/AE/*IM; Male; Middle Age; Occupational Dermatitis/DI/*ET; Patch Tests.
.T
Contact allergy to iodine in Japanese sargassum.
.P
JOURNAL ARTICLE.
.A
van der Willigen AH; Habets JM; van Joost T; Stolz E; Nienhuis PH.
.I 90416
.U
88242236
.S
Contact Dermatitis 8809; 18(4):252-3
.M
Adult; Case Report; Dermatitis, Contact/DI/*ET; Human; Ketoconazole/IM; Male; Patch Tests; Sulfites/*IM.
.T
Allergic contact dermatitis from sodium sulfite.
.P
JOURNAL ARTICLE.
.A
Vissers-Croughs KJ; van der Kley AM; Vulto AG; Hulsmans RF.
.I 90417
.U
88242237
.S
Contact Dermatitis 8809; 18(4):253
.M
Adult; Case Report; Dermatitis, Contact/DI/*ET; Female; Human; Patch Tests; Phenylenediamines/*AE; Rubber/AE.
.T
A case of allergic isopropyl-p-phenylenediamine (IPPD) dermatitis from a watch strap.
.P
JOURNAL ARTICLE.
.A
Foussereau J; Cavelier C; Protois JC.
.I 90418
.U
88242238
.S
Contact Dermatitis 8809; 18(4):254
.M
Dermatitis, Contact/*PC; Human; Resins/*IM; Sweden; Warts/*DT.
.T
Colophony-free wart removers in Sweden [letter]
.P
LETTER.
.A
Karlberg AT.
.I 90419
.U
88242239
.S
Contact Dermatitis 8809; 18(4):254-5
.M
Cobalt/*AN; Household Products/*AN; Hypochlorous Acids/*AN; Nickel/AN.
.T
Cobalt content of household cleaning products [letter]
.P
LETTER.
.A
Vilaplana J; Grimalt F; Romaguera C; Mascaro JM.
.I 90420
.U
88242361
.S
Dis Colon Rectum 8809; 31(6):423-6
.M
Aneuploidy; Colonic Neoplasms/*GE/PA; Colonic Polyps/*GE/PA; Diploidy; DNA, Neoplasm/AN/*GE; Flow Cytometry; Human; Risk Factors; Support, Non-U.S. Gov't.
.T
DNA aneuploidy in solitary colonic adenomas and the future risk of colorectal cancer.
.P
JOURNAL ARTICLE.
.W
Flow cytometric DNA analysis was performed on the colonic adenomas of 24 patients who had resection of an invasive colorectal carcinoma subsequent to polypectomy. The incidence of DNA aneuploidy among these adenomas was only 13 percent. Thus, simple recognition of colonic adenomas as being DNA diploid or DNA aneuploid is unlikely to be helpful for identifying patients with adenoma who are at high risk for developing a future colorectal carcinoma.
.A
Scott NA; Weiland LH; Dozois RR; Beart RW Jr; Lieber MM.
.I 90421
.U
88242362
.S
Dis Colon Rectum 8809; 31(6):427-9
.M
Carcinoma, Squamous Cell/SU; Cefamandole/*TU; Colonic Neoplasms/*SU; Colonic Polyps/SU; Female; Human; Intestinal Polyps/SU; Male; Middle Age; Premedication; Prospective Studies; Random Allocation; Rectal Neoplasms/*SU; Support, Non-U.S. Gov't; Surgical Wound Infection/*PC.
.T
A prospective, randomized trial of perioperative prophylactic cefamandole in elective colorectal surgery for malignancy.
.P
JOURNAL ARTICLE.
.W
The impact on wound infection of the addition of perioperative cefamandole to a mechanical bowel preparation with oral antibiotics was studied in a prospective randomized series of patients undergoing elective colectomy for biopsy-proven carcinoma or adenomatous polyps. Seventy patients were randomized, all underwent mechanical bowel preparation and received oral neomycin and erythromycin base. Thirty-four patients also received a preoperative and four postoperative doses of cefamandole, while 36 patients were randomized to receive no parenteral antibiotics. The two groups were well stratified for age, sex, and risk factors. The Dukes stage was similar and the surgical procedures were equally distributed in the two groups. There were no wound infections in the 34 patients receiving cefamandole and only one wound infection (2.8 percent) in the 36 control patients. Therefore, the addition of perioperative intravenous cefamandole to a good mechanical bowel preparation with oral antibiotics was of no benefit in reducing wound infections following resection of colorectal malignancies in this select group of patients.
.A
Petrelli NJ; Conte CC; Herrera L; Stulc J; O'Neill P.
.I 90422
.U
88242363
.S
Dis Colon Rectum 8809; 31(6):430-2
.M
Adult; Aged; Aged, 80 and over; Colonic Neoplasms/*PC; Colonic Polyps/*SU; Colonoscopy; Female; Human; Middle Age; Questionnaires; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Vitamins/*TU.
.T
Vitamin supplements among women with adenomatous polyps and cancer of the colon. Preliminary findings.
.P
JOURNAL ARTICLE.
.W
Chemoprevention of various epithelial cancers with vitamins or minerals has been the subject of multiple intervention trials to assess the impact of supplementation. These include several trials in patients with adenomatous polyps of the colon, a precursor lesion for colon cancer. The authors interviewed 255 women who underwent colonoscopy at Columbia Presbyterian Medical Center between 1983 and 1985 with a telephone-administered structured questionnaire. Eleven interviews were excluded for various reasons. Overall, 57.7 percent of the 244 interviewees used vitamin pills on a regular basis (at least once a week for a year); 6.6 percent of the interviewees used vitamin A, 20.7 percent used vitamin C, and 16.2 percent used vitamin E. There were no statistically significant differences in vitamin usage among women with adenomatous polyps of the colon (105 cases), women with colon cancer (56 cases), and women without colonic neoplasia (83 cases). Despite widespread use of supplementary vitamins, this study failed to demonstrate major benefits in preventing colon polyps or cancer.
.A
Neugut AI; Johnsen CM; Forde KA; Treat MR; Nims C.
.I 90423
.U
88242364
.S
Dis Colon Rectum 8809; 31(6):433-8
.M
Adult; Aged; Aged, 80 and over; Anus/*PH; Comparative Study; Electric Stimulation; Fecal Incontinence/*PP; Female; Hemorrhoids/*PP; Human; Male; Manometry; Middle Age; Sensory Thresholds; Support, Non-U.S. Gov't; Temperature.
.T
Anal sensation and the continence mechanism.
.P
JOURNAL ARTICLE.
.W
Thermal sensation is thought to be important in sensory discrimination between different substances. The aim of this study was to determine the thermal sensitivity in the anal canal in continent patients with hemorrhoids (N = 20), a group that has been reported to have a sensory deficit, and to compare the results with control subjects (N = 40) and patients with idiopathic fecal incontinence (IFI) (N = 22). Anal manometry was performed and sensation to mucosal electrostimulation and temperature change in the lower, middle, and upper zones of the anal canal assessed. Thermal sensation was impaired in the hemorrhoid group as compared with controls, but not to the same degree as in IFI (e.g., median thermal sensitivity in mid anal canal, control 0.9 degrees C, hemorrhoid 1.2 degrees C, IFI 2.0 degrees C, P less than .05 and less than .001, respectively). The correlation between the two tests of sensation was 0.54 (P less than .001) and the reproducibility of thermal sensory thresholds was 0.82 (P less than .001). In conclusion, patients with hemorrhoids have a mild anal sensory deficit, but continence in this group is likely to be augmented by other factors.
.A
Miller R; Bartolo DC; Roe A; Cervero F; Mortensen NJ.
.I 90424
.U
88242365
.S
Dis Colon Rectum 8809; 31(6):439-44
.M
Adult; Age Factors; Aged; Colonic Neoplasms/GE/PA; Colonoscopy; Colorectal Neoplasms, Hereditary Nonpolyposis/*PA; Female; Human; Male; Middle Age; Neoplasms, Multiple Primary/GE; Rectal Neoplasms/GE/PA; Support, U.S. Gov't, P.H.S..
.T
Natural history of colorectal cancer in hereditary nonpolyposis colorectal cancer (Lynch syndromes I and II).
.P
JOURNAL ARTICLE.
.W
Approximately 5 to 6 percent of the total colorectal cancer burden is accounted for by hereditary nonpolyposis colorectal cancer (HNPCC). Because clinical premonitory signs such as those seen in familial polyposis coli (FPC) are lacking, the clinician must recognize clinical findings and family history typical of HNPCC. The authors have described colorectal cancer expression from a survey of ten HNPCC kindreds. Kindred members with colorectal cancer differed significantly (P less than .05) from patients with sporadic colorectal cancer: 1) mean age of initial colon cancer diagnosis was 44.6 years; 2) 72.3 percent of first colon cancers were located in the right colon, and only 25 percent were in the sigmoid colon and rectum; 3) 18.1 percent had synchronous colon cancers; and 4) 24.2 percent developed metachronous colon cancer, with a risk for metachronous lesions in ten years of 40 percent. Affecteds and their first-degree relatives should undergo early intensive education and surveillance. In families with an early age of onset, colonoscopy should begin at age 25, and biannually thereafter, with fecal occult blood testing of the stool semiannually. Third-party carriers must become more responsive to the costly surveillance measures required for these otherwise healthy patients.
.A
Lynch HT; Watson P; Lanspa SJ; Marcus J; Smyrk T; Fitzgibbons RJ Jr; Kriegler M; Lynch JF.
.I 90425
.U
88242370
.S
Dis Colon Rectum 8809; 31(6):462-6
.M
Adenocarcinoma/PA; Aged; Aged, 80 and over; Anus Neoplasms/DT/*PA/SU; Case Report; Female; Fluorouracil/TU; Human; Male; Neoplasms, Multiple Primary/PA; Paget's Disease, Extra-Mammary/DT/*PA/SU; Rectal Neoplasms/PA.
.T
Perianal Paget's disease. Report of three cases.
.P
JOURNAL ARTICLE.
.W
Three cases of perianal Paget's disease are presented. Clinically, three patients had a chronic irritating perianal rash resistant to hydrocortisone cream. One patient had an underlying rectal adenocarcinoma. The controversies in the histogenesis of Paget's cells in perianal Paget's disease remain unresolved, but it appears that perianal Paget's disease probably is more than one disease and is biologically different from mammary Paget's disease.
.A
Tjandra J.
.I 90426
.U
88242371
.S
Dis Colon Rectum 8809; 31(6):467-9
.M
Adult; Anastomosis, Surgical; Anus/*SU; Case Report; Colitis, Ulcerative/SU; Defecation; Female; Human; Ileostomy/*MT; Reoperation.
.T
Kock's pouch converted to a pelvic pouch. Report of a case.
.P
JOURNAL ARTICLE.
.W
This study reports a patient previously operated upon with proctocolectomy and construction of a continent ileostomy (Kock pouch). The sphincter muscles, which were preserved by using the mucosal proctectomy technique, were used for conversion to a pelvic pouch five years later. The functional result was satisfactory and superior to that commonly seen in an average J-pouch patient. Patients with a continent ileostomy and in whom the rectum or sphincters have been preserved may be easily converted to a pelvic pouch, should they wish. Patients in whom a short mesentery prevents construction of a pelvic pouch, may be recommended a continent ileostomy as a temporary measure. Due to subsequent expansion of the reservoir, a restorative ileopouch-anal anastomosis may be possible at a later date. The good functional result in this case implies that the double folded reservoir according to Kock's original technique exhibits the same unique reservoir properties even when employed for an ileopouch-anal anastomosis.
.A
Hulten L; Fasth S; Nordgren S; Oresland T.
.I 90427
.U
88242372
.S
Dis Colon Rectum 8809; 31(6):470-3
.M
Adolescence; Buttocks/IN/SU; Case Report; Human; Male; Rectum/*IN/SU; Reoperation; Sacrum/*IN; Surgical Flaps/*.
.T
Reconstruction of partial rectal and sacral loss by gracilis and gluteus maximus muscle island transfer. Report of a case.
.P
JOURNAL ARTICLE.
.W
This study presents a rare case of extensive tissue loss from the posterior pelvic wall (gluteal, sacral, and perianal region) and from the intrapelvic organs (rectum) following unusual trauma. This patient underwent successful reconstruction by a method that has not been previously described. Rectal wall reconstruction was performed using gracilis muscle transfer, and sacral reconstruction was performed by gluteus maximus muscle island transfer. Three-year follow-up demonstrated a normal life pattern.
.A
Govila A.
.I 90428
.U
88242373
.S
Dis Colon Rectum 8809; 31(6):474-80
.M
Adult; Anus/EM; Fetus/AH; Hemorrhoids/CL/EM/*PA; Human; Male.
.T
Histoclinical basis for a new classification of hemorrhoidal disease.
.P
JOURNAL ARTICLE.
.W
The present classification of first, second, and third grade hemorrhoids only reflects variation in size of a normal human tissue and does not relate to "hemorrhoidal disease." Cross-sections and coronal sections of the anal canal in 32 fetuses, with ages ranging from 28 to 38 weeks of development, were studied and the following fundamental facts were found: in the lumen of the anal canals of fetuses, there are prominences of mucosa formed by conjunctive and muscular tissue, arterial and venous vessels and glands, arranged without following any particular pattern, which resemble similar formations found in the adult that protrude equally in the inside of the canal, known as hemorrhoids. The muscular tissue, smooth or striated, is grouped in bundles, and bunches of collagen fibers of homogeneous, nonfragmented, and regular aspect are found between them. Blood vessels have an ample lumen with a defined structure of collagen tissue as well as muscular tissue in its walls. Prominences of mucosa are connected to the remainder of the intestinal wall by defined conjunctive thick, nonfragmented fibers, that permit firm adherence. In healthy adults, the findings were similar but there was an evident degenerative process in the collagen fibers. In 100 surgical specimens of hemorrhoidectomies, the histologic investigation demonstrated a severe inflammatory reaction that especially affected the blood vessel wall and conjunctive tissue, which probably produced an ischemic lesion of the mucosa that could condition the onset of a vascular thrombosis, allowing displacement of the mucosa and its protrusion through the anus. The files of 815 patients suffering from hemorrhoidal disease were also studied. The main physical findings were bleeding, thrombosis of the internal hemorrhoidal plexus, prolapse of the anal cushions, or a combination of these. The authors propose to classify hemorrhoidal disease as bleeding, prolapsing, thrombotic, and mixed hemorrhoidal disease, aiming toward a rational treatment.
.A
Morgado PJ; Suarez JA; Gomez LG; Morgado PJ Jr.
.I 90429
.U
88242377
.S
Dis Colon Rectum 8809; 31(6):495-6
.M
Anastomosis, Surgical/AE; Colostomy/*; Human; Rectal Neoplasms/*SU.
.T
Complications after low anterior resection [letter]
.P
LETTER.
.A
Graffner H.
.I 90430
.U
88242380
.S
Dig Dis Sci 8809; 33(7):779-83
.M
Adult; Comparative Study; Dyspepsia/*DT; DTPA/DU; Female; Gastric Emptying/*DE; Human; Indium Radioisotopes/DU; Male; Middle Age; Piperidines/*TU; Technetium Tc 99m Sulfur Colloid/DU.
.T
Effect of cisapride on gastric emptying in dyspeptic patients.
.P
JOURNAL ARTICLE.
.W
The effect of the new gastrokinetic agent cisapride on gastric emptying was evaluated in 17 dyspeptic patients using the dual radionuclide technique. Eight patients with idiopathic dyspepsia and nine postsurgical dyspeptic patients were studied and compared to a control group. Gastric emptying of solids and liquids was determined after ingestion of a standardized meal using 99mTc-sulfur colloid scrambled eggs as the solid phase and [111In]DTPA-labeled water as the liquid phase. Following a basal study and on a separate occasion, each patient received an intravenous bolus of 10 mg of cisapride after ingestion of the test meal; 10 of the patients were restudied after a two-week period of chronic oral administration of the drug (10 mg four times a day). Baseline gastric emptying of solids was significantly delayed in idiopathic and postsurgical patients; liquid emptying was only delayed in the postsurgical group. Intravenous and oral administration of cisapride significantly shortened gastric emptying in both groups. In all but one patient, the clinical improvement was confirmed by the test. Cisapride appears to be a good alternative to metoclopramide and domperiodone in the treatment of dyspeptic patients. The dual radionuclide technique appears to be a useful physiologic tool for evaluating and predicting the efficacy of a gastric prokinetic therapy in man.
.A
Urbain JL; Siegel JA; Debie NC; Pauwels SP.
.I 90431
.U
88242381
.S
Dig Dis Sci 8809; 33(7):784-94
.M
Animal; Caloric Intake/*; Dogs; Duodenostomy; Female; Food, Formulated/*; Gastrectomy/*MT; Gastric Emptying/*; Gastrointestinal Motility/*; Postgastrectomy Syndromes/*PP; Pressure; Support, Non-U.S. Gov't; Viscosity.
.T
Effects of nutrients on gastrointestinal motility and gastric emptying after Billroth-I gastrectomy in dogs.
.P
JOURNAL ARTICLE.
.W
We wanted to clarify the way in which nutrients influence gastrointestinal motility and gastric emptying following distal gastrectomy with Billroth-I gastroduodenostomy. Four gastrectomized dogs were equipped with extraluminal strain gauge transducers. Gastric emptying was measured radiographically. Four intact dogs were used as controls for emptying studies. Following gastrectomy, gastric emptying of both acaloric and nutrient meals was rapid in the initial period of the experiments. Gastric outflow was supported by propagating duodenal contractions. Compared with control dogs, the early emptying of nutrient meals was accelerated. In the following period, nutrients markedly slowed gastric emptying compared with acaloric meals due to a segmenting contractile pattern of the duodenum and a significant diminution of gastrointestinal motility. Results suggest that after Billroth-I gastrectomy (1) the control of gastric emptying by nutrients acts too late to slow the initial enhanced gastric outflow, and (2) the duodenal contractile patterns influence gastric emptying.
.A
Buhner S; Ehrlein HJ; Thoma G; Schumpelick V.
.I 90432
.U
88242382
.S
Dig Dis Sci 8809; 33(7):795-800
.M
Animal; Body Weight; Cell Count; Chromaffin System/*PA; Enterochromaffin Cells/*PA; Gastric Mucosa/*PA; Gastrins/AN; Hyperplasia; Hypertrophy; Male; Organ Weight; Pyloric Stenosis/ET/*PA; Rats; Rats, Inbred Strains; Stomach/PA; Support, Non-U.S. Gov't.
.T
G-cell hyperplasia in rats with pyloric stenosis.
.P
JOURNAL ARTICLE.
.W
Since little is known about the pathophysiology of pyloric stenosis, we created a partial gastric outlet obstruction in 13 Wistar rats by placing a nonabsorbable ligature of defined size around the pylorus. Sham operations were performed in 10 rats. The animals from both groups were killed after four months. G-cell count and gastrin content were determined in 10 parallel strips, which were cut by razor blades mounted on a handle. Gastric size and weight as well as thickness of mucosal and muscular layers and serum gastrin concentration were also determined. Body weight of the animals with pyloric stenosis was lower and gastric weight higher than that of the controls. Furthermore, we found an enlarged G-cell area and G-cell hyperplasia, an increased surface area and thickness of the mucosal and muscular layers of the stomach, and in the majority of rats, elevated serum gastrin levels. Total G-cell count was 583,720 +/- 90,561 in the rats with pyloric stenosis and 385,775 +/- 15,820 (mean +/- SEM) in the control rats (P less than 0.04). We conclude that partial gastric outlet obstruction in rats leads to G-cell hyperplasia and that this experiment may serve as a model for pyloric stenosis in man.
.A
Feurle GE; Tischbirek K; Baca I.
.I 90433
.U
88242387
.S
Dig Dis Sci 8809; 33(7):824-7
.M
Duodenal Ulcer/*SU; Gastric Acid/*SE; Human; Male; Middle Age; Pepsinogen/*BL; Postoperative Period; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Time Factors; Vagotomy, Proximal Gastric/*.
.T
Effect of proximal gastric vagotomy on serum pepsinogen I and II concentrations and acid secretion in duodenal ulcer patients.
.P
JOURNAL ARTICLE.
.W
Acid secretion and basal serum pepsinogen I and II concentrations were measured in 14 duodenal ulcer patients before and at intervals up to six years after proximal gastric vagotomy. Vagotomy led to significant and long-standing reductions in basal, vagally mediated (induced by sham feeding), and peak pentagastrin-stimulated acid secretion. Serum pepsinogen I concentrations also decreased significantly after vagotomy but to a significantly lesser extent than acid secretion. There was no correlation between serum pepsinogen I concentrations and peak acid secretion, either before or after vagotomy. Serum pepsinogen II concentrations decreased only slightly and transiently after vagotomy. Thus, proximal gastric vagotomy reduces acid hypersecretion and pepsinogen I hypersecretion, but not pepsinogen II hypersecretion, in duodenal ulcer patients.
.A
Feldman M; Blair AJ 3d; Richardson CT; Samloff IM.
.I 90434
.U
88242388
.S
Dig Dis Sci 8809; 33(7):828-32
.M
Animal; Dogs; Female; Gastrointestinal Hormones/*PD; Male; Pancreas/BS/*DE/SE; Pancreatic Juice/*SE; Peptides/*PD; Regional Blood Flow; Support, Non-U.S. Gov't.
.T
Effect of natural peptide YY on blood flow and exocrine secretion of pancreas in dogs.
.P
JOURNAL ARTICLE.
.W
Little is known regarding the mechanism by which peptide YY exerts an inhibitory effect on exocrine pancreatic secretion. The purpose of this study is to determine if peptide YY affects pancreatic blood flow with simultaneous measurement of exocrine pancreatic secretion in dogs. Pancreatic blood flow was measured by a laser Doppler flowmeter which allows continuous measurement of tissue blood flow. Natural peptide YY (0.1, 0.5, 1 microgram/kg) was infused intravenously as a bolus under background infusion of secretin (1 unit/kg/hr) in combination with cholecystokinin-octapeptide (0.1 microgram/kg/hr). Peptide YY caused a reduction of pancreatic blood flow in a dose-dependent manner as well as inhibition of pancreatic protein output, attaining the maximal reduction (28 +/- 4%) and inhibition (45 +/- 9%) at a dose of 1 microgram/kg, respectively. Simultaneous and continuous observation on tissue blood flow and exocrine secretion of the pancreas revealed that there was a highly significant correlation between the percent reduction of pancreatic blood flow and that of volume of pancreatic juice in response to peptide YY (r = 0.849, P less than 0.001). This study provides evidence that the mechanism of peptide YY-induced inhibition of exocrine pancreatic secretion is mediated, at least partly, through the decreased pancreatic blood flow.
.A
Inoue K; Hosotani R; Tatemoto K; Yajima H; Tobe T.
.I 90435
.U
88242389
.S
Dig Dis Sci 8809; 33(7):833-8
.M
Ascites/*ET; Ascitic Fluid/*AN; Cholesterol/*AN; Comparative Study; Fibronectins/*AN; Hepatoma/*CO; Human; Liver Neoplasms/*CO; Peritoneal Neoplasms/*CO; Serum Albumin/*AN; Support, Non-U.S. Gov't.
.T
Diagnosis of malignant ascites. Comparison of ascitic fibronectin, cholesterol, and serum-ascites albumin difference.
.P
JOURNAL ARTICLE.
.W
The ascitic fluid concentrations of cholesterol and fibronectin and the serum-ascites albumin difference were compared with two conventional tests of ascitic fluid, total protein and LDH, in their diagnostic ability for detection of malignancy in ascitic samples from 69 patients with ascites: 54 with ascites due to liver disease and 15 whose ascites was caused by peritoneal metastases. Sixteen cirrhotic patients with superimposed hepatocellular carcinoma in whom ascites was of uncertain etiology were considered separately. The mean ascitic fluid total protein, LDH, cholesterol, and fibronectin values in the peritoneal metastases group were 3.70 +/- 1.20 g/dl, 247.26 +/- 148.14 units/liter, 109.06 +/- 29.85 mg/dl, and 91.57 +/- 41.52 micrograms/ml, respectively, and all were significantly higher than the corresponding values in the liver disease group (P less than 0.001), which were 1.37 +/- 0.59 g/dl, 75.40 +/- 110.70 units/liter, 23.75 +/- 11.22 mg/dl, and 31.86 +/- 10.51 micrograms/ml, respectively. Mean serum-ascites albumin difference in the peritoneal metastases group was 0.62 +/- 0.38 g/dl, which was significantly different from the corresponding value in the liver disease group (1.92 +/- 0.41 g/dl, P less than 0.001). Both ascitic cholesterol above 46 mg/dl and an ascitic fibronectin concentration greater than 50 micrograms/ml had high diagnostic accuracy (97%) for malignancy, being higher than that achieved using a serum-ascites albumin difference under 1.1 g/dl and an ascitic total protein above 2.5 g/dl, which had accuracies of 94% and 93%, respectively. Ascitic fluid LDH was the least reliable test. No differences in the ascitic fluid analysis were found between cirrhotic patients with and without hepatocellular carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Prieto M; Gomez-Lechon MJ; Hoyos M; Castell JV; Carrasco D; Berenguer J.
.I 90436
.U
88242392
.S
Dig Dis Sci 8809; 33(7):851-6
.M
Adult; Case Report; Delta Infection/*IM; Hepatitis B/*IM; Hepatitis B Antibodies/IM; Hepatitis B Surface Antigens/*IM; Hepatitis, Chronic Active/*IM; Homosexuality; Human; Liver/IM; Male; Substance Abuse; Time Factors.
.T
Permanent HBsAg clearance in chronic hepatitis B viral infection following acute delta superinfection.
.P
JOURNAL ARTICLE.
.W
Three patients are described with chronic hepatitis B virus infection for three to six years before hepatitis delta virus superinfection occurred. Liver biopsy performed in two patients prior to their delta illness revealed chronic persistent hepatitis and chronic active hepatitis, respectively. Within one to seven months of the acute delta event, all three patients lost their circulating hepatitis B surface antigen. Subsequently, delta antibody also cleared. Clinical well-being and normal transaminases were documented over 10-44 months of follow-up. Although most cases of delta infection in chronic hepatitis B result in severe or progressive disease, a small number of patients may develop clearance of the HBsAg with clearance of both B and delta infections.
.A
Chin KP; Govindarajan S; Redeker AG.
.I 90437
.U
88242393
.S
Dig Dis Sci 8809; 33(7):857-64
.M
Allopurinol/TU; Animal; Free Radicals; Gastric Mucosa/BS/*PA; Glutathione/AA/ME; Ischemia/*PA; Microscopy, Electron, Scanning; Oxygen/*TO; Papio; Shock, Hemorrhagic/*PA; Superoxide Dismutase/TU; Time Factors.
.T
Gastric mucosal lesions induced by hemorrhagic shock in baboons. Role of oxygen-derived free radicals.
.P
JOURNAL ARTICLE.
.W
In this study we sought to define the role of oxygen-derived free radicals during ischemia and reperfusion in the production of acute damage to the gastric mucosa of baboons. The protective effect of the xanthine oxidase inhibitor, allopurinol, the superoxide scavenger, superoxide dismutase (SOD), and a long-acting SOD-albumin was determined. Mucosal damage was evaluated using light and scanning electron microscopy. Evidence for oxidative insult to the gastric mucosa was sought by measuring tissue concentrations of reduced (GSH) and oxidized (GSSG) glutathione. Gastric mucosal blood flow was estimated using the microsphere technique. A similar pattern of tissue damage was found at the end of ischemia in all three groups. Thirty minutes after reperfusion, severe mucosal damage (grade 3) increased only in the untreated control. In the two treated groups, grade 3 damage remained unchanged during reperfusion and a decrease in the percentage of moderate damage (grade 2) was seen. Both GSH and GSSG tissue concentrations were lower in the untreated controls as compared to the scavenger-treated groups, making it questionable whether GSH/GSSG tissue levels adequately reflect oxidative stress. We conclude that in our ischemia-reperfusion model the generation of oxygen-derived free radicals produces mucosal damage and prevents the restitution of moderate mucosal damage during reperfusion. In ischemia, factors other than free radicals seem to be responsible for mucosal damage. The protective effect of allopurinol and SOD was not mediated by changes in gastric mucosal blood flow.
.A
von Ritter C; Hinder RA; Oosthuizen MM; Svensson LG; Hunter SJ; Lambrecht H.
.I 90438
.U
88242394
.S
Dig Dis Sci 8809; 33(7):865-71
.M
Alcohol, Ethyl/*TO; Animal; Antioxidants/TU; Free Radicals; Gastric Mucosa/*DE; Indomethacin/TU; Male; Oxygen/*TO; Premedication; Rats; Rats, Inbred Strains; Superoxide Dismutase/TU.
.T
Possible role of oxygen free radicals in ethanol-induced gastric mucosal damage in rats.
.P
JOURNAL ARTICLE.
.W
The involvement of oxygen free radicals in the development of the ethanol-induced gastric mucosal damage has been investigated. We found that oral administration of superoxide dismutase reduced the incidence of ethanol-induced mucosal lesions. Reduction of superoxide dismutase activity by diethyldithiocarbamate led to a pronounced aggravation of mucosal damage. Inhibition of the chloride-bicarbonate channel by a stilbene derivative also aggravated the ethanol-induced hemorrhagic lesions. Neither glutathione peroxidase, catalase, nor ceruloplasmin were capable of inhibiting the development of mucosal damage. Compounds with scavenging properties such as thiourea, 1-phenyl-3-(2-thiazolyl)-2-thiourea, dimethyl sulfoxide, various inorganic compounds (elements of the first and second subgroups and of the sixth group of the periodic table) and sulfhydryl-containing substances protected the gastric mucosa against ethanol-induced injury in a dose-related manner. Naturally occurring antioxidants such as alpha-tocopherol, beta-carotene, and coenzyme Q10 were ineffective. The present results suggest that superoxide free radicals are involved in the development of ethanol-induced gastric mucosal lesions, probably via an interaction with cellular membranes.
.A
Szelenyi I; Brune K.
.I 90439
.U
88242395
.S
Dig Dis Sci 8809; 33(7):872-7
.M
Alcohol, Ethyl/*TO; Animal; Blood Flow Velocity; Gastric Mucosa/BS/*DE/PA; Male; Microcirculation; Necrosis; Rats; Rats, Inbred Strains; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Time Factors.
.T
Microcirculatory stasis precedes tissue necrosis in ethanol-induced gastric mucosal injury in the rat.
.P
JOURNAL ARTICLE.
.W
The relation of blood flow stasis to the development of unequivocal histologic necrosis (loss of parietal cells from the column of contiguous cells) in ethanol-induced gastric mucosal injury was studied in anesthetized rats. The most rapid vascular change that occurred when the gastric mucosa was exposed to 100% ethanol was a severe segmental constriction of the large submucosal venules. At 22 sec, the average venular diameter was 52.2 +/- 6.0% of the original one. This was followed by complete superficial mucosal blood flow stasis at 49 +/- 4 sec and appearance of histologic evidence of necrosis in one of seven rats at 2.5 min, four of six rats at 10 min, and seven of seven rats at 60 min. We conclude that in ethanol-induced gastric mucosal injury, submucosal venular constriction occurs first, followed by cessation of mucosal blood flow to be followed later on with histologic evidence of necrosis.
.A
Bou-Abboud CF; Wayland H; Paulsen G; Guth PH.
.I 90440
.U
88242396
.S
Dig Dis Sci 8809; 33(7):878-82
.M
Animal; Duodenum/*ME; Gastric Mucosa/ME; Male; Pancreas/*ME; Rats; Rats, Inbred Strains; Shock/CO/*ME; Somatostatin/*ME; Stomach/*ME; Stomach Ulcer/ET; Support, Non-U.S. Gov't.
.T
Gastric, duodenal, and pancreatic somatostatin-like immunoreactivity during hypovolemic shock.
.P
JOURNAL ARTICLE.
.W
Because hypovolemic shock is known to cause gastric ulcers in animals and human beings, we investigated the tissue levels of somatostatin-like immunoreactivity (SLI) in the gastric corpus and antrum, duodenum, and pancreas during hypovolemic shock in rats. We studied male Wistar rats (N = 10 each) 15 min, 2 hr, and 12 hr after hypovolemic shock and compared results to a control group (N = 15). Two rats in both 2-hr and 12-hr groups showed gastric ulcers: three corporal and one antral. One animal developed multiple ulcers. In the gastric corpus and antrum and in the duodenum, tissue SLI showed significant decrease 15 min and 2 hr after shock. Gastric SLI remained low, whereas duodenal SLI recovered and rose above control level at 12 hr. Pancreatic SLI showed no significant changes during hypovolemic shock. Gastric tissue SLI levels that were significantly lower after shock than those of normal controls may have contributed to the peptic ulcer disease induced by hypovolemic shock in this experimental model.
.A
Wiles D; Yeginsu O; Ozden A; Covington SM; Rice J; Ertan A.
.I 90441
.U
88242397
.S
Dig Dis Sci 8809; 33(7):883-8
.M
Alcohol, Ethyl/PK/*TO; Animal; Blood Flow Velocity/DE; Blood Viscosity/DE; Capillary Permeability/*DE; Gastric Mucosa/BS/*DE; Male; Rats; Rats, Inbred Strains; Regional Blood Flow/DE; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Ethanol-induced gastric mucosal blood flow and vascular permeability changes in the rat.
.P
JOURNAL ARTICLE.
.W
Ethanol-induced gastric mucosal injury is accompanied by complete cessation of blood flow in the lesion area. An in vivo microscopy technique was used in the rat to determine whether this cessation of blood flow could be due to increased microvascular permeability with marked plasma exudation and a resultant increase in blood viscosity. The topical application of 100% ethanol to the mucosa caused complete stasis of mucosal blood flow within 1 min. Fluorescent in vivo microscopy revealed that topical ethanol also caused a prompt increase in mucosal microvascular permeability to albumin. This, however, did not explain the slowing and cessation of mucosal microvascular blood flow as these preceded the permeability change.
.A
Ohya Y; Guth PH.
.I 90442
.U
88242398
.S
Dig Dis Sci 8809; 33(7):889-96
.M
Animal; Digitoxin/*TO; Duodenal Ulcer/*CI/ME; Duodenum/*; Female; Gastric Acid/*SE; Intestinal Secretions/*SE; Pregnancy; Pregnancy Complications/*CI/ME; Rats; Support, Non-U.S. Gov't.
.T
Pathogenesis of digitoxin-induced duodenal ulcers in pregnant rats. Roles of gastric acid and duodenal alkaline secretion.
.P
JOURNAL ARTICLE.
.W
Late-stage pregnant rats (day 17) had higher rates of gastric acid secretion (45-55 mu eq/15 min) as compared to nonpregnant and middle-stage pregnant (day 10) rats (20-25 mu eq/15 min). In contrast, basal rates of duodenal alkaline secretion were significantly lower (2-3 mu eq/15 min) in pregnant rats (day 10 and 17) than those in nonpregnant rats (approximately 5 mu eq/15 min), although the duodenal mucosa responded to acid with a significant rise in HCO3- output in these three groups of rats. In pregnant rats (day 17), a single injection of digitoxin, a Na+ K+-ATPase inhibitor (10 mg/kg, subcutaneously), had no effect on basal acid and alkaline secretions, but significantly blocked the acid-induced HCO3- secretion for more than 18 hr from 6 hr after administration. This drug, when given once daily for four days (10 mg/kg, subcutaneously), produced well-defined ulcers in the proximal duodenum with few lesions in the stomach of female rats, and the severity and incidence were significantly higher in late-stage pregnant rats than in the other two groups of rats. Following repeated administration of digitoxin (10 mg/kg) to late-stage pregnant rats (days 17-20), acid secretion significantly declined after two days of treatment, while the acid-induced HCO3- secretion was significantly attenuated after one day of treatment and remained inhibited during the whole period. These results suggest that an impairment of the mechanisms related to acid-induced HCO3- secretion may be associated with the induction of duodenal ulcers caused by digitoxin in female rats, and the high incidence of these ulcers in late-stage pregnant rats may be due to acid hypersecretion.
.A
Furukawa O; Takeuchi K; Nishiwaki H; Okabe S.
.I 90443
.U
88242399
.S
Dig Dis Sci 8809; 33(7):897-912
.M
Animal; Duodenal Ulcer/*; Human; Stomach Ulcer/*.
.T
Abstracts of the sixth International Conference on Experimental Ulcer. August 28-31, 1988, Jerusalem, Israel.
.P
JOURNAL ARTICLE.
.I 90444
.U
88242952
.S
Diabetes 8809; 37(4):371-6
.M
Animal; Blood Glucose/ME; Body Weight; Bone and Bones/AN/ME; Cartilage/AN/ME; Collagen/*ME; Diabetes Mellitus, Experimental/*ME; DNA/AN; Male; Proteins/ME; Rats; Rats, Inbred Strains; Support, U.S. Gov't, P.H.S.; Time Factors.
.T
Decreased collagen production in diabetic rats.
.P
JOURNAL ARTICLE.
.W
Many of the chronic complications of diabetes mellitus involve defects in the connective tissue such as poor wound healing, diminished bone formation, and decreased linear growth. Because collagen is the major protein component of these connective tissues, we examined collagen production in diabetic rats as a probe of this generalized defect in connective tissue metabolism. Doses of streptozocin ranging from 35 to 300 mg/kg were used to induce diabetes of graded metabolic severity in rats. Parietal bone or articular cartilage was removed and incubated at 37 degrees C with 5 microCi L-[5-3H]proline for 2 h, and collagen and noncollagen protein production were quantitated after separation with purified bacterial collagenase. Within 2 wk after induction of diabetes, collagen production was significantly reduced in bone and cartilage from diabetic rats to 52% (P less than .01) and 51% (P less than .01) of control (buffer-injected) levels, respectively. In contrast, noncollagen protein production in bone and cartilage from diabetic animals was no different from in tissue from control rats. The correlation between collagen relative to total protein production (relative rate) and the degree of hyperglycemia was highly significant for both bone (r = -.77, P less than .001) and cartilage (r = -.87, P less than .001). Other factors found to correlate with altered collagen production were the duration of diabetes and the amount of weight loss. Thus, diabetes is associated with a marked decrease in collagen production, which was seen early after induction of diabetes and was specific when compared with noncollagen protein production. Cumulative effects of these marked changes in collagen production may contribute to the chronic connective tissue complications in diabetes.
.A
Spanheimer RG; Umpierrez GE; Stumpf V.
.I 90445
.U
88242957
.S
Diabetes 8809; 37(4):405-12
.M
Adult; Aged; Aging/ME; Blood Glucose/ME; Diabetes Mellitus, Non-Insulin-Dependent/BL/*CO/EP; Female; Human; Male; Middle Age; Minnesota; Proteinuria/BL/*EP/ET; Risk Factors; Sex Factors; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Epidemiology of persistent proteinuria in type II diabetes mellitus. Population-based study in Rochester, Minnesota.
.P
JOURNAL ARTICLE.
.W
Clinical risk factors for nephropathy were assessed in a population-based study of Rochester, Minnesota, residents with diabetes mellitus initially diagnosed between 1945 and 1969 (incidence cohort). The 1031 Rochester residents with non-insulin-dependent diabetes mellitus (NIDDM) were followed through their complete medical records in the community to 1 January 1982. The prevalence of persistent proteinuria was 8.2% at the diagnosis of NIDDM. Among those initially free of persistent proteinuria, the subsequent incidence was 15.3/1000 person-yr. Twenty years after the diagnosis of diabetes, the cumulative incidence of persistent proteinuria was 24.6%. A proportional hazards model identified the following risk factors for persistent proteinuria in NIDDM: elevated initial fasting blood glucose (P less than .01); older age at onset of diabetes (P less than .01); male gender (P = .05); and presence of macrovascular disease (P = .05), diabetic retinopathy (P = .05), or glycosuria (P = .07) at the diagnosis of diabetes. Separate analyses controlling for attained age indicated no association between duration of NIDDM and the incidence of persistent proteinuria. Stratified analysis of the two most significant risk factors (fasting blood glucose and age) indicated that hyperglycemia was a stronger risk factor for proteinuria in younger diabetic subjects, perhaps because of a competing risk of death in the elderly diabetic patient. In contrast to a recently described decreasing secular trend of proteinuria in Danish insulin-dependent diabetes mellitus patients, there was no decrease over the past 40 yr in proteinuria risk in this NIDDM incidence cohort.
.A
Ballard DJ; Humphrey LL; Melton LJ 3d; Frohnert PP; Chu PC; O'Fallon WM; Palumbo PJ.
.I 90446
.U
88242963
.S
Diabetes 8809; 37(4):446-51
.M
Adult; Autonomic Nervous System/*PP; Darkness; Diabetes Mellitus, Insulin-Dependent/*PP; Diabetic Retinopathy/PP; Female; Human; Male; Photic Stimulation; Pupil/PH; Reflex, Pupillary/*; Sensory Thresholds; Support, Non-U.S. Gov't; Vibration.
.T
Reduced pupillary unrest. Autonomic nervous system abnormality in diabetes mellitus.
.P
JOURNAL ARTICLE.
.W
Pupillary unrest (fluctuations in pupil size) was measured by infrared television videopupillography in 80 insulin-dependent diabetic patients (age 25-43 yr, diabetes duration 0-35 yr) and 26 control subjects (age 26-39 yr). In darkness, pupillary unrest was 21% less in diabetic subjects than in controls. During prolonged and brief illumination, pupillary unrest was 35 and 37% less in diabetic subjects than in controls, respectively, and in both cases the unrest was inversely correlated to the duration of diabetes. There were inverse correlations between 1) vibratory perception threshold, long-term high blood glucose levels, and severity of retinopathy, and 2) pupillary unrest in darkness and during prolonged illumination. The fractional reduction in pupil size (relative miosis) was 19% less during prolonged illumination in diabetic subjects than in controls and was positively correlated to the pupillary unrest in both groups. For a given fractional reduction in pupil size during illumination, diabetic subjects still had a smaller unrest than controls. Pupil size in darkness was 19% smaller in diabetic subjects than in controls, and in diabetic subjects it was positively correlated to the unrest in darkness and during prolonged and brief illumination. None of the pupillary abnormalities showed correlation to biomicroscopic changes in the iris. The autonomic nervous system abnormalities reflected in the pupil in longstanding diabetes are 1) a reduction in pupillary unrest in light and in darkness, more pronounced in light, 2) a reduction in the ability to maintain miosis in continuous light, and 3) a reduction in size.
.A
Hreidarsson AB; Gundersen HJ.
.I 90447
.U
88242968
.S
Diabetes 8809; 37(4):471-5
.M
Adult; Blood Glucose/ME; Diabetes Mellitus, Insulin-Dependent/*BL; Erythrocyte Deformability/*; Erythrocytes/*ME; Female; Human; Male; Phthalazines/*PD; Pyridazines/*PD; Sorbitol/*ME; Support, Non-U.S. Gov't.
.T
Effect of statil (ICI 128436) on erythrocyte viscosity in vitro.
.P
JOURNAL ARTICLE.
.W
The hypothesis that sorbitol accumulation could contribute to a reduced erythrocyte deformability in diabetes was investigated. Erythrocyte sorbitol and erythrocyte viscosity at high and low shear rates were studied in 20 insulin-dependent diabetic (IDDM) and 20 matched control subjects. An increased erythrocyte sorbitol and an increased low-shear erythrocyte viscosity were found in the IDDM patients, but there was no significant correlation (r = .11, NS) between the parameters. Incubation (3 h, 37 degrees C) in a Krebs buffer containing 33.3 mM glucose resulted in a significant sorbitol accumulation, but erythrocyte viscosity was not affected. Despite this fact, addition of 1 mM statil (ICI 128436) in the 5.5- and 33.3-mM glucose media not only prevented erythrocyte sorbitol accumulation but also improved erythrocyte viscosity in diabetic and control subjects. The effect was more pronounced at the low (approximately 16%) than at the high (approximately 2%) shear rate. The effect on erythrocyte viscosity disappeared by washing the erythrocytes after incubation, although erythrocyte sorbitol remained different. Our results suggest that sorbitol accumulation does not contribute to an increased erythrocyte viscosity in diabetes, and statil shows a positive effect on erythrocyte viscosity independent of its aldose reductase-inhibiting property.
.A
Rillaerts EG; Vertommen JJ; De Leeuw IH.
.I 90448
.U
88243124
.S
Hospitals 8809; 62(12):19
.M
Economics, Hospital/*TD; Evaluation Studies; Prospective Payment Assessment Commission/*; Prospective Payment System/*; United States.
.T
Hospitals stuck in pre-PPS mode: ProPAC reports.
.P
JOURNAL ARTICLE.
.A
Robinson ML.
.I 90449
.U
88243125
.S
Hospitals 8809; 62(12):20, 22-3
.M
American Hospital Association/*; Capital Financing/*TD; Commerce; Financial Management/*TD; Financial Management, Hospital/*TD; United States.
.T
AHA and Ponder put new twist on pooled financing.
.P
JOURNAL ARTICLE.
.A
Solovy AT.
.I 90450
.U
88243126
.S
Hospitals 8809; 62(12):23-4
.M
Community-Institutional Relations; Hospital Bed Capacity, 500 and over; Hospitals, Public/*OG; Ownership; Tennessee.
.T
Public hospital's conversion plans spook the locals.
.P
JOURNAL ARTICLE.
.A
Traska MR.
.I 90451
.U
88243128
.S
Hospitals 8809; 62(12):28
.M
Employment; Health Facilities/*LJ; Health Facility Closure/*LJ; Personnel Administration, Hospital/*LJ; Time Factors; United States.
.T
Plant closing provision would include hospitals.
.P
JOURNAL ARTICLE.
.A
Solovy AT.
.I 90452
.U
88243129
.S
Hospitals 8809; 62(12):30-1
.M
Health Services Accessibility/*EC; Insurance, Liability/*EC; Michigan.
.T
Michigan insurance costs threaten access to care.
.P
JOURNAL ARTICLE.
.A
Holthaus D.
.I 90453
.U
88243130
.S
Hospitals 8809; 62(12):31
.M
American Hospital Association/*; Insurance/*OG; Insurance Carriers/*OG; Insurance, Liability/*; United States.
.T
Health Providers plays broad role in liability insurance market.
.P
JOURNAL ARTICLE.
.A
Holthaus D.
.I 90454
.U
88243131
.S
Hospitals 8809; 62(12):32, 34
.M
Career Choice; Marketing of Health Services/*; New Jersey; Nursing Staff, Hospital/*SD; Societies/*; Societies, Hospital/*.
.T
Tackling the nursing shortage through marketing.
.P
JOURNAL ARTICLE.
.A
Droste T.
.I 90455
.U
88243132
.S
Hospitals 8809; 62(12):34
.M
Community-Institutional Relations; Consumer Satisfaction/*; Empathy; Hospital Administration/*ST; Human; Patient Advocacy/*; United States.
.T
Passion, compassion: managing quality through good customer service.
.P
JOURNAL ARTICLE.
.A
Droste T.
.I 90456
.U
88243134
.S
Hospitals 8809; 62(12):36-7
.M
Health Facilities/*; Health Facilities, Proprietary/EC; Health Facility Closure/*; Health Maintenance Organizations/*EC; United States.
.T
HMO sales signal Maxicare break-up.
.P
JOURNAL ARTICLE.
.A
Traska MR.
.I 90457
.U
88243136
.S
Hospitals 8809; 62(12):40-5
.M
Career Choice; Employment/*; Health Manpower/*; Hospitals; Marketing of Health Services; Minority Groups/*; Statistics; Training Support/TD; United States.
.T
Removing minority employment roadblocks.
.P
JOURNAL ARTICLE.
.A
Martinsons JN.
.I 90458
.U
88243138
.S
Hospitals 8809; 62(12):56
.M
Economic Competition/LJ; Medical Staff Privileges/*LJ; Medical Staff, Hospital/*LJ; Oregon; Peer Review/*LJ; United States; United States Federal Trade Commission.
.T
The Patrick case: will it hinder peer review?
.P
JOURNAL ARTICLE.
.A
Holthaus D.
.I 90459
.U
88243139
.S
Hospitals 8809; 62(12):60, 62
.M
Decision Making; Health Benefit Plans, Employee/*TD; Health Maintenance Organizations/*ST; Industry; Insurance, Health/*TD; United States.
.T
HMOs: employers shed casual attitudes, contracts.
.P
JOURNAL ARTICLE.
.A
Droste T.
.I 90460
.U
88243140
.S
Hospitals 8809; 62(12):62-3
.M
Ambulatory Care/EC; Catastrophic Illness/EC; Health Benefit Plans, Employee/*TD; Human; Insurance, Health/*TD; United States.
.T
Benefit trends: fewer incentives for outpatient.
.P
JOURNAL ARTICLE.
.A
Droste T.
.I 90461
.U
88243141
.S
Hospitals 8809; 62(12):64-5
.M
Career Choice; Faculty, Medical; Minority Groups/*; Physicians/*SD; United States.
.T
Minority roadblocks to the M.D. degree.
.P
JOURNAL ARTICLE.
.A
Koska MT.
.I 90462
.U
88243142
.S
Hospitals 8809; 62(12):65
.M
California; Medical Staff Privileges/*; Medical Staff, Hospital/*; Peer Review/*ST; United States.
.T
Is there a proctor in the house?
.P
JOURNAL ARTICLE.
.A
Koska MT.
.I 90463
.U
88243143
.S
Hospitals 8809; 62(12):65
.M
Constitution and Bylaws; Medical Staff, Hospital/*ST; Peer Review/*LJ; United States.
.T
Proper procedures are key to peer review legality experts say.
.P
JOURNAL ARTICLE.
.A
Koska MT.
.I 90464
.U
88243144
.S
Hospitals 8809; 62(12):66
.M
Facility Regulation and Control/*; Hospitals/*ST; Mortality; Quality of Health Care/*EC; State Government; United States.
.T
State regulation bounces back on quality issue.
.P
JOURNAL ARTICLE.
.A
Larkin H.
.I 90465
.U
88243145
.S
Hospitals 8809; 62(12):70-2
.M
Communication; Hospital Bed Capacity, 100 to 299; Job Satisfaction; Personnel Administration, Hospital/*; Strikes, Employee/*; West Virginia.
.T
The aftermath of a strike: "Everyone lost" [interview by Alden Solovy]
.P
JOURNAL ARTICLE.
.A
Graham R.
.I 90466
.U
88243146
.S
Hospitals 8809; 62(12):76, 78
.M
Capital Expenditures; Hospitals, Psychiatric/*EC; Neuropsychology/IS; Psychiatry/IS; Technology, High-Cost/*TD; United States.
.T
Costly equipment moves into psychiatric care.
.P
JOURNAL ARTICLE.
.A
Souhrada L.
.I 90467
.U
88243147
.S
Hospitals 8809; 62(12):78-9
.M
Data Collection; Health Facility Administrators/*; Hospital Administration/*; Hospital Administrators/*; Hospitals, Voluntary/*OG; Materials Management, Hospital/*OG; Role; United States.
.T
Not-for-profit CEOs reveal materials management ideals.
.P
JOURNAL ARTICLE.
.A
Souhrada L.
.I 90468
.U
88243148
.S
Hospitals 8809; 62(12):80
.M
Bacterial Infections/PC; Housekeeping, Hospital/TD; Human; Skin Diseases/TH; Ultrasonic Therapy/*TD; Ultrasonics; Wounds and Injuries/TH.
.T
New method sounds out bacteria in skin wounds.
.P
JOURNAL ARTICLE.
.A
Souhrada L.
.I 90469
.U
88243149
.S
Hospitals 8809; 62(12):84-5
.M
Automatic Data Processing/*UT; Data Collection; Hospital Departments/*OG; Medical Records Department, Hospital/*OG; Statistics; United States.
.T
Hospitals embrace medical records automation.
.P
JOURNAL ARTICLE.
.A
Packer CL.
.I 90470
.U
88243150
.S
Hospitals 8809; 62(12):85
.M
Attitude of Health Personnel/*; Computer Communication Networks/*; Computer Systems/*; Health Facilities/*; Nursing Staff, Hospital; Patients' Rooms/*; United States.
.T
Bedside terminals have nurses' support: study.
.P
JOURNAL ARTICLE.
.A
Cerne F.
.I 90471
.U
88243151
.S
Hospitals 8809; 62(12):86
.M
Durable Medical Equipment/*EC; Economic Competition/LJ; Florida; Hospital Administration/*LJ; Hospital Restructuring/*LJ; Industry; United States; United States Federal Trade Commission.
.T
Lawsuit prompts CEOs to examine DME ventures.
.P
JOURNAL ARTICLE.
.A
Koska MT.
.I 90472
.U
88243152
.S
Hospitals 8809; 62(12):96
.M
Communication; Financial Management/*; Financial Management, Hospital/*; Interprofessional Relations/*; Medical Staff, Hospital/*; United States.
.T
MD communication key to controlling utilization.
.P
JOURNAL ARTICLE.
.A
Goldsmith J.
.I 90473
.U
88243604
.S
J Appl Physiol 8809; 64(4):1322-6
.M
Animal; Guinea Pigs; Lung/AH/PA/*PH; Lung Compliance; Organ Weight; Postmortem Changes/*; Support, Non-U.S. Gov't.
.T
Prevention of abnormal pulmonary mechanics in the postmortem guinea pig lung.
.P
JOURNAL ARTICLE.
.W
Severe postmortem bronchoconstriction has been shown previously in guinea pig lungs and linked to pulmonary blood loss during exsanguination (Lai et al., J. Appl. Physiol. 56: 308-314, 1984). To reexamine this phenomenon we measured postmortem airway function in anesthetized open-chest guinea pigs after sudden circulatory arrest. Animals were divided into 4 groups of 10 and ventilated for 15 min postmortem with different gases: 1) room air, 2) conditioned air, 3) dry 5% CO2-21% O2-74% N2, and 4) conditioned 5% CO2-21% O2-74% N2. In room air-ventilated lungs there was a 50% decrease in dynamic compliance (Cdyn) by 15 min and marked gas trapping compared with control lungs. Conditioning the room air did not attenuate these changes, but when 5% CO2 was added to the conditioned postmortem inspirate, gas trapping was eliminated and the fall in Cdyn was almost abolished. Ventilation with a dry 5% CO2 gas mixture at room temperature resulted in a 31% fall in Cdyn at 15 min but no gas trapping. We conclude that marked abnormalities of airway function occur postmortem in room air-ventilated guinea pig lungs in the absence of pulmonary blood loss. The changes are mainly due to airway hypocarbia, a known cause of bronchoconstriction, but a reduction in Cdyn can also occur if there is marked airway cooling and drying. Acute postmortem airway dysfunction can be prevented in the guinea pig by maintaining normal airway gas composition.
.A
Reynolds AM; McEvoy RD.
.I 90474
.U
88243605
.S
J Appl Physiol 8809; 64(4):1327-32
.M
Animal; Blood Pressure; Female; Hyaluronic Acid/*ME; Hydrostatic Pressure; Lung/CY/*PH; Lymph/*PH; Lymph Nodes/PH; Male; Sheep; Support, Non-U.S. Gov't.
.T
Effect of increased hydrostatic pressure on lymphatic elimination of hyaluronan from sheep lung.
.P
JOURNAL ARTICLE.
.W
The effects of increased hydrostatic pressure on the concentrations of hyaluronan (hyaluronic acid) in lung lymph and serum were investigated in awake sheep with a cannula in the efferent vessel from the caudal mediastinal lymph node. Lung lymph was sampled at base line [left atrial pressure (LAP) 6.5 +/- 1.7 mmHg] and after two increases of LAP to 25.7 +/- 2.2 mmHg (level 1) and 37.0 +/- 5.1 mmHg (level 2). The lung lymph flow increased from 1.9 +/- 0.5 at base line to 9.3 +/- 2.2 and 15.9 +/- 0.7 ml/30 min, and the lymph-to-plasma concentration ratio of total protein decreased from 0.63 +/- 0.02 to 0.32 +/- 0.04 and 0.32 +/- 0.05 at the two elevated levels of LAP, respectively. The hyaluronan concentration in lung lymph was unchanged, and there was a flow-dependent elimination of hyaluronan from the lung that increased from 23 +/- 8 to 87 +/- 19 and 137 +/- 37 micrograms/30 min, respectively. The lung concentration of hyaluronan was 167 +/- 28 micrograms/g fresh lung, and at base line it was calculated that slightly less than 2% of the lung hyaluronan was eliminated by the lymphatic route in 24 h. If extrapolated to 24 h, the elimination rate of hyaluronan seen during elevated LAP would result in lymphatic elimination of 18% of the lung hyaluronan over this time period. Since hyaluronan is responsible for part of the protein exclusion in the extracellular matrix, it is plausible that washout of interstitial hyaluronan contributes to the decrease in albumin exclusion from the interstitium that occurs after an elevation of LAP.
.A
Lebel L; Smith L; Risberg B; Gerdin B; Laurent TC.
.I 90475
.U
88243606
.S
J Appl Physiol 8809; 64(4):1333-6
.M
Acclimatization/*; Animal; Catalase/*ME; Exertion/*; Kinetics; Lipid Peroxides/*ME; Liver/*EN; Male; Malondialdehyde/ME; Muscles/*EN; Rats; Rats, Inbred Strains; Superoxide Dismutase/*ME; Support, Non-U.S. Gov't.
.T
Lipid peroxidation and scavenger enzymes during exercise: adaptive response to training.
.P
JOURNAL ARTICLE.
.W
This study was designed to determine whether endurance training would influence the production of lipid peroxidation (LI-POX) by-products as indicated by malondialdehyde (MDA) at rest and after an acute exercise run. Additionally, the scavenger enzymes catalase (CAT) and superoxide dismutase (SOD) were examined to determine whether changes in LIPOX are associated with alterations in enzyme activity both at rest and after exercise. Male Sprague-Dawley rats (n = 32) were randomly assigned to either trained or sedentary groups and were killed either at rest or after 20 min of treadmill running. The training program increased oxidative capacity 64% in leg muscle. After exercise, the sedentary group demonstrated increased LIPOX levels in liver and white skeletal muscle, whereas the endurance-trained group did not show increases in LIPOX after exercise. CAT activity was higher in both red and white muscle after exercise in the trained animals. Total SOD activity was unaffected by either acute or chronic exercise. These data suggest that endurance training can result in a reduction in LIPOX levels as indicated by MDA during moderate-intensity exercise. It is possible that activation of the enzyme catalase and the increase in respiratory capacity were contributory factors responsible for regulating LIPOX after training during exercise.
.A
Alessio HM; Goldfarb AH.
.I 90476
.U
88243607
.S
J Appl Physiol 8809; 64(4):1337-45
.M
Afferent Pathways/*PH; Animal; Cats; Electric Stimulation; Evoked Potentials; Female; Laryngeal Nerves/*PH; Male; Motor Neurons/*PH; Neurons/*PH; Phrenic Nerve/*PH; Respiration/*; Spinal Cord/*PH; Support, U.S. Gov't, P.H.S.; Vagotomy.
.T
Influences from laryngeal afferents on expiratory bulbospinal neurons and motoneurons.
.P
JOURNAL ARTICLE.
.W
The purpose of this study is to analyze the reflex effects of laryngeal afferent activation on respiratory patterns in anesthetized, vagotomized, paralyzed, ventilated cats. We recorded simultaneously from the phrenic nerve, T10 internal intercostal nerve, and single bulbospinal expiratory neurons of the caudal ventral respiratory group (VRG). Laryngeal afferents were activated by electrical stimulation of the superior laryngeal nerve (SLN) or by cold-water infusion into the larynx. Both types of stimuli caused inhibition of phrenic activity and facilitation of internal intercostal nerve activity, indicating expiratory effort. The activity of 46 bulbospinal expiratory cells was depressed during SLN electrical stimulation, and 13 of them were completely inhibited. In 44 of 56 neurons tested, mean firing frequency (FFmean) was decreased in response to cold-water infusion and 8 others responded with increased FFmean; in the remaining 4 neurons, FFmean was unchanged. Possible reasons for different neuronal responses to SLN electrical stimulation and water infusion are discussed. We conclude that bulbospinal expiratory neurons of VRG were not the source of the reflex motoneuronal expiratory-like activity produced by SLN stimulation. Other, not yet identified inputs to spinal expiratory motoneurons are activated during this experimental condition.
.A
Jodkowski JS; Berger AJ.
.I 90477
.U
88243608
.S
J Appl Physiol 8809; 64(4):1346-53
.M
Adult; Airway Resistance; Anesthesia, Local/*; Human; Lidocaine; Male; Pharynx/*PH; Respiration/*; Sleep/*PH; Wakefulness/PH.
.T
Effects of upper airway anesthesia on pharyngeal patency during sleep.
.P
JOURNAL ARTICLE.
.W
Pharyngeal patency depends, in part, on the tone and inspiratory activation of pharyngeal dilator muscles. To evaluate the influence of upper airway sensory feedback on pharyngeal muscle tone and thus pharyngeal patency, we measured pharyngeal airflow resistance and breathing pattern in 15 normal, supine subjects before and after topical lidocaine anesthesia of the pharynx and glottis. Studies were conducted during sleep and during quiet, relaxed wakefulness before sleep onset. Maximal flow-volume loops were also measured before and after anesthesia. During sleep, pharyngeal resistance at peak inspiratory flow increased by 63% after topical anesthesia (P less than 0.01). Resistance during expiration increased by 40% (P less than 0.01). Similar changes were observed during quiet wakefulness. However, upper airway anesthesia did not affect breathing pattern during sleep and did not alter awake flow-volume loops. These results indicate that pharyngeal patency during sleep is compromised when the upper airway is anesthetized and suggest that upper airway reflexes, which promote pharyngeal patency, exist in humans.
.A
DeWeese EL; Sullivan TY.
.I 90478
.U
88243609
.S
J Appl Physiol 8809; 64(4):1354-8
.M
Asthma/*BL/PP; Asthma, Exercise-Induced/BL; Calcium/*BL; Exertion; Forced Expiratory Volume; Human; Reference Values; Support, Non-U.S. Gov't.
.T
Low plasma concentrations of ionized calcium in patients with asthma.
.P
JOURNAL ARTICLE.
.W
It has been suggested that calcium homeostasis is abnormal in the vascular smooth muscle of hypertensive patients and in the bronchial smooth muscle in asthmatics. We have found the mean baseline concentration of plasma ionized calcium to be significantly lower both in 12 asthmatics with exercise-induced asthma (EIA) [1.16 +/- 0.01 (SE) mmol/l, P less than 0.001] and in 20 asthmatics without EIA (1.16 +/- 0.01; P less than 0.001) compared with 42 healthy subjects (1.24 +/- 0.01). The mean concentrations of plasma ionized calcium were not significantly different in asthmatics with and without EIA when measured either before treadmill exercise, during the last seconds of this exercise, or 10 or 20 min after exercise but were significantly lower than in another seven healthy subjects who undertook the same exercise protocol. Total plasma calcium concentrations in the three exercising groups were not significantly different at any point in time. The results suggest that in bronchial asthma an alteration of calcium metabolism may be important, but they also suggest that there is no simple relationship between the plasma ionized calcium concentration and acute exercise-induced bronchoconstriction.
.A
Gugger M; Staubli M; Peheim E; Bachofen H.
.I 90479
.U
88243610
.S
J Appl Physiol 8809; 64(4):1359-68
.M
Elasticity; Human; Mathematics; Models, Anatomic; Models, Biological/*; Respiration/*; Trachea/*PH.
.T
A finite-element model of tracheal collapse.
.P
JOURNAL ARTICLE.
.W
The trachea has been approximated by an appropriate finite-element model. The three-dimensional equilibrium problems set by the tracheal deformation under various stresses have been solved using a convenient augmented Lagrangian functional. The dimensions were obtained from human tracheae. Mechanical constants for the anatomic components were calculated from the stress-strain relationships. The compressive narrowing is essentially due to the invagination of the posterior membrane in the tracheal lumen for transmural pressures down to -7 kPa. A surface of contact between the membranous wall and the lateral walls appears when the transmural pressure equals -6 kPa. The transmural pressure-area relationship is sigmoidal with a compliance equal to 0.08 kPa-1 for a transmural pressure of -2 kPa. The tracheal collapse is greater when the material constants of the membranous wall decrease or when the tracheal segment is subjected to a longitudinal tension. A slight flexion of the trachea induces an asymmetric deformation.
.A
Begis D; Delpuech C; Le Tallec P; Loth L; Thiriet M; Vidrascu M.
.I 90480
.U
88243612
.S
J Appl Physiol 8809; 64(4):1376-81
.M
Animal; Benzoflavones/*PD; Comparative Study; Cytochrome P-450/*BI; Enzyme Induction; Flavones/*PD; Male; Methylcholanthrene/*PD; Mice; Mice, Inbred C57BL; Mice, Inbred DBA; Microsomes, Liver/DE/*ME; Oxygen/*TO; Phenobarbital/*PD; Pulmonary Edema/ET/GE/*PC; Species Specificity.
.T
Genetic differences in response to pulmonary cytochrome P-450 inducers and oxygen toxicity.
.P
JOURNAL ARTICLE.
.W
The effects of cytochrome P-450 inducers on O2 toxicity were studied in mice. We first examined three cytochrome P-450 inducers, which differ by their specific tissue affinity: phenobarbital sodium (PB), essentially active in the liver, and 3-methylcholanthrene (3-MC) and beta-naphthoflavone (BNF), which are also active in the lung. Both BNF and 3-MC increased the survival rate and significantly decreased pulmonary edema (pulmonary water and wet-to-dry weight ratio) in C57BL/6J mice exposed to hyperoxia (O2 greater than or equal to 95%), whereas PB had no protective effect. In the second part of this study, we compared the action of BNF in two strains of mice. In one (C57BL/6J), cytochrome P-450 can be induced by aromatic hydrocarbons, whereas in the other (DBA/2J) cytochrome P-450 is not inducible by these compounds. Protection against O2 toxicity was assessed in terms of lethality and pulmonary edema and of lung lipid peroxidation (assessed by measuring malondialdehyde). BNF only protected against O2 toxicity in the inducible strain. This protective effect of BNF on O2 toxicity in C57BL/6J mice was associated mainly with a large increase in the components of the cytochrome P-450 system (cytochrome P-450 and cytochrome b5) in the lung. The activity of pulmonary superoxide dismutase was also slightly increased, but the enhancement was not statistically significant. In contrast, in DBA/2J mice neither the components of the cytochrome P-450 system nor the activity of superoxide dismutase showed any increase.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Mansour H; Levacher M; Azoulay-Dupuis E; Moreau J; Marquetty C; Gougerot-Pocidalo MA.
.I 90481
.U
88243613
.S
J Appl Physiol 8809; 64(4):1382-6
.M
Adolescence; Altitude/*; Anaerobiosis; Anthropometry; Child; Comparative Study; Energy Metabolism/*; Exertion; Human; Kinetics; Lactates/BL; Male; Puberty/*; Saliva/AN; Support, Non-U.S. Gov't; Testosterone/ME.
.T
Anaerobic metabolism during pubertal development at high altitude.
.P
JOURNAL ARTICLE.
.W
In a previous study we showed that there were no differences in anaerobic metabolism between groups of 11-yr-old children living at high (3,700 m) and low (330 m) altitudes. The aim of this study is to investigate changes in this metabolism during pubertal development. We compare blood lactate concentration ([L]) after maximal bicycle exercise in 20 boys acclimatized to high altitude (HA, 12 yr old) and at low altitude in 14 boys (LA1, 12 yr old) and in 13 boys (LA2, 14 yr old). The subjects had the same level of physical fitness and the same nutritional and socioeconomic status. Pubertal development was identified by salivary testosterone concentration ([T]). Results (means +/- SE) showed 1) at the age of 12 years, [L] and [T] in HA were significantly higher than in LA1 ([L] was 9.2 +/- 0.5 vs. 6.8 +/- 0.5 mmol/l, [T] was 233 +/- 66 vs. 132 +/- 30 pmol/l), 2) [L] and [T] in HA were statistically the same as in LA2, and 3) a linear relationship between [L] and [T] was significant (P less than 0.05) in all HA and LA subjects. This suggests that the higher [L] in 12-yr-old boys living at HA could result in an enhanced anaerobic metabolism linked to an earlier gonadal maturation evaluated by testosterone level.
.A
Fellmann N; Bedu M; Spielvogel H; Falgairette G; Van Praagh E; Jarrige JF; Coudert J.
.I 90482
.U
88243614
.S
J Appl Physiol 8809; 64(4):1387-96
.M
Acoustic Impedance Tests; Airway Obstruction/*PP; Airway Resistance/*; Animal; Disease Models, Animal; In Vitro; Lung/*PH/PP; Support, Non-U.S. Gov't; Swine.
.T
Site of airway obstruction: effects on the acoustic impedance of excised pig lungs.
.P
JOURNAL ARTICLE.
.W
We investigated the relationship between the site of airway obstruction and the frequency dependence (FD) of lung acoustic impedance (ZL). The real (RL) and imaginary (XL) parts of ZL were measured by forced random noise in excised left pig lungs, before (base line) and after 1) no airway obstruction (controls, n = 10), 2) insufflation of 1-mm (B1, n = 5) or 2-mm (B2, n = 7) beads, and 3) partial reversible obstruction of lower lobar (LL) and then main-stem (MS) bronchus (n = 4). The beads caused both partial and total obstruction of airways with internal diameters of 2 mm (B1) and 2-6 mm (B2). Compared with base line, a negative FD of RL appeared from 4 to 10 Hz in LL, B1, and B2 obstructions. The FD of XL greater than 20 Hz increased in MS and LL obstruction exclusively and was the ZL feature that most clearly differentiated central from peripheral obstruction. In this experimental model, the anatomic limit distal from which obstruction no longer causes the "central" type of ZL change lies in airways with internal diameters notably greater than 2 mm.
.A
Feihl F; Simon N; Jaeggi C; Depeursinge C; Perret C.
.I 90483
.U
88243615
.S
J Appl Physiol 8809; 64(4):1397-404
.M
Adult; Energy Metabolism/*; Fatigue; Female; Human; Male; Mathematics; Models, Biological; Pressure; Respiration/*; Respiratory Muscles/*PH; Time Factors.
.T
Pressure-time product, work rate, and endurance during resistive breathing in humans.
.P
JOURNAL ARTICLE.
.W
We examined the effect of increasing work rate, without a corresponding increase in the pressure-time product, on energy cost and inspiratory muscle endurance (Tlim) in five normal subjects during inspiratory resistive breathing. Tidal volume, mean inspiratory mouth pressure, duty cycle, and hence the pressure-time product were kept constant, whereas work rate was varied by changing the frequency of breathing. There was a linear decrease in Tlim of -2.1 +/- 0.5 s.J-1.min-1 (r = 0.87 +/- 0.06) with increasing work rate. The data satisfied a model of energy balance during fatiguing runs (Monod and Scherrer. Ergonomics 8: 329-337, 1965) and were consistent with the hypothesis that the rate of energy supply, or respiratory muscle blood flow, is fixed when the pressure-time product is constant. Our results indicate that during inspiratory resistive breathing against fatiguing loads, work rate determines endurance independently of the pressure-time product. On the basis of the model, our results lead to estimates of respiratory muscle blood flow and available energy stores under the conditions of our experiment.
.A
Dodd DS; Kelly S; Collett PW; Engel LA.
.I 90484
.U
88243616
.S
J Appl Physiol 8809; 64(4):1405-11
.M
Animal; Brain Stem/PH; Cats; Facial Nerve/*PH; Female; Kainic Acid; Male; Medulla Oblongata/*PH; Organ Specificity; Phrenic Nerve/*PH; Pons/PH; Reference Values; Respiration/*; Support, U.S. Gov't, P.H.S..
.T
Respiratory neural activities after caudal-to-rostral ablation of medullary regions.
.P
JOURNAL ARTICLE.
.W
The purpose is to assess the importance of medullary mechanisms for the neurogenesis of eupnea. Cats that were used were decerebrate, cerebellectomized, vagotomized, paralyzed, and ventilated. Activities of the phrenic, facial, and mylohyoid nerves were monitored. Progressive caudal-to-rostral transections of the spinal cord and medulla were performed. Phrenic activity was eliminated by C1 spinal transections. Only modest changes in facial and mylohyoid activities resulted from transections as far rostral as the level of the dorsal respiratory nucleus. Rhythmic discharges ceased on transections at the pontomedullary junction. However, rhythmic mylohyoid discharges were maintained if protriptyline and strychnine were administered before and during the transection. In other studies rhythmic phrenic, facial, and mylohyoid discharges continued, albeit with an altered rhythm, after destruction of neurons in the dorsal respiratory nucleus by kainic acid. We conclude that caudal medullary mechanisms do not play an essential role in the neurogenesis of breathing movements. Rather, structures in rostral medulla and pons appear necessary for sustaining eupneic neural activities. The concept of multiple brain stem sites for ventilatory neurogenesis is discussed.
.A
Huang Q; St. John WM.
.I 90485
.U
88243617
.S
J Appl Physiol 8809; 64(4):1412-20
.M
Apnea/PP; Comparative Study; Human; Infant, Newborn; Infant, Premature/*; Larynx/DE/*PH/PP; Reflex; Sodium Chloride/*PD; Support, U.S. Gov't, P.H.S.; Theophylline/TU; Water.
.T
Upper airway chemoreflex responses to saline and water in preterm infants.
.P
JOURNAL ARTICLE.
.W
Laryngeal chemoreflex (LCR) responses elicited by fluid irrigation of the larynx have been described repeatedly in animals, whereas evidence for a similar reflex in human infants is extremely limited. Using nasopharyngeal catheters to instill small volumes of warm saline or water into the pharynx, we examined the incidence and characteristics of such a reflex in nine premature infants. Saline and water elicited the same pattern of responses, which frequently included swallows, central apnea, and airway obstruction and less commonly featured coughs, prolonged apnea, and arousal. With the exception of arousal, the incidence of these responses was significantly greater after delivery of water stimuli than after saline bolus administration. We therefore deduce chemoreceptor involvement in generation of these reflex responses and propose a laryngeal site for this sensory system, as in animals. Since greater potency of water compared with saline was demonstrable in all the infants studied, we further conclude that most preterm infants possess an upper airway chemoreflex.
.A
Davies AM; Koenig JS; Thach BT.
.I 90486
.U
88243618
.S
J Appl Physiol 8809; 64(4):1421-7
.M
Adenosine Triphosphate/ME; Central Nervous System/*PH; Electric Stimulation; Energy Metabolism/*; Exertion/*; Fatigue; Female; Glycogen/ME; Human; Isometric Contraction; Lactates/ME; Male; Muscle Contraction/*; Muscles/*PH; Phosphocreatine/ME; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Motor drive and metabolic responses during repeated submaximal contractions in humans.
.P
JOURNAL ARTICLE.
.W
Contractile failure during various types of exercise has been attributed to intramuscular metabolic changes. We examined the temporal changes in force-generating capacity and metabolic state during intermittent isometric contractions in humans. One-legged quadriceps contractions at 30% maximum voluntary contraction (MVC) were executed for 6 s, with 4 s of rest between. The decrease in force-generating capacity was tested from brief MVC's and short bursts of 50-Hz stimulation applied at 5-min intervals. After 1 min of exercise, the MVC force declined linearly and in parallel to the 50-Hz stimulation force, indicating that the contractile failure was due to intramuscular processes. After 30 min of exercise the MVC force had declined by approximately 40% compared with the value obtained after 1 min. In separate experiments the same contraction protocol was followed, but two-legged contractions were used. Muscle biopsies taken after 5, 15, and 30 min of exercise showed only minor changes in the concentrations of glycogen, lactate, creatine phosphate (CrP), and ATP. However, at exhaustion, defined as loss of ability to sustain the target force, the concentrations of CrP and glycogen were reduced by 73 and 32%, and muscle lactate concentration had increased to 4.8 mmol/kg wet wt. Thus the gradual decline in force-generating capacity was not due to lactacidosis or lack of substrates for ATP resynthesis and must have resulted from excitation/contraction coupling failure, whereas exhaustion was closely related to phosphagen depletion, without significant lactacidosis.
.A
Vollestad NK; Sejersted OM; Bahr R; Woods JJ; Bigland-Ritchie B.
.I 90487
.U
88243621
.S
J Appl Physiol 8809; 64(4):1439-44
.M
Adenosine Triphosphate/ME; Adult; Blood Pressure/DE; Electric Stimulation; Energy Metabolism/DE; Epinephrine/AD/*PD; Female; Glycogen/*ME; Glycogen Phosphorylase/ME; Glycolysis/DE; Heart Rate/DE; Human; Infusions, Intravenous; Isometric Contraction/*DE; Male; Muscle Contraction/*DE; Muscles/DE/ME/*PH; Phosphocreatine/ME; Reference Values; Support, Non-U.S. Gov't.
.T
Epinephrine infusion enhances muscle glycogenolysis during prolonged electrical stimulation.
.P
JOURNAL ARTICLE.
.W
To determine the effects of epinephrine (EPI) infusion on muscle glycogenolysis and force production, the quadriceps muscles of both legs in six subjects were intermittently stimulated for 30 min. Contractions lasted 1.6 s (20 Hz) and were separated by 1.6 s of rest. EPI was infused (approximately 0.14 micrograms.kg body wt-1.min-1) in one leg during the last 15 min and the vastus lateralis was biopsied at rest (control leg only) and after 15, 18 (EPI leg only), and 30 min of stimulation. EPI infusion doubled the mole fraction of phosphorylase a (22.5 +/- 4.1 to 44.8 +/- 9.0%) and glycogenolysis (2.16 +/- 0.72 to 5.45 +/- 0.81 mmol glucosyl U.kg dry muscle wt-1.min-1) during stimulation. Muscle glucose 6-phosphate increased from 3.04 +/- 0.17 to 6.43 +/- 0.20 mmol/kg dry muscle wt, and lactate increased from 25.8 +/- 4.4 to 34.3 +/- 4.6 mmol/kg after 3 min of EPI infusion. Isometric force production was unaltered by EPI infusion. These results demonstrate a strong glycogenolytic effect of EPI infusion during prolonged electrical stimulation and suggest that the extra pyruvate formed was converted mainly to lactate. Exclusive anaerobic metabolism of the extra substrate would provide only a 10% increase in total ATP production, possibly accounting for the lack of improvement in force production. We suggest that the decrease in force production during prolonged electrical stimulation is related to decreased excitation of the contractile mechanism rather than inhibition of cross-bridge turnover caused by a shortage of energy or accumulation of hyproducts.
.A
Spriet LL; Ren JM; Hultman E.
.I 90488
.U
88243622
.S
J Appl Physiol 8809; 64(4):1445-50
.M
Adult; Aminophylline/*PD; Anoxia/*PP; Comparative Study; Female; Human; Male; Reference Values; Respiration/*/DE; Support, Non-U.S. Gov't.
.T
Ventilatory response to sustained hypoxia after pretreatment with aminophylline.
.P
JOURNAL ARTICLE.
.W
During sustained hypoxia the decline in ventilation that occurs in normal adult humans may be related to central accumulation of a neurochemical with net inhibitory effect. Recent investigations have shown that the putative neurotransmitter adenosine can effect a prolonged respiratory inhibition. Therefore we evaluated the possible role of adenosine in the hypoxia ventilatory decline by employing aminophylline as an adenosine blocker. We evaluated the ventilatory response to 25 min of sustained hypoxia (80% arterial O2 saturation), in eight young adults after pretreatment with either intravenous saline or aminophylline. With a mean serum aminophylline level of 15.7 mg/l, over 25 min of sustained hypoxia, peak hypoxic ventilation decreased by only 12.8% compared with 24.8% with saline, a significant difference. However, the ventilatory decline during sustained hypoxia was not abolished by the aminophylline pretreatment. Unlike the usual tidal volume-dependent attenuation of hypoxic ventilation exhibited after saline, after aminophylline the ventilatory decline was achieved predominantly through alterations in respiratory timing. Thus aminophylline pretreatment did alleviate the hypoxic ventilatory decline, although the associated alterations in breathing pattern were uncharacteristic. We conclude that adenosine may play a contributing role in the hypoxic ventilatory decline.
.A
Easton PA; Anthonisen NR.
.I 90489
.U
88243624
.S
J Appl Physiol 8809; 64(4):1457-65
.M
Animal; Cerebrovascular Circulation/*; Comparative Study; Electromyography; Goats; Male; Respiration/*; Sleep/PH; Sleep, REM/*PH; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Wakefulness/PH.
.T
Linkage between brain blood flow and respiratory drive during rapid-eye-movement sleep.
.P
JOURNAL ARTICLE.
.W
The correlation between brain blood flow (BBF) and respiratory neuromotor output, as reflected by diaphragmatic electromyogram (EMG) activity (EMGdi), was studied during wakefulness, rapid-eye-movement (REM) sleep, and non-REM sleep (NREM). Compared with the awake state, mean BBF increased by 4.7% during NREM and by 32.6% during REM (P less than 0.001). Also, surges of BBF during REM occurred during periods of intense phasic activity. EMGdi [peak and peak/inspiratory time (TI)] was highly variable within REM periods but fluctuated as a reciprocal function of simultaneously measured BBf (r = -0.49, P less than 0.001). Furthermore, mean EMGdipeak decreased from NREM to REM in a manner reciprocally related to the corresponding change in BBF (r = -0.77, P = 0.015). These findings suggest that a component of the reduction of respiratory neuromotor output during REM is attributable to increased BBF with consequent relative hypocapnia in the central chemoreceptor environment.
.A
Parisi RA; Neubauer JA; Frank MM; Santiago TV; Edelman NH.
.I 90490
.U
88243625
.S
J Appl Physiol 8809; 64(4):1466-71
.M
Adenosine Triphosphatase, Calcium/ME; Animal; Body Weight; Diastole; Exertion/*; Female; Heart/*PH; Hemodynamics; Myocardial Contraction/*; Myocardium/EN; Myosin/ME; Organ Weight; Rats; Rats, Inbred Strains; Support, U.S. Gov't, P.H.S.; Swimming; Systole/*.
.T
Effects of systolic overload and swim training on cardiac mechanics and biochemistry in rats.
.P
JOURNAL ARTICLE.
.W
We have previously shown that swim conditioning corrects the depressed mechanical function and myosin adenosinetriphosphatase (ATPase) activities associated with renovascular hypertension (HTN) in the rat. The present study was designed to assess the effects of swim conditioning on another form of systolic overload, subdiaphragmatic suprarenal aortic stenosis. Cardiac mechanics in an isolated working heart apparatus and myosin enzymology were studied in four groups of rats: controls (C), animals with chronic systolic overload secondary to aortic constriction (St), swim-conditioning animals (Sw), and animals exposed to a combined load (St-Sw). Heart weight was increased by 23% in St, 27% in Sw, and 36% in St-Sw. In contrast to HTN, cardiac pump and muscle function were not depressed in St. Sw was associated with improved cardiac output, stroke work, and velocity of circumferential fiber shortening. St-Sw showed improved mechanical cardiac performance relative to both C and St. The percent of ventricular myosin of the V1 type and Ca2+-activated myosin ATPase activity relative to C was unchanged in Sw but was depressed in St and St-Sw. These data demonstrate that the salutory mechanical effects of Sw can be superimposed on the systolic overload of St. However, the dissociation between mechanics and myosin enzymology suggests that factors in excitation-contraction coupling other than myosin isoenzyme shifts are responsible for this finding.
.A
Buttrick PM; Malhotra A; Scheuer J.
.I 90491
.U
88243626
.S
J Appl Physiol 8809; 64(4):1472-9
.M
Adult; Anthropometry; Body Composition; Exertion/*; Female; Human; Male; Muscles/*AH/PH; Oxygen/BL; Respiration; Support, Non-U.S. Gov't.
.T
Muscle mass as a factor limiting physical work.
.P
JOURNAL ARTICLE.
.W
Maximal exercise has been performed by eight men and eight women, using four types of ergometer (2-leg, 1-leg, arm + shoulder, and arm) while breathing room air and while breathing 12% O2. Results have been related to anthropometric estimates of muscle mass in the active limbs. Although significant sex differences of O2 transfer and power output are shown, the sex-specific aerobic performance was roughly proportional to active muscle volume (both when comparing individuals on a given type of ergometer and when comparing average scores of the several types of ergometer). However, the relationship was closer for steady power output than for peak O2 intake (where the scores for arm work were boosted by the use of accessory muscles and by hyperventilation). When breathing 12% O2, the 2-leg performance was substantially reduced (an average of 28.7% for O2 transport and 19.2% for power output). This effect dropped to 9.1% for O2 transport and 12% for power output in one-leg ergometry and was negligible for arm or arm plus shoulder work. It is argued that because of difficulty in perfusing small muscles, arm work is limited largely by the intrinsic power of the active muscles, that single-leg ergometry is limited rather equally by central circulatory and muscular factors, and that two-leg ergometry is almost entirely dependent on the central circulatory transport of O2.
.A
Shephard RJ; Bouhlel E; Vandewalle H; Monod H.
.I 90492
.U
88243628
.S
J Appl Physiol 8809; 64(4):1486-92
.M
Acclimatization; Anoxia/*PP; Comparative Study; Exertion; Heart Rate; Human; Male; Oxygen Consumption/*; Oxyhemoglobins/ME; Respiration.
.T
Linear relationship between VO2max and VO2max decrement during exposure to acute hypoxia.
.P
JOURNAL ARTICLE.
.W
The purpose of these experiments is to test the hypothesis that exercise-induced hypoxemia at sea level in highly trained athletes might be exacerbated during acute hypoxia and therefore result in correspondingly larger decrements in maximal O2 uptake (VO2max) compared with less trained individuals. Thirteen healthy male volunteers were divided into two groups according to their level of fitness: 1) trained endurance athletes (T) (n = 7), with a VO2max range of 56-75 ml.kg-1.min-1 and 2) untrained individuals (UT) (n = 6), with a VO2max range of 33-49 ml.kg-1.min-1. Subjects performed two incremental cycle ergometry tests to determine VO2max under hypoxic conditions [14% O2-86% N2, barometric pressure (PB) = 760 Torr] and normoxic conditions (21% O2-79% N2, PB = 760 Torr). Tests were single blind, randomly administered, and separated by at least 72 h. Mean percent oxyhemoglobin saturation (%SaO2) during maximal exercise under hypoxic conditions was significantly (P less than 0.05) lower in the T group (77%) compared with the UT group (86%). Furthermore, the T group exhibited larger decrements (P less than 0.05) in VO2max (normoxic-hypoxic) compared with the UT group. Finally, a significant linear correlation (r = 0.94) existed between normoxic VO2max (ml.kg-1.min-1) and delta VO2max (normoxic-hypoxic). These data suggest that highly T endurance athletes suffer more severe gas exchange impairments during acute exposure to hypoxia than UT individuals, and this may explain a portion of the observed variance in delta VO2max among individuals during acute altitude or hypoxia exposure.
.A
Lawler J; Powers SK; Thompson D.
.I 90493
.U
88243630
.S
J Appl Physiol 8809; 64(4):1500-5
.M
Adult; Comparative Study; Elbow Joint/PH; Electromyography; Exertion/*; Human; Isometric Contraction/*; Male; Muscle Contraction/*; Muscles/IR/*PH; Support, Non-U.S. Gov't.
.T
Myoelectrical and mechanical changes linked to length specificity during isometric training.
.P
JOURNAL ARTICLE.
.W
Mechanical and neural activation changes that accompanied muscle isometric training were studied in males. Training and testing sessions consisted of right elbow isometric flexions. Each experimental group was trained during 5 wk at one of the following angles: 25, 80, and 120 degrees. Bipolar surface electromyogram (EMG) was recorded from the biceps brachii and brachioradialis muscles. An improvement of maximal voluntary contraction (MVC) was always found at the training angle and was systematically greater than at the other angles. Moreover, the shorter the muscle length at which the training has been carried out, the more the gain was limited to the training angle. An increase of the maximal integrated EMG of both biceps brachii and brachioradialis frequently accompanied the improvement of MVC at the training angle.
.A
Thepaut-Mathieu C; Van Hoecke J; Maton B.
.I 90494
.U
88243631
.S
J Appl Physiol 8809; 64(4):1506-17
.M
Animal; Blood Pressure; Diastole/*; Dogs; Electric Stimulation; Esophagus/IR/PH; Heart/*PH; Hemodynamics/*; Lung/*PH; Myocardial Contraction/*; Phrenic Nerve/PH; Pressure; Regional Blood Flow; Respiration.
.T
Transient analysis of cardiopulmonary interactions. I. Diastolic events.
.P
JOURNAL ARTICLE.
.W
The etiology of the fall in left ventricular stroke volume (LVSV) with negative intrathoracic pressure (NITP) during inspiration has been ascribed to a reduction in LV preload. This study evaluated the effects of NITP with and without airway obstruction confined to early (ED), mid- (MD), or late diastole (LD) on the subsequent LVSV, anteroposterior (AP), and right-to-left (RL) aortic diameters (DAO) (series I, n = 6) as well as on phasic arterial blood flow out of the thorax (series II, n = 6) in anesthetized dogs. Transient NITP was obtained by electrocardiogram-triggered phrenic nerve stimulation. In series I, NITP applied for 60% of diastole with the airway obstructed caused decreases of LVSV during ED [-7.7 +/- 3.2% (SE) NS], MD (-11.7 +/- 3.9%, P less than 0.05), and LD (-14.6 +/- 1.5%, P less than 0.01) associated with significant increases of left ventricular end-diastolic pressures relative to both atmospheric and esophageal pressures during MD and LD. NITP increased DAO(AP) and DAO(RL), resulting in increases in diastolic aortic cross-sectional area by an average of 6.1-8.3% (P less than 0.01). Similar changes were seen with the airway unobstructed during NITP. In series II, NITP caused diminished diastolic antegrade carotid artery and/or descending aortic flow run off in all dogs. Transient retrograde arterial flows with NITP were observed in more than half of the animals consistent with increases in aortic diameters. We conclude that a decrease of intrathoracic pressure confined to diastole can 1) diminish the ensuing LVSV, presumptively reducing preload by ventricular interdependence; 2) distend the intrathoracic aorta; 3) diminish antegrade flow out of the thorax independent of effects on cardiac performance; and 4) cause transient retrograde carotid and aortic blood flow. The intrathoracic aorta and, presumably, the arterial intrathoracic vascular compartment can be viewed as an elastic container driven by changes in intrathoracic pressure.
.A
Peters J; Kindred MK; Robotham JL.
.I 90495
.U
88243632
.S
J Appl Physiol 8809; 64(4):1518-26
.M
Airway Obstruction/PP; Animal; Aorta/PH; Dogs; Electric Stimulation; Esophagus/PH; Heart/*PH; Hemodynamics/*; Lung/*PH; Myocardial Contraction/*; Phrenic Nerve/PH; Systole/*.
.T
Transient analysis of cardiopulmonary interactions. II. Systolic events.
.P
JOURNAL ARTICLE.
.W
The etiology of the fall in left ventricular stroke volume (LVSV) and arterial pressure with a negative intrathoracic pressure (NITP) during inspiration is controversial. An increase in LV afterload produced by NITP has been proposed as one explanation but is difficult to evaluate if preload is also altered. To test the hypothesis that a systolic event alone, i.e., a change in LV afterload or contractility, can reduce LVSV during inspiration independent of changes in LV preload, a rapid transient NITP confined to systole was produced by electrocardiogram-triggered phrenic nerve stimulation in eight anesthetized dogs. Intrathoracic descending aortic diameters were measured by sonomicrometry to transduce qualitative changes in aortic transmural pressure. With the airway completely obstructed systolic NITP resulted in a decrease in LVSV (-8.1%, P less than 0.001) but an increase in the systolic anteroposterior (0.54 mm, P less than 0.01) and right-to-left (0.45 mm, P less than 0.01) aortic diameters compared with preceding beat. Similar significant changes were observed with the airway unobstructed. These observations are consistent with an increased afterload imposed on the LV reducing LVSV and egress of blood out of the thorax. Prolonging NITP to include both systole and diastole, a profound fall in LVSV is observed, consistent with the independent influences of systolic and diastolic events combining to diminish LVSV.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Peters J; Kindred MK; Robotham JL.
.I 90496
.U
88243633
.S
J Appl Physiol 8809; 64(4):1527-36
.M
Adult; Aerosols; Bronchitis/PA/PP; Comparative Study; Human; Lung/PA/PH/*PP; Lung Diseases, Obstructive/PA/PP; Lung Volume Measurements; Middle Age; Reference Values; Respiratory Tract Diseases/PA/*PP; Smoking/PP; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Measurement of total lung aerosol deposition as an index of lung abnormality.
.P
JOURNAL ARTICLE.
.W
Total aerosol deposition in the lung was measured in 100 subjects with various lung conditions. The subjects consisted of 40 normals (N), 15 asymptomatic smokers (S), 10 smokers with small airway disease (SAD), 20 with chronic simple bronchitis (SB), and 15 with chronic obstructive bronchitis (COPD), and a relationship of total aerosol deposition to degree of lung abnormality was investigated. The subjects were categorized by medical history and a battery of pulmonary function tests, including spirometry, body plethysmography, and single and multiple N2 washout measurements. Subjects repeatedly breathed a monodisperse test aerosol (1.0 micron diam) from a collapsible rebreathing bag (0.5 liter volume) at a rate of 30 breaths/min, while inhaled and exhaled aerosol concentrations were continuously monitored by a laser aerosol photometer in situ and recorded on a strip-chart recorder. The number of rebreathing breaths resulting in 90% aerosol loss from the bag (N90) was determined, and percent predicted N90 values were then determined from the results of computer simulation and used as a deposition index. The percent predicted N90 values were 99.7 +/- 14, 86.5 +/- 15, 66.9 +/- 17, 51 +/- 12, and 30.9 +/- 9, respectively, for N, S, SAD, SB, and COPD. All of these values were significantly different from each other (P less than 0.05). There was no difference between male and female but percent predicted N90 values were slightly higher in young than in old normals. Percent predicted N90 values showed a strong linear correlation with spirometric measurements of forced expiratory volume in 1 s and maximum midexpiratory flow rate. However, many of the SAD and SB with normal spirometry showed abnormal N90. These results suggest that total lung aerosol deposition is a sensitive index of lung abnormality and may be of potential use for nonspecific general patient screening.
.A
Kim CS; Lewars GA; Sackner MA.
.I 90497
.U
88243634
.S
J Appl Physiol 8809; 64(4):1537-45
.M
Animal; Blood Pressure; Elasticity; Histamine/PD; In Vitro; Lung/PH; Muscle Contraction/DE; Muscle, Smooth, Vascular/PH; Plethysmography; Pulmonary Artery/*PH; Swine/*PH.
.T
Mechanical properties of porcine intralobar pulmonary arteries.
.P
JOURNAL ARTICLE.
.W
The isobaric and isovolumetric properties of intrapulmonary arteries were evaluated by placing a highly compliant balloon inside arterial segments. The passive pressure-volume (P-V) curve was obtained by changing volume (0.004 ml/s) and measuring pressure. The isobaric active volume change (delta V) or isovolumetric active pressure change (delta P) generated by submaximal histamine was measured at four different transmural pressures (Ptm's) reached by balloon inflation. The maximal delta P = 11.2 +/- 0.6 cmH2O (mean +/- SE) was achieved at 30.8 +/- 1.2 cmH2O Ptm and maximal delta V = 0.20 +/- 0.02 ml at 16.7 +/- 1.7 cmH2O Ptm. The P-V relationships were similar when volume was increased after either isobaric or isovolumetric contraction. The calculated length-tension (L-T) relationship showed that the active tension curve was relatively flat and that the passive tension at the optimal length was 149 +/- 11% of maximal active tension. These data show that 1) a large elastic component operates in parallel with the smooth muscle in intralobar pulmonary arteries, and 2) the change in resistance associated with vascular expansion of the proximal arteries is independent of the type of contraction that occurs in the more distal arterial segments.
.A
Ohtaka H; Hogg JC; Moreno RH; Pare PD; Schellenberg RR.
.I 90498
.U
88243635
.S
J Appl Physiol 8809; 64(4):1546-53
.M
Animal; Dogs; Electric Conductivity; Electric Stimulation; Electromyography; Lung/*PH; Phrenic Nerve/PH; Respiration/*; Respiratory Muscles/*PH; Support, Non-U.S. Gov't.
.T
Mechanics of the parasternal intercostals during occluded breaths in dogs.
.P
JOURNAL ARTICLE.
.W
The electrical activity and the respiratory changes in length of the third parasternal intercostal muscle were measured during single-breath airway occlusion in 12 anesthetized, spontaneously breathing dogs in the supine posture. During occluded breaths in the intact animal, the parasternal intercostal was electrically active and shortened while pleural pressure fell. In contrast, after section of the third intercostal nerve at the chondrocostal junction and abolition of parasternal electrical activity, the muscle always lengthened. This inspiratory muscle lengthening must be related to the fall in pleural pressure; it was, however, approximately 50% less than the amount of muscle lengthening produced, for the same fall in pleural pressure, by isolated stimulation of the phrenic nerves. These results indicate that 1) the parasternal inspiratory shortening that occurs during occluded breaths in the dog results primarily from the muscle inspiratory contraction per se, and 2) other muscles of the rib cage, however, contribute to this parasternal shortening by acting on the ribs or the sternum. The present studies also demonstrate the important fact that the parasternal inspiratory contraction in the dog is really agonistic in nature.
.A
De Troyer A; Farkas GA; Ninane V.
.I 90499
.U
88243636
.S
J Appl Physiol 8809; 64(4):1554-60
.M
Aerosols; Carbon Monoxide; Human; Lung/PH/PP; Lung Diseases, Obstructive/*PP; Lung Volume Measurements/*; Reference Values; Respiration; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Use of aerosols to estimate mean air-space size in chronic obstructive pulmonary disease.
.P
JOURNAL ARTICLE.
.W
Using in vivo measures of aerosol recovery (RC) as a function of breath-hold time (t) (Gebhart et al. J. Appl. Physiol. 51: 465-476, 1981), we estimated the mean diameter (D) of the pulmonary air spaces in subjects diagnosed with chronic obstructive pulmonary disease (COPD) (n = 8) and in subjects with normal pulmonary function (n = 10). For each subject, RC (aerosol expired/aerosol inspired) decreased exponentially with t. Based on a model of the lung as a system of randomly oriented cylindrical tubes, the half time (t1/2) (i.e., the breath-hold time to reach 50% of RC with no breath hold) is proportional to a mean diameter (D) of air spaces filled with aerosol. Subjects with normal pulmonary function had a mean t1/2 = 6.5 +/- 0.8 s, corresponding to a mean D = 0.36 +/- 0.05 mm. On the other hand, subjects with COPD had a mean t1/2 = 12.7 +/- 3.2 s, corresponding to a mean D = 0.70 +/- 0.18 mm [i.e., twice as large (P less than 0.01) as normal subjects]. Furthermore, D correlated significantly with diffusing capacity in the patients with COPD (r = -0.95, P less than 0.001 for D vs. percent predicted diffusing capacity of CO) but not with any other measure of pulmonary function. In contrast, D varied only slightly in normals and did not correlate with any measure of pulmonary function. We conclude that in vivo measures of RC vs. t, in conjunction with other pulmonary function tests, may be a useful tool for identifying actual changes in pulmonary air-space sizes associated with pulmonary disease.
.A
Bennett WD; Smaldone GC.
.I 90500
.U
88243637
.S
J Appl Physiol 8809; 64(4):1561-6
.M
Animal; Blood Volume; Lung/*PH; Lung Volume Measurements; Models, Biological; Pulmonary Circulation; Sheep/*PH.
.T
Noninvasive measurement of regional interstitial lung volume in sheep.
.P
JOURNAL ARTICLE.
.W
The noninvasive external radioflux detection method (ERD) measures net transvascular flux of tracer protein into and out of the lung extravascular compartment (EV) and time to zero flux between compartments. With this information we can now estimate regional interstitial volume in the field of the external probe (VIs). Dividing the mass of EV tracer by VIs, we obtain interstitial concentration ([Is]). Directly sampling plasma concentration of the tracer, we can construct plasma-interstitium equilibration curves that are analogous to plasma-lymph equilibration curves without invasive surgery. We completed 46 ERD studies in 21 sheep with chronic lung lymph fistulas. Sheep were studied under baseline conditions (n = 30) and after elevating left atrial pressure by mitral obstruction (n = 7), or intravascular volume infusion (n = 8), and increasing lung vascular permeability (n = 1). In each study we compared the slope of the regression through plasma-lymph concentration of tracer protein over time ([P]-[L], measured directly) with that through values of plasma-interstitial concentration ([P]-[Is], assessed noninvasively), an index of vascular permeability. For this correlation, r = 0.94, and the regression line approximates identity. Mean [Is] appears to approximate [L] in sheep.
.A
Gorin AB.
.I 90501
.U
88243639
.S
J Appl Physiol 8809; 64(4):1575-9
.M
Adult; Body Temperature Regulation/*; Exertion/*; Female; Human; Male; Oxygen Consumption; Plethysmography; Regional Blood Flow; Skin/BS; Sleep Deprivation/*; Sweating; Wakefulness/*PH.
.T
Exercise thermoregulation after prolonged wakefulness.
.P
JOURNAL ARTICLE.
.W
The effect of 33 h of wakefulness on the control of forearm cutaneous blood flow and forearm sweating during exercise was studied in three men and three women. Subjects exercised for 30 min at 60% peak O2 consumption while seated behind a cycle ergometer (Ta = 35 degrees C, Pw = 1.0 kPa). We measured esophageal temperature (Tes), mean skin temperature, and arm sweating continuously and forearm blood flow (FBF) as an index of skin blood flow, twice each minute by venous occlusion plethysmography. During steady-state exercise, Tes was unchanged by sleep loss. The sensitivity of FBF to Tes was depressed an average of 30% (P less than 0.05) after 33 h of wakefulness with a slight decrease (-0.15 degrees C, P less than 0.05) in the core temperature threshold for vasodilatory onset. Sleep loss did not alter the Tes at which the onset of sweating occurred; however, sensitivity of arm sweating to Tes tended to be lower but was not significant. Arm skin temperature was not different between control and sleep loss experiments. Reflex cutaneous vasodilation during exercise appeared to be reduced by both central and local factors after 33 h of wakefulness.
.A
Kolka MA; Stephenson LA.
.I 90502
.U
88243640
.S
J Appl Physiol 8809; 64(4):1580-3
.M
Animal; Capillaries/PH; Horses/*PH; Human; Regional Blood Flow; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Toes/*BS; Vascular Resistance.
.T
Evaluation of Starling forces in the equine digit.
.P
JOURNAL ARTICLE.
.W
A pump-perfused extracorporeal digital preparation was used to evaluate blood flow, arterial pressure, venous pressure, isogravimetric capillary filtration coefficient, capillary pressure, and vascular compliance in six normal horses. From these data, pre- and postcapillary resistances and pre- and postcapillary resistance ratios were determined. Vascular and tissue oncotic pressures were estimated from plasma and lymph protein concentrations, respectively. By use of the collected and calculated data, tissue pressure in the digit was calculated using the Starling equation. In the isolated equine digit, isogravimetric capillary pressure averaged 36.7 mmHg, plasma and lymph oncotic pressures averaged aged 19.12 and 6.6 mmHg, respectively, interstitial fluid pressure averaged 25.6 mmHg, and the capillary filtration coefficient averaged 0.0013 ml.min-1.mm-1.100 g-1. Our results indicate that digital capillary pressure in the laterally recumbent horse is much higher than in analogous tissues in other species such as dog and human. However, the potential edemagenic effects of this high digital capillary pressure are opposed by at least two mechanisms: 1) a high tissue pressure and 2) a low microvascular surface area for fluid exchange and/or a low microvascular permeability to filtered fluid.
.A
Allen D Jr; Korthuis RJ; Clark S.
.I 90503
.U
88243641
.S
J Appl Physiol 8809; 64(4):1584-90
.M
Animal; Cyanates/*PD; Dogs; Kinetics; Male; Oxygen/*BL; Oxygen Consumption/*DE; Oxyhemoglobins/*ME; Reference Values.
.T
Chronic administration of sodium cyanate decreases O2 extraction ratio in dogs.
.P
JOURNAL ARTICLE.
.W
It has been proposed that an increase in the affinity of hemoglobin for O2 may be beneficial in severe hypoxemia. To test this hypothesis, we compared the response to progressive hypoxemia in dogs with normal hemoglobin affinity (P50 = 32.4 +/- 0.7 Torr) to dogs with a left shift of the oxyhemoglobin dissociation curve (P50 = 21.9 +/- 0.5 Torr) induced by chronic oral administration of sodium cyanate. Animals were anesthetized, paralyzed, and mechanically ventilated. The inspired O2 fraction was progressively lowered by increasing the inspired fraction of N2. The lowest level of O2 transport required to maintain base-line O2 consumption (VO2) was 9.3 +/- 0.8 ml.min-1.kg-1 for control and 16.5 +/- 1.1 ml.min-1.kg-1 for the sodium cyanate-treated dogs (P less than 0.01). Other measured parameters at this level of O2 transport were, for experimental vs. control: arterial PO2 19.3 +/- 2.4 (SE) Torr vs. 21.8 +/- 1.6 Torr (NS); arterial O2 content 10.0 +/- 1.2 ml/dl vs. 4.9 +/- 0.4 ml/dl (P less than 0.01); mixed venous PO2 14.0 +/- 1.5 Torr vs. 13.8 +/- 1.0 Torr (NS); mixed venous O2 content 6.8 +/- 1.0 ml/dl vs. 2.3 +/- 0.2 ml/dl (P less than 0.01); and O2 extraction ratio 32.7 +/- 2.8% vs. 51.2 +/- 3.8% (P less than 0.01). We conclude that chronic administration of sodium cyanate appears to be detrimental to O2 transport, since the experimental dogs were unable to increase their O2 extraction ratios to the same level as control, thus requiring a higher level of O2 transport to maintain their base-line VO2 values.
.A
Warley AR; Gutierrez G.
.I 90504
.U
88243644
.S
J Appl Physiol 8809; 64(4):1607-14
.M
Animal; Atelectasis/*PP; Lung/*PH/PP; Lung Volume Measurements; Male; Oscillometry; Oxygen/BL; Partial Pressure; Pressure; Rabbits; Respiration/*; Support, Non-U.S. Gov't.
.T
Lung volume recruitment during high-frequency oscillation in atelectasis-prone rabbits.
.P
JOURNAL ARTICLE.
.W
In diffuse lung injury, optimal oxygenation occurs with high-frequency oscillatory ventilation (HFO-A, where A is active expiratory phase) when sustained inflations (SI) are applied periodically to recruit lung volume. Theoretically pulsed pressures may be safer and more effective than static pressures for reexpanding alveoli. We compared the increases in lung volume and arterial PO2 (PaO2) induced by 30-s increases in mean airway pressure in six New Zealand White rabbits made atelectasis prone by saline lavage plus 1 h of conventional ventilation. Pulsatile SI's (HFO-A left on during increase in mean pressure) of delta PSI = 5, 10, and 15 cmH2O and static SI's (HFO-A off during SI) of delta PSI = 5, 10, 15, and 20 cmH2O were delivered in random order. Lungs were ventilated at 15 Hz, inspired fractional concentration of O2 = 1.0, and mean airway pressure 15-20 cmH2O between test periods and deflated to functional residual capacity before each SI to standardize volume history. With both maneuvers, increases in lung volume and PaO2 induced by SI's were proportional to the magnitude of the SI (P less than 0.001) in all cases. Pulsatile SI's consistently increased lung volume and PaO2 more than static SI's having the same delta PSI (P less than 0.005) such that any given target PaO2 or change in volume (delta V) was achieved at 5 cmH2O less mean pressure with the pulsatile maneuver. Respiratory system compliance increased after both types of SI. Oxygenation and lung volume changes at 5 min were related with r = 0.58 (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Byford LJ; Finkler JH; Froese AB.
.I 90505
.U
88243645
.S
J Appl Physiol 8809; 64(4):1615-23
.M
Adult; Bronchi/DE/*PH; Cells, Cultured; Chemotaxis, Leukocyte; Cotton; Human; Inflammation; Irrigation; Leukotrienes B/PD; Lung Volume Measurements; Neutrophils/*PH; Plant Extracts/*PD; Pulmonary Alveoli/DE/*PH; Reference Values; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S..
.T
Bronchoalveolar cell activation after inhalation of a bronchoconstricting agent.
.P
JOURNAL ARTICLE.
.W
Airway inflammation is thought to be an important determinant of bronchoconstriction and bronchial hyperreactivity. We have recently demonstrated that bronchoconstriction induced by an aqueous extract of cotton bracts (CBE) is associated with bronchoalveolar complement activation, release of polymorphonuclear neutrophil (PMN) chemoattractants by pulmonary cells, and increased numbers of bronchoalveolar lavage PMN's. In the present study we performed bronchoalveolar lavage (BAL) on subjects after CBE or control (saline) challenge and examined whether BAL cells were activated in vitro to produce other inflammatory agonists. After CBE administration, cultured BAL cells released increased amounts of the reactive O2 species, superoxide (O2-.), and the cyclooxygenase products prostaglandin E2 and thromboxane B2. Although none of these in vitro parameters of BAL cell activation appeared to correlate with the degree of bronchoconstriction induced by CBE, BAL fluid levels of thromboxane B2 were also increased after CBE administration and in vivo amounts of this eicasanoid did correlate with the degree of bronchoconstriction induced by CBE (r = 0.50, P less than 0.04). Finally, although cell culture supernatants were highly chemotactic for PMN's, concentrations of leukotriene B4 were not increased, suggesting other chemotaxins were released by BAL cells in this setting. We conclude that CBE administration activates bronchoalveolar cells to release reactive O2 species and cyclooxygenase products that may be important in the bronchoconstricting response to CBE.
.A
Cooper JA Jr; Merrill WW; Rankin JA; Sibille Y; Buck MG.
.I 90506
.U
88243646
.S
J Appl Physiol 8809; 64(4):1624-8
.M
Adult; Aspiration/*; Cardiac Output/*; Heart Rate; Human; Male; Oxygen Consumption/*; Pulmonary Circulation; Respiration/*; Respiratory Muscles/PH; Stroke Volume; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Cardiac output and O2 consumption during inspiratory threshold loaded breathing.
.P
JOURNAL ARTICLE.
.W
In this study, noninvasive measurements of cardiac output and O2 consumption were performed to estimate the blood flow to and efficiency of the respiratory muscles that are used in elevated inspiratory work loads. Five subjects were studied for 4.5 min at a respiratory rate of 18 breaths/min and a duty cycle of 0.5. Studies were performed at rest without added respiratory loads and at elevated inspiratory work loads with the use of an inspiratory valve that permitted flow only when a threshold pressure was maintained. Cardiac output and O2 consumption were calculated using a rebreathing technique. Respiratory muscle blood flow and O2 consumption were estimated as the difference between resting and loaded breathing. Work of breathing was calculated by integrating the product of mouth pressure and volume. Increases in cardiac output and O2 consumption in response of 4.5 min loaded breathing averaged 1.84 l/min and 108 ml/min, respectively. No increases were seen in response to 20-s loaded breathing. In a separate series of experiments on four subjects, though, cardiac output increased for the first 2 min then leveled off. These results indicate that the increase in cardiac output was a metabolic effect of the increased work load and was not caused primarily by the influence of the highly negative intrathoracic pressure on venous return. Efficiency of the respiratory muscles during inspiratory threshold loading averaged 5.9%, which was similar to measurements of efficiency of respiratory muscles using whole-body O2 consumption that have been reported previously in humans and in dogs.
.A
Coast JR; Jensen RA; Cassidy SS; Ramanathan M; Johnson RL Jr.
.I 90507
.U
88243647
.S
J Appl Physiol 8809; 64(4):1629-35
.M
Aging; Animal; Animals, Newborn; Organ Weight; Perfusion; Pressure; Pulmonary Alveoli/GD/*PH; Rabbits; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Alveolar liquid pressures in newborn and adult rabbit lungs.
.P
JOURNAL ARTICLE.
.W
To study the effects of lung maturation and inflation on alveolar liquid pressures, we isolated lungs from adult and newborn rabbit pups (1-11 days old). We used the micropuncture technique to measure alveolar liquid pressure at several transpulmonary pressures on lung deflation. Alveolar liquid pressure was greater than pleural pressure but less than airway pressure at all transpulmonary pressures. Alveolar liquid pressure decreased further below airway pressure with lung inflation. At high transpulmonary pressure, alveolar liquid pressure was less in newborn than in adult lungs. To study the effects of edema, we measured alveolar liquid pressures in newborn lungs with different wet-to-dry weight ratios. Alveolar liquid pressure increased with progressive edema. In addition, we compared alveolar liquid and perivenular interstitial pressures in perfused newborn lungs and found that they were similar. Thus alveolar liquid pressure can be used to estimate perivenular interstitial pressure. We conclude that the transvascular pressure gradient for fluid flux into the interstitium might increase with lung inflation and decrease with progressive edema. Furthermore, this gradient might be greater in newborn than adult lungs at high inflation pressures.
.A
Fike CD; Lai-Fook SJ; Bland RD.
.I 90508
.U
88243649
.S
J Appl Physiol 8809; 64(4):1644-9
.M
Adult; Altitude/*; Blood Flow Velocity/*; Blood Transfusion, Autologous; Cardiac Output; Comparative Study; Exertion/*; Female; Heart Rate; Human; Oxygen/BL; Oxygen Consumption; Polycythemia/ET/*PP; Stroke Volume.
.T
Effect of simulated altitude erythrocythemia in women on hemoglobin flow rate during exercise.
.P
JOURNAL ARTICLE.
.W
The effect of simulated altitude erythrocythemia on hemoglobin flow rate and maximal O2 uptake (VO2max) was determined for nine women sea-level residents. Test conditions included normoxia and normobaric hypoxia (16% O2-84% N2). Cycle tests were performed under normoxia (T1-N) and hypoxia (T1-H) at prereinfusion control and under hypoxia 48 h after a placebo infusion (T2-H) and 48 h after autologous infusion of 334 ml of erythrocytes (T3-H). Hematocrit (38.1-44.9%) and hemoglobin concentration (12.7-14.7 g.dl-1) increased from control to postreinfusion. At peak exercise, VO2max decreased from T1-N (2.40 l.min-1) to T1-H (2.15 l.min-1) then increased at T3-H (2.37 l.min-1). Maximal arterial-mixed venous O2 difference decreased from T1-N to T1-H and increased at T3-H. Cardiac output (Q), stroke volume, heart rate, and total peripheral resistance during maximal exercise were unchanged from T1-N through T3-H. Hemoglobin flow rate (Hb flow) at maximum did not change from T1-N to T1-H but increased at T3-H. When compared with submaximal values for T1-N, VO2 was unchanged at T1-H and T3-H; Q increased at T1-H and decreased at T3-H; arterial-mixed venous O2 difference decreased at T1-H and increased at T3-H; Hb flow did not change at T1-N but increased at T3-H. For young women, simulated altitude erythrocythemia increased peak Hb flow and decreased physiological altitude (227.8 m) but did not affect maximum cardiac output (Qmax).
.A
Robertson RJ; Gilcher R; Metz KF; Caspersen CJ; Allison TG; Abbott RA; Skrinar GS; Krause JR; Nixon PA.
.I 90509
.U
88243650
.S
J Appl Physiol 8809; 64(4):1650-8
.M
Airway Resistance; Animal; Dogs; Forced Expiratory Flow Rates/*; In Vitro; Lung/*PH; Maximal Expiratory Flow Rate/*; Models, Biological; Pressure; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Trachea/*PH.
.T
Properties of steady maximal expiratory flow within excised canine central airways.
.P
JOURNAL ARTICLE.
.W
Using our transistor model of the lung during forced expiration (J. Appl. Physiol. 62: 2013-2025, 1987), we recently predicted that 1) axially arranged choke points can exist simultaneously during forced expiration with sufficient effort, and 2) overall maximal expiratory flow may be relatively insensitive to nonuniform airways obstruction because of flow interdependence between parallel upstream branches. We tested these hypotheses in excised central airways obtained from five canine lungs. Steady expiratory flow was induced by supplying constant upstream pressure (Pupstream = 0-16 cmH2O) to the bronchi of both lungs while lowering pressure at the tracheal airway opening (16 to -140 cmH2O). Intra-airway pressure profiles obtained during steady maximal expiratory flow disclosed a single choke point in the midtrachea when Pupstream was high (2-16 cmH2O). However, when Pupstream was low (0 cmH2O), two choke sites were evident: the tracheal site persisted, but another upstream choke point (main carina or both main bronchi) was added. Flow interdependence was studied by comparing maximal expiratory flow through each lung before and after introduction of a unilateral external resistance upstream of the bronchi of one lung. When this unilateral resistance was added, ipsilateral flow always fell, but changes in flow through the contralateral lung depended on the site of the most upstream choke. When a single choke existed in the trachea, addition of the external resistance increased contralateral flow by 38 +/- 28% (SD, P less than 0.003). In contrast, when the most upstream choke existed at the main carina or in the bronchi, addition of the external resistance had no effect on contralateral maximal expiratory flow.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Solway J.
.I 90510
.U
88243651
.S
J Appl Physiol 8809; 64(4):1659-75
.M
Adolescence; Adult; Aged; Aging; Collagen/*AN; Computer Simulation; Elastin/*AN; Female; Human; Lung/GD; Male; Middle Age; Models, Biological; Pulmonary Alveoli/*AH/AN; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Collagen and elastin fibers in human pulmonary alveolar walls.
.P
JOURNAL ARTICLE.
.W
The morphology and morphometric data of collagen and elastin fibers in the pulmonary alveolar walls are presented. Specimens were obtained from postmortem lungs quick-frozen at specified transpulmonary pressures. Collagen was stained by silver, and elastin was stained by orcein. Photomicrographs were composed by computer. Young lungs typically show small collagen fibers that radiate from the "posts," whereas larger fiber bundles traverse the septum irrespective of capillary blood vessels. In older lungs, rings of collagen around the posts appear enlarged. Elastin bundles do not show obvious variation in pattern with age and inflation pressure. Statistical frequency distributions of the fiber width and curvature are both skewed, but the square root of the width and the cube root of the curvature have approximate normal distributions. Typically, for young lungs at transpulmonary pressure of 4 cmH2O, the mean of (width)1/2 (in micron1/2) for collagen fibers is 0.952 +/- 0.242 (SD), that of (curvature)1/3 (in micron-1/3) is 0.349 +/- 0.094. The corresponding values for elastin are 0.986 +/- 0.255 and 0.395 +/- 0.094.
.A
Sobin SS; Fung YC; Tremer HM.
.I 90511
.U
88243655
.S
J Appl Physiol 8809; 64(4):1693-9
.M
Aspiration/*; Fatigue/*; Human; Learning; Pressure; Respiration/*; Respiratory Function Tests/IS/MT; Respiratory Muscles/*PH; Support, U.S. Gov't, P.H.S..
.T
Fatigue of the inspiratory muscle pump in humans: an isoflow approach.
.P
JOURNAL ARTICLE.
.W
A new method is described for measurement of inspiratory muscle endurance in humans that is based on isokinetic principles of muscle testing (i.e., measurement of maximum force during a constant velocity of shortening). Subjects inspired maximally while their lungs were inflated at a constant rate during each breath for 10 min. Inspiratory and expiratory time, flow rate, tidal volume, and end-tidal CO2 were maintained constant. In each subject, maximum inspiratory mouth pressure exponentially decayed over the first few minutes to an apparent sustainable value. Repeated tests in experienced subjects showed high reproducibility of sustainable pressure measurements. To determine the effects of flow, endurance tests were repeated in four subjects at flows of 0.75, 1.0, and 1.25 l/s, with a constant duty cycle. As flow increased, the maximum pressures that could be attained at rest and the maximum sustainable pressures decreased. At each flow, the sustainable pressure remained a constant fraction of the maximum pressure attainable at rest. We interpret the decay in mouth pressure during isoflow endurance tests to directly reflect the loss of net inspiratory muscle force available by maximum voluntary activation of the inspiratory pump.
.A
Clanton TL; Ameredes BT.
.I 90512
.U
88243657
.S
J Appl Physiol 8809; 64(4):1709-20
.M
Animal; Aspiration/*; Cats; Computer Simulation; Decerebrate State; Kinetics; Laryngeal Nerves/*PH; Lung/IR/*PH; Models, Biological; Phrenic Nerve/*PH; Respiration/*; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Power spectra of inspiratory nerve activity with lung inflations in cats.
.P
JOURNAL ARTICLE.
.W
To investigate the effect of lung inflations on the high-frequency synchrony (70-122 Hz) observed in the inspiratory activity of respiratory motor nerves of decerebrate cats, I applied a step increase in lung inflation pressure at fixed delays into the inspiratory phase and computed power spectra of phrenic neurograms before and during inflation. In 25 decerebrate paralyzed cats the frequency of the high spectral peak was 92.3 +/- 11.1 Hz before and 105.3 +/- 12.1 Hz during the step in inflation pressure, shifting upward by 13.0 +/- 6.0 Hz. For 8 of the 25 cats, the recurrent laryngeal and phrenic neurograms were recorded simultaneously. The high spectral peak was present during inspiration in the recurrent laryngeal power spectra and coherent with the high peak in the phrenic power spectra. In response to lung inflation, the high peak disappeared from the power spectra of the recurrent laryngeal nerve as the inspiratory activity was inhibited; a shift upward in frequency was not detectable. Comparing inspiratory times (TI, based on the phrenic neurograms) for breaths with no lung inflations to those for breaths with lung inflations, I found that lung inflations early in inspiration caused a decrease in TI, lung inflations at intermediates times had no effect on TI, and lung inflations late in inspiration caused an increase in TI. Despite lung inflation decreasing, not affecting, or increasing inspiratory duration and amplitude of the phrenic neurogram, lung inflation always caused a shift upward in the high-frequency peak of the phrenic power density. The fact that lung inflation, a powerful respiratory stimulus, affected the frequency of the high peak in a consistent manner suggests that the high-frequency synchrony is an important and robust feature of the central respiratory pattern generator.
.A
Richardson CA.
.I 90513
.U
88243658
.S
J Appl Physiol 8809; 64(4):1721-32
.M
Adolescence; Animal; Child; Female; Foreign Bodies; Human; Liver/PH; Lung/GD/PH; Male; Maximal Midexpiratory Flow Rate; Models, Theoretical/*; Random Allocation; Rats; Regression Analysis/*; Research/*MT; Smoking; Support, U.S. Gov't, P.H.S..
.T
Families of lines: random effects in linear regression analysis.
.P
JOURNAL ARTICLE.
.W
Laboratory experiments often involve two groups of subjects, with a linear phenomenon observed in each subject. Simple linear regression as propounded in standard textbooks is inadequate to treat this experimental design, particularly when it comes to dealing with random variation of slopes and intercepts among subjects. The author describes several techniques that can be used to compare two independent families of lines and illustrates their use with laboratory data. The methods are described tutorially, compared, and discussed in the context of more sophisticated and more naive approaches to this common data-analytic problem. Technical details are supplied in APPENDIX A.
.A
Feldman HA.
.I 90514
.U
88243659
.S
J Appl Physiol 8809; 64(4):1733-9
.M
Fourier Analysis; Gases; Human; Mathematics; Methods; Models, Biological; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Ventilation-Perfusion Ratio/*.
.T
Spectral analysis of inert gas elimination data: resolution limits.
.P
JOURNAL ARTICLE.
.W
A new method of analyzing inert gas data for recovery of the pulmonary ventilation-perfusion ration (VA/Q) distribution is proposed. It is shown that the conventional inert gas elimination equation takes the form of a convolution integral, and the relationship between VA/Q distribution and inert gas elimination resembles that of a noncausal low-pass filter with infinite zero-frequency gain. With the use of this formulation, characteristic features of VA/Q distribution may be represented in the frequency domain in terms of the corresponding energy spectrum. It is shown that the lack of resolution associated with finite data samples and measurement error is caused by distortions in the high-frequency contents of the resulting VA/Q distribution. With six inert gases, the technique cannot resolve a log SD less than 0.21 decade and a modal separation less than 0.87 decade. In the presence of measurement error, the degree of resolution is even less. It is suggested that for maximum resolution the number of discrete and duplicate data samples should be chosen so that the resulting noise and sampling cutoff frequencies are approximately equal.
.A
Poon CS.
.I 90515
.U
88243660
.S
J Appl Physiol 8809; 64(4):1740-5
.M
Acclimatization/*; Animal; Exertion/*; Habituation (Psychophysiology); Hindlimb; Methods; Motivation; Muscles/AH/*PH; Organ Weight; Rats; Support, Non-U.S. Gov't.
.T
A model for quantitative strength training of hindlimb muscles of the rat.
.P
JOURNAL ARTICLE.
.W
Rats were taught to lift up a lever to train the plantar flexors. After 2 wk of adaptation the rats were trained for 36 wk. The mass of weights on the lever rose by 85% over the 36-wk period (P less than 0.05) The estimated force that the plantar flexors had to develop to lift the lever rose by 32% (P less than 0.05), just as the work per lift rose by 28% (P less than 0.05). For the trained group of rats the soleus muscles of the right and the left limb were 34% (P less than 0.05) and 31% (P less than 0.05) heavier, respectively, after the training period than those of the control group. Similarly, the plantaris muscles of both the right and the left limb were 24% heavier (P less than 0.05). For the trained group the maximum twitch and tetanus tensions of the soleus were 63% (P less than 0.05) and 65% (P less than 0.05) higher, respectively. Relative to the plantaris these measures were 79% (P less than 0.05) and 37% (P less than 0.05), respectively. The described model, therefore, seems appropriate for the study of the skeletal muscles' adaptation to usage.
.A
Klitgaard H.
.I 90516
.U
88243661
.S
J Appl Physiol 8809; 64(4):1746-8
.M
Animal; Blood Proteins/*AN; Blood Volume; Capillary Permeability; Filtration; Human; Mathematics; Methods; Models, Theoretical; Support, U.S. Gov't, P.H.S..
.T
Calculation of the reflection coefficient from measurements of endogenous vascular indicators.
.P
JOURNAL ARTICLE.
.W
The solvent drag reflection coefficient (sigma) for total proteins can be estimated by comparing the relative degrees of concentration of erythrocytes and plasma proteins that occur during fluid filtration in an isolated perfused organ. In this analysis, we evaluated the accuracy of equations proposed by Pilati and Maron [Am. J. Physiol. 247 (Heart Circ. Physiol. 16): H1-H7, 1984] and Wolf et al. [Am. J. Physiol. 253 (Heart Circ. Physiol. 22): H194-H204, 1987] to calculate sigma from these concentration changes. We calculated sigma with each equation using data generated from a mathematical model of fluid and solute flux in membranes with known sigma's. We found that the equation of Wolf et al. provided the closest approximation to the true sigma over the entire range of filtration fractions tested (0.1-0.6), with the differences between the two equations increasing with filtration fraction. At low filtration fractions, the difference in sigma obtained using either approach was found to be inconsequential. At larger filtration fractions, a closer approximation of the true sigma can be obtained using the equation of Wolf et al.
.A
Maron MB; Pilati CF.
.I 90517
.U
88243662
.S
J Appl Physiol 8809; 64(4):1749-56
.M
Human; Mathematics; Models, Biological; Plethysmography/*/MT; Respiration/*; Support, Non-U.S. Gov't.
.T
What does inductance plethysmography really measure?
.P
JOURNAL ARTICLE.
.W
Inasmuch as it has been claimed that inductance plethysmography can measure cross-sectional area changes, we tested this assumption. We present experimental and computed relationships between self-inductance (L) of coils and areas (A) included inside for a coil with a well-defined side wavy pattern (triangular or sinusoidal) and for a real belt (Respitrace) placed on elliptical or rectangular configurations. The results are applied to the physiological field using measurements obtained from a computed tomography experiment. We demonstrate that the L-A relationships vary not only with shape or ellipticity of the cross section but also with the wavy pattern shape. This last parameter is critical because it is difficult to actually control. When the coil wavy pattern remains steady, there are some physiological situations where inductance plethysmography can more accurately estimate area changes: when the configuration shape is constant, the correspondence between delta L and delta A is almost linear with a shape-dependent sensitivity; when the configuration is nearly circular (ellipticity in the range 0.8-1), the relative error in delta A estimation is less than 5%.
.A
Martinot-Lagarde P; Sartene R; Mathieu M; Durand G.
.I 90518
.U
88243663
.S
J Appl Physiol 8809; 64(4):1757
.M
Animal; Dogs; Free Radicals; In Vitro; Lung/DE/*PA/PH; Oxygen/*TO; Perfusion.
.T
O2 radicals mediate reperfusion lung injury [letter]
.P
LETTER.
.A
Pietz JT; Guttenberg NA.
.I 90519
.U
88243664
.S
J Appl Physiol 8809; 64(4):1758-60
.M
Anaerobiosis; Animal; Exertion; Heart Rate/*; Lactates/ME; Myocardium/ME; Support, Non-U.S. Gov't.
.T
Use of the heart rate deflection point to assess the anaerobic threshold [letter]
.P
LETTER.
.A
Leger L; Tokmakidis S.
.I 90520
.U
88243665
.S
J Appl Physiol 8809; 64(4):1760
.M
Human; Pleura/*PH; Pleural Effusion/PP; Pressure.
.T
Pleural liquid pressure [letter]
.P
LETTER.
.A
Agostoni E; D'Angelo E.
.I 90521
.U
88243887
.S
J Cardiovasc Surg (Torino) 8809; 29(3):245-56
.M
Adult; Aged; Aged, 80 and over; Aneurysm, Dissecting/DI/MO/*SU; Aorta/SU; Aorta, Thoracic/IN/SU; Aortic Aneurysm/DI/MO/*SU; Aortic Rupture/DI/MO/*SU; Blood Vessel Prosthesis; Extracorporeal Circulation; Follow-Up Studies; Human; Middle Age.
.T
Surgical treatment of thoracic aortic aneurysms. Personal experience.
.P
JOURNAL ARTICLE.
.W
A series of 262 observed cases of aneurysm of the thoracic aorta is examined in which 216 cases of surgical correction were performed between 1974 and 1987. Dissecting aneurysms and post-traumatic pseudoaneurysms, although of different aetiology and morbid anatomy, are also included since the surgical technique adopted is similar in all groups. Clinically different aspects of acute and chronic lesions are analyzed. Of all preoperative examinations, angiography is preferred as it gives the most precise definition of the aortic lesion. This is especially necessary in the case of acute dissection or rupture of thoracic aorta although the role of CAT scan is becoming progressively more important. In cases of aortic dissection with massive aortic valve insufficiency, the substitution of the ascending aorta and aortic valve with reimplantation of coronary arteries, in accordance with Bentall's technique is also indicated. The improvement in surgical results is emphasized, since surgical mortality has decreased from 30.6% to 22% in the last eight years. This is due to improvement in surgical technique, to extra corporeal circulation and myocardial protection.
.A
Ruberti U; Odero A; Arpesani A; Giorgetti PL; Cugnasca M; Rampoldi V; Anguissola GB; Morbidelli A; Scorza R; Selva S.
.I 90522
.U
88243890
.S
J Cardiovasc Surg (Torino) 8809; 29(3):268-76
.M
Anastomosis, Surgical; Animal; Aorta, Abdominal/PA/*SU; Arteriosclerosis/*PC; Atherosclerosis/BL/PA/*PC; Cholesterol, Dietary/*AE; Endothelium, Vascular/UL; Injections; Lipids/BL; Male; Microscopy, Electron, Scanning; Pancreatopeptidase/AD/*TU; Rabbits.
.T
Effect of pancreatopeptidase E (elastase) on the suppression of intimal fibrous proliferation after arterial reconstruction in high cholesterol fed rabbits.
.P
JOURNAL ARTICLE.
.W
The purpose of this study was to investigate the effect of pancreatopeptidase E (Elastase) administration on the healing of anastomosed arteries. A segment of infrarenal aorta was resected and reanastomosed in rabbits. In the control group, rabbits were fed commercial chow (ORC 4). In the cholesterol group, rabbits were fed a diet of 1% cholesterol added to ORC 4. In the Elastase group, rabbits were fed the same diet as the cholesterol group but received intraabdominal injections of Elastase. The rabbits were kept for 4 months and the abdominal aorta was retrieved for examination. All anastomosed aortas were patent. The cholesterol group developed aneurysmal dilatation in one and stenosis of the anastomosed sites due to hypergranulation in the remaining rabbits. Neither aneurysmal nor stenotic changes were detected in the other groups. We concluded that the administration of Elastase suppressed cholesterol induced atherosclerotic changes at the anastomotic sites in these animals.
.A
O-hara M; Esato K; Mohri H.
.I 90523
.U
88243891
.S
J Cardiovasc Surg (Torino) 8809; 29(3):277-82
.M
Adult; Aged; Aged, 80 and over; Carotid Arteries/*SU; Carotid Artery Diseases/SU; Cerebral Infarction/SU; Cerebral Ischemia, Transient/SU; Cerebrovascular Disorders/ET/SU; Endarterectomy/*/AE/MO; Female; Heart Surgery; Human; Male; Middle Age; Neurosurgery; Specialties, Surgical/*; Surgery; Vascular Surgery.
.T
Indications and complications of carotid endarterectomy as performed by four different surgical specialty groups.
.P
JOURNAL ARTICLE.
.W
The results of 518 carotid endarterectomies (CEA) performed by four surgical specialty groups were evaluated for complications and categorized according to their presentations. Nineteen surgeons performing CEA were classified into four groups: general surgeons (GS), general vascular surgeons (GVS), cardiovascular surgeons (CVS), and neurosurgeons (NS). The stroke and combined stroke and death rates respectively by the four groups were 6.1% and 6.1%; 3.2% and 3.5%; 6.5% and 8.7%; and 6.5% and 6.5%. The indications of CEA varied among the groups. Asymptomatic stenosis constituted 10.6%, 16.0%, 19.0%, and 0% of the total CEA performed by the groups respectively; nonhemispheric transient ischemic attacks (TIA) constituted 3.0%, 18.4%, 8.7%, and 0%; hemispheric TIA constituted 77.3%, 58.1%, 63.0% and 90.3%; and stroke constituted 9.1%, 7.5%, 8.7% and 9.7%. When CEA for asymptomatic stenosis and nonhemispheric TIA were combined, the stroke rate was 22.2% for the GS group; 1.6% for the GVS group; and 15.4% for the CVS group. In conclusion, the overall stroke rate was close for the four groups at 6.1%, 3.2%, 6.5% and 6.5% respectively. However, asymptomatic and nonhemispheric TIA patients had significantly lower complication rates when operated on by the GVS group in contrast to the other groups (1.6% for the GVS in contrast to 22.2% for the GS and 15.4% for the CVS). The GVS and CVS groups operated more frequently on asymptomatic and nonhemispheric TIA patients than the GS and NS groups.
.A
AbuRahma AF; Robinson P.
.I 90524
.U
88243893
.S
J Cardiovasc Surg (Torino) 8809; 29(3):290-5
.M
Aged; Aged, 80 and over; Arterial Occlusive Diseases/CO/*SU; Blood Vessel Prosthesis; Female; Femoral Artery/PH/*SU; Graft Occlusion, Vascular; Human; Iliac Artery/PH/*SU; Male; Middle Age; Regional Blood Flow; Risk Factors; Vascular Patency; Veins/TR.
.T
Long-term results of 44 cross-over bypasses.
.P
JOURNAL ARTICLE.
.W
Forty-four patients with an unilateral iliac obstruction were treated with a cross-over bypass. The ASPI at rest in the recipient leg was 0.53 +/- 0.16 pre-operatively and had increased to 0.82 +/- 0.13 3 months after operation (p less than 0.001). One patient died within 30 days of operation and in another graft thrombosis occurred within this period. In 2 patients above-knee amputation had to be performed owing to graft failure. During the follow-up period (3 months to 10 years) 9 patients died and 8 late graft failures (30 days) occurred without limb loss. The cumulative patency rate amounted to 73.7% after 5 years. A significant steal effect could not be demonstrated. The cross-over bypass is a procedure justified in unilateral iliac occlusion in high- and moderate risk patients with intermittent claudication and pain at rest or gangrene.
.A
Brouwer MH; Biemans RG; Donders HP.
.I 90525
.U
88243895
.S
J Cardiovasc Surg (Torino) 8809; 29(3):300-5
.M
Aged; Comparative Study; Female; Fibrin/ME; Fibrinolysis/*; Human; Intermittent Claudication/PP; Ischemia/PP; Male; Middle Age; Serum Globulins/ME; Thrombophlebitis/PP; Thrombosis/PP; Vascular Diseases/*PP.
.T
Resting plasma fibrinolytic activity and fibrinolytic potential in peripheral vascular disease.
.P
JOURNAL ARTICLE.
.W
Reduced plasma fibrinolytic activity may be a risk factor in venous and arterial thrombotic disease. Resting plasma fibrinolytic activity and fibrinolytic potential after ten minutes of venous occlusion were compared in 100 patients with peripheral vascular disease of varying severity and 20 age-sex matched controls. The fibrinolytic assay used was the euglobulin lysis time. Resting plasma fibrinolytic activity was significantly reduced in patients with a recent arterial thrombosis (p = 0.02) and ischaemic rest pain (p = 0.008) compared with controls. Fibrinolytic potential after venous occlusion was significantly reduced also in patients with a recent arterial thrombosis (p = 0.02) and ischaemic rest pain (p = 0.05) compared with controls. There were no significant differences between patients with claudication and controls. A reduced plasma fibrinolytic activity has been confirmed in patients with peripheral vascular disease and fibrinolytic potential may be a superior method of assessment as the euglobulin lysis time after venous occlusion is independent of the fibrinogen concentration. It remains uncertain whether the finding of reduced plasma fibrinolytic activity in patients with peripheral vascular disease is cause or effect and whether the finding has prognostic significance.
.A
Earnshaw JJ; Westby JC; Hopkinson BR; Makin GS.
.I 90526
.U
88243899
.S
J Cardiovasc Surg (Torino) 8809; 29(3):318-9
.M
Aorta, Abdominal/RA/*SU; Biopsy, Needle/*MT; Blood Vessel Prosthesis/*AE; Case Report; Human; Male; Middle Age; Suppuration/PA; Surgical Wound Infection/*PA/RA; Tomography, X-Ray Computed/*.
.T
CT guided periaortic fluid aspiration diagnosing aortic graft infection.
.P
JOURNAL ARTICLE.
.W
CT guided diagnostic aspiration was performed on a patient suspected of aortic graft infection. The positive aspiration prompted aggressive successful surgical intervention.
.A
Rabinovici R; Fields S; Berlatzky Y; Shifrin EG; Romanoff H.
.I 90527
.U
88243900
.S
J Cardiovasc Surg (Torino) 8809; 29(3):320-1
.M
Aged; Aneurysm/*RA; Blood Vessel Prosthesis/*AE; Case Report; Femoral Artery/*SU; Human; Male; Polyethylene Terephthalate/*; Popliteal Artery/*SU; Tomography, X-Ray Computed.
.T
Unusual pseudoaneurysm of Dacron femoro-popliteal graft shaft. A case report.
.P
JOURNAL ARTICLE.
.W
An unusual case of pseudoaneurysm in the mid segment of a Dacron femoro-popliteal graft is reported. The radiological diagnosis was based on computed tomography which correlated well with the surgical findings. A manufacturing defect seems to be the most likely cause of this pseudoaneurysm.
.A
Lantsberg L; Khodadadi J; Golcman L; Hertzanu Y; Szendro G.
.I 90528
.U
88243901
.S
J Cardiovasc Surg (Torino) 8809; 29(3):322-5
.M
Adult; Aneurysm/ET; Case Report; Cerebral Embolism and Thrombosis/*ET; Cerebral Infarction/*ET; Human; Male; Subclavian Artery/PA; Thoracic Outlet Syndrome/*CO/PA.
.T
Embolic brain infarction: a rare complication of thoracic outlet syndrome. A report of two cases.
.P
JOURNAL ARTICLE.
.W
The thoracic outlet syndrome is known to cause brachial neuropathy. Pressure on the subclavian artery causing post-stenotic dilatation with intraluminal thrombosis is not a common complication. This may lead to antegrade embolisation and ischemic changes in the upper limb. In right sided thoracic outlet syndrome the thrombus may extend retrogradely. From this an embolus may detach to the right hemisphere of the brain resulting in left sided hemiplegia. This is a rare but serious complication from a neglected, relatively benign, curable condition. This report describes two cases of a right sided thoracic outlet syndrome due to cervical rib compression with retrograde embolisation.
.A
al-Hassan HK; Abdul Sattar M; Eklof B.
.I 90529
.U
88243902
.S
J Cardiovasc Surg (Torino) 8809; 29(3):326-8
.M
Adult; Aneurysm/*PA/SU; Arteries; Case Report; Human; Male; Thumb/*BS; Ulna/*BS.
.T
A case of ulnar aneurysm. Clinical and surgical considerations.
.P
JOURNAL ARTICLE.
.W
Although ulnar artery aneurysms have been known since the 17th century, fewer than 100 cases have been reported. Because of the rarity of this condition, a case of traumatic ulnar artery aneurysm which was operated on in our department is presented and the clinical findings, diagnosis and surgical implications are considered.
.A
Kutsal A; Kivanc O.
.I 90530
.U
88243903
.S
J Cardiovasc Surg (Torino) 8809; 29(3):329-31
.M
Adult; Arterial Occlusive Diseases/*CO; Case Report; Endothelium, Vascular/PA; Female; Fibromuscular Dysplasia/*CO/PA; Human; Hypertension, Renovascular/*ET; Renal Artery/*AB/PA; Renal Artery Obstruction/*CO/PA.
.T
Renovascular hypertension: a case of intimal fibroplasia with congenital anomaly of the renal artery.
.P
JOURNAL ARTICLE.
.W
We report a case of renovascular hypertension caused by fibromuscular dysplasia (intimal fibroplasia) with congenital anomaly of the renal artery. Arteriography revealed complete occlusion from the root to the middle of the right renal artery and a collateral artery from the right lumbar artery. Histological examination showed intimal fibroplasia and three arterioles in the intima of the renal artery.
.A
Yamana K; Nakayama Y; Kinoshita T; Nakama T; Haraguchi S; Imamura A; Ohba S; Hirata Y; Akashi H; Koga M.
.I 90531
.U
88243904
.S
J Cardiovasc Surg (Torino) 8809; 29(3):332-4
.M
Aged; Aneurysm/*SU; Cardiopulmonary Bypass/*; Carotid Artery Diseases/*SU; Case Report; Heart Arrest, Induced/*; Human; Hypothermia, Induced/*; Male; Neck; Rupture, Spontaneous.
.T
Surgery of extracranial carotid artery aneurysm using cardiopulmonary bypass, hypothermia and circulatory arrest.
.P
JOURNAL ARTICLE.
.W
A patient with a large, rapidly expanding extracranial carotid artery aneurysm was successfully operated upon during intentional arrest of the circulation. This was accomplished with cardiopulmonary bypass and hypothermia. The advantages and disadvantages of this technique are discussed.
.A
Thelin S; Almgren B; Hansson HE; Tyden H.
.I 90532
.U
88243905
.S
J Cardiovasc Surg (Torino) 8809; 29(3):335-8
.M
Adult; Child; Child, Preschool; Coronary Vessel Anomalies/CO/*DI/SU; Diagnosis, Differential; Female; Heart Failure, Congestive/ET; Human; Infant; Ligation; Male; Mitral Valve Insufficiency/ET; Pulmonary Artery/*AB/SU.
.T
Anomalous origin of the left coronary artery from the pulmonary artery. Experience with 13 cases.
.P
JOURNAL ARTICLE.
.W
The authors present their clinical and surgical experience with 13 cases of anomalous origin of the left coronary artery from the pulmonary artery. The series confirms the existence of 2 different anatomical types of this anomaly depending upon the different development of the intercoronary collateral blood-flow: the "infantile" and the "adult" types. Mitral incompetence is a frequent associated anomaly which may sometimes be the presenting clinical feature, thus masking the underlying disease. The results with different surgical techniques performed in 7 patients are discussed.
.A
Tiraboschi R; Manasse E; Borghi A; Brunelli F; Parenzan L.
.I 90533
.U
88243906
.S
J Cardiovasc Surg (Torino) 8809; 29(3):339-42
.M
Adolescence; Aorta/SU; Child; Child, Preschool; Coronary Vessel Anomalies/CO/*SU; Female; Follow-Up Studies; Human; Infant; Ligation; Male; Postoperative Complications; Pulmonary Artery/*AB/SU.
.T
The need for follow-up after surgical correction of anomalous left coronary artery arising from the pulmonary artery.
.P
JOURNAL ARTICLE.
.W
Four patients are described with an anomalous origin of the left coronary artery from the pulmonary artery. Three were treated by ligation of the abnormal left coronary artery at its anomalous origin; one of them died during surgery. One patient was treated with reimplantation of the left coronary artery into the aorta. Of the survivors 2 are in normal health, but 1 developed aortic valve incompetence after reimplantation of the left coronary artery into the aorta and 1 had persistent left ventricular wall motion abnormalities and developed mitral valve prolapse. The third survivor has impaired health with diffuse left ventricular wall motion abnormality. Careful follow-up after surgery for an anomalous left coronary artery arising from the pulmonary artery is necessary for secondary prevention of problems due to incomplete recovery of myocardium or problems as a consequence of surgical therapy.
.A
Bogers AJ; Quaegebeur JM; Huysmans HA.
.I 90534
.U
88243909
.S
J Cardiovasc Surg (Torino) 8809; 29(3):354-5
.M
Dissection/MT; Human; Internal Mammary-Coronary Artery Anastomosis/*MT; Silicone Elastomers; Surgical Flaps.
.T
A safe and rapid method for the mobilization of the internal mammary pedicle.
.P
JOURNAL ARTICLE.
.W
A simple method is described for the safe and rapid dissection of the internal mammary pedicle. The essential feature of this technique is the use of Silicone Rubber devices, for the identification and retraction of the internal mammary pedicle during its preparation.
.A
Schachner A; Hauptman E; Deviri E; Levy MJ.
.I 90535
.U
88243910
.S
J Cardiovasc Surg (Torino) 8809; 29(3):356-9
.M
Adult; Bioprosthesis/*/AE; Case Report; Endocarditis/ET/*SU; Female; Heart Valve Diseases/SU; Heart Valve Prosthesis/*/AE; Human; Lupus Erythematosus, Systemic/CO; Tricuspid Valve/*/SU.
.T
Bioprosthetic valve excision without replacement in the tricuspid position in a patient with Libman-Sacks endocarditis.
.P
JOURNAL ARTICLE.
.W
A 19 year old girl with Systemic Lupus Erythematosus (SLE), in chronic renal failure and on haemodialysis, underwent tricuspid valve replacement with a Carpentier-Edwards xenograft because of a large calcified mass invading the right side of the heart. The mass caused no symptoms and had been discovered accidentally on a routine chest X-ray. The bioprosthetic valve had subsequently to be removed, having developed functional stenosis, and was not replaced. Despite the absence of a tricuspid valve, the patient remains well five years after the operation.
.A
Ledingham SJ; Pellegrini A; Deverall PB.
.I 90536
.U
88243911
.S
J Cardiovasc Surg (Torino) 8809; 29(3):360-3
.M
Aortic Valve/MI/SU; Bioprosthesis; Case Report; Coxiella/IP; Endocarditis, Bacterial/*DI/SU; Heart Valve Prosthesis/*; Human; Male; Middle Age; Mitral Valve; Q Fever/*DI/SU; Recurrence.
.T
Q fever endocarditis: relapse five years after successful valve replacement for a first unrecognized episode.
.P
JOURNAL ARTICLE.
.W
A 59-yr-old man presented with mitral endocarditis and negative blood cultures. Antibodies to phase 2 and phase 1 antigens of Coxiella burneti were detected and a diagnosis of Q fever endocarditis was made. Five years earlier, this patient had been successfully treated by aortic valve replacement for a first episode of endocarditis with negative blood cultures. Giemsa and Machiavello stains of the native aortic valve were made retrospectively and showed coccobacilli highly suggestive of Coxiella organisms. It is concluded that the first episode was Q fever endocarditis and that the failure to recognize this aetiology at that time, and the absence of adequate medical therapy, is the cause of the present episode.
.A
Noseda A; Liesnard C; Goffin Y; Thys JP.
.I 90537
.U
88244002
.S
J Clin Endocrinol Metab 8809; 67(1):1-5
.M
Apolipoproteins/BL; Blood Glucose/*ME; Blood Pressure/*DE; Capsules; Combined Modality Therapy; Diabetes Mellitus, Non-Insulin-Dependent/BL/*DT/PP; Diabetic Diet; Drug Evaluation; Fatty Acids, Unsaturated/*TU; Female; Fish Oils/*TU; Human; Lipids/*BL; Lipolysis; Lipoproteins/BL; Male; Middle Age; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Effects of omega-3 fish oils on lipid metabolism, glycemic control, and blood pressure in type II diabetic patients.
.P
JOURNAL ARTICLE.
.W
We investigated the effects of omega-3 fish oil (FO) supplementation on lipid metabolism, glycemic control, and blood pressure (BP) in patients with type II diabetes mellitus. In 22 diabetic patients without overt hyperlipidemia, serum triglyceride, total cholesterol, high density lipoprotein (HDL)-cholesterol, HDL2-cholesterol, HDL3-cholesterol, and apolipoprotein A-I (apo A-I) levels did not change during omega-3 FO supplementation for 8 weeks. The mean serum apo B concentration increased significantly [baseline, 2.56 +/- 0.11 (+/- SEM) mmol/L; 4 weeks, 2.82 +/- 0.13 mmol/L; 8 weeks, 2.80 +/- 0.13 mmol/L; P less than 0.01]. The mean plasma postheparin lipoprotein lipase activity increased transiently during the fourth week (baseline, 168 +/- 17 U/mL; 4 weeks, 182 +/- 18 U/mL; P less than 0.05), whereas postheparin hepatic triglyceride lipase activity did not change. Glycemic control worsened transiently during the fourth week, (baseline, 7.7 +/- 0.4%; 4 weeks, 8.4 +/- 0.3%; P less than 0.05). Both systolic and diastolic BP decreased significantly throughout the study (systolic BP: baseline, 142 +/- 5 mm Hg; 8 weeks, 128 +/- 5 mm Hg; diastolic BP: baseline, 88 +/- 4 mm Hg; 8 weeks, 80 +/- 3 mm Hg; P less than 0.01). These findings suggest that in type II diabetics without overt hyperlipidemia, omega-3 FO supplementation does not improve either the glycemic control or serum lipids, and it is associated with a potentially detrimental rise in serum apo B concentrations. Until more information is available, use of such supplementation should be discouraged.
.A
Kasim SE; Stern B; Khilnani S; McLin P; Baciorowski S; Jen KL.
.I 90538
.U
88244003
.S
J Clin Endocrinol Metab 8809; 67(1):104-9
.M
Adult; Androgens/BI/BL/*GE; Comparative Study; Human; Male; Metabolic Clearance Rate; Middle Age; Stanolone/AD/BL/GE; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Testosterone/AD/BL/GE; Time Factors; Twins, Dizygotic; Twins, Monozygotic; Variation (Genetics); 5-Androstane-3,17-diol/BL.
.T
Quantitating genetic and nongenetic factors influencing androgen production and clearance rates in men.
.P
JOURNAL ARTICLE.
.W
Both hereditary and nonhereditary factors have a decided influence on plasma sex steroid concentrations in men. We studied the relative contributions of genetic and nongenetic factors on the production rate (PR) and MCR of testosterone and dihydrotestosterone (DHT) and their conversion ratios to other metabolites in monozygotic (MZ; n = 22) and dizygotic (DZ; n = 24) male twins. Zygosity was determined by measurement of 10 blood proteins and enzymes. The kinetic studies were conducted with isotope dilution techniques. The genetic effect was determined from the equation: 2[rMZ - rDZ], where r is intraclass correlation. A heritability of over 40% was found for the PRs of DHT/body surface area and of testosterone/body surface area. Nongenetic factors accounted for 50% or more of the variation of the conversion ratios for testosterone/3 alpha-androstanediol and DHT/3 alpha-androstanediol. The results suggest that genetic factors markedly influence the PRs of testosterone and DHT, suggesting that the PR of these potent androgens is under genetic control despite the decided influence of environmental factors on their clearance.
.A
Meikle AW; Stringham JD; Bishop DT; West DW.
.I 90539
.U
88244004
.S
J Clin Endocrinol Metab 8809; 67(1):110-5
.M
Adrenal Cortex Hormones/AN/*IP; Adult; Comparative Study; Dialysis; Female; Human; In Vitro; Kidney Failure, Chronic/BL/TH; Male; Middle Age; Peritoneal Dialysis, Continuous Ambulatory/*; Protein Binding; Research Design; Serum Albumin/AN; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Transcortin/AN.
.T
Dialysance of adrenocorticoids during continuous ambulatory peritoneal dialysis.
.P
JOURNAL ARTICLE.
.W
We postulated that significant quantities of both protein-bound and unbound adrenocorticoids are lost during continuous ambulatory peritoneal dialysis (CAPD). To test this hypothesis we measured the dialysate removal rates (DRR) of adrenocorticoids in six CAPD patients. The distribution of the adrenocorticoids among unbound, albumin-bound, and transcortin-bound fractions in dialysate effluent was determined. The distribution of cortisol among unbound, albumin-bound, and transcortin-bound fractions in plasma was determined in six other CAPD patients. The mean DRR of cortisol was 193.8 +/- 20.3 (+/- SE) nmol/day. Smaller quantities of 11-deoxycorticosterone, corticosterone, aldosterone, 18-hydroxy-11-deoxycorticosterone, and 18-hydroxycorticosterone were removed during CAPD. The mean DRR values for total protein, albumin, and transcortin were 11.2 +/- 2.1, 6.0 +/- 2.2, and 0.087 +/- 0.018 g/day, respectively. The distribution of cortisol among unbound, albumin-bound, and transcortin-bound fractions was normal in plasma from CAPD patients. Plasma transcortin had a normal affinity (2 x 10(7) mol/L-1) and a normal binding capacity (559 nmol/L) for cortisol. In contrast, dialysate transcortin had a low affinity (1.4 x 10(7) mol/L-1) for cortisol and a low cortisol-binding capacity (11.5 nmol/L). The fractional occupancy rates of high affinity cortisol-binding sites on transcortin were 52.0 +/- 3.3% and 3.3 +/- 0.6% in plasma and dialysate effluent, respectively (P less than 0.001). The transcortin to cortisol molar concentration ratio in dialysate (6.3 +/- 0.6) was significantly higher than that in plasma (1.6 +/- 0.2; P less than 0.001). These results demonstrate that cortisol is the major adrenocorticoid lost during CAPD. However, the amount of cortisol removed in the dialysate is less than 1% of the normal daily secretion rate. Significant quantities of other adrenocorticoids are also lost during CAPD. The adrenocorticoids present in dialysate effluent are principally unbound, in contrast to their state in plasma. However, small fractions of the respective steroids are bound to transcortin and albumin.
.A
Zager PG; Spalding CT; Frey HJ; Brittenham MC; Nevarez M.
.I 90540
.U
88244005
.S
J Clin Endocrinol Metab 8809; 67(1):116-23
.M
Activity Cycles/*; Adult; Circadian Rhythm/*; Fourier Analysis; Human; Hypothalamo-Hypophyseal System/*PH; LH/BL/*SE; Male; Methods; Prolactin/BL/*SE; Radioimmunoassay; Reference Values; Statistics; Support, U.S. Gov't, P.H.S.; Testis/*PH; Time Factors.
.T
Operating characteristics of the hypothalamo-pituitary-gonadal axis in men: circadian, ultradian, and pulsatile release of prolactin and its temporal coupling with luteinizing hormone.
.P
JOURNAL ARTICLE.
.W
To investigate the circadian, ultradian, and pulsatile nature of PRL release in the human, we sampled blood at 10-min intervals for 24 h in each of 12 normal young men. The subsequent serum PRL time series were subjected to contemporary techniques of rhythmic and episodic peak detection. Fourier analysis revealed a significant circadian rhythm in serum PRL concentrations in all 12 men. The mean circadian amplitude was 2.1 +/- 0.3 ng/mL (micrograms/L), which accounted for an average of 30 +/- 4% of the 24-h mean PRL concentration. In addition, multiple ultradian PRL rhythms were found with periodicities ranging from 22-242 min. Spectral analysis disclosed ultradian cycles with periodicities of 30-32, 51-59, 90-98, and 234 min. Assessment of episodic PRL pulsatility by Cluster analysis revealed 14 +/- 1 PRL peaks/24 h (P less than 0.01 vs. signal-free noise), which occurred at an interpulse interval of 95 +/- 6 min. The average duration of a serum PRL peak was 67 +/- 5 min, and its incremental amplitude was 4.0 +/- 0.3 ng/ml (micrograms/L), which represented a 58 +/- 6% increase above the preceding nadir. Discrete PRL peaks were separated by nonpulsatile valleys, with a mean duration of 27 +/- 1 min. Analysis of the temporal coupling between LH and PRL release by bivariate autoregressive modeling in six men revealed significant cross-correlations between LH and simultaneous PRL concentrations as well as between LH and PRL concentrations that lagged LH by 10 or 20 min. Cross-spectral analysis demonstrated significantly correlated PRL and LH cycles with periodicities of 33-37, 47-52, and 84-106 min. In summary, PRL release in normal young men is characterized by significant circadian and ultradian periodicities, by discrete episodic pulsations that occur approximately every 95 min, and by a close temporal coupling with LH (temporal lag between LH and PRL of 0-20 min).
.A
Veldhuis JD; Johnson ML.
.I 90541
.U
88244006
.S
J Clin Endocrinol Metab 8809; 67(1):124-30
.M
Adult; Amenorrhea/*BL/ET; Bone and Bones/AN; Bone Diseases, Metabolic/*BL/ET; Comparative Study; Densitometry, X-Ray/MT; Estrogens/*DF; Female; Human; Hyperprolactinemia/BL/CO; Hypothalamic Diseases/BL/CO; Menstrual Cycle; Prolactin/*BL; Risk Factors; Support, U.S. Gov't, P.H.S..
.T
Effects of prolactin and estrogen deficiency in amenorrheic bone loss.
.P
JOURNAL ARTICLE.
.W
To determine whether hyperprolactinemic women with menses are at risk for the development of osteopenia and to define the effects of PRL excess and estrogen deficiency on bone mass in amenorrheic women, spinal and radial bone densities were measured in 25 hyperprolactinemic women (13 with amenorrhea and 12 with regular menstrual periods) and 11 women with hypothalamic amenorrhea. The degree of hyperprolactinemia was comparable in the hyperprolactinemic women with and without menstrual periods [mean, 55 +/- 18 (+/- SD) and 57 +/- 16 micrograms/L, respectively]. The mean spinal bone density in the hyperprolactinemic amenorrheic women (148 +/- 26 mg/K2HPO4.cm3) was significantly lower (P less than 0.01) than that in 19 normal women (178 +/- 21 mg/K2HPO4.cm3), and 6 of the former group had values greater than 2 SD below normal. However, the mean spinal bone density in the eumenorrheic hyperprolactinemic women (171 +/- 22 mg/K2HPO4.cm3) was similar to that in the normal women and was significantly greater (P less than 0.05) than that in the hyperprolactinemic amenorrheic women. The mean spinal bone density in the women with hypothalamic amenorrhea (128 +/- 24 mg/K2HPO4.cm3) and normal PRL levels was also significantly (P less than 0.001) lower than that in normal women or hyperprolactinemic euenorrheic women. Six of the women with hypothalamic amenorrhea had bone density measurements greater than 2 SD below normal. The spinal bone density values were similar in the amenorrheic women with or without hyperprolactinemia. The mean radial bone density in the hyperprolactinemic women with amenorrhea (0.69 +/- 0.03 g/cm2) was comparable to that in the women with hypothalamic amenorrhea (0.69 +/- 0.05 g/cm2), and both groups had significantly (P less than 0.05) lower values than normal women (0.72 +/- 0.03 g/cm2). Radial bone density was normal in the hyperprolactinemic eumenorrheic women. The mean serum estradiol level in the hyperprolactinemic amenorrheic women (120 +/- 90 pmol/L) was significantly (P less than 0.05) lower than that in the hyperprolactinemic eumenorrheic women measured during the follicular phase of their cycles (240 +/- 180 pmol/L) and was comparable to that in the women with hypothalamic amenorrhea (80 +/- 40 pmol/L). Multiple comparisons of clinical variables, serum hormone concentrations, and bone mass demonstrated a significant correlation (P = 0.0125) between bone density and serum dehydroepiandrosterone sulfate levels, which suggests a role for endogenous androgens in the maintenance of premenopausal bone mass.(ABSTRACT TRUNCATED AT 400 WORDS)
.A
Klibanski A; Biller BM; Rosenthal DI; Schoenfeld DA; Saxe V.
.I 90542
.U
88244008
.S
J Clin Endocrinol Metab 8809; 67(1):139-43
.M
Adrenal Glands/*PH; Adrenalectomy; Chronic Disease; Cold; Combined Modality Therapy; Comparative Study; Cushing's Syndrome/BL/PP/TH; Epinephrine/BL; Female; Fludrocortisone/TU; Glucocorticoids, Synthetic/TU; Hemodynamics/*; Human; Mental Processes/PH; Norepinephrine/BL; Posture; Support, Non-U.S. Gov't; Sympathetic Nervous System/*PH.
.T
Hemodynamic reactivity to sympathoadrenal stimulation in adrenalectomized women.
.P
JOURNAL ARTICLE.
.W
To determine the extent to which circulating epinephrine (E) mediates the cardiovascular effects of sympathoadrenal stimulation, we studied the blood pressure (BP), heart rate, forearm vascular resistance, and plasma catecholamine responses to a mental arithmetic test, head-up tilt test, and cold pressor test in 10 adrenalectomized women and 10 age-matched normotensive women. The mean basal diastolic BP was slightly higher in the adrenalectomized women (80 vs. 68 mm Hg; P less than 0.05). During mental arithmetic, the adrenalectomized women had a smaller heart rate increase than the normal women [6 +/- 1% (+/- SE) vs. 16 +/- 4%; P less than 0.05], but the BP response was not different. During the head-up tilt and cold pressor tests the hemodynamic responses were similar in the adrenalectomized and normal women. As expected, plasma E was undetectable in the adrenalectomized women. Plasma norepinephrine (NE) did not change in either group during mental arithmetic. In the adrenalectomized women the plasma NE increases during the head-up tilt and cold pressor test were not significantly different from those in the normal women. Thus, the adrenalectomized women had a normal pressor response during all 3 types of adrenergic stimulation, apparently independent of plasma E. Together with the normal plasma NE responses to head-up tilt and cold exposure, we challenge the contention that the E-mediated presynaptic beta-adrenergic stimulation of NE release plays a pivotal physiological role during short term adrenergic stress.
.A
Lenders JW; Peters JH; Pieters GF; Willemsen JJ; Thien T.
.I 90543
.U
88244012
.S
J Clin Endocrinol Metab 8809; 67(1):161-8
.M
Animal; Antigen-Antibody Reactions; Antigens/IM/IP; Chromatography, Affinity; Comparative Study; Goiter, Nodular/IM; Graves' Disease/IM; Human; Immune Sera/IM/IP; Immunization/MT; Rabbits; Radioimmunoassay; Structure-Activity Relationship; Support, U.S. Gov't, P.H.S.; Thyroglobulin/*IM/IP; Thyroid Diseases/*IM; Thyroid Gland/IM; Thyroid Neoplasms/IM.
.T
Altered immunoreactivity of thyroglobulin in thyroid disease.
.P
JOURNAL ARTICLE.
.W
We prepared 3 samples of 19S thyroglobulin (Tg), 1 from a patient with Graves' disease, another from a patient with nontoxic goiter, and the third from a pool of Tg from normal subjects, and used each Tg preparation to produce a polyvalent antiserum in rabbits. The 3 antisera were similar to each other in their reactivity with thyroid Tg samples from 25 patients with various thyroid disorders and from 10 normal subjects. However, the immunoreactivity of the 35 individual Tg samples varied considerably. Decreased reactivity was associated with proteolysis during Tg preparation, iodination in vitro with 20 or more atoms of iodine/molecule Tg, the 27S species of Tg, Tg from 3 patients with thyroid cancer, and Tg from several patients with Graves' disease. The antiserum to Graves' Tg contained some antibodies that did not bind normal Tg on an affinity column, and these antibodies reacted more with Tg from patients with Graves' disease than with Tg from normal subjects or patients with nontoxic goiters. Thus, Tg from patients with Graves' disease may contain antigenic sites that are not present or exposed in Tgs from other subjects. We conclude that thyroid Tgs from patients with Graves' disease and from those with thyroid cancer may be different in structure from the Tgs of normal subjects. This conclusion is important to an understanding of Tg structure in thyroid disease and to the use of thyroid Tg for preparation of antisera and standards for measuring serum Tg concentrations.
.A
Kim PS; Dunn AD; Dunn JT.
.I 90544
.U
88244014
.S
J Clin Endocrinol Metab 8809; 67(1):17-24
.M
Binding, Competitive/DE; Catalysis; Comparative Study; Female; Human; In Vitro; Iodide Peroxidase/ME; Iodine/*ME; Iodine Radioisotopes/DU; Kinetics; Liver/DE/*EN; Male; Microsomes, Liver/DE/EN; Substrate Specificity/DE; Thyroid Hormones/*ME; Time Factors.
.T
Deiodination of thyroid hormone by human liver.
.P
JOURNAL ARTICLE.
.W
Liver is an important site for the peripheral production of T3 by outer ring deiodination (ORD) of T4 as well as for the clearance of plasma rT3, which is produced by inner ring deiodination (IRD) of T4 in other tissues. However, little is known about the underlying enzymatic reactions, and current concepts about thyroid hormone deiodination are largely based on studies in rat tissue. Here we describe the results of detailed studies of the catalytic properties of the iodothyronine deiodinase activity of human liver. The results demonstrated a high degree of similarity with the type I deiodinase of rat liver. The enzyme activity was found in the microsomal fraction. rT3 was the preferred substrate, since its ORD was catalyzed roughly 400 times more efficiently than the ORD or IRD of T4 or the IRD of T3. The deiodination of sulfated substrates was more rapid, as demonstrated by the roughly 30-fold increase in the IRD of T3 sulfate (T3S) compared with T3. The deiodinations exhibited ping-pong-type kinetics with dithiothreitol as the cofactor. Inhibition by propylthiouracil was uncompetitive with substrate and competitive with dithiothreitol, and PTU was an equally effective inhibitor of the ORD of rT3 and the IRD of T3S (Ki, 0.10-0.16 mumol/L). Various compounds with widely different inhibitory potencies had similar effects on ORD (rT3) and IRD (T3S). These results suggest that in human liver microsomes a single enzyme catalyzes the deiodination of the outer as well as the inner ring of iodothyronines by the same catalytic mechanism and with the same substrate specificity as the type I deiodinase of rat liver.
.A
Visser TJ; Kaptein E; Terpstra OT; Krenning EP.
.I 90545
.U
88244020
.S
J Clin Endocrinol Metab 8809; 67(1):198-202
.M
Adult; Calcitriol/BL; Calcium/AN; Chromatography, High Pressure Liquid; Comparative Study; Dihydrotachysterol/*BL/PD; Female; Human; Male; Middle Age; Phosphorus/AN; Reference Values; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Time Factors.
.T
Serum dihydrotachysterol levels and biological action in normal man.
.P
JOURNAL ARTICLE.
.W
Dihydrotachysterol (DHT2) has been a safe and effective treatment for hypocalcemic disorders for many years, but few assays for quantitation of DHT2 have been developed. Thus little is known about its pharmacokinetics. The 2-fold purpose of this study was 1) to develop a practical method for quantitating DHT2 after oral dosing in normal subjects, and 2) to assess changes in serum DHT2 levels and calcium and phosphorus metabolism after DHT2 administration for 8 days. Peak serum DHT2 levels in six normal subjects, assayed by high performance liquid chromatography were achieved 4 h after administration of 0.4-0.8 mg DHT2; at 24 h, levels had declined by 70% whether DHT2 had been given for 1 or 8 days. These data indicate that a standard approach is needed to interpret the results of serum DHT2 measurements in treated patients. Interfering substances were detected in lipemic serum. The major biological effects of DHT2 administration were hypercalciuria in two subjects and a fall in serum 1,25-dihydroxyvitamin D[1,25-(OH)2D] levels, including free levels when measured, in all subjects. Possible explanations for this fall in serum 1,25-(OH)2D levels include decreased 1,25-(OH)2D production because of competition for the 1 alpha-hydroxylase enzyme by a metabolite(s) of DHT or increased metabolic clearance of 1,25-(OH)2D.
.A
Taylor A; Bikle DD; Norman ME.
.I 90546
.U
88244024
.S
J Clin Endocrinol Metab 8809; 67(1):30-5
.M
Aging/BL; Apolipoproteins/*BL/IP; Body Weight; Cholesterol/BL; Comparative Study; Electrophoresis, Polyacrylamide Gel/MT; Enzyme-Linked Immunosorbent Assay; Female; Human; Lipoproteins, HDL Cholesterol/BL; Lipoproteins, LDL/*BL/IP; Lipoproteins, LDL Cholesterol/BL; Menopause/*BL; Particle Size; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Triglycerides/BL.
.T
Differences in low density lipoprotein subfractions and apolipoproteins in premenopausal and postmenopausal women.
.P
JOURNAL ARTICLE.
.W
Postmenopausal or oophorectomized women are at higher risk for the development of coronary artery disease than are premenopausal women. These differences in risk may be due to alternations in plasma lipoproteins modulated by hormonal changes. Plasma cholesterol, triglyceride, lipoprotein cholesterol, and apolipoprotein A-I and B (apoB) concentrations, as well as low density lipoprotein (LDL) particle size (LDL 1-7), as assessed by 2-16% polyacrylamide-agarose gradient gel electrophoresis, were determined in 87 premenopausal and 43 postmenopausal women. All were participants in the Framingham Offspring Study, were gynecologically normal, and were not taking any hormones. The postmenopausal women had significantly (P less than 0.05) higher plasma LDL cholesterol concentrations than did the premenopausal women. Plasma triglyceride, total cholesterol, very low density lipoprotein cholesterol, and apoB levels were higher, and apoA-I and high density lipoprotein cholesterol were lower in the postmenopausal group, but these differences were not significant at P less than 0.05. The postmenopausal women were likely to have small LDL particles compared to premenopausal women. Controlling for age and body mass index effects significantly reduced the differences in total cholesterol, LDL cholesterol, apoB, and LDL particle size and broadened the differences in apoA-I and high density lipoprotein cholesterol. These data indicate that menopause is positively correlated with LDL cholesterol (P less than 0.05) and decreased LDL particle size (P less than 0.05) after adjusting for significant covariates.
.A
Campos H; McNamara JR; Wilson PW; Ordovas JM; Schaefer EJ.
.I 90547
.U
88244026
.S
J Clin Endocrinol Metab 8809; 67(1):41-5
.M
Adult; Amyloidosis/*DI/ET/PA; Case Report; Comparative Study; Crohn Disease/CO/PA; Female; Human; Male; Middle Age; Recurrence; Syndrome; Thyroid Diseases/*DI/ET/PA; Thyroid Gland/PA; Thyroiditis, Subacute/*DI/ET/PA; Thyroxine/BL; Triiodothyronine/BL.
.T
Thyroid amyloidosis with recurrent subacute thyroiditis-like syndrome.
.P
JOURNAL ARTICLE.
.W
We studied 2 men with a subacute thyroiditis-like syndrome (STLS) associated with systemic amyloidosis. Both had very tender, diffuse, firm goiters, low thyroidal radioactive iodine uptake values, and increased erythrocyte sedimentation rates. Glucocorticoid therapy resulted in dramatic improvement. Compared to 18 patients with subacute thyroiditis, these 2 men had 1) persistence of goiter even in remission, 2) repeated exacerbation of STLS, 3) pain always localized in the same site, and 4) gastrointestinal, renal, and cardiac abnormalities. Histological examination of the patients' thyroid glands revealed amyloid deposition and no evidence of subacute thyroiditis. In addition, 1 man had low T3 thyrotoxicosis with an elevated rT3/T3 ratio, suggesting impaired peripheral conversion of T4 to T3, and immunological and histological evidence of Hashimoto's thyroiditis. These findings suggest that thyroid amyloidosis may be associated with STLS. When patients with clinical features of subacute thyroiditis have an unusual course, the possibility of thyroid amyloidosis should be considered.
.A
Ikenoue H; Okamura K; Kuroda T; Sato K; Yoshinari M; Fujishima M.
.I 90548
.U
88244027
.S
J Clin Endocrinol Metab 8809; 67(1):46-53
.M
Adenosine Cyclic Monophosphate/ME; Animal; Bone and Bones/PA; Case Report; Cells, Cultured; Combined Modality Therapy; Femoral Neoplasms/BL/*CO/PA/TH; Hemangiopericytoma/BL/*CO/PA/TH; Human; Kidney/DE/*EN; Male; Mice; Mice, Nude; Middle Age; Neoplasm Transplantation; Osteomalacia/BL/*ET/PA/TH; Phosphates/*BL; Steroid Hydroxylases/*AI; Support, Non-U.S. Gov't; Tissue Extracts/*PD; 25-Hydroxycholecalciferol 1-Hydroxylase/*AI.
.T
Hemangiopericytoma-induced osteomalacia: tumor transplantation in nude mice causes hypophosphatemia and tumor extracts inhibit renal 25-hydroxyvitamin D 1-hydroxylase activity.
.P
JOURNAL ARTICLE.
.W
Although more than 50 patients with the tumor-induced osteomalacia syndrome, characterized by remission of unexplained osteomalacia after resection of a coexisting tumor, have been reported, the pathogenesis of this syndrome is still not clear. We investigated the cause of biopsy-confirmed osteomalacia which was resistant to treatment with 1 alpha-hydroxyvitamin D3 in a 54-yr-old man. He had severe hypophosphatemia, a high serum alkaline phosphatase level, a low plasma 1,25-dihydroxyvitamin D level, and remarkably increased urinary phosphorus excretion. A tumor, with histological characteristics of a hemangiopericytoma, was found on his left thigh. After surgical removal of this tumor, his plasma 1,25-dihydroxyvitamin D and serum phosphorus levels increased to normal levels, and his bone pain subsided. The tumor was transplanted to athymic nude mice. A nodule formed in each mouse, with histological features identical to those of the original tumor, and the tumor-bearing mice had hypophosphatemia, high serum alkaline phosphatase levels, and increased urinary phosphorus excretion. When extracts of the original tumor were added to primary cultures of renal tubular cells, renal cAMP levels did not change, but 25-hydroxyvitamin D-1 alpha-hydroxylase activity was significantly inhibited. These data indicate tumoral production of some humoral factor(s) inhibiting 25-hydroxyvitamin D-1 alpha-hydroxylase activity and phosphorus reabsorption unrelated to adenylate cyclase-cAMP production in proximal renal tubules.
.A
Miyauchi A; Fukase M; Tsutsumi M; Fujita T.
.I 90549
.U
88244028
.S
J Clin Endocrinol Metab 8809; 67(1):54-61
.M
Adult; Blood Glucose/AN; Body Composition/*DE; Body Weight/DE; Combined Modality Therapy; Comparative Study; Diet, Reducing/*; Drug Evaluation; Female; Human; Insulin-Like Growth Factor I/BL; Lipolysis/*DE; Male; Middle Age; Nitrogen/ME; Obesity/ME/*TH; Recombinant Proteins/TU; Somatotropin/*AA/TU; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Time Factors.
.T
Treatment of obese, diet-restricted subjects with growth hormone for 11 weeks: effects on anabolism, lipolysis, and body composition.
.P
JOURNAL ARTICLE.
.W
We found in a previous study that injections of GH for 3 weeks caused nitrogen conservation despite restriction of intake to 24 Cal (100 kJ)/kg ideal BW (IBW). To determine the effects of longer periods of treatment and further caloric restriction on nitrogen balance, lipolysis, and body composition, 20 obese (30-67% over IBW) subjects (16 women and 4 men; 20-54 yr old) were fed a diet of 18 Cal (75 kJ)/kg IBW with 1.2 g protein/kg IBW daily for 13 weeks. During weeks 2-12, 10 subjects received injections of recombinant methionyl GH (0.1 mg/kg IBW every other day), and the other 10 sex-, age-, and weight-matched subjects were given injections of saline. There were no significant differences between the two groups in total weight loss [GH, 13.9 +/- 3.0 (+/- SD) kg; saline, 15.2 +/- 3.8 kg ) or the percentage of body fat lost (GH, 8.1 +/- 2.4%; saline, 7.5 +/- 1.5%), although GH injection caused a significant acute increment in serum FFA concentrations (GH, 0.53 +/- 0.37 mmol/L; saline, 0.08 +/- 0.22 mmol/L; P less than 0.001) throughout the study. This acute lipolytic response to GH decreased significantly, from 0.86 +/- 0.32 mmol/L on day 1 of GH treatment to 0.35 +/- 0.41 mmol/L by day 35 of GH injection (P less than 0.01). Nitrogen balance was significantly more positive in the group receiving GH during the first 33 days of the GH injection period [GH, +0.07 +/- 1.82 g/day (+5.0 +/- 130.0 mmol/day); saline, -1.91 +/- 1.10 g/day (-136.3 +/- 78.5 mmol/day); P less than 0.001]. During the last 44 days of GH injection, however, the nitrogen balance in the two groups was similar [GH, -0.90 +/- 1.65 g/day (-64.2 +/- 117.8 mmol/day); saline, -1.08 +/- 0.95 g/day (-77.1 +/- 67.8 mmol/day); P = NS]. Mean plasma insulin-like growth factor I (IGF-I) concentrations rose from a basal value of 1.6 +/- 0.8 to 2.9 +/- 1.2 U/mL by 48 h after the first GH injection and ranged subsequently from 3.2 +/- 1.3 to 4.9 +/- 3.3 U/mL during GH injection (P less than 0.001). In contrast, the mean IGF-I concentration did not change in the group that received saline. Dietary restriction during the first week of study caused serum T3 concentrations to decline in both groups.(ABSTRACT TRUNCATED AT 400 WORDS)
.A
Snyder DK; Clemmons DR; Underwood LE.
.I 90550
.U
88244029
.S
J Clin Endocrinol Metab 8809; 67(1):6-16
.M
Abetalipoproteinemia/BL; Adult; Apolipoproteins E/DF; Chromatography, Gel; Comparative Study; Female; Human; Hypercholesterolemia, Familial/BL; Hyperlipoproteinemia Type III/BL; Hyperlipoproteinemia Type IV/BL; Lipoprotein Lipase Deficiency, Familial/BL; Lipoproteins/*BL; Male; Middle Age; Protein Binding; Reference Values; Support, Non-U.S. Gov't; Tangier Disease/BL; Thyroid Hormones/*BL.
.T
Binding of thyroid hormones to human plasma lipoproteins.
.P
JOURNAL ARTICLE.
.W
The binding of T4, T3, and rT3 to plasma lipoproteins was investigated in normal subjects and patients with abnormal lipoprotein metabolism. Gel filtration on Sepharose CL-6B demonstrated iodothyronine binding to all lipoprotein classes. In the total lipoprotein fraction (density less than 1.210 g/mL), high density lipoproteins (HDL) were the major binders, accounting for 92% of lipoprotein-bound T4, 99% of lipoprotein-bound T3, and 55% of lipoprotein-bound rT3. The estimated iodothyronine binding in normal plasma to HDL, low density lipoproteins (LDL), and very low density lipoproteins (VLDL) was 3%, 0.2%, and 0.03% for T4, 6%, 0.05%, and 0.02% for T3, and 0.1%, 0.1%, and 0.01% for rT3, respectively. These estimates may be low owing to possible dissociation during chromatography and the short incubation period used to avoid changes in lipoprotein structure. In VLDL and LDL deficiency (abetalipoproteinemia), HDL deficiency (Tangier disease), LDL excess (type IIa hyperlipoproteinemia), and VLDL excess (type III, IV, and V hyperlipoproteinemia), the distribution of iodothyronines reflected the lipoprotein abnormality. Variations resulting from altered distribution within HDL subclasses were also found. Binding was saturable, with approximate dissociation constants for VLDL, LDL, and HDL of 10(-5)-10(-6) mol/L. We conclude that thyroid hormones bind specifically to apolipoproteins, although additional binding by solubilization in the lipid components of the lipoproteins may also occur.
.A
Benvenga S; Gregg RE; Robbins J.
.I 90551
.U
88244032
.S
J Clin Endocrinol Metab 8809; 67(1):74-9
.M
Adenyl Cyclase/*BI; Animal; Cattle; Cell Line; Cells, Cultured; Comparative Study; Drug Contamination; DNA/BI/*DE; Enzyme Induction/DE; Gonadotropins, Chorionic/IP/*PD; Iodides/*ME; Rats; Rats, Inbred F344; Stimulation, Chemical; Support, U.S. Gov't, Non-P.H.S.; Thymidine/ME; Thyroid Gland/*DE/ME; Thyrotropin/PD.
.T
Human chorionic gonadotropin stimulates iodide uptake, adenylate cyclase, and deoxyribonucleic acid synthesis in cultured rat thyroid cells.
.P
JOURNAL ARTICLE.
.W
hCG stimulates thyroid function, but it has been suggested that it is impurities in commercial hCG preparations or a variant of hCG that are responsible for the thyrotropic activity. In this study, we tested the thyrotropic activity of purified and commercial hCG and compared its action with that of bovine TSH (bTSH) in cultured rat FRTL-5 cells in regard to stimulation of iodide uptake, activation of adenylate cyclase, and synthesis of DNA. Iodide uptake was measured after incubation of the cells for 48-72 h with the test hormones, followed by a 40-min incubation with 0.1 microCi Na125I and 10 mumol/L carrier NaI; the 125I in the washed cells was counted. Adenylate cyclase was measured after incubation of the cells with the test stimulators for 3 h in hypotonic medium by RIA of cAMP in the medium. DNA synthesis was measured after incubation of the cells with the test substances for 24 h, followed by addition of [3H]thymidine for 3 h and then measuring the incorporation of [3H]thymidine into the cells. Both purified and commercial hCG produced a dose-related increase in iodide uptake. The relative potency of commercial hCG was 0.024 microU bTSH/U hCG and that of purified hCG was 0.042 microU bTSH/U hCG; compared with human TSH, the potency of purified hCG was 0.72 microU/U hCG. hCG caused a dose-related increment of adenylate cyclase and [3H]thymidine incorporation. The effect of hCG on iodide uptake and [3H]thymidine incorporation was additive with that of bTSH; hCG was not an antagonist of TSH in these cultured rat thyroid cells. We conclude that hCG has intrinsic thyrotropic activity in FRTL-5 cells in regard to stimulation of iodide uptake, activation of adenylate cyclase, and stimulation of DNA synthesis.
.A
Hershman JM; Lee HY; Sugawara M; Mirell CJ; Pang XP; Yanagisawa M; Pekary AE.
.I 90552
.U
88244034
.S
J Clin Endocrinol Metab 8809; 67(1):88-92
.M
Absorption; Calcifediol/BL; Calcinosis/*BL/GE; Calcitriol/*BL; Calcium/BL; Comparative Study; Creatinine/BL; Human; Kidney Tubules/ME; Parathyroid Hormones/*BL; Phosphorus/*BL; Renal Tubular Transport, Inborn Errors/BL; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Correlations of serum concentrations of 1,25-dihydroxyvitamin D, phosphorus, and parathyroid hormone in tumoral calcinosis.
.P
JOURNAL ARTICLE.
.W
The inherited metabolic disorder tumoral calcinosis is characterized by elevated serum phosphorus and 1,25-dihydroxyvitamin D [1,25-(OH)2D] levels and paraarticular calcific tumors. The pathogenesis of this disease is obscure, but an elevated renal phosphate reabsorption threshold and increased production of 1,25-(OH)2D are postulated as defects. We studied nine affected patients and found that both serum phosphorus and renal phosphate reabsorption threshold (TmP/GFR) were positively correlated with serum 1,25-(OH)2D levels. Since tumoral calcinosis is a disorder with abnormal renal phosphate transport, we compared the TmP/GFR and serum 1,25-(OH)2D levels to values obtained in patients with two other diseases with renal phosphate transport defects: oncogenic osteomalacia and X-linked hypophosphatemic rickets. We found a significant correlation between TmP/GFR and 1,25-(OH)2D levels in all three diseases, suggesting that in these diseases 1,25-(OH)2D production is regulated in some manner by phosphate transport. Furthermore, previous work indicated that in tumoral calcinosis broad variation exists in serum phosphorus levels. In our patients a negative correlation was found between the serum PTH concentrations and both serum phosphorus levels and TmP/GFR values, respectively. We postulate that although the basic defect in tumoral calcinosis most likely resides in the proximal renal tubular cell, the variation in serum phosphorus levels and possibly disease expression is modulated in part by PTH.
.A
Lyles KW; Halsey DL; Friedman NE; Lobaugh B.
.I 90553
.U
88244036
.S
J Clin Endocrinol Metab 8809; 67(1):98-103
.M
Animal; Blood Proteins/ME; Blood-Testis Barrier; Cell Membrane Permeability; Comparative Study; Estradiol/*ME; Human; Male; Prostate/*ME; Protein Binding; Rats; Rats, Inbred Strains; Sertoli Cells/ME; Sex Hormone-Binding Globulin/*ME; Support, U.S. Gov't, P.H.S.; Testis/*ME; Testosterone/*ME; Tritium/DU.
.T
Influx of testosterone-binding globulin (TeBG) and TeBG-bound sex steroid hormones into rat testis and prostate.
.P
JOURNAL ARTICLE.
.W
The availability of testosterone and estradiol to Sertoli and prostate cells is dependent upon 1) the permeability properties of the blood-tubular barrier (BTB) of the testis or prostate cell membrane, and 2) sex steroid binding to plasma proteins, such as albumin or testosterone-binding globulin (TeBG). Sex steroid influx into these tissues was studied after in vivo arterial bolus injections of [3H]testosterone or [3H]estradiol in anesthetized rats. Both testosterone and estradiol were readily cleared across the BTB or prostate cell membrane in the absence of plasma proteins and in the presence of human pregnancy serum, in which testosterone or estradiol are 80-95% distributed to TeBG. The extravascular extraction of [3H]TeBG across the BTB or prostate plasma membrane [73 +/- 2% (+/- SE) and 92 +/- 9%, respectively] was significantly greater than extraction of [3H]albumin or other plasma space markers and indicative of a rapid first pass clearance of TeBG by Sertoli or prostate cells. In summary, these studies indicate that 1) testosterone and estradiol are readily cleared by Sertoli and prostate cells; 2) albumin- and TeBG-bound sex steroids represent the major circulating pool of bioavailable hormone for testis or prostate; and 3) the TeBG-sex steroid complex may be nearly completely available for influx through the BTB or prostate plasma membrane.
.A
Sakiyama R; Pardridge WM; Musto NA.
.I 90554
.U
88244190
.S
J Am Coll Cardiol 8809; 12(1):103-5
.M
Animal; Arteries/*SU; Catheterization; Coronary Disease/SU; Fiber Optics; Human; Laser Surgery/*; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Laser arterial recanalization: a current perspective.
.P
JOURNAL ARTICLE.
.A
Abela GS.
.I 90555
.U
88244191
.S
J Am Coll Cardiol 8809; 12(1):106-13
.M
Coronary Circulation; Coronary Disease/PA/*PP; Coronary Vessels/*PA/PP; Electrocardiography/*; Exercise Test/*; Female; Hemodynamics; Human; Male; Middle Age; Perfusion; Support, U.S. Gov't, P.H.S.; Thallium Radioisotopes/DU.
.T
Effect of isolated proximal coronary stenotic lesions on distal myocardial perfusion during exercise.
.P
JOURNAL ARTICLE.
.W
This study tested the hypothesis that the absolute dimension of a coronary stenotic lesion is a more important determinant of its hemodynamic effect on regional myocardial perfusion during exercise than is relative percent stenosis. In 31 patients with an isolated lesion of the left anterior descending coronary artery, regional myocardial perfusion was determined from thallium-201 scans recorded in the left anterior oblique projection after symptom-limited treadmill exercise. Thallium-201 uptake in the distribution of the left anterior descending coronary artery was expressed as a ratio of thallium-201 uptake in the left circumflex artery distribution. Percent area stenosis, minimal cross-sectional area and mean diameter of each stenotic lesion were measured by computer-assisted cinevideodensitometric analysis of projected coronary arteriograms digitized in a 512 X 512 pixel matrix with 256 gray levels. Thallium-201 uptake in the left anterior descending coronary artery distribution, expressed as a ratio, correlated poorly (r = 0.65) with relative percent stenosis, but correlated significantly (r = 0.83; p less than 0.05) with absolute lesion area. For all 16 patients with reduced regional perfusion in the left anterior descending coronary artery distribution during exercise, lesion cross-sectional area was less than 1.8 mm2 (mean 0.9 +/- 0.6); for 13 of the 15 patients with normal distal perfusion, the area of the stenotic lesion was greater than 1.8 mm2 (mean 2.7 +/- 0.7; p less than 0.001). Percent coronary stenosis failed to predict flow-limiting lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Nichols AB; Buczek JA; Schwann TA; Esser PD; Blood DK.
.I 90556
.U
88244192
.S
J Am Coll Cardiol 8809; 12(1):114-20
.M
Adult; Blood Flow Velocity; Comparative Study; Diabetes Mellitus, Insulin-Dependent/*PP; Diastole/*; Echocardiography/*; Female; Heart/*PP; Hemodynamics; Human; Male; Middle Age; Myocardial Contraction/*; Myocardial Diseases/DI/PP.
.T
Diastolic abnormalities in young asymptomatic diabetic patients assessed by pulsed Doppler echocardiography.
.P
JOURNAL ARTICLE.
.W
Indexes of left ventricular diastolic filling were measured by pulsed Doppler echocardiography in 21 insulin-dependent diabetic patients and 21 control subjects without clinical evidence of heart disease. No patient had chest pain or electrocardiographic changes during exercise testing. The mean age of patients was 32 years. All patients had a normal ejection fraction. Six (29%) of the 21 diabetic patients had evidence of diastolic dysfunction as assessed by the presence of at least two abnormal variables of mitral inflow velocity. The ratio of peak early to peak late (atrial) filling velocity was significantly decreased in diabetic compared with control subjects (1.24 +/- 0.21 versus 1.66 +/- 0.30, p. less than 0.001). Atrial filling velocity was significantly increased in diabetic patients (74.3 +/- 16.7 versus 60.3 +/- 12.2 cm/s, p less than 0.004), whereas early filling velocity was reduced by a nearly significant degree (88.8 +/- 12.6 versus 98.5 +/- 18.8 cm/s, p less than 0.057). The atrial contribution to stroke volume as assessed by area under the late diastolic filling envelope compared to total diastolic area was also significantly increased in diabetic compared with control subjects (35 versus 27%, p less than 0.001). Left ventricular diastolic filling abnormalities in diabetic patients did not correlate with duration of diabetes, retinopathy, nephropathy or peripheral neuropathy. These data suggest that approximately one-third of such patients have subclinical myocardial dysfunction unrelated to accelerated atherosclerosis. Doppler echocardiography may offer a reliable noninvasive means to assess diastolic function and to follow up diabetic patients serially for any deterioration in cardiac status before the appearance of clinical symptoms.
.A
Zarich SW; Arbuckle BE; Cohen LR; Roberts M; Nesto RW.
.I 90557
.U
88244194
.S
J Am Coll Cardiol 8809; 12(1):131-9
.M
Aged; Anti-Arrhythmia Agents/*AE; Cardiac Pacing, Artificial/*; Electric Countershock; Electrocardiography/*; Electrophysiology; Female; Follow-Up Studies; Human; Male; Middle Age; Tachycardia/*CI/PP; Ventricular Fibrillation/*CI/PP.
.T
Proarrhythmic effects of antiarrhythmic drugs in patients with malignant ventricular arrhythmias evaluated by electrophysiologic testing.
.P
JOURNAL ARTICLE.
.W
The provocation or worsening of arrhythmias by antiarrhythmic regimens was evaluated in patients with malignant ventricular arrhythmias undergoing electrophysiologic studies. In 314 patients with sustained or nonsustained ventricular tachycardia or ventricular fibrillation, 801 drug studies were performed using a standard protocol of programmed electrical stimulation. The criteria for proarrhythmia were: 1) initiation of sustained ventricular tachyarrhythmia in a patient in whom only nonsustained tachycardia was induced at baseline; 2) conversion of a sustained tachycardia that could be terminated by programmed electrical stimulation at baseline to one that required cardioversion for termination during drug therapy; 3) initiation of a sustained tachyarrhythmia by a less aggressive mode of stimulation than was required at baseline; and 4) development of spontaneous or incessant ventricular tachycardia. Proarrhythmia criterion 1 occurred during 20 (18%) of 118 studies and at least once in 15 (28%) of 54 patients. Criterion 2 was met during 39 (7%) of 578 studies and at least once in 29 (13%) of 220 patients. Criterion 3 was achieved during 135 (20%) of 687 studies in patients with sustained ventricular tachyarrhythmias at baseline. Criterion 4 occurred during 9 (1%) of 801 drug studies. In 40 patients in whom well tolerated ventricular tachycardia was initiated with fewer extrastimuli during drug study than at baseline, the drug was continued and the patients were followed up. The recurrence rate of tachycardia was the same in these patients as in 73 patients followed up on regimens on which the number of extrastimuli required for initiation was not reduced.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Rae AP; Kay HR; Horowitz LN; Spielman SR; Greenspan AM.
.I 90558
.U
88244195
.S
J Am Coll Cardiol 8809; 12(1):140-9
.M
Adult; Amiodarone/TU; Anti-Arrhythmia Agents/*TU; Cardiac Pacing, Artificial/*; Electrocardiography/*; Electrophysiology; Female; Follow-Up Studies; Hemodynamics/DE; Human; Male; Middle Age; Predictive Value of Tests; Support, Non-U.S. Gov't; Tachycardia/DT/*PP; Ventricular Fibrillation/DT/*PP.
.T
Reappraisal of criteria for assessing drug efficacy in patients with ventricular tachyarrhythmias: complete versus partial suppression of inducible arrhythmias.
.P
JOURNAL ARTICLE.
.W
To test whether increased difficulty in inducing ventricular tachycardia during antiarrhythmic therapy can be considered a sufficient criterion for predicting long-term efficacy of such therapy in patients with ventricular tachyarrhythmias, 95 patients were studied with a graded stimulation protocol (single and double premature stimuli during sinus rhythm and ventricular drives of 120, 140, 160 and 180 beats/min). After a control study, the effects of oral antiarrhythmic drugs on the ability to induce ventricular tachycardia were assessed. The median number of drug trials was four per patient. After antiarrhythmic therapy, four subgroups of patients were identified. In 36 patients, there was no change in inducibility (group 1), whereas in 18 patients ventricular tachycardia was rendered more difficult to induce; that is, a sustained ventricular tachycardia was inducible at a basic drive at least 40 beats/min faster than during the control study (group 2). In 34 patients, ventricular tachycardia induction was suppressed (group 3) and in 7 patients with nonsustained ventricular tachycardia, only 3 to 5 repetitive ventricular responses were induced after treatment (group 4). During follow-up of 15.5 +/- 11.5 months, 10 patients of group 1 had a recurrence of ventricular tachycardia and 6 died suddenly, whereas in group 2 only 1 patient died suddenly and in group 3, 2 patients had a recurrence of ventricular tachycardia (group 1 versus 2 and 3, p less than 0.001, Mantel-Cox and Breslow; group 2 versus 3, no difference). Thus, increased difficulty in inducing ventricular tachycardia is a sufficient criterion for predicting long-term efficacy of an antiarrhythmic drug regimen.
.A
Borggrefe M; Trampisch HJ; Breithardt G.
.I 90559
.U
88244196
.S
J Am Coll Cardiol 8809; 12(1):150-8
.M
Adult; Aged; Comparative Study; Coronary Disease/*PP; Electrocardiography/*MT; Female; Fourier Analysis; Human; Male; Middle Age; Support, Non-U.S. Gov't; Tachycardia/*PP.
.T
Comparison of frequency and time domain analysis of the signal-averaged electrocardiogram in patients with ventricular tachycardia and coronary artery disease: methodologic validation and clinical relevance.
.P
JOURNAL ARTICLE.
.W
Frequency analysis with fast Fourier transform and time domain analysis after signal averaging of the electrocardiogram (ECG) have given contradictory results in patients with sustained ventricular tachycardia after myocardial infarction. Therefore, the same orthogonal ECGs were analyzed in the frequency domain (Blackman-Harris window) and the time domain after signal averaging and high gain, low noise amplification (0 to 300 Hz) in 30 patients with sustained ventricular tachycardia after myocardial infarction, 15 patients without ventricular tachycardia after infarction and 15 healthy subjects. Patients with bundle branch block were not excluded. Twenty-one of the 30 patients with ventricular tachycardia had late potentials in the time domain and abnormal Fourier transform of the ST segment (defined as increased spectral area of 60 to 120 Hz and spectral peaks greater than 10 dB). Among the remaining nine patients with ventricular tachycardia all had no late potentials in the time domain and one manifested abnormal frequency spectra. In contrast, of the 15 patients without ventricular tachycardia after infarction, 2 had late potentials in the time domain and only 1 demonstrated abnormal frequency spectra; none of the healthy subjects manifested either phenomenon. Patients with bundle branch block were correctly classified by Fourier analysis, but were frequently missed by time domain analysis. Normalization of the spectra and area ratio proved potential pitfalls, and the choice of an appropriate ST segment was crucial: if the segment was long with respect to the duration of the late potentials and if it extended too far into the QRS complex, fast Fourier transform yielded random results.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Haberl R; Jilge G; Pulter R; Steinbeck G.
.I 90560
.U
88244197
.S
J Am Coll Cardiol 8809; 12(1):159-65
.M
Aged; Arrhythmia/*PP; Cardiac Pacing, Artificial; Echocardiography; Electrocardiography/*; Electrophysiology; Female; Heart Arrest/*PP; Human; Male; Middle Age; Recurrence; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Tachycardia/*PP.
.T
Sustained ventricular arrhythmias: differences between survivors of cardiac arrest and patients with recurrent sustained ventricular tachycardia.
.P
JOURNAL ARTICLE.
.W
Clinical, angiographic, echocardiographic and electrophysiologic data were examined in 101 patients with a history of sustained ventricular arrhythmia not associated with acute myocardial infarction. These patients included 66 survivors of out of hospital cardiac arrest and 35 patients presenting with hemodynamically well tolerated sustained ventricular tachycardia. On univariate analysis, patients in the cardiac arrest group had a lower incidence of previous myocardial infarction and left ventricular aneurysm and a higher ejection fraction compared with the ventricular tachycardia group. During electrophysiologic testing, the arrhythmia induced in the patients in the cardiac arrest group was fast and polymorphic and frequently degenerated into ventricular fibrillation. In contrast, in the ventricular tachycardia group, a slower, monomorphic and hemodynamically well tolerated ventricular tachycardia was commonly induced. On multivariate analysis, a polymorphic pattern of the induced ventricular arrhythmia was the only independent variable that distinguished the survivors of cardiac arrest from those presenting with sustained ventricular tachycardia. These results suggest that 1) the survivors of cardiac arrest and patients presenting with sustained well tolerated ventricular tachycardia are clinically distinct groups; and 2) the polymorphic tachycardia induced during programmed electrical stimulation in the survivors of cardiac arrest may indicate an unstable tachycardia mechanism. This may explain why these patients present with ventricular fibrillation and cardiac arrest, whereas others present with hemodynamically stable ventricular tachycardia.
.A
Adhar GC; Larson LW; Bardy GH; Greene HL.
.I 90561
.U
88244198
.S
J Am Coll Cardiol 8809; 12(1):166-74
.M
Aged; Cardiac Pacing, Artificial; Coronary Vessels/RA; Death, Sudden/EP; Electrocardiography; Female; Human; Male; Middle Age; Monitoring, Physiologic; Prognosis; Recurrence; Tachycardia/*ET/MO/PP; Ventricular Fibrillation/*ET/MO/PP.
.T
Prognosis of patients with ventricular tachycardia and ventricular fibrillation: role of the underlying etiology.
.P
JOURNAL ARTICLE.
.W
The prognosis of 149 patients with ventricular tachycardia (n = 108) or ventricular fibrillation (n = 41) was analyzed to assess the importance of the underlying etiology of the arrhythmia. Seventy-three patients (Group I) had a previous myocardial infarction and documented late sustained monomorphic ventricular tachycardia. Thirty-five (Group II) also had a previous myocardial infarction but had late ventricular fibrillation. There were 41 patients (Group III) without coronary artery disease: 9 patients with right ventricular dysplasia, 26 with idiopathic sustained ventricular tachycardia and 6 with idiopathic ventricular fibrillation. The mean follow-up period for all patients was 22 to 57 months. The total mortality rate in Group I (16%) and Group II (34%) and the arrhythmic mortality rate in Group I (5%) and Group II (11%) were significantly higher than the rates in Group III. In the latter group the total mortality rate was 4% for those with idiopathic ventricular tachycardia and 11% for those with right ventricular dysplasia, and there were no deaths due to arrhythmia (p less than 0.05). Left ventricular ejection fraction was significantly lower and left ventricular end-diastolic pressure was significantly higher in Group I and Group II than in Group III. There were nonfatal recurrences of ventricular tachycardia in 33 to 56% of patients, and the number of these episodes did not differ significantly in those with and without coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Trappe HJ; Brugada P; Talajic M; Della Bella P; Lezaun R; Mulleneers R; Wellens HJ.
.I 90562
.U
88244200
.S
J Am Coll Cardiol 8809; 12(1):187-93
.M
Animal; Aorta/PP; Blood Pressure; Cardiac Output; Cardiac Tamponade/*PP; Comparative Study; Dogs; Female; Heart/*PP; Heart Atrium/PP; Heart Ventricle/PP; Male.
.T
Cardiac tamponade: a comparison of right versus left heart compression.
.P
JOURNAL ARTICLE.
.W
It has been postulated that in cardiac tamponade, the hemodynamic effects of compression of the right heart chambers and great veins are more important than are the effects of left heart compression. In 10 anesthetized dogs with surgically compartmented pericardium, the hemodynamic effects of right atrial and right ventricular compression were compared with the hemodynamic effects of left atrial and left ventricular compression. The effects of right heart compression, left heart compression, and then effects of combined right and left heart compression, were compared at three levels of intrapericardial pressure: 10, 15 and 20 mm Hg. Aortic mean pressure decreased significantly at each level of intrapericardial pressure with right-sided tamponade but not with left-sided tamponade. Left atrial mean pressures decreased significantly with right-sided tamponade and increased with left-sided and combined tamponade. Right atrial mean pressures increased significantly with right-sided and combined tamponade, but not with left-sided tamponade. Heart rate increased significantly with each of the three varieties of tamponade. Cardiac output and stroke volume, which decreased with each variety of tamponade, were significantly lower during right-sided than during left-sided tamponade. Combined tamponade lowered stroke volume more than did right-sided tamponade, and lowered cardiac output more at 15 and 20 mm Hg intrapericardial pressure. It is concluded that, in this preparation, right-sided cardiac compression has more important hemodynamic effects than does left-sided compression. However, left-sided tamponade still makes a significant contribution to the total hemodynamic picture of cardiac tamponade.
.A
Fowler NO; Gabel M; Buncher CR.
.I 90563
.U
88244201
.S
J Am Coll Cardiol 8809; 12(1):19-24
.M
Aged; Arrhythmia/ET/PP; Electrophysiology; Female; Fibrinolytic Agents/*TU; Follow-Up Studies; Heart Aneurysm/CO/*PP; Heart Catheterization; Heart Ventricle/PP; Human; Male; Middle Age; Monitoring, Physiologic; Myocardial Infarction/CO/DT/*PP; Prospective Studies.
.T
Electrophysiologic effects of thrombolytic therapy in patients with a transmural anterior myocardial infarction complicated by left ventricular aneurysm formation.
.P
JOURNAL ARTICLE.
.W
To assess the effects of early thrombolytic therapy on the incidence of clinical and induced ventricular arrhythmias in high risk postmyocardial infarction patients, 32 patients with a transmural anterior myocardial infarction complicated by left ventricular aneurysm formation were prospectively evaluated. Sixteen patients (Group A) received routine care because of contraindication to thrombolytic therapy or other factors and 16 (Group B) received either tissue plasminogen activator or streptokinase within 6 h of the onset of chest pain. The two groups were similar in left ventricular ejection fraction (mean +/- SD, 28 +/- 9% [Group A] versus 30 +/- 8% [Group B]) and occurrence of spontaneous nonsustained ventricular tachycardia, new bundle branch block and congestive heart failure. Group B patients had higher peak creatine kinase MB levels (446 +/- 336 versus 205 +/- 120 IU; p = 0.017) and earlier time to peak creatine kinase values (13.4 +/- 6.6 versus 19.1 +/- 6.1 h; p = 0.006). Twenty patients who had no clinical sustained ventricular arrhythmias underwent electrophysiologic study 13 +/- 6 days after infarction. Ventricular tachycardia was induced during the study in 7 (88%) of 8 Group A patients, but in only 1 (8%) of 12 Group B patients given thrombolytic therapy (p = 0.0008). During a mean follow-up period of 11 +/- 8 months, eight Group A patients (50%) died suddenly or were resuscitated from sustained ventricular tachycardia; all Group B patients are alive and have had no clinical arrhythmic events (p = 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Sager PT; Perlmutter RA; Rosenfeld LE; McPherson CA; Wackers FJ; Batsford WP.
.I 90564
.U
88244202
.S
J Am Coll Cardiol 8809; 12(1):194-5
.M
Animal; Cardiac Tamponade/*PP; Heart/PP; Hemodynamics; Human.
.T
Changing concepts of cardiac tamponade [editorial]
.P
EDITORIAL.
.A
Shabetai R.
.I 90565
.U
88244203
.S
J Am Coll Cardiol 8809; 12(1):196-201
.M
Animal; Contrast Media; Coronary Disease/PA/*PP; Coronary Vessels/PA/PP; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Echocardiography/*MT; Image Processing, Computer-Assisted; Internal Mammary Artery Implantation/*; Intraoperative Period; Myocardial Revascularization/*; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Vascular Patency/*.
.T
Success of internal mammary bypass grafting can be assessed intraoperatively using myocardial contrast echocardiography.
.P
JOURNAL ARTICLE.
.W
To determine whether the success of internal mammary artery bypass grafting can be assessed intraoperatively using myocardial contrast echocardiography, sonicated Renografin-76 was injected into the aortic root of 11 dogs during the delivery of cardioplegic solution. Studies were performed with the left anterior descending coronary artery patent and totally occluded, and after internal mammary artery bypass grafting distal to the occluded vessel. Flow rate during cardioplegia was constant for all three stages in each experiment. Myocardial contrast echocardiography clearly demonstrated homogeneous myocardial perfusion with the left anterior descending coronary artery patent, lack of perfusion in the left anterior descending artery bed during its occlusion and excellent perfusion of the occluded bed after internal mammary artery bypass grafting distal to the occlusion in 10 of the 11 dogs. In one dog, the bypass graft was technically inadequate and contrast opacification was not noted in the left anterior descending artery bed after internal mammary artery bypass grafting. The exponential function C(t) = Ae-alpha t + Be-beta t was fitted to computer-derived time-intensity curves from the myocardium, where alpha denotes contrast washout and beta denotes contrast appearance. Respective values for alpha and beta (mean + 1 SD) were similar for the patent left anterior descending coronary artery and after internal mammary artery bypass grafting distal to the occluded artery (0.11 +/- 0.10 versus 0.10 +/- 0.10, and 2.5 +/- 2.4 versus 1.1 +/- 0.56). In conclusion, myocardial contrast echocardiography has potential for intraoperative assessment of the adequacy of coronary artery bypass grafting.
.A
Spotnitz WD; Keller MW; Watson DD; Nolan SP; Kaul S.
.I 90566
.U
88244204
.S
J Am Coll Cardiol 8809; 12(1):202-8
.M
Animal; Arteries/*PP; Arterioles/*PP; Body Fluids/*AN; Body Weight; Dogs; Exertion; Heart Failure, Congestive/*PP; Hemodynamics; Male; Muscles/*BS; Sodium/*AN; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Thigh; Vascular Resistance; Vasodilation.
.T
Effect on peripheral arterioles of chronic fluid and sodium retention in heart failure.
.P
JOURNAL ARTICLE.
.W
To determine whether chronic fluid and sodium retention in heart failure adversely affects peripheral arteriolar behavior, systemic vascular resistance and skeletal muscle vasodilation were compared in eight control dogs and nine dogs with chronic fluid and sodium retention (ascites = 2.3 +/- 2.3 liters) induced by rapid ventricular pacing for 2 months. At rest, both groups exhibited comparable systemic vascular resistance (control 45 +/- 14 versus heart failure 40 +/- 7 U) and femoral bed vascular resistance (control 18.7 +/- 6.9 versus heart failure 19.0 +/- 7.2 x 10(2) U) (both p = NS). Femoral bed resistance also decreased similarly in both groups during treadmill exercise (resistance at peak exercise: control 4.7 +/- 3.0 versus heart failure 4.9 +/- 0.9 x 10(2) U [p = NS]). In isolated gracilis muscle, vascular resistance was also comparable in both groups at rest (control 7.3 +/- 3.3 versus heart failure 10.2 +/- 3.6 x 10(3) U/100 g), at peak exercise (control 1.6 +/- 0.5 versus heart failure 1.8 +/- 0.9 x 10(3) U/100 g) and after maximal vasodilation with papaverine (control 0.7 +/- 0.3 versus heart failure 0.9 +/- 0.3 x 10(3) U/100 g) (all p = NS). These data suggest that chronic fluid and sodium retention in heart failure does not alter peripheral arteriolar behavior.
.A
Wilson JR; Lanoce V; Frey MJ; Ferraro N.
.I 90567
.U
88244205
.S
J Am Coll Cardiol 8809; 12(1):209-17
.M
Animal; Coronary Circulation; Coronary Vessels/PA/PP; Dogs; Hemodynamics/DE; Myocardial Infarction/*PA/PP; Oxypurinol/BL/*PD; Perfusion; Pyrimidines/*PD; Support, U.S. Gov't, P.H.S.; Time Factors.
.T
The xanthine oxidase inhibitor oxypurinol does not limit infarct size in a canine model of 40 minutes of ischemia with reperfusion.
.P
JOURNAL ARTICLE.
.W
Free radicals such as superoxide (.O2-) produced by xanthine oxidase might cause cell death during reperfusion after myocardial ischemia. The effect of the xanthine oxidase inhibitor allopurinol on infarct size in ischemia-reperfusion models has been variable, possibly because of differences in treatment duration. Adequate inhibition of xanthine oxidase may require a sufficient pretreatment period to permit conversion of allopurinol to oxypurinol, the actual inhibitor of superoxide production. To test more definitively whether xanthine oxidase-derived free radicals cause cell death during reperfusion, the effect of oxypurinol on infarct size was evaluated in an ischemia-reperfusion model. Open chest dogs underwent 40 min of circumflex coronary artery occlusion followed by reperfusion for 4 days. Twelve dogs were treated with oxypurinol (10 mg/kg body weight intravenously 10 min before occlusion and 10 mg/kg intravenously 10 min before reperfusion) and 11 control dogs received drug vehicle alone (pH 10 normal saline solution). Nine control dogs from a concurrent study also were included. Infarct size was measured histologically and analyzed with respect to its major baseline predictors, including anatomic area at risk and collateral blood flow (measured with radioactive microspheres). Infarct size as a percent of the area at risk averaged 23.8 +/- 2.7% (mean +/- SEM) in the oxypurinol group (n = 10) and 23.1 +/- 4.2% in the control group (n = 17) (p = NS). Collateral blood flow to the inner two thirds of the ischemic wall averaged 0.08 +/- 0.01 ml/min per g in the oxypurinol group and 0.09 +/- 0.02 ml/min per g in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Kinsman JM 3d; Murry CE; Richard VJ; Jennings RB; Reimer KA.
.I 90568
.U
88244206
.S
J Am Coll Cardiol 8809; 12(1):218-23
.M
Animal; Comparative Study; Dogs; Echocardiography/*IS; Electrodes; Electrophysiology; Female; Fluoroscopy; Heart/*PH; Heart Catheterization/*IS; Male; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
The echo-transponder electrode catheter: a new method for mapping the left ventricle.
.P
JOURNAL ARTICLE.
.W
The ability to locate catheter position in the left ventricle with respect to endocardial landmarks might enhance the accuracy of ventricular tachycardia mapping. An echo-transponder system (Telectronics, Inc.) was compared with biplane fluoroscopy for left ventricular endocardial mapping. A 6F electrode catheter was modified with the addition of a piezoelectric crystal 5 mm from the tip. This crystal was connected to a transponder that received and transmitted ultrasound, resulting in a discrete artifact on the two-dimensional echocardiographic image corresponding to the position of the catheter tip. Catheters were introduced percutaneously into the left ventricle of nine anesthetized dogs. Two-dimensional echo-transponder and biplane fluoroscopic images were recorded on videotape with the catheter at multiple endocardial sites. Catheter location was marked by delivering radiofrequency current to the distal electrode, creating a small endocardial lesion. Catheter location by echo-transponder and by fluoroscopy were compared with lesion location without knowledge of other data. Location by echo-transponder was 8.7 +/- 5.1 mm from the center of the radiofrequency lesion versus 14 + 7.8 mm by fluoroscopy (n = 15, p = 0.023). Echo-transponder localization is more precise than is biplane fluoroscopy and may enhance the accuracy of left ventricular electrophysiologic mapping.
.A
Langberg JJ; Franklin JO; Landzberg JS; Herre JM; Kee L; Chin MC; Bharati S; Lev M; Himelman RB; Schiller NB; et al.
.I 90569
.U
88244207
.S
J Am Coll Cardiol 8809; 12(1):224-8
.M
Adolescence; Altitude/*; Child; Child, Preschool; China; Ductus Arteriosus, Patent/EH/EP; Ethnic Groups; Female; Heart Defects, Congenital/EH/*EP; Heart Septal Defects, Atrial/EH/EP; Human; Male; Support, Non-U.S. Gov't.
.T
Prevalence of congenital cardiac anomalies at high altitude [see comments]
.P
JOURNAL ARTICLE.
.W
The effect of high altitude on the prevalence of congenital heart disease was tested by examining 1,116 school children at four study sites in the People's Republic of China. Sites ranged in altitude from sea level to 4,500 m above sea level. Children were screened by physical examination, and an echocardiogram and electrocardiogram were performed on each child suspected of having a cardiac anomaly. A high prevalence of patent ductus arteriosus and atrial septal defect was found at the three high altitude sites and the effect of altitude was progressive. Both anomalies were postulated to be the result of the lower atmospheric oxygen tension present at high altitude. Failure of lower oxygen tension to constrict the ductus is thought to be the mechanism in patent ductus arteriosus. It is theorized that the persistence of high pulmonary vascular resistance and high right heart pressures at high altitude inhibits early closure of the foramen ovale. Subsequent growth may result in stretching of the fossa ovalis and incompetence of the flap and may produce an atrial septal defect. The high prevalence of atrial septal defect in tetralogy of Fallot is cited as a possible analogy because right ventricular pressure is high and right ventricular compliance is low from birth.
.A
Miao CY; Zuberbuhler JS; Zuberbuhler JR.
.I 90570
.U
88244208
.S
J Am Coll Cardiol 8809; 12(1):229-37
.M
Ambulatory Care; Atrioventricular Node/PP; Bundle of His/PP; Cardiac Pacing, Artificial; Electrocardiography/*; Electrophysiology; Follow-Up Studies; Heart Catheterization; Heart Conduction System/*PP; Human; Infant; Infant, Newborn; Sinoatrial Node; Support, U.S. Gov't, P.H.S.; Transposition of Great Vessels/*PP/SU.
.T
Electrophysiologic consequences of the arterial switch repair of d-transposition of the great arteries.
.P
JOURNAL ARTICLE.
.W
Electrophysiologic studies were performed at 12.7 +/- 4 months postoperatively in 20 patients who had the arterial switch repair at 1 to 120 days (mean 13 +/- 26 [SD]) for d-transposition of the great arteries. Preoperative electrocardiograms (ECGs) at rest revealed an ectopic atrial rhythm in one patient. Postoperative rest ECGs revealed transient postoperative ectopic atrial or junctional rhythms in two patients, intermittent ectopic atrial rhythms in two and right bundle branch block in nine with a normal QRS axis. In addition, ambulatory monitor recordings revealed infrequent premature ventricular complexes in five patients. Catheter endocardial mapping revealed sinus rhythm in 18 patients and ectopic atrial rhythm in 1 patient. Atrial activation after the switch repair was comparable with normal atrial activation. Activation of all low atrial sites was significantly earlier after the switch repair than after the Mustard repair. Mild abnormalities of sinus node function were present and consisted of slight prolongation of corrected sinus node recovery time in six patients and slightly increased sinoatrial conduction time in four. The ratio of sinus node recovery time to sinus cycle length was normal in all 20 patients. Atrial effective and functional refractory periods were normal in all patients and no atrial arrhythmias could be induced by programmed stimulation. Atrioventricular (AV) node conduction was excellent with normal AV node effective and functional refractory periods. The only electrophysiologic abnormality of His-Purkinje function was distal right bundle branch block in nine patients. Programmed stimulation of the ventricle produced repetitive ventricular responses in four patients: bundle branch reentry in three and intraventricular reentry in one.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Vetter VL; Tanner CS.
.I 90571
.U
88244210
.S
J Am Coll Cardiol 8809; 12(1):25-34
.M
Adult; Aged; Ambulatory Care; Angina Pectoris/PP/*RI; Comparative Study; Electrocardiography/*; Exercise Test/*; Female; Heart Catheterization/*; Hemodynamics; Human; Male; Middle Age; Myocardial Infarction/PP/*RI; Prognosis; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Thallium Radioisotopes/*DU.
.T
Superiority of quantitative exercise thallium-201 variables in determining long-term prognosis in ambulatory patients with chest pain: a comparison with cardiac catheterization [see comments]
.P
JOURNAL ARTICLE.
.W
The purpose of this study was to determine the prognostic utility of quantitative exercise thallium-201 imaging and compare it with that of cardiac catheterization in ambulatory patients. Accordingly, long-term (4 to 9 years) follow-up was obtained in 293 patients who underwent both tests for the evaluation of chest pain: 89 had undergone coronary artery bypass graft surgery within 3 months of testing and were excluded from analysis, 119 experienced no cardiac events and 91 had an event (death in 20, nonfatal myocardial infarction in 21 and coronary artery bypass operations performed greater than 3 months after cardiac catheterization in 50). When all variables were analyzed using Cox regression analysis, the quantitatively assessed lung/heart ratio of thallium-201 activity was the most important predictor of a future cardiac event (chi 2 = 40.21). Other significant predictors were the number of diseased vessels (chi 2 = 17.11), patient gender (chi 2 = 9.43) and change in heart rate from rest to exercise (chi 2 = 4.19). Whereas the number of diseased vessels was an important independent predictor of cardiac events, it did not add significantly to the overall ability of the exercise thallium-201 test to predict events. Furthermore, information obtained from thallium-201 imaging alone was marginally superior to that obtained from cardiac catheterization alone (p = 0.04) and significantly superior to that obtained from exercise testing alone (p = 0.02) in determining the occurrence of events. In addition, unlike the exercise thallium-201 test, which could predict the occurrence of all categories of events, catheterization data were not able to predict the occurrence of nonfatal myocardial infarction. The exclusion of bypass surgery and previous myocardial infarction did not alter the results. In conclusion, data from this study demonstrate that exercise thallium-201 imaging may be superior to data from both exercise testing alone and cardiac catheterization data alone for predicting future events in ambulatory patients who have undergone both exercise thallium-201 imaging and catheterization for the evaluation of chest pain.
.A
Kaul S; Finkelstein DM; Homma S; Leavitt M; Okada RD; Boucher CA.
.I 90572
.U
88244212
.S
J Am Coll Cardiol 8809; 12(1):255-61
.M
Arrhythmia/*; Curriculum; Education, Medical, Continuing/*; Electrophysiology/*ED; Fellowships and Scholarships; Human; Teaching/MT.
.T
Teaching objectives for fellowship programs in clinical electrophysiology.
.P
JOURNAL ARTICLE.
.A
Scheinman M; Akhtar M; Brugada P; Denes P; Garan H; Griffin JC; Rosen M; Saksena S; Woosley R.
.I 90573
.U
88244213
.S
J Am Coll Cardiol 8809; 12(1):262-4
.M
Heart Failure, Congestive/DT/PP/*TH; Human; Vasodilator Agents/TU.
.T
Symposium on therapeutic challenges in the management of congestive heart failure. Part I.
.P
JOURNAL ARTICLE.
.A
Packer M.
.I 90574
.U
88244217
.S
J Am Coll Cardiol 8809; 12(1):286-7
.M
Cardiovascular Diseases/*TH; Human; Patient Advocacy/*; Physician's Role/*; Role/*.
.T
Physicians as advocates in the 1980s and 1990s.
.P
JOURNAL ARTICLE.
.A
Klocke FJ.
.I 90575
.U
88244218
.S
J Am Coll Cardiol 8809; 12(1):288
.M
Electrocardiography/*; Human; Myocardial Infarction/*PP.
.T
Clinical distinctions between Q wave and non-Q wave infarction [letter]
.P
LETTER.
.A
Spodick DH.
.I 90576
.U
88244219
.S
J Am Coll Cardiol 8809; 12(1):288
.M
Human; Vascular Diseases/*.
.T
Where does peripheral vascular disease belong? [letter]
.P
LETTER.
.A
Spittell JA Jr.
.I 90577
.U
88244220
.S
J Am Coll Cardiol 8809; 12(1):35-6
.M
Ambulatory Care; Angina Pectoris/*RI; Coronary Disease/*RI; Electrocardiography; Exercise Test; Heart Catheterization/*; Human; Predictive Value of Tests; Risk Factors; Thallium Radioisotopes/*DU.
.T
Thallium-201 scintigraphy in risk assessment for ambulatory patients with chest pain: does everyone need catheterization?
.P
JOURNAL ARTICLE.
.A
Cerqueira M; Ritchie JL.
.I 90578
.U
88244221
.S
J Am Coll Cardiol 8809; 12(1):37-41
.M
Aged; Coronary Disease/*PP/RA/RI; Coronary Vessels/PP/RA/RI; Dipyridamole/*DU; Electrocardiography/*; Electrophysiology; Female; Heart Catheterization; Hemodynamics; Human; Male; Middle Age; Predictive Value of Tests; Support, Non-U.S. Gov't; Thallium Radioisotopes/*DU.
.T
Dipyridamole-induced ST segment depression during thallium-201 imaging in patients with coronary artery disease: angiographic and hemodynamic determinants.
.P
JOURNAL ARTICLE.
.W
To examine the angiographic and hemodynamic determinants of dipyridamole-induced ST segment depression in patients with coronary artery disease, 41 patients with angiographically documented coronary disease who underwent dipyridamole-thallium-201 myocardial scintigraphy were studied. Dipyridamole-induced ST depression occurred in 14 (34%) of the 41 patients. Stepwise multivariate logistic regression was performed to compare the predictive value of angiographic findings (good coronary collateral vessels, jeopardized collateral vessels, multivessel disease), hemodynamic changes (changes in heart rate, systolic pressure, diastolic pressure and rate-pressure product), thallium-201 results (perfusion defect, thallium-201 redistribution) and demographic data (age, gender, medications). Only the presence of good coronary collateral vessels (p less than 0.02) and increases in rate-pressure product after dipyridamole infusion (p less than 0.02) were significant multivariate predictors of dipyridamole-induced ST depression. Good collateral vessels were more common in the group with ST depression (11 [79%] of 14) than they were in the group without ST depression (6 [22%] of 27; p less than 0.001). Rate-pressure product increased 2,835 +/- 1,648 beats/min.mm Hg in the group with ST depression compared with 1,179 +/- 1,417 beats/min.mm Hg in patients without ST depression (p less than 0.005). In conclusion, dipyridamole-induced ST segment depression in patients with coronary artery disease appears to be related to 1) the presence of good coronary collateral vessels, which may act by facilitating "coronary steal", and 2) increases in rate-pressure product, reflecting increased myocardial oxygen demand. These observations may explain the lack of prognostic value of dipyridamole-induced ST segment depression described in previous reports.
.A
Chambers CE; Brown KA.
.I 90579
.U
88244222
.S
J Am Coll Cardiol 8809; 12(1):42-8
.M
Adult; Aged; Angioplasty, Transluminal/*/AE; Coronary Disease/RA/*TH; Coronary Vessels/RA; Female; Follow-Up Studies; Human; Male; Middle Age; Recurrence.
.T
Triple vessel coronary angioplasty: acute outcome and long-term results.
.P
JOURNAL ARTICLE.
.W
Triple vessel coronary angioplasty, defined as angioplasty of one or more lesions in each of the three major coronary arteries (left anterior descending, left circumflex, right coronary artery) was performed in 50 (11%) of 469 patients who had angioplasty of multiple vessels. There were 32 men and 18 women with a mean age of 56 years. All 50 patients had severe three vessel coronary disease and represent approximately 5% of patients with three vessel disease who had revascularization in this institution; 8 (16%) had previous coronary bypass surgery, and 23 (46%) had previous myocardial infarction. Unstable angina was present in 33 patients (66%) and 96% had Canadian Heart Association class III or IV angina; mean left ventricular ejection fraction was 57 +/- 11%. Angioplasty was performed in 176 vessels (3.5 vessels per patient, range 3 to 6) and in 250 lesions (5 lesions per patient, range 3 to 9); angiographic success was achieved in 240 lesions (96%) and 166 vessels (94%). Success in all vessels attempted was achieved in 40 (80%) of the 50 patients. Clinical success (angiographic success associated with clinical improvement) was obtained in all 50 patients in whom triple vessel angioplasty was performed; none of them required urgent bypass surgery and 5 patients (10%) had a non-Q wave myocardial infarction. In four other patients triple vessel angioplasty was planned but not performed because of failure to dilate the primary vessel; urgent bypass surgery was required in one of these, who developed a Q wave infarction. Thus, overall clinical success in 54 patients was 93%; the incidence rate of myocardial infarction was 11%, and that of urgent surgery 1.8%.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
DiSciascio G; Cowley MJ; Vetrovec GW; Kelly KM; Lewis SA.
.I 90580
.U
88244223
.S
J Am Coll Cardiol 8809; 12(1):49-55
.M
Adult; Angioplasty, Transluminal/*; Coronary Arteriosclerosis/*PP/RA/TH; Coronary Vessels/PP/RA; Female; Follow-Up Studies; Human; Male; Middle Age; Prospective Studies; Recurrence.
.T
Restenosis and progression of coronary atherosclerosis after coronary angioplasty.
.P
JOURNAL ARTICLE.
.W
The relation between restenosis and progression of atherosclerosis in other coronary segments after angioplasty was studied in 98 consecutive patients with 110 coronary stenoses successfully treated with angioplasty. At early angiographic restudy (5 +/- 2 months after angioplasty) 37 patients (38%) had restenosis (defined as a stenosis greater than or equal to 50% of the luminal diameter or loss of greater than or equal to 50% of the gain achieved by angioplasty); progression of atherosclerosis was observed in 4 patients with and 7 without restenosis (13 versus 11%, p = NS). Ninety of the 98 patients underwent a late angiographic restudy a mean of 34 +/- 11 months after angioplasty. Late restenosis was found in one patient. Progression of coronary artery disease (defined as a greater than or equal to 20% decrease in the diameter of a vessel initially narrowed by greater than or equal to 50% or a greater than or equal to 30% decrease when the initial stenosis was less than 50%) was examined in relation to restenosis in 85 of the 90 patients. It occurred in 9 of 27 patients with and 22 of 58 patients without restenosis (33 versus 38%, p = NS). Restenosis developed more rapidly than did progression of disease. Diameter stenosis increased from 35 +/- 8 to 73 +/- 11% at the early restudy in lesions with restenosis; in lesions with disease progression it increased from 9 +/- 18 to 20 +/- 28% (p less than 0.001) at the early restudy to 53 +/- 21% (p less than 0.001) at the late restudy.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Cequier A; Bonan R; Crepeau J; Cote G; De Guise P; Joly P; Lesperance J; Waters DD.
.I 90581
.U
88244224
.S
J Am Coll Cardiol 8809; 12(1):56-62
.M
Aged; Coronary Arteriosclerosis/PP/*RA; Coronary Vessels/PP/*RA; Electrocardiography; Female; Heart Catheterization; Human; Male; Middle Age; Myocardial Infarction/PP/*RA; Retrospective Studies.
.T
Angiographic progression of coronary artery disease and the development of myocardial infarction.
.P
JOURNAL ARTICLE.
.W
There are few data on angiographic coronary artery anatomy in patients whose coronary artery disease progresses to myocardial infarction. In this retrospective analysis, progression of coronary artery disease between two cardiac catheterization procedures is described in 38 patients: 23 patients (Group I) who had a myocardial infarction between the two studies and 15 patients (Group II) who presented with one or more new total occlusions at the second study without sustaining an intervening infarction. In Group I the median percent stenosis on the initial angiogram of the artery related to the infarct at restudy was significantly less than the median percent stenosis of lesions that subsequently were the site of a new total occlusion in Group II (48 versus 73.5%, p less than 0.05). In the infarct-related artery in Group I, only 5 (22%) of 23 lesions were initially greater than 70%, whereas in Group II, 11 (61%) of 18 lesions that progressed to total occlusion were initially greater than 70% (p less than 0.01). In Group I, patients who developed a Q wave infarction had less severe narrowing at initial angiography in the subsequent infarct-related artery (34%) than did patients who developed a non-Q wave infarction (80%) (p less than 0.05). Univariate and multivariate analysis of angiographic and clinical characteristics present at initial angiography in Group I revealed proximal lesion location as the only significant predictor of evolution of lesions greater than or equal to 50% to infarction. This retrospective study suggests that myocardial infarction frequently develops from previously nonsevere lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Ambrose JA; Tannenbaum MA; Alexopoulos D; Hjemdahl-Monsen CE; Leavy J; Weiss M; Borrico S; Gorlin R; Fuster V.
.I 90582
.U
88244230
.S
J Am Coll Cardiol 8809; 12(1):94-102
.M
Adult; Aged; Aortic Diseases/*PA/SU; Arteriosclerosis/*PA; Atherosclerosis/*PA/SU; Fluorescence; Human; Laser Surgery/*; Middle Age.
.T
Human arterial surface fluorescence: atherosclerotic plaque identification and effects of laser atheroma ablation.
.P
JOURNAL ARTICLE.
.W
In vivo plaque recognition may be important for safe and precise intra-arterial atheroma ablation during laser coronary angioplasty. This study examined the feasibility and sensitivity of utilizing quantitative fluorescence spectroscopy and video-enhanced fluorescence imaging for plaque identification in atherosclerotic human necropsy arterial wall before and after laser atheroma ablation. With wide-band (450 to 490 nm) blue light excitation, the 540 nm fluorescence intensity ratio of normal to diseased sites (n = 13) was 2.09 +/- 0.82 (p less than 0.001) and video fluorescence imaging provided enhanced delineation of atheroma surface characteristics. Continuous argon and pulsed excimer (308 nm) laser ablation of atheroma decreased fluorescence intensity ratios by 42 and 20% (p less than 0.001), respectively (that is, from abnormal to nearly normal). Low power 325 nm laser-excited fluorescence spectroscopy from normal (n = 115) and abnormal (n = 146) necropsy sites revealed an average 45% decrease in atheroma fluorescence intensity (p less than 0.0001) and changes in fluorescence spectra appearance that corresponded to plaque morphologic subtypes. Studies using a dual laser system combining 325 nm laser-excited fluorescence plaque recognition and a 480 nm pulsed dye laser for tissue ablation with common optical fibers demonstrated normalization of both fluorescence intensity and spectra appearance after laser atheroma ablation. Thus, in vitro analysis of surface arterial fluorescence by quantitative spectroscopy and video fluorescence imaging reliably differentiate plaque from normal tissue and may provide the feedback signal needed to activate a laser source for selective plaque removal.
.A
Leon MB; Lu DY; Prevosti LG; Macy WW Jr; Smith PD; Granovsky M; Bonner RF; Balaban RS.
.I 90583
.U
88244232
.S
J Allergy Clin Immunol 8809; 81(6):1082-7
.M
Adolescence; Antibodies, Bacterial/*BI; Bacterial Vaccines/IM; Child; Child, Preschool; Human; Hypergammaglobulinemia/*IM; IgE/*BI; IgG/BI/CL; Immunization, Secondary; Polysaccharides, Bacterial/IM; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Syndrome; Teichoic Acids/IM; Tetanus Toxoid/IM.
.T
Impaired antibody responses in the hyperimmunoglobulin E syndrome.
.P
JOURNAL ARTICLE.
.W
Patients with the hyper-IgE (HIE) syndrome have recurrent bacterial infections with Staphylococcus aureus and other polysaccharide encapsulated organisms. To determine whether an impairment of the antibody response to polysaccharide antigens contributes to infections in this syndrome, we measured serum antibody to the teichoic acid of S. aureus and to the capsular polysaccharide of Haemophilus influenzae type b. Compared to control subjects who had no history of S. aureus infections (N = 14), sera from patients with HIE (N = 9) lacked the expected elevation of serum antibody to teichoic acid (p greater than 0.05) and had significantly lower levels of this antibody than sera from 14 patients with atopic dermatitis, complicated by recurrent cutaneous S. aureus infections (p less than 0.01). After immunization with the capsular polysaccharide of Haemophilus influenzae type of vaccine, the antibody response of patients with HIE was significantly impaired compared to that of age-matched control subjects (p = 0.01). Although patients with HIE syndrome had normal total IgG levels, most patients with HIE but not patients with atopic dermatitis had IgG2 subclass deficiency. Defective antibody responses in patients with HIE were not restricted to polysaccharide antigens because the serum levels of antitetanus toxoid antibody in these patients were significantly lower than that of control subjects (p less than 0.001). Impaired antigen-specific antibody responses in patients with HIE syndrome may contribute to their increased susceptibility to infection.
.A
Leung DY; Ambrosino DM; Arbeit RD; Newton JL; Geha RS.
.I 90584
.U
88244234
.S
J Allergy Clin Immunol 8809; 81(6):1096-100
.M
Adult; Animal; Ant Venoms/CS/*IM/ME; Ants/*IM; Arthropod Venoms/*IM; Binding Sites, Antibody/*; Binding, Competitive; Female; Human; Hypersensitivity/DI; IgE/AN; Male; Piperidines/IM/ME; Radioallergosorbent Test/*; Radioimmunoassay/*; Support, U.S. Gov't, P.H.S.; Tissue Extracts/*IM/ME.
.T
RAST-inhibition studies of the imported fire ant Solenopsis invicta with whole body extracts and venom preparations.
.P
JOURNAL ARTICLE.
.W
Whole body extracts of imported fire ants (IFAWBE) are the only reagents currently available for diagnosis and immunotherapy of patients with anaphylaxis to these Hymenoptera. To characterize better IFAWBE of the species Solenopsis invicta, we evaluated the sera of 29 patients with systemic or large local reactions to imported fire ant (IFA) stings. Forty-eight percent (14/29) of these sting-sensitive patients were IFAWBE RAST positive (greater than or equal to 6% binding of total radioactivity added). With a pool of sera with an initial IFAWBE-RAST value of 16.2% binding, we evaluated RAST inhibition by IFA venom (IFAV), IFAWBE, and the venom component, transpiperidine. Maximum RAST inhibition obtained was 84% with 300 micrograms/ml of IFAV, 95% with 5 mg/ml of protein IFAWBE, and insignificant with undiluted transpiperdine. We conclude that IFAWBE contains large quantities of immunoreactive venom components other than transpiperidine and that the allergenicity of IFAWBE and venom resides in the small amount of protein present in IFAV.
.A
Butcher BT; deShazo RD; Ortiz AA; Reed MA.
.I 90585
.U
88244237
.S
J Allergy Clin Immunol 8809; 81(6):1117-21
.M
Adult; Air Pollutants/AE; Allergens/*AD; Animal; Female; Hay Fever/ET; Histamine/AD; Human; Hypersensitivity, Delayed/DI/*ET/IM; Injections, Intradermal/*; Injections, Subcutaneous/*; Male; Middle Age; Mites/*IM; Pollen/*IM; Support, Non-U.S. Gov't.
.T
The pattern of human late-phase skin reactions to extracts of aeroallergens.
.P
JOURNAL ARTICLE.
.W
The kinetics and dose response of cutaneous late phase reactions (LPR) (defined as greater than 5 mm induration 6 hours after intradermal challenge with allergen) were studied in 20 randomly selected subjects with atopic rhinitis. When subjects were challenged intradermally with 0.2 biologic unit (BU) of Dermatophagoides pteronyssinus or grass pollen, wheal-and-flare reactions were elicited without subsequent LPRs. With 30 BU, all subjects developed LPRs, whereas 1 and 10 BU provoked LPRs in 28% and 64%, respectively. No biphasic responses were detected. At all concentrations which progressed to form an LPR, a palpable skin reaction was continuously present and either remained constant or increased steadily in magnitude during 6 hours. Skin reactions of similar diameter provoked by histamine resolved fully within 2 hours. Thus, we confirm that the development of a macroscopic cutaneous LPR requires a higher concentration of allergen than the wheal-and-flare reaction. Together with our other findings, these results suggest that all untreated atopic individuals are capable of mounting an LPR if they are challenged with sufficient allergen. In contrast to the asthmatic response to inhaled allergen, the cutaneous wheal and LPR are not biphasic.
.A
Frew AJ; Kay AB.
.I 90586
.U
88244238
.S
J Allergy Clin Immunol 8809; 81(6):1122-5
.M
Adolescence; Airway Obstruction/ET; Asthma/*DI; Case Report; Diagnosis, Differential; Human; Laryngeal Muscles/*PP; Male; Muscles/*PP; Respiratory Sounds/ET; Vocal Cord Paralysis/CO/*DI/PP.
.T
Bilateral abductor paresis masquerading as asthma.
.P
JOURNAL ARTICLE.
.W
Rare upper airway lesions may be mistaken for asthma. A 16-year-old Hispanic male athlete presented to our allergy clinic with a 4-month history of wheezing and snoring with hoarseness and progressive fatigue on exertion or during sleep. His mother taped periods of harsh stridor and sleep apnea. There was no family history of vocal cord abnormalities. A year before the onset of symptoms, he suffered injury to his oral cavity with a loss of consciousness during a wrestling match. He denied dysphagia or dysphonia. He failed to respond to bronchodilators, cromolyn, or prednisone therapy during 4 weeks. On referral to our clinic, his physical examination and tape recording were characterized by harsh inspiratory stridor. His pulmonary function tests were significant for peak flow depressed out of proportion to FEV1 with reduced FVC, no response to bronchodilator, and flattened inspiratory loop unresponsive to cough or panting. Fluoroscopy and endoscopy of the upper airway was consistent with "marked bilateral limitation of vocal cord abduction." Sleep study demonstrated desaturation with CO2s in the 60s during sleep. He was started on continuous positive airway pressure, 10 cm at night, with no desaturation or sleep disturbance on follow-up.
.A
Randolph C; Lapey A; Shannon DC.
.I 90587
.U
88244239
.S
J Allergy Clin Immunol 8809; 81(6):1126-34
.M
Acid Phosphatase/ME; Alkaline Phosphatase/ME; Cell Extracts/AN; Chromatography/*MT; Esterases/ME; Isoelectric Focusing; Kinetics; Phosphatases/ME; Pollen/*AN/IP; Substrate Specificity.
.T
Pollen grain column chromatography: quantitation and biochemical analysis of ragweed-pollen solutes.
.P
JOURNAL ARTICLE.
.W
The kinetics, quantitative yield, and sequence of solute release during the extraction of allergenic substances from short ragweed (Ambrosia artemisiifolia) pollen were compared with a conventional batch-type method and the novel technique of pollen grain column chromatography. With the batch method, 14.6 +/- 1.7 mg of pollen solutes were eluted per 100 mg of dried defatted pollen in 1 minute; the 24-hour solute yield was 27.4 +/- 2.7 mg. With the column method, 3.7 +/- 1.3 mg of pollen solutes were eluted in 1 minute; the 24-hour solute yield was 29.3 +/- 2.1 mg. The kinetics of solute release with the column method were modeled as the simultaneous first-order elution of ragweed-pollen solutes into three hypothetical compartments. The theoretical initial solute concentration was 50 gm/L. The isoelectric focusing patterns, optical properties, distributions of enzymes, Ra5, and antigen E activities were consistent with the sequential separation of ragweed-pollen solutes and the three compartment model. Enzyme activities were eluted either maximally in the first minute (phosphatases and N-acetyl-beta-glucaminidase) or delayed until 10 minutes (leucine aminopeptidase). Ra5 was eluted rapidly, whereas antigen E was eluted during a more prolonged period. Pollen grain chromatography provides a simple, reproducible method for studying pollen solute release.
.A
Baraniuk JN; Esch RE; Buckley CE 3d.
.I 90588
.U
88244240
.S
J Allergy Clin Immunol 8809; 81(6):1135-42
.M
Adolescence; Allergens/*AD/IM; Child; Child, Preschool; Collodion; Dermatitis, Atopic/ET/*IM; Electrophoresis, Polyacrylamide Gel/*/MT; Enzyme-Linked Immunosorbent Assay/*; Food Hypersensitivity/ET; Human; IgE/AN; IgG/AN; Infant; Paper; Soybeans/AE/*IM; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Vegetable Proteins/*AD/AE/IM.
.T
Allergenicity of major component proteins of soybean determined by enzyme-linked immunosorbent assay (ELISA) and immunoblotting in children with atopic dermatitis and positive soy challenges.
.P
JOURNAL ARTICLE.
.W
Recent studies have implicated soybeans as one of the major food allergens in children. Serum from eight patients with atopic dermatitis and positive double-blind, placebo-controlled food challenges to soy were used to investigate allergen-specific IgE and IgG antibody to soy protein and its fractions. ELISA and immunoblotting techniques were used for this purpose. A crude soy extract, as well as the 7S, 11S, and whey fractions, were isolated and purified for the in vitro studies from commercial defatted soy flakes. ELISA results demonstrated a statistically significant increased IgE and IgG response to the crude soy extract compared to that of normal control subjects. There was also an increase in IgE specific for 7S and IgG specific for 11S in the atopic group. The immunoblots reveal that IgE and IgG are present in varying amounts to multiple fractions of the soy protein. These results indicate that IgE and IgG specific to crude soy are elevated in patients with positive double-blind, placebo-controlled food challenges to soy but that no one fraction is clearly more antigenic.
.A
Burks AW Jr; Brooks JR; Sampson HA.
.I 90589
.U
88244241
.S
J Allergy Clin Immunol 8809; 81(6):1143-8
.M
Adolescence; Adult; Age Factors; Aged; Air Pollutants/AE; Allergens/*AD; Child; Child, Preschool; Comparative Study; Female; Fusarium/IM; Histamine/*DU; Human; Hypersensitivity, Immediate/*DI/ET/PP; Male; Middle Age; Mucor/IM; Respiratory Hypersensitivity/*CO/PP; Sex Factors; Skin Tests/*; Support, Non-U.S. Gov't.
.T
Immediate skin test reactivity to common aeroallergens in patients with respiratory allergies: a comparative analysis of allergen-induced skin reactions and their histamine controls.
.P
JOURNAL ARTICLE.
.W
The results of the immediate skin test response to a panel of 16 common aeroallergens performed in a group of 659 consecutive patients with symptoms suggestive of a respiratory allergy were analyzed. A group of 108 healthy individuals served as control subjects. Ninety-four percent of the patients and 87% of the control subjects had at least one allergen-induced reaction (wheal greater than or equal to 2 by 2 mm). The prevalence of positive skin reactions to each aeroallergen was equally high in both groups. However, if a skin reaction is considered as positive only when an allergen-induced wheal is equal or larger compared to the 50% of the wheal obtained with the histamine control in that individual, 70% of the patients had positive skin reactions and only 38% of the control subjects were positive (p less than 0.05). Similarly, the prevalence rates to five aeroallergens (pollen, Fusarium, Mucor, Pullularia, and Curvularia) in the patient group were reduced to those levels observed with the control group, suggesting they are clinically less important. The age and not the sex influenced both the prevalence rates (p less than 0.001) and the mean size (p less than 0.01) of allergen and histamine-induced skin reactions. Lower prevalence rates and mean size values were observed in the youngest group (0 to 9 years). Moreover, there was an inverse relationship between lower skin reactivity with more younger subjects in our patient population. These results indicate that patients and healthy individuals have similar mechanisms for skin reactivity.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Lopez LR; Noriega Y; Losno R.
.I 90590
.U
88244242
.S
J Allergy Clin Immunol 8809; 81(6):1149-54
.M
Basophils/PA; Cell Differentiation; Cell Division; Colony-Forming Units Assay; Culture Media/*PD; Eosinophils/PA; Epithelium/PA; Granulocytes; Hematopoietic Stem Cells/*PA; Human; Hypersensitivity, Immediate/*BL; Macrophages; Mast Cells/PA; Nasal Mucosa/*; Rhinitis, Allergic, Perennial/*BL; Support, Non-U.S. Gov't.
.T
Allergic rhinitis nasal mucosal conditioned medium stimulates growth and differentiation of basophil/mast cell and eosinophil progenitors from atopic blood.
.P
JOURNAL ARTICLE.
.W
In previous studies of human nasal polyps and nasal mucosa from subjects with allergic rhinitis, we have demonstrated hematopoietic progenitors, measured as colony-forming units (CFU) in culture, and colony-stimulating activities for basophil/mast cells (BMC) and basophil/eosinophils (Eo). In the present study, conditioned medium (CM) from short-term cultures of nasal mucosal scrapings of subjects with allergic rhinitis are compared with those from normal subjects for colony-stimulating activities, with BMC and Eo CFU in methylcellulose assays of peripheral blood from atopic (N = 6) or nonatopic (N = 6) individuals. CM derived from cultures of nasal mucosal scrapings from subjects with allergic rhinitis stimulated a significantly greater number of BMC/Eo CFU from the peripheral blood of atopic (out-of-season and ragweed-allergic) subjects than from peripheral blood of nonatopic subjects in a series of matched-control experiments (20.6 +/- 4.6 versus 1.9 +/- 0.8; p less than 0.002); in contrast, nasal mucosal CM from normal control subjects did not stimulate an increase in these CFU in peripheral blood from atopic compared to nonatopic subjects. These studies further support the hypothesis that in situ hematopoietic mechanisms are operative in allergic inflammatory reactions and suggest the presence of cells in affected (allergic) epithelium that are "activated" to produce large amounts of BMC and Eo growth and differentiation factors.
.A
Ohnishi M; Ruhno J; Dolovich J; Denburg JA.
.I 90591
.U
88244243
.S
J Allergy Clin Immunol 8809; 81(6):1155-8
.M
Adolescence; Adult; Angioneurotic Edema/*DI/ET; Child; Compound 48-80/*DU; Exercise Test/*; Female; Food/*; Food Hypersensitivity/*DI/ET; Histamine/DU; Human; Intradermal Tests/*; Male; Skin Tests/*.
.T
The effect of food and exercise on the skin response to compound 48/80 in patients with food-associated exercise-induced urticaria-angioedema.
.P
JOURNAL ARTICLE.
.W
Food-associated, exercise-induced urticaria-angioedema is increasingly being recognized. We studied five atopic individuals in whom ingestion of food was followed by exercise-induced urticaria-angioedema. The combined effect of food and exercise on skin wheal response to compound 48/80 and histamine was studied. Symptoms could be reproduced in only four of the patients who performed strenuous exercise after ingestion of food to which they were skin sensitive. When symptoms appeared, that is, after a combination of food and exercise challenge, there was a marked increase in the wheal response to compound 48/80 (greater than 200%) and not to histamine. Food or exercise challenge alone did not induce any significant change in the skin reactivity to compound 48/80 or to histamine. It was concluded that mast cell releasability could be increased when the patient was subjected to combined factors.
.A
Kivity S; Sneh E; Greif J; Topilsky M; Mekori YA.
.I 90592
.U
88244244
.S
J Allergy Clin Immunol 8809; 81(6):1159-67
.M
Adult; Animal; Asthma/*CO; Basidiomycetes/AN; Double-Blind Method; Female; Food Hypersensitivity/*ET; Food Preservation/AE/AN; Food Preservatives/*AE/AN; Fruit/AE/AN; Human; Male; Middle Age; Potatoes/AE/AN; Shrimp/AN; Sulfites/*AE; Support, Non-U.S. Gov't; Vegetables/AE/AN.
.T
Sensitivity to sulfited foods among sulfite-sensitive subjects with asthma.
.P
JOURNAL ARTICLE.
.W
Eight individuals with asthma who had been diagnosed as sulfite sensitive on the basis of double-blind capsule-beverage challenges were subjected to challenges with various sulfited foods, including lettuce, shrimp, dried apricots, white grape juice, dehydrated potatoes (as mashed potatoes), and mushrooms. Four of these patients failed to respond to challenges with any of the sulfited foods. The other four patients experienced a decrease in pulmonary function on double-blind challenges with sulfited lettuce. Two of three of these patients reacted to challenges with dried apricots and white grape juice; the fourth patient has not yet been challenged with these products. Only one of these four patients reacted to challenges with dehydrated potatoes and mushrooms, and, in this case, the response to double-blind challenges with dehydrated potatoes was not consistent. None of the sulfite-sensitive subjects with asthma responded to challenges with sulfited shrimp. It is concluded that sulfite-sensitive subjects with asthma will not necessarily react after ingestion of sulfited foods. The likelihood of a reaction is dependent on the nature of the food, the level of residual sulfite, the sensitivity of the patient, and perhaps on the form of residual sulfite and the mechanism of the sulfite-induced reaction.
.A
Taylor SL; Bush RK; Selner JC; Nordlee JA; Wiener MB; Holden K; Koepke JW; Busse WW.
.I 90593
.U
88244245
.S
J Allergy Clin Immunol 8809; 81(6):1168-74
.M
Adrenergic Beta Receptor Agonists/AD; Adult; Aged; Asthma/*CO/DT/PP; Double-Blind Method; Female; Gastroesophageal Reflux/*CI/PP; Human; Hydrogen-Ion Concentration; Male; Middle Age; Nebulizers and Vaporizers; Random Allocation; Respiratory Function Tests; Theophylline/*AE/TU.
.T
Effect of theophylline on gastroesophageal reflux in patients with asthma [see comments]
.P
JOURNAL ARTICLE.
.W
A possible role of methylxanthines in the high incidence of gastroesophageal reflux (GER) in patients with asthma has been suggested. Therefore, we used a randomized, double-blind, crossover design to compare the effects of a 1-week conventional theophylline treatment and a 1-week placebo treatment in 16 adult patients with asthma. No oral or parenteral glucocorticoids were administered, but seven patients were taking inhaled corticoids. All patients needed inhaled adrenergic drugs. At the end of each period of theophylline or placebo treatment, the patients were carefully questioned with respect to respiratory and digestive symptoms, forced expiratory flows were measured, and GER was assessed by prolonged nocturnal intraesophageal pH monitoring. Peak expiratory flow was measured three times a day throughout the study. No significant increase in GER was found with theophylline compared to placebo, and forced expiratory flows improved with theophylline (p less than 0.05 for FEV1 and p less than 0.01 for peak expiratory flow rate). There was no correlation between GER, the duration of asthma, and forced expiratory flows. Thus, our study failed to demonstrate any adverse effect of a slow-release theophylline preparation on GER in patients with asthma. These results further suggest that the presence of GER is not a contraindication to the use of a slow-release theophylline in subjects with asthma.
.A
Hubert D; Gaudric M; Guerre J; Lockhart A; Marsac J.
.I 90594
.U
88244247
.S
J Allergy Clin Immunol 8809; 81(6):1180-6
.M
Allergens/*AD/IM; Animal; Disease Susceptibility; Double-Blind Method; Food Hypersensitivity/*DI/ET/IM; Human; Hypersensitivity, Immediate/DI; Medical History Taking; Pruritus/ET; Radioallergosorbent Test; Shrimp/*; Skin Tests; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Urticaria/ET.
.T
Provocation-challenge studies in shrimp-sensitive individuals.
.P
JOURNAL ARTICLE.
.W
Thirty individuals with history of immediate, objective, adverse reactions after shrimp ingestion underwent double-blind, placebo-controlled shrimp-food challenges. All individuals who did not exhibit a positive response (reproduction of objective symptoms) were administered an open challenge of 16 whole cooked shrimp. Positive challenge responses occurred in 9/30 subjects (30%); six of these subjects experienced a positive response during the double-blind phase. Of the 21 remaining subjects, 12 experienced generalized pruritus as their only symptom, whereas nine subjects had completely negative challenge responses. All placebo challenges were negative. Although a positive skin test was strongly associated with challenge symptoms (p less than 0.001), the shrimp prick skin test titration end points were not different among the challenge groups. The serum shrimp RAST percent was significantly higher in the positive challenge group (p less than 0.02). Mean levels of shrimp-specific serum IgG, IgA, and IgM levels were not different among the challenge groups. Although no single immunologic variable could be consistently used to identify subjects more likely to exhibit a positive challenge response, the composite of a positive shrimp prick skin test and elevated serum shrimp-specific IgE (RAST percent label bound greater than 11%) demonstrated a correct predictive value of 87% in this group of shrimp-sensitive subjects.
.A
Daul CB; Morgan JE; Hughes J; Lehrer SB.
.I 90595
.U
88244248
.S
J Allergy Clin Immunol 8809; 81(6):1187-91
.M
Acetylcholine/PD; Aged; Animal; Atropine/PD; Bronchi/*DE; Dinoflagellida/*AN; Dogs; Dose-Response Relationship, Drug; Female; Human; Male; Marine Toxins/AI/*PD; Middle Age; Muscle, Smooth/*DE; Tetrodotoxin/PD; Verapamil/PD.
.T
In vitro red tide toxin effects on human bronchial smooth muscle.
.P
JOURNAL ARTICLE.
.W
Airborne Ptychodiscus brevis toxin (PBTX), produced by Ptychodiscus brevis (Florida red tide), induces cough, rhinorrhea, watery eyes, and sneezing in normal individuals and wheezing in subjects with asthma. The mechanism of PBTX-induced contractile response has been investigated by the authors in vitro in dog and rat tissue. PBTX stimulates neuronal sodium channels, resulting in activation of autonomic cholinergic and adrenergic nerve endings in canine upper and lower airway smooth muscle and in rat vas deferens, respectively. This article concerns the investigation of the effect and mechanism of action of PBTX on human airways in order to determine the unique role of the toxin in the pathogenesis of asthma. PBTX elicited contractions of isolated human airway smooth muscle with a threshold concentration of 0.1 micrograms/ml, very similar to values obtained in canine lower airways. Pharmacologic analysis demonstrated that atropine (10(-6) mol/L) blocked the response to both PBTX and acetylcholine; tetrodotoxin (10(-7) mol/L) blocked PBTX but not acetylcholine; and verapamil (10(-5) mol/L) attenuated but neostigmine (10(-8) mol/L) potentiated the response to PBTX. Other selected blockers did not affect the PBTX response. These data indicate that PBTX produces contraction of human lower airway smooth muscle via stimulation of cholinergic nerve fiber sodium channels. The concept that PBTX triggers asthma through this mechanism is strengthened by these results.
.A
Shimoda T; Krzanowski J Jr; Nelson R; Martin DF; Polson J; Duncan R; Lockey R.
.I 90596
.U
88244250
.S
J Allergy Clin Immunol 8809; 81(6):1199-204
.M
Angioneurotic Edema/BL/*IM; Antigen-Antibody Reactions; Antigenic Determinants/IM; Autoantibodies/*PH; Autoimmune Diseases/BL/*IM; Binding Sites, Antibody; Complement 1 Inactivators/BL/*IM/IP; Human; Immunoglobulins/PH; Molecular Weight.
.T
Acquired angioedema: observations on the mechanism of action of autoantibodies directed against C1 esterase inhibitor.
.P
JOURNAL ARTICLE.
.W
We describe a mechanism of action of autoantibodies reactive with the C1 esterase inhibitor (C1EI) molecule found in three patients with acquired angioedema without associated diseases. All of these patients have a circulating C1EI of lower molecular weight than that of normal control subjects. When native C1EI was added to patient, but not control, plasmas, it was cleaved to a lower molecular weight fragment under conditions that allowed contact system activation. In a partially purified system, patient immunoglobulin preparations impaired stable complex formation between plasmin and C1EI and exaggerated the cleavage of the latter to a lower molecular weight fragment. We propose that the autoantibody does not interfere with the cleavage of the bait sequence of the inhibitor but reduces the availability of the reactive center of the molecule in a way that interferes with the irreversible inhibition of target enzymes. In this way unregulated activation of the kinin and complement pathways occurs, leading to disease manifestations via as yet uncharacterized mediators.
.A
Malbran A; Hammer CH; Frank MM; Fries LF.
.I 90597
.U
88244251
.S
J Allergy Clin Immunol 8809; 81(6):1204-7
.M
Allergy and Immunology/*ED/ST; Certification; Clinical Competence; Faculty, Medical/OG/ST; Hypersensitivity/DI; Immunologic Tests; Internal Medicine; Internship and Residency/OG/*ST; Medical Directors; Pediatrics; Peer Review; United States.
.T
Special requirements for residency training in allergy and immunology.
.P
JOURNAL ARTICLE.
.I 90598
.U
88244374
.S
J Immunol 8809; 141(1):10-6
.M
Animal; Antigen-Presenting Cells/*IM; Antigenic Determinants/IM; Clone Cells/IM/TR; Comparative Study; Helper Cells/IM; Hybridomas/*IM/TR; Hypersensitivity, Delayed/ET/*IM; Lymphocyte Transformation; Macrophages/*IM/TR; Mice; Nitrophenols/IM; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Suppressor Cells/*IM; Trinitrobenzenes/IM.
.T
Functional analysis of cloned macrophage hybridomas. VI. Differential ability to induce immunity or suppression.
.P
JOURNAL ARTICLE.
.W
We previously screened a series of macrophage hybridomas derived from fusion of P388D1 (H-2d) tumor cells with CKB (H-2k) splenic adherent cells for their ability to induce I-J restricted Ts cell responses. One Ia+ macrophage clone (63) consistently induced Ag-specific, I-J-restricted Ts. To evaluate whether macrophage hybridoma 63 also induced delayed-type hypersensitivity (DTH) immunity, mice were immunized with hapten-coupled macrophage hybridoma cells. Hapten-coupled splenic adherent cells and control macrophage hybridomas induced significant primary DTH responses, whereas hapten-coupled macrophage 63 induced little or no immunity when injected into H-2 compatible hosts. However, macrophage hybridoma 63 specifically activated I-Ak, I-Ad, or I-Ed restricted T cell hybridomas/clones, in vitro in the presence of appropriate Ag. Three different strategies designed to eliminate suppressor cell activity were successfully used to demonstrate that hapten-coupled macrophage 63 could also induce in vivo immunity. First, after immunization with hapten-coupled macrophages, mice were treated with cyclophosphamide. Second, macrophage 63 was treated with anti-IJ idiotype antibody before 4-hydroxy-3-nitrophenyl acetyl hapten (NP) coupling. Finally, haptenated macrophages were injected into I-A compatible but I-J incompatible recipients. These protocols are known to inhibit the induction of Ts activity, thus these results indirectly suggest that there is stimultaneous generation of Ts activity in vivo. The latter hypothesis was tested in adoptive transfer experiments. Transfer of lymph node cells from NP-63 primed B10.BR (H-2k) mice induced immunity in naive 4R animals, whereas the same number of immune cells suppressed NP-induced DTH responses in 5R mice. The combined results indicate that a cloned macrophage line can activate both Th and Ts cells. Macrophages which induce Ts activity may be responsible for maintaining the balance of immunity vs suppression. The data support the hypothesis that IJ interacting molecules (IJ-IM) expressed on macrophages are critical for induction of suppressor cell activity.
.A
Kuchroo VK; Minami M; Diamond B; Dorf ME.
.I 90599
.U
88244378
.S
J Immunol 8809; 141(1):125-30
.M
Adolescence; Adult; Antigen-Antibody Complex/*ME; Chromatography, Gel; Complement Inactivators/AN/PH; Female; Glomerulonephritis, IGA/BL/*IM; Human; IgA/*PH; Male; Middle Age; Precipitin Tests; Rheumatoid Factor/*PH; Solubility; Support, Non-U.S. Gov't.
.T
Polymeric IgA and IgA rheumatoid factor decrease the capacity of serum to solubilize circulating immune complexes in patients with primary IgA nephropathy.
.P
JOURNAL ARTICLE.
.W
Primary IgA nephropathy (IgAN) is characterized by the presence of immune complexes (IC), high levels of polymeric IgA (pIgA), and IgA rheumatoid factor (RF) in the blood. The impaired capacity of serum to solubilize IC in the presence of normal values of C hemolytic activity as well as high serum levels of C3, C4, and properdin factor B have led us to analyze whether pIgA and IgA RF from patients with IgAN where capable of inhibiting the capacity of normal human serum to solubilize immune precipitates (BSA-anti-BSA) preformed at equivalence. The results showed a significant reduced mean capacity of serum from patients with IgAN to solubilize "in vitro" immune precipitates (p less than 0.001) and significant high mean levels of pIgA (p less than 0.001) and IgA RF (p less than 0.005) in the blood. Increasing amounts of pIgA inhibited solubilization of IC in the fluid phase, and inhibitory activity was also shown by the IgA RF. There were inverse correlations between pIgA and the capacity of serum to solubilize IC (r = -0.36; p less than 0.05), and between IgA RF and the complement-mediated solubilization (r = -0.57; p less than 0.001). It is suggested that pIgA and IgA RF may be responsible for the impaired complement-mediated solubilization of serum and the persistence of insoluble nephritogenic IC in the blood of patients with primary IgAN.
.A
Schena PF; Pastore A; Sinico RA; Montinaro V; Fornasieri A.
.I 90600
.U
88244387
.S
J Immunol 8809; 141(1):180-8
.M
Animal; Complement 3/BI/GE; Gene Expression Regulation/*DE; Glucuronidase/BI/GE; Immune Sera/PD; Interferon Type I/IM/*PH; Kinetics; Macrophage Activation/*DE; Macrophages/EN/IM/*ME; Mice; Mice, Inbred C3H; Neutralization Tests; Poly I-C/*PD; Properdin Factor B/BI/GE; RNA, Messenger/ME; Support, U.S. Gov't, P.H.S..
.T
Differential regulation of gene expression during macrophage activation with a polyribonucleotide. The role of endogenously derived IFN.
.P
JOURNAL ARTICLE.
.W
The activation of macrophages by exposure to the polyribonucleotide, poly [I:C], is accompanied by a large stimulation of the synthesis of the C components factor B and C3, and a concomitant inhibition of the synthesis of the lysosomal enzyme beta-glucuronidase. Northern blot analysis of poly [A+] RNA extracted from poly [I:C]-stimulated cells revealed that the changes in the synthesis of factor B and C3 were related to changes in the levels of their respective mRNA and hence the expression of these proteins appeared to be regulated at a pre-translational level. The down-regulation of the synthesis of beta-glucuronidase appeared to be regulated at both translational and pre-translational levels. In view of the proposed role of macrophage-derived IFN in the regulation of macrophage activation, we investigated the possible role of IFN-alpha/beta in the regulation of the synthesis of factor B, C3, and beta-glucuronidase. Exposure of macrophages to mouse IFN-alpha and IFN-beta induced limited changes in the synthesis of factor B, C3, and beta-glucuronidase. However, pretreatment of macrophages with only 500 U/ml of IFN-beta primed the cells thereby increasing their sensitivity to poly [I:C]. IFN-alpha was less effective as a priming agent. When macrophages were exposed to poly [I:C] in the presence of an anti-mouse IFN-alpha/beta antiserum, the changes in the synthesis of factor B, C3, and beta-glucuronidase were partially inhibited. Collectively, these data indicate first, that exposure of mouse bone marrow-derived macrophages to poly [I:C] differentially regulates the expression of the products of the genes for factor B, C3, and beta-glucuronidase. Second, IFN-alpha and IFN-beta prime macrophages to increase the sensitivity of macrophages to poly [I:C]. Third, in the absence of exogenous IFN, macrophage-derived IFN appears to participate in priming the cells in an autocrine or paracrine fashion.
.A
Riches DW; Henson PM; Remigio LK; Catterall JF; Strunk RC.
.I 90601
.U
88244393
.S
J Immunol 8809; 141(1):221-7
.M
Animal; Cell Communication; Cell Line, Transformed; Cell Movement/*; Cell Transformation, Viral/*; Cytotoxicity, Immunologic/*; Female; Fibroblasts/*IM/MI/PH; Immunity, Natural; Macrophage Activation; Macrophages/IM/MI/*PH; Mice; Mice, Inbred C3H; Support, U.S. Gov't, P.H.S.; SV40 Virus/*.
.T
Target-induced changes in macrophage migration may explain differences in lytic sensitivity among simian virus 40-transformed fibroblasts.
.P
JOURNAL ARTICLE.
.W
Time-lapse video microscopy has been used to study macrophage movement in the presence of SV40-transformed fibroblasts. In all, five different SV40-transformed cell lines (an uncloned line and four clones derived from it) were tested for their affects on the movement of LPS-activated macrophages (AM). Conditions for video microscope recording were designed to simulate, as best as possible, the conditions used in a 51Cr-release cytotoxicity assay. Our analysis shows that these targets had a range of effects on macrophage migration, from stimulation to complete inhibition of movement. Two of the targets we tested (SV-COL and SV-COL-E8) both highly sensitive to lysis, stimulated macrophage movement, inducing an "agitated" response. Two other targets (SV-COL-F11 and SV-COL-H5), both of intermediate sensitivity had, for the most part, a suppressive effect on macrophage movement. Finally, we found that one target, clone SV-COL-F5, which is completely resistant to lysis by AM, was able to completely inhibit macrophage movement. This inhibitory effect was accompanied by a "pathologic" change in the structure of the macrophage cytoplasm suggesting that this target escapes lysis in vitro by secreting a factor that incapacitates the effector cell. Overall, these observations suggest that target cell products that can affect the behavior of the AM may be important in determining the lytic sensitivity of transformed target cells.
.A
Laster SM; Wood JG; Gooding LR.
.I 90602
.U
88244394
.S
J Immunol 8809; 141(1):228-33
.M
Adenosine Diphosphate Ribose/ME; Binding, Competitive; Cytoplasmic Granules/ME; Glucuronidase/ME; Human; IgG/*ME; Intracellular Fluid/ME; Molecular Weight; Muramidase/ME; N-Formylmethionine Leucyl-Phenylalanine/PD; Neutrophils/DE/EN/*ME; Pertussis Toxins/*PD; Phagocytosis/DE; Receptors, Fc/*DE/PH; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Pertussis toxin inhibits human neutrophil responses mediated by the 42-kilodalton IgG Fc receptor.
.P
JOURNAL ARTICLE.
.W
The effects of pertussis toxin (PT) on human neutrophil responses mediated by the 42-kDa IgG Fc R (Fc gamma R42) were compared with its effects on responses mediated by the FMLP receptor. Pre-treatment of neutrophils with PT completely inhibited FMLP stimulation of superoxide production and blocked over 95% of FMLP-stimulated degranulation. PT inhibited superoxide production stimulated by Fc gamma R42 cross-linking by 92%. In contrast, degranulation stimulated by Fc gamma R42 was only partially inhibited, with beta-glucuronidase release inhibited by 54%, lysozyme by 33%, and lactoferrin by 78%. With either stimulus, PT inhibition was maximal in the range from 1.8 to 2 micrograms/ml. Responses to both stimuli declined in a parallel fashion with increasing time of exposure to PT with maximal inhibition occurring after 2 h of exposure. Inhibition of FMLP responses and Fc gamma R42-mediated superoxide production, but not degranulation, correlated with ADP-ribosylation of a 45-kDa membrane protein. Inhibition by PT of Fc gamma R42-mediated responses was not due to a change in receptor number. These data suggest that activation of polymorphonuclear neutrophils via Fc gamma R42 proceeds through two pathways, only one of which is regulated by a PT-sensitive G protein.
.A
Feister AJ; Browder B; Willis HE; Mohanakumar T; Ruddy S.
.I 90603
.U
88244395
.S
J Immunol 8809; 141(1):234-40
.M
Catalase/PD; Cell Adhesion/DE; Cell Division/DE; Cell Survival/*/DE; Cell-Free System; Growth Inhibitors/PD; Human; Hydrogen Peroxide/PH; Immune Sera/PD; Neutrophils/DE/IM/*PH; Oxygen Consumption; Superoxide Dismutase/PD; Thymidine/ME; Tumor Cells, Cultured/ME/PA; Tumor Necrosis Factor/IM/*PD.
.T
Characteristics and mechanism of neutrophil-mediated cytostasis induced by tumor necrosis factor.
.P
JOURNAL ARTICLE.
.W
After being treated with rTNF, polymorphonuclear neutrophils (PMN) were highly suppressive to the growth of four different tumor target cells, Raji, K562, UCLA-SO-M14, and U937. Neutralizing TNF with specific antibodies before PMN were treated blocked induction of the anti-proliferative activity against Raji. However, after PMN were exposed to TNF the cytostatic activity could not be reversed by the antibody or by washing off TNF, indicating that the continuous presence of TNF was not required for expression of the anti-proliferative function. Addition of the hydrogen peroxide (HP) scavenger, catalase, at the beginning of the assay inhibited the cytostatic activity, suggesting that HP was involved in suppressing the tumor cell growth. In contrast, other reactive oxygen species inhibitors such as superoxide dismutase, sodium azide, L-methionine, or deferoxamine did not inhibit the cytostasis. HP alone at above 10 microM was cytostatic to Raji cells. The presence of TNF did not increase the sensitivity of Raji to HP. TNF activated PMN to produce HP but the amount of HP released in the culture supernatant was too low for direct cytostasis. PMN also became more adherent after TNF treatment. Therefore, the TNF-induced cytostasis may be mediated by local high concentrations of HP produced by PMN.
.A
Shau H.
.I 90604
.U
88244396
.S
J Immunol 8809; 141(1):241-8
.M
Animal; Disease Susceptibility; Female; H-2 Antigens/*GE/IM; Host-Parasite Relations/*; Immunity, Natural/*; Malaria/*GE/IM/MO; Male; Mice; Mice, Inbred AKR; Mice, Inbred BALB C; Mice, Inbred C3H; Mice, Inbred C57BL; Mice, Inbred DBA; Mice, Nude; Plasmodium yoelii/*GE/IM; Species Specificity; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Immunoregulation in murine malaria. Susceptibility of inbred mice to infection with Plasmodium yoelii depends on the dynamic interplay of host and parasite genes.
.P
JOURNAL ARTICLE.
.W
Inbred and H-2 congenic mouse strains were tested for their ability to resist infections with the non-lethal 17X or with the lethal YM isolates of Plasmodium yoelii. DBA/2 and B10.D2 mice, which best resisted infections with non-lethal P. yoelii, were exquisitely susceptible to infection with lethal isolates of this malaria species. In contrast, B6 and B10 mice, which were susceptible to infection with non-lethal P. yoelii, were resistant to infection with the lethal isolates. This reversal of host response phenotype was influenced by H-2 genes, as evidenced by the divergent responses of the H-2 congenic strains B10 and B10.D2. However, a survey of mouse strains sharing common H-2 genes, but expressing different genetic backgrounds, demonstrated that genes outside the H-2 complex also influence the outcome of P. yoelii infections. By enumerating the numbers of P. yoelii-specific antibody-secreting cells in the spleens of infected mice, it was demonstrated that B6 mice, although susceptible to infection with non-lethal P. yoelii, nonetheless made a far stronger anti-parasite response after infection than did resistant DBA/2 mice. Using FACS analysis it was shown that infected B6 mice also produced large amounts of antibodies which bound to the surface of uninfected RBC. Thus, in B6 mice infected with non-lethal P. yoelii, a strong parasite-induced immune response was associated with susceptibility rather than resistance to infection. When T cell-deficient nude mice and their normal littermates were infected with the different isolates of P. yoelii, the nude mice had lower levels of parasitemia and higher RBC counts during the early stages of these infections, and lived longer than did normal littermates after infection with the lethal isolate. These data and the data from studies of B6 and DBA/2 mice support the idea that a strong immune response may be associated with susceptibility rather than resistance to P. yoelii, at least during the early stages of the infection. The finding that a single strain of mouse may present as resistant to infection with one P. yoelii isolate yet be exquisitely susceptible to infection with another suggests that the outcome of these murine malaria infections is dependent on a dynamic interplay between host and parasite genes. Thus, when genetic variability exists in both the host and the parasite populations, as would occur in nature, there may be little directed evolutionary change toward one phenotype or another.(ABSTRACT TRUNCATED AT 400 WORDS)
.A
Sayles PC; Wassom DL.
.I 90605
.U
88244397
.S
J Immunol 8809; 141(1):249-57
.M
Animal; Autoimmune Diseases/*IM/ME; Cell Separation; Female; IgE/AN/*BI; IgG/CL; IgM/AN; Immunologic Deficiency Syndromes/*IM/ME; Lymphocytes/CL/*ME; Male; Mice; Mice, Inbred BALB C; Mice, Inbred CBA; Mice, Inbred C57BL; Nematode Infections/BL/*IM/ME; Nippostrongylus; Phenotype; Receptors, Fc/*AN; Rosette Formation/MT; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
IgE formation and Fc receptor-positive lymphocytes in normal, immuno-deficient, and auto-immune mice infected with Nippostrongylus brasiliensis.
.P
JOURNAL ARTICLE.
.W
The IgE serum levels and IgE FcR-positive lymphocytes (Fc epsilon R) in the spleen and mesenteric lymph nodes (MLN) of normal and immunologically mutant strains of mice were determined before and 14 days after infection with Nippostrongylus brasiliensis (Nbr) parasites. By IgE rosetting of cells immunofluorescently stained for sIg. Thy-1.2, Lyt-2, and L3T4, only sIg+ IgE rosetting lymphocytes were detected in both normal and Nbr-infected mice. IgE high responder mice had the same percentage of Fc epsilon R+ spleen and MLN lymphocytes as low responder mice. After Nbr infection, the percentages of splenic and MLN Fc epsilon R+ cells increased in parallel to a similar increase of sIg+ B cells. Athymic C57BL/6J-nu mice had 62% Fc epsilon R+ spleen and 85% Fc epsilon R+ MLN cells before and after Nbr infection, but IgE serum levels were less than 5 ng IgE/ml. C57BL/6J mice with the viable moth-eaten mutation mev which have almost exclusively Ly-1+ B cells, had less than 1% Fc epsilon R+ lymphocytes and formed only small amounts of IgE. C57BL/6J mice with the lymphoproliferation (lpr) or generalized lymphoproliferative disease (gld) mutations had low numbers of Fc epsilon R+ cells but formed 15 to 30 times more IgE after Nbr infection than control C57BL/6J mice. The IgE response of mice with the beige mutation (bg) did not differ from control mice. Mice with the xid mutation had few Fc epsilon R+ and sIg+ cells but showed high IgE responses. These data demonstrate that Fc epsilon R are typical cell surface markers for approximately 90% of murine Ly-1-, sIg+ B cells and that the number of Fc epsilon R+ cells does not correlate with the capacity of the mice to form IgE. The IgE response to Nbr infection is normal in mice homozygous for the bg mutation, elevated in mice homozygous for the xid, lpr, and gld mutations, and decreased in mice homozygous for the mev and nu mutations.
.A
Lebrun P; Sidman CL; Spiegelberg HL.
.I 90606
.U
88244398
.S
J Immunol 8809; 141(1):258-64
.M
Animal; Antigens, Protozoan/*IM/IP; Erythrocyte Membrane/IM; Erythrocytes/PS; H-2 Antigens/*IM; Immunity, Active/*; Leukocytosis/IM; Malaria/BL/PC/PS; Membrane Glycoproteins/*IM; Mice; Mice, Inbred AKR; Mice, Inbred BALB C; Mice, Inbred CBA; Mice, Inbred C57BL; Monocytes; Plasmodium yoelii/*IM; Support, Non-U.S. Gov't; Vaccines/IM.
.T
An immunogenic antigen of murine Plasmodium yoelii 17X associates with class I MHC glycoproteins.
.P
JOURNAL ARTICLE.
.W
Reticulocytes infected with the non-lethal variant of Plasmodium yoelii 17X (PY17X-NL) express elevated levels of class I, but not class II, MHC Ag when compared with non-parasitized reticulocytes. In contrast, class I Ag are not detectable on erythrocytes parasitized by the lethal variant PY17X-L. In addition, the responder status of various inbred strains of mice to PY17X-NL has been shown to positively correlate with the levels of class I MHC antigens expressed on PY17X-NL parasitized red blood cells (PRBC). MHC Ag are known to restrict, or guide, immune responses. However, earlier studies have failed to demonstrate H-2 restricted activity in the effector arm of immunity to blood-stage murine malaria. Therefore, we have examined the induction of immunity by irradiated PY17X-NL PRBC. No MHC restriction was observed in the ability of PRBC to immunize recipients. However, using irradiated PRBC bearing low, intermediate or high levels of class I Ag we found that the levels, rather than haplotype, of class I Ag expressed on irradiated PRBC greatly influenced their ability to induce immunity. Furthermore, class I-associated parasite-directed Ag were isolated as an immunogenic complex with anti-class I MHC antibody. Such complexes induced immunity in vivo in the absence of adjuvant suggesting a biologically important mechanism by which non-lethal, reticulocytic forms of malarial parasites may immunize their hosts.
.A
Mogil RJ; Patton CL; Green DR.
.I 90607
.U
88244399
.S
J Immunol 8809; 141(1):265-72
.M
Animal; Cell Adhesion/*; Contact Inhibition; Electrophoresis, Polyacrylamide Gel; Hamsters; Human; Leishmania donovani/GD/*PH/PY; Leishmaniasis, Visceral/ME/PS; Macrophages/*PS; Male; Membrane Glycoproteins/IP/ME/*PH; Mesocricetus; Molecular Weight; Receptors, Concanavalin A/IP/ME/*PH; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Virulence.
.T
The major concanavalin A-binding surface glycoprotein of Leishmania donovani chagasi promastigotes is involved in attachment to human macrophages.
.P
JOURNAL ARTICLE.
.W
Leishmania donovani, the protozoan causing visceral leishmaniasis, is an obligate intracellular parasite of mammalian macrophages. Considerable evidence has suggested that the ingestion of L. donovani promastigotes by macrophages occurs via receptors on the surface of the phagocyte. During this study, a glycoconjugate that may be involved in the receptor-mediated ingestion of L. donovani chagasi promastigotes was isolated from the parasite membrane. Octyl glucoside-soluble extracts of promastigote membranes contained a predominant doublet migrating at 60 kDa, seen by SDS-PAGE. The 60-kDa molecule was the major externally disposed promastigote surface protein labeled by 125I, and it was the major Con A-binding protein on L. donovani chagasi, as determined by Con A binding to parasite proteins transferred to nitrocellulose. Attachment of promastigotes to human monocyte-derived macrophages was inhibited by varying concentrations of the membrane extract containing both proteins, and adsorption of extracts on Con A-Sepharose resulted in both removal of the 60,000 Mr glycoprotein and loss of the ability of extracts to inhibit promastigote attachment to human macrophages. After further purification of the 60-kDa glycoprotein by gel filtration, its inhibitory activity increased 45-fold over the unpurified membrane extract. Examination of Con A blots of stationary phase promastigotes isolated from an infected hamster revealed a marked loss in the major Con A-binding glycoprotein over 4 mo in in vitro culture after isolation from the rodent host, corresponding to a loss in infectivity of the promastigotes for hamsters. The results suggest that the major Con A-binding surface glycoprotein from L. donovani chagasi promastigotes is important in attachment to human macrophages, and may be a factor in parasite virulence for a mammalian host.
.A
Wilson ME; Hardin KK.
.I 90608
.U
88244405
.S
J Immunol 8809; 141(1):295-301
.M
Animal; Base Sequence; Evolution/*; Genes, MHC Class I/*; H-2 Antigens/*GE; Haplotypes; Mice; Mice, Inbred BALB C/GE; Mice, Inbred C57BL/GE; Molecular Sequence Data; Nucleic Acid Hybridization; Repetitive Sequences, Nucleic Acid/*; Support, U.S. Gov't, P.H.S..
.T
Tracing the evolution of H-2 D region genes using sequences associated with a repetitive element.
.P
JOURNAL ARTICLE.
.W
The class I genes in the murine MHC are genetically divided into the K, D, Qa, and T1a region subfamilies. These genes presumably arose by duplication from a common class I ancestor. Oligonucleotide probes specific for sequences associated with a moderately repetitive B2 SINE element, which is inserted into the 3' untranslated region of the H-2D and H-2L genes, were used to examine the evolutionary relationship between these classically defined D region genes (H-2D and H-2L) and the other members of the class I gene family. Hybridization analyses of recombinant cosmid and genomic DNA indicated that the D region genes separated genetically from the other members of the class I gene family 12 to 14 million years ago. The evidence suggests that during this time frame the chromosomal segment harboring the characteristic insertion became fixed in the ancestral population which gave rise to Mus domesticus. Previous studies have shown that the number of genes present in the Qa and T1a regions varies among inbred strains and among laboratory stocks of wild mice derived from more distant species on the genus Mus. No evidence was found in this study to support the hypothesis that variation in class I gene number is the result of recent duplications of the functionally defined class I genes of the D region, H-2D and H-2L.
.A
Duran LW; Pease LR.
.I 90609
.U
88244408
.S
J Immunol 8809; 141(1):315-23
.M
Aging/*; Animal; Comparative Study; Cytotoxicity, Immunologic/*; Glycosphingolipids; Hepatectomy; Interphase; Killer Cells, Natural/CL/IM/*PH; Kinetics; Leukocyte Count; Leukocytes, Mononuclear; Liver/CY/*IM/PH; Liver Regeneration/*; Male; Mice; Mice, Inbred C3H; Mice, Inbred C57BL; Mice, Inbred DBA; Organ Weight; Phenotype; Spleen/CY; Support, Non-U.S. Gov't.
.T
Age-related variation in the proportion and activity of murine liver natural killer cells and their cytotoxicity against regenerating hepatocytes.
.P
JOURNAL ARTICLE.
.W
We investigated the distribution of liver NK cells in mice of various ages and their cytotoxicity against regenerating hepatocytes. Liver NK cells were identified by asialo GM1 antibody in mononuclear cell suspension from the liver, whereas NK activity was assayed against YAC-1 target cells. Mononuclear cells in the liver consisted of more than 25% NK cells with potent NK activity in C3H/He mice, 8 wk of age. The strain-specific distribution (C3H/He greater than C57BL/6 greater than DBA/2) of liver NK cells was the same as those in the spleen and blood. The proportion of liver NK cells and the level of NK activity in C3H/He mice were further demonstrated to vary depending on age, in that both the proportion and the function were generated at 4 wk of age, reached a maximum between the 6th and 8th wk, and then rapidly decreased around the 9th wk. The appearance of an increased number of NK cells in the liver seemed to coincide with the slowing of the rapid increase of murine liver weight. We then investigated whether liver NK cells mediated their cytotoxicity against regenerating hepatocytes. Both specific 51Cr-release assay and single cell cytotoxicity assay demonstrated that liver NK cells were significantly cytotoxic against regenerating hepatocytes in partially hepatectomized liver, but to a lesser extent against normal hepatocytes in resting liver. Morphologic study revealed that normal liver predominantly consisted of hepatocytes with binuclei (greater than 60%) but that regenerating liver mainly consisted of hepatocytes with a single nucleus (greater than 70%). One-nucleus hepatocytes were more susceptible to the cytotoxicity of liver NK cells. A comparative study of restoration kinetics of the liver weight and the number of liver NK cells after partial hepatectomy also showed a unique relationship. These results raise the possibility that liver NK cells might be responsible for regulating hepatocyte growth.
.A
Itoh H; Abo T; Sugawara S; Kanno A; Kumagai K.
.I 90610
.U
88244409
.S
J Immunol 8809; 141(1):324-32
.M
Animal; Antibodies, Monoclonal/*/BI/PH; Antigenic Determinants/*IM; Binding Sites, Antibody; Catfish/*IM; Cytotoxicity Tests, Immunologic/MT; Cytotoxicity, Immunologic/*; Female; Hybridomas/ME; Ictaluridae/*IM; Immunity, Cellular/*; Immunosuppressive Agents/PH; Kidney/CY; Male; Mice; Mice, Inbred BALB C; Receptors, Antigen/IM/*IP; Spleen/CY; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Identification of a putative antigen receptor on fish nonspecific cytotoxic cells with monoclonal antibodies.
.P
JOURNAL ARTICLE.
.W
In the present study mAb were derived against flow cytometry (FCM) purified fish (Ictalurus punctatus) nonspecific cytotoxic cells (NCC). mAb 5C6.10.4 and 6D3.2.10 produced 60 to 65% inhibition of lysis of NC-37 target cells (a human B-lymphoblastoid cell line) by unfractionated NCC. mAb 2B2.4.9 and 6D3.4.4 were noninhibitors of cytotoxicity. All mAb were the same isotype (IgM) and were cloned by limiting dilution (2x). Inhibitory activity was specific for the effector cells because the mAb had no effect on NCC cytotoxicity when only the target cells were treated. Inhibition could be produced by preincubation of the mAb with NCC or by no preincubation, and inhibition was not reversible. Killing by FCM-sorted NCC of NC-37 target cells was inhibited almost 100% by mAb 5C6.10.4. Inhibitor mAb also significantly reduced NCC killing of MOLT-4, K562, P815, U937, Daudi, YAC-1, and HL-60 cells. Experiments also were conducted to determine at which stage of the lytic cycle the mAb acted. Both inhibitor mAb significantly inhibited conjugate formation between effector and NC-37 target cells. The technique of FCM was combined with competitive binding experiments to determine that the Ag recognized by both inhibitor and noninhibitor mAb was found on the membranes of the same cells. These results were confirmed by demonstrating (by using FCM) that FITC-labeled inhibitor and biotinylated noninhibitor mAb bound to the same cells. FCM also was next used to determine mAb binding to various effector cell populations. Inhibitor and noninhibitor mAb bound to approximately 25% (5C6.10.4) and 39% (6D3.4.4) of fish anterior kidney cells; to 42% (5C6.10.4) and 54% (6D3.4.4) of fish spleen cells; and to 2.5% (5C6.10.4 and 6D3.4.4) of fish peripheral blood. mAb were used to purify the target cell binding structure found on NCC. Con A-Sepharose purified mAb were used as the fixed ligand for Affi-Gel-10 affinity chromatography experiments. FCM-purified NCC were solubilized and the receptor was purified by using this technique. Analysis of the NCC-purified receptor by 12% SDS-PAGE indicated that the mAb purified structure may be composed of a dimeric molecule consisting of 41 kDa and 38 kDa proteins. The same dimer was purified by using either inhibitory (6D3.2.10) or noninhibitory (6D3.4.4) mAb. Similar results were obtained with immunoprecipitation experiments by using mAb 5C6.10.4. These studies demonstrate that the Ag-binding receptor structure on fish NCC may be comprised of a dimeric complex.
.A
Evans DL; Jaso-Friedmann L; Smith EE Jr; St. John A; Koren HS; Harris DT.
.I 90611
.U
88244412
.S
J Immunol 8809; 141(1):347-51
.M
Animal; Cell Adhesion/DE; Culture Media; Female; Immune Tolerance; Immunity, Natural/*; Kinetics; Lectins/PD; Poxviridae/*IM; Rabbits; Shope Fibroma Virus/*IM; Spleen/CY; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Suppressor Factors, Immunologic/ME/*PH; Tumor Virus Infections/ET/*IM/ME.
.T
Immunosuppression during viral oncogenesis. V. Resistance to virus-induced immunosuppressive factor.
.P
JOURNAL ARTICLE.
.W
Rabbits given malignant rabbit fibroma virus (MV) develop severe immunologic dysfunction during the course of infection. Splenic T lymphocytes from these rabbits elaborate a soluble non-specific immunosuppressive factor (virus-induced suppressor factor (VISF]. As malignant rabbit fibroma virus infection progresses, normal immunologic responsiveness returns. This recovery is multi-factorial and involves production by T lymphocytes of a soluble factor capable of antagonizing the activity of VISF. This soluble anti-suppressor factor (ASF) is not a generalized immunologic potentiator. Its sole apparent effect on immune function appears to be to antagonize the activity of VISF. The protective effects of ASF are evident only when suppressor factors and ASF are simultaneously present in culture. Pre-treatment of target cells with ASF-containing culture supernatants does not render them insensitive to the immunosuppressive effects of subsequent treatment with VISF. In addition, ASF appears to be directly responsible for antagonizing VISF activity. That is, ASF does not appear to initiate an anti-suppressive cascade by activating a population of cells that in turn generate secondary protective factors. ASF-producing cells do not bind Vicia villosa lectin, as do contra-suppressor cells described by others. In almost all of these features, the system we describe herein differs from systems in which other investigators have described factors that antagonize the effects of suppressor factors.
.A
Strayer DS; Dombrowski J.
.I 90612
.U
88244589
.S
J Fam Pract 8809; 26(6):613
.M
Behavior Therapy/*; Chewing Gum; Female; Human; Male; Nicotine/AD; Smoking/*TH.
.T
Nicotine chewing gum and smoking cessation [letter]
.P
LETTER.
.A
Lawrence DA.
.I 90613
.U
88244590
.S
J Fam Pract 8809; 26(6):613-4
.M
Family Practice/*ED; Health Maintenance Organizations/*; Internship and Residency/*OG; North Carolina.
.T
Community-based family practice residency and HMO [letter]
.P
LETTER.
.A
Fields KB; Taylor DA; Cable TA.
.I 90614
.U
88244591
.S
J Fam Pract 8809; 26(6):614, 616
.M
Family Practice; Human; Mass Screening; Sigmoidoscopy/*.
.T
Screening flexible sigmoidoscopy [letter]
.P
LETTER.
.A
Varma JR.
.I 90615
.U
88244592
.S
J Fam Pract 8809; 26(6):617-8
.M
Coronary Care Units/*; Human; Myocardial Infarction/*TH.
.T
Managing the patient with possible acute myocardial infarction.
.P
JOURNAL ARTICLE.
.A
Ewy GA.
.I 90616
.U
88244593
.S
J Fam Pract 8809; 26(6):621-6
.M
Attitude to Health; Case Report; Eye Neoplasms/GE/*PX; Family/*; Female; Human; Infant, Newborn; Male; MMPI; Pregnancy; Retinoblastoma/GE/*PX; Stress, Psychological/*.
.T
Retinoblastoma and a family in crisis [clinical conference]
.P
JOURNAL ARTICLE.
.A
Saultz JW; Olenick J; Commerford K; Clack S.
.I 90617
.U
88244595
.S
J Fam Pract 8809; 26(6):633-5
.M
Ambulatory Care Facilities; Antibodies, Bacterial/AN; Bronchitis/*MI; Female; Human; Legionella/IM; Legionnaires' Disease/*DI; Male; Middle Age; Respiratory Tract Infections/*MI; Support, Non-U.S. Gov't.
.T
The incidence of Legionella pneumophila as the cause of acute ambulatory lower respiratory tract infection.
.P
JOURNAL ARTICLE.
.W
Seventy-nine ambulatory patients with acute lower respiratory tract infection were evaluated for Legionella pneumophila by acute and convalescent antibody titers. None of the patients met the traditional criteria for the diagnosis of acute infection caused by Legionella pneumophila. Currently accepted criteria for diagnosing legionellosis by serologic means may or may not be applicable to mild respiratory tract infections.
.A
Guthrie R; Sickles RT; Draeger S; Brose J; Athens WJ; Bontrager RR; O'Handley J; Heffelfinger J.
.I 90618
.U
88244596
.S
J Fam Pract 8809; 26(6):639-41
.M
Adult; Comparative Study; Female; Human; Prospective Studies; Vaginal Smears/*IS/MT.
.T
Improved endocervical cell yield with Cytobrush.
.P
JOURNAL ARTICLE.
.W
A prospective study of 402 Papanicolaou smears was done comparing the effectiveness of three techniques in obtaining endocervical cells. The Zelsmyr Cytobrush cell collector yielded the greatest concentration of endocervical cells. More than one half (53.6 percent) of all cell samples obtained with the Zelsmyr Cytobrush produced "moderate" or "large" concentrations. The extended-tip spatula and cotton-tip swab techniques produced only 38.5 percent and 24.2 percent, respectively, in these categories. The Zelsmyr Cytobrush cell collector is an effective instrument, yielding increased numbers of endocervical cells on Papanicolaou smear.
.A
Deckert JJ; Staten SF; Palermo V.
.I 90619
.U
88244597
.S
J Fam Pract 8809; 26(6):643-7
.M
Adult; Child; Child, Preschool; Consumer Satisfaction/*; Family Practice; Human; Internship and Residency/*; Patient Compliance/*; Patient Education/*; Questionnaires; Recall.
.T
Communicating information to patients. Patient satisfaction and adherence as associated with resident skill.
.P
JOURNAL ARTICLE.
.W
A study investigated the degree to which residents' communication of specific information about medications and follow-up appointments had an impact on patient recall, satisfaction, and adherence. Twenty-nine interactions between patients and residents were taped and analyzed by two trained observers. Patients were interviewed immediately after their interactions with residents to assess their ability to recall instructions and to assess their levels of satisfaction with the visit. Patients' overall global satisfaction with their interactions was highly correlated with their ratings of resident information giving (Pearson r = .90, P less than .001). Patients who expressed higher levels of satisfaction also had higher recall rates (Pearson r = .39, P less than .01), although overall patient recall rate was only slightly above 50 percent. Observers' analysis of residents giving information reveals a mean performance rating of 40 percent. Only 31 percent of patients returned for their follow-up appointments. The study suggests that information itself may not be so important in determining patient satisfaction as are patients' perceptions that physicians attempt to give them information. Such information may, however, have greater impact on patient adherence with physician recommendations.
.A
Falvo D; Tippy P.
.I 90620
.U
88244598
.S
J Fam Pract 8809; 26(6):651-5
.M
Absenteeism/*; Adult; Aged; Attitude of Health Personnel/*; Family Practice; Female; Human; Male; Middle Age; Personnel Management/*; Physician-Patient Relations; Physician's Role/*; Questionnaires; Role/*.
.T
Absenteeism certification: the physician's role.
.P
JOURNAL ARTICLE.
.W
Two hundred five family physicians and 135 personnel managers were surveyed to determine the physician's role in certifying absenteeism. Fifty-four percent of the managers returned the questionnaire and indicated that the physician's certificate reduced absenteeism. Even though they expressed dissatisfaction with the certificate's content, the personnel managers usually did not request additional information. Sixty-six percent of the physicians returned questionnaires, with 80 percent reporting one or more requests for certification per week, and 41 percent feeling pressured to write unwarranted excuses. The primary factor the physicians considered when writing an excuse was whether the illness could be verified. Requests for excuses when conditions lacked objective findings produced physician feelings of reluctance, of suspicion, and of being manipulated.
.A
Mayhew HE; Nordlund DJ.
.I 90621
.U
88244600
.S
J Fam Pract 8809; 26(6):665-70
.M
Adult; Aged; Anticholesteremic Agents/*TU; Attitude of Health Personnel; Coronary Disease/ET/PC; Female; Human; Hypercholesterolemia/CO/*DT/ET; Lipoproteins, HDL Cholesterol/BL; Lipoproteins, LDL Cholesterol/BL; Male; Middle Age; Obesity/CO; Risk Factors; Smoking/AE.
.T
Should cholesterol-lowering drugs be used routinely to treat moderate hypercholesterolemia in patients with serum cholesterol levels of 6.20 to 6.85 mmol/L (240 to 265 mg/dL). An affirmative view.
.P
JOURNAL ARTICLE.
.A
Crouch MA.
.I 90622
.U
88244602
.S
J Fam Pract 8809; 26(6):679-80
.M
Adult; Caffeine/*AE; Case Report; Female; Human; Hypokalemia/*CI/PP.
.T
Coffee and hypokalemia.
.P
JOURNAL ARTICLE.
.A
Rudy DR; Lee S.
.I 90623
.U
88244603
.S
J Fam Pract 8809; 26(6):687-8
.M
Attitude of Health Personnel; Certification/*; Geriatrics/*; Questionnaires; United States.
.T
Certification of added qualification in geriatrics: the academic perspective.
.P
JOURNAL ARTICLE.
.A
Goodenough GK; Whitman N.
.I 90624
.U
88244721
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):473-5
.M
Axons/UL; Biopsy; Case Report; Female; Foot/*IR; Hand/*IR; Human; Microscopy, Electron; Middle Age; Nerve Degeneration; Nerve Fibers, Myelinated/PA; Neuritis/*PA; Sensation/*PH; Sural Nerve/PA.
.T
Sensory perineuritis.
.P
JOURNAL ARTICLE.
.W
A case of sensory perineuritis is described, affecting individual cutaneous nerves in the extremities and with a chronic inflammatory exudate confined to the perineurium in a sural nerve biopsy. No cause was found. The condition slowly resolved on steroid treatment.
.A
Matthews WB; Squier MV.
.I 90625
.U
88244722
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):476-80
.M
Adult; Aged; Alcoholism/*MO/PP; Autonomic Nervous System Diseases/*MO/PP; Cause of Death; Follow-Up Studies; Human; Male; Middle Age; Risk Factors; Support, Non-U.S. Gov't; Vagus Nerve/PP.
.T
Mortality in alcoholics with autonomic neuropathy.
.P
JOURNAL ARTICLE.
.W
Seventy-nine male chronic alcoholics who had been tested for autonomic neuropathy using four tests of vagus nerve function were followed for up to 7 years (mean 5.5 years). Thirty-two subjects had no vagal neuropathy, 25 had one abnormal test and 22 had two or more abnormal vagal function tests and two of these also had orthostatic hypotension. There were no differences between the reported alcohol consumptions and evidence of central or peripheral nerve or liver damage between the three groups. Twelve patients died during the follow-up period. At 7 years the percentage survival for the subjects with no evidence of vagal neuropathy was 91%, with one abnormal test it was 66% and with two or more abnormal tests it was 79%. The expected percentage survival for each of the group was 94%, 91% and 88% respectively. The results suggest that evidence of vagal neuropathy in chronic alcoholics is associated with a significantly higher mortality than in the general population and that deaths due to cardiovascular disease are a major cause.
.A
Johnson RH; Robinson BJ.
.I 90626
.U
88244724
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):487-94
.M
Adult; Afferent Pathways/PP; Disability Evaluation; Electric Stimulation/MT; Electromagnetics; Electromyography; Female; Human; Male; Middle Age; Motor Neurons/PH; Multiple Sclerosis/*PP; Muscles/IR; Neural Transmission/*; Reaction Time/PH; Spinal Cord/*PP; Support, Non-U.S. Gov't.
.T
Central motor conduction in multiple sclerosis: evaluation of abnormalities revealed by transcutaneous magnetic stimulation of the brain.
.P
JOURNAL ARTICLE.
.W
Magnetic stimulation of the brain and spinal column was used to assess conduction in the descending central motor pathways controlling arm and leg muscles of 20 patients with multiple sclerosis, and 10 normal subjects. The multiple sclerosis patients had relapsing and remitting disease but all were ambulant and in stable clinical remission. Increased central motor conduction times (CMCTs), up to three times normal, were frequently encountered in multiple sclerosis patients and in leg muscles these correlated closely with clinical signs of upper motor neuron disturbance; in the upper limb muscles a higher proportion of subclinical lesions was present. Weak muscles were almost invariably associated with abnormal central conduction but increased CMCTs were also found for 52 of the 104 muscles with normal strength. CMCTs for lower limb muscles were directly related (p less than 0.005) to functional motor disability (Kurtzke and Ambulatory Index Scales). No patient developed clinical evidence of relapse during follow-up of at least 8 months. Magnetic brain stimulation is easy to perform, painless, and safe, and provides clinically relevant information in the diagnosis and monitoring of multiple sclerosis patients.
.A
Ingram DA; Thompson AJ; Swash M.
.I 90627
.U
88244725
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):495-8
.M
Adult; Female; Human; Multiple Sclerosis/*PP; Nervous System/PP; Pregnancy; Pregnancy Complications/*PP; Pregnancy Outcome; Puerperal Disorders/PP; Recurrence; Support, Non-U.S. Gov't.
.T
Pregnancy and multiple sclerosis.
.P
JOURNAL ARTICLE.
.W
The effect of pregnancy on the relapse rate of multiple sclerosis has been investigated. Obstetric and relapse histories of 52 women with clinically definite multiple sclerosis were obtained; there were 101 pregnancies of which 85 were at risk of a multiple sclerosis relapse. By comparing the number of relapses in the pregnancy period (9 months of pregnancy and 6 months immediately post partum) with the number in non-pregnancy periods for the same women, no increased risk of relapse during the pregnancy period was demonstrated. However, of the relapses that did occur during the pregnancy period, there was a significant reduction in the number of relapses in the first and second trimesters.
.A
Frith JA; McLeod JG.
.I 90628
.U
88244726
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):499-508
.M
Adult; Afferent Pathways/PH; Electric Stimulation/IS; Electrodes; Evoked Potentials, Somatosensory/*; H-Reflex/*; Human; Reaction Time/PH; Reference Values; Reflex, Monosynaptic/*; Spinal Cord/*PH; Sural Nerve/PH; Tibial Nerve/PH; Vibration.
.T
The origins of lumbosacral spinal evoked potentials in humans using a surface electrode recording technique.
.P
JOURNAL ARTICLE.
.W
Somatosensory evoked potentials were recorded over the lumbar spine and scalp in 12 normal subjects after stimulating the posterior tibial nerve at the knee and ankle and the sural nerve at the ankle. The H-reflex from the soleus muscle was recorded at the same time. The effects of stimulus intensity, frequency of stimulation and vibration were assessed. It was concluded that when the posterior tibial nerve was stimulated in the popliteal fossa, three negative peaks were recorded over the lumbosacral area. They arose from activity in the dorsal roots, the dorsal horn of the spinal cord (SD) and the ventral roots. In contrast when the posterior tibial nerve and the sural nerve were stimulated at the ankle only two negative peaks were recorded, a dorsal root potential and a spinal cord dorsum potential. In addition the data suggested that the peripheral nerve fibres that are involved with generating the surface recorded spinal potential with mixed nerve stimulation are primarily muscle afferents.
.A
Yiannikas C; Shahani BT.
.I 90629
.U
88244727
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):509-15
.M
Aged; Brain Stem/*PA; Case Report; Cerebellar Ataxia/PA; Cerebral Hemorrhage/*PA; Cerebral Infarction/*PA; Dysarthria/PA; Facial Paralysis/PA; Female; Hemiplegia/PA; Human; Male; Middle Age; Pons/PA; Supranuclear Palsy, Progressive/PA; Tomography, X-Ray Computed.
.T
Lacunar syndromes due to brainstem infarct and haemorrhage.
.P
JOURNAL ARTICLE.
.W
Nine patients with brainstem infarct and two with brainstem haemorrhage presented with pure motor stroke, pure supranuclear facial palsy, sensorimotor stroke or ataxic hemiparesis. Despite the clinical similarity with hemispheric lacunes, brainstem infarcts causing lacunar syndromes probably have a greater tendency to progress. Small brainstem haemorrhages should also be considered as a cause of lacunar syndromes and the difficulty in differentiating them from small infarcts without CT is emphasised.
.A
Huang C; Woo E; Yu YL; Chan FL.
.I 90630
.U
88244728
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):516-20
.M
Cerebral Aneurysm/*PA; Cerebral Angiography; Cerebral Ventricles/*PA; Human; Hydrocephalus/*PA; Hyponatremia/*PA; Sodium/BL; Subarachnoid Hemorrhage/*PA; Tomography, X-Ray Computed.
.T
Enlargement of the third ventricle and hyponatraemia in aneurysmal subarachnoid haemorrhage [published erratum appears in J Neurol Neurosurg Psychiatry 1988 Aug;51(8):1110]
.P
JOURNAL ARTICLE.
.W
Hyponatraemia following aneurysmal subarachnoid haemorrhage is associated with an increased risk of cerebral infarction. Whether the development of hyponatraemia was related to enlargement of the third ventricle on the admission CT scan was investigated in a consecutive series of 133 patients who were seen within 72 hours of aneurysmal haemorrhage. Hyponatraemia occurred significantly more often in patients with enlargement of the third ventricle (with or without dilatation of the lateral ventricles) than in patients with a normal ventricular system (20/41 versus 24/92, p = 0.016). After ventricular drainage, the sodium levels returned to normal in two patients in whom the size of the third ventricle decreased and not in four patients with persistent enlargement of the third ventricle. The significant relationship between enlargement of the third ventricle and hyponatraemia remained after adjustment for the amount of cisternal blood, but not after adjustment for the amount of intraventricular blood. These results suggest that the size of the third ventricle is an important but not the only factor in the relationship between acute hydrocephalus and hyponatraemia in patients with aneurysmal subarachnoid haemorrhage.
.A
Wijdicks EF; Vandongen KJ; Vangijn J; Hijdra A; Vermeulen M.
.I 90631
.U
88244729
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):521-5
.M
Adult; Cerebral Ventricles/*PA; Cerebrospinal Fluid/*PH; Cerebrospinal Fluid Shunts/*; Human; Hydrocephalus/*SU; Hydrocephalus, Normal Pressure/PA/*SU; Intracranial Pressure; Postoperative Complications/*PA; Support, Non-U.S. Gov't; Tomography, X-Ray Computed.
.T
Reduction of ventricular size after shunting for normal pressure hydrocephalus related to CSF dynamics before shunting.
.P
JOURNAL ARTICLE.
.W
Reduction of ventricular size was determined by repeated computed tomography in 30 adult patients shunted for normal pressure hydrocephalus (NPH) and related to the pressure-volume index (PVI) and resistance to outflow of cerebrospinal fluid (Rcsf) measured before shunting. Rapid and marked reduction of ventricular size (n = 10) was associated with a significantly lower PVI than slow and moderate to marked (n = 13) or minimal to mild reduction (n = 7). Otherwise no relationship could be found between the reduction of ventricular size and PVI or Rcsf. It is concluded that both rate and magnitude of reduction of ventricular size after shunting for NPH are extremely variable. High brain elasticity seems to be the best predictor of rapid and marked reduction.
.A
Tans JT; Poortvliet DC.
.I 90632
.U
88244730
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):526-8
.M
Adolescence; Adult; Aged; Aged, 80 and over; Brain Concussion/RA; Brain Injuries/*RA; Cerebral Hemorrhage/RA; Coma/RA; Female; Human; Male; Middle Age; Prospective Studies; Risk Factors; Skull Fractures/*RA.
.T
Skull fracture as a risk factor of intracranial complications in minor head injuries: a prospective CT study in a series of 98 adult patients.
.P
JOURNAL ARTICLE.
.W
Ninety eight patients admitted to hospital after a minor head injury were studied by CT. Forty seven patients had a skull fracture and 51 did not. Significantly more intracranial lesions were found in those with a fracture (16) that those without (3) (p less than 0.01). Nine of the patients with a skull fracture and positive CT were transferred to a neurosurgical department, where six underwent operation. Operation was not required in patients without a skull fracture. Head injured patients with a skull fracture should undergo CT scanning to enable early detection of an intracranial haematoma.
.A
Servadei F; Ciucci G; Pagano F; Rebucci GG; Ariano M; Piazza G; Gaist G.
.I 90633
.U
88244732
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):534-9
.M
Adult; Cerebral Palsy/*PP; Electromyography; Facial Muscles/*IR; Human; Isometric Contraction; Masseter Muscle/*IR; Masticatory Muscles/*IR; Motor Neurons/*PH; Psychomotor Performance/PH; Reflex, Abnormal/PP; Support, Non-U.S. Gov't.
.T
Motor control deficits of orofacial muscles in cerebral palsy.
.P
JOURNAL ARTICLE.
.W
Voluntary control of the masseter and orbicularis oris superioris muscles was examined in able bodied and cerebral palsied subjects using visual tracking tasks. A smoothed measure of muscle activity (the full-wave rectified and low-pass filtered electromyogram) was presented as a marker on a computer display screen and the subjects could control the vertical position of the marker by voluntarily altering the level of isometric contraction of one of the muscles. A target marker was also displayed on the screen and the subjects were required to follow or "track" the irregular movements of this target with the response marker. Their success in aligning the response marker with the target was analysed for these orofacial muscles. The masseter is influenced by muscle spindle based reflexes, while the orbicularis oris superioris lacks such reflex control. The cerebral palsied subjects displayed similarly poor control over both muscles, implying that their voluntary motor deficits are not related to abnormal muscle spindle based reflexes. It is suggested that the impairment may be related to perceptual-motor integration.
.A
Vaughan CW; Neilson PD; O'Dwyer NJ.
.I 90634
.U
88244733
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):540-3
.M
Aged; Aged, 80 and over; Alzheimer's Disease/*PP; Female; Frontal Lobe/PP; Hippocampus/PP; Human; Male; Middle Age; Neural Pathways/PP; Parkinson Disease/*PP; Pons/*PP; Supranuclear Palsy, Progressive/*PP; Tegmentum Mesencephali/*PP.
.T
The pedunculopontine nucleus in Parkinson's disease, progressive supranuclear palsy and Alzheimer's disease.
.P
JOURNAL ARTICLE.
.W
Significant loss of neurons in the pedunculopontine nucleus pars compacta (PPNc), a putative cholinergic nucleus involved in modulating somatic motor activities, has been demonstrated in progressive supranuclear palsy (PSP) and Parkinson's disease but not in Alzheimer's disease. A morphometric study of this nucleus was performed in two cases of PSP and in a cohort of cases of Parkinson's disease, Alzheimer's disease, senile dementia of Alzheimer type (SDAT), and age-matched controls. In PSP a significant 60% neuronal loss in PPNc was associated with neurofibrillary tangles in 40 to 64% of the remaining neurons. In Parkinson's disease there was a significant decrease in cell numbers and density by 53 and 51%, respectively, with Lewy bodies involving 6 to 39% of all neurons. In Alzheimer's disease and SDAT, large neurons were reduced by 29 and 33.8%, respectively, with tangles in 9 to 38% of the remaining cells. The selective affection of this putative cholinergic nucleus in PSP and Parkinson's disease appears to be related to motor dysfunctions in these disorders.
.A
Jellinger K.
.I 90635
.U
88244735
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):549-51
.M
Aged; Aged, 80 and over; Alzheimer's Disease/*EN/PA; Brain/PA; Dementia, Senile/*EN/PA; Female; Human; Male; Middle Age; Phosphopyruvate Hydratase/*CF; Radioimmunoassay; Support, Non-U.S. Gov't.
.T
Cerebrospinal fluid neuron-specific enolase is decreased in multi-infarct dementia, but unchanged in Alzheimer's disease.
.P
JOURNAL ARTICLE.
.W
Cerebrospinal fluid (CSF) levels of neuron-specific enolase (NSE) were measured in 22 patients with probable Alzheimer's disease and in 35 patients with multi-infarct dementia, and in 15 controls. CSF NSE in patients with Alzheimer's disease did not differ from those in controls. In patients with multi-infarct dementia without recent vascular events CSF NSE was lower than in controls or in Alzheimer patients. This finding is in accord with the prevailing opinion that vascular dementia is caused by multiple infarcts and not by continuous neuronal ischaemia.
.A
Sulkava R; Viinikka L; Erkinjuntti T; Roine R.
.I 90636
.U
88244737
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):557-62
.M
Aged; Beta-Thromboglobulin/*ME; Brain/PA; Cerebral Arteriosclerosis/BL; Cerebral Embolism and Thrombosis/BL; Cerebral Infarction/*BL/PA; Cerebral Ischemia, Transient/BL; Female; Human; Male; Middle Age; Support, Non-U.S. Gov't; Tomography, X-Ray Computed.
.T
Beta-thromboglobulin in cerebral infarction.
.P
JOURNAL ARTICLE.
.W
Plasma beta-thromboglobulin (BTG) was significantly elevated in the acute phase of 116 atherosclerotic thrombotic (p less than 0.0001) and 36 cardioembolic (p less than 0.005) infarcts but normal for 96 lacunes compared with controls. This elevation persisted into the 6th week after the acute event. Among atherosclerotic thrombotic infarcts, the acute beta-thromboglobulin level showed a tendency to correlate with infarct size on CT and predicted mortality at 6 weeks. These results suggest that platelet aggregation plays a primary role in the pathogenesis of atherothrombosis.
.A
Woo E; Huang CY; Chan V; Chan YW; Yu YL; Chan TK.
.I 90637
.U
88244738
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):563-7
.M
Adult; Case Report; Cerebral Cortex/*PP; Electroencephalography; Electromyography; Female; Human; Leg/IR; Muscles/IR; Peripheral Nerves/*PP; Reflex Sympathetic Dystrophy/*PP; Signal Processing, Computer-Assisted; Spasm/*PP; Urinary Incontinence/PP.
.T
Painful muscle spasms complicating algodystrophy: central or peripheral disease?
.P
JOURNAL ARTICLE.
.W
A 21 year old female patient developed Sudeck's atrophy of the right foot secondary to a chronic Achilles tendinitis. The condition was complicated by the occurrence of painful muscle spasms in the right leg and incontinence of urine. The spasms had characteristics of both a tonic ambulatory foot response and a spinal flexor reflex. The movements disappeared during sleep. Regional anaesthesia of the right leg made the spasms disappear both in and outside the region of anaesthesia. Backaveraging of the EEG showed the involuntary spasms to be preceded by a cortical potential similar to a readiness potential, indicating a cortical potential similar to a readiness potential, indicating a cortical component in the pathophysiology of the muscle spasms complicating Sudeck's atrophy.
.A
Robberecht W; Van Hees J; Adriaensen H; Carton H.
.I 90638
.U
88244739
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):568-71
.M
Adolescence; Adult; Aged; Brain Damage, Chronic/PP; Electromyography; Exercise Test; Human; Middle Age; Motor Neurons/*PH; Muscle Spasticity/PP; Muscles/IR; Paralysis/*PP; Reflex, Abnormal/*PP; Spinal Cord/*PP; Support, Non-U.S. Gov't.
.T
Spastic paresis: impaired spinal reflexes and intact motor programs.
.P
JOURNAL ARTICLE.
.W
Leg muscle EMG responses evoked by short treadmill acceleration impulses applied during stance were analysed in patients with spastic hemiparesis. The compensatory reactions on the unaffected side consisted of a diphasic pattern of leg muscle activation. The first response could best be described as a polysynaptic spinal stretch reflex response. This response was absent on the spastic side, except for its later, declining component. This remainder of the first response and the following activation of the antagonistic muscle was identical on both the unaffected and the spastic side. This part of the pattern is assumed to be centrally programmed (at the spinal level) and triggered by the termination of the acceleration impulse.
.A
Berger W; Horstmann GA; Dietz V.
.I 90639
.U
88244740
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):572-5
.M
Aged; Brain Stem/*PP; Case Report; Cerebral Cortex/PP; Cerebral Infarction/PP; Electroencephalography; Evoked Potentials, Auditory/*; Evoked Potentials, Somatosensory/*; Human; Male; Median Nerve/PP; Myoclonus/*PP; Reaction Time/PH; Reflex, Abnormal/*PP; Support, Non-U.S. Gov't; Tomography, X-Ray Computed.
.T
Somatosensory and acoustic brain stem reflex myoclonus.
.P
JOURNAL ARTICLE.
.W
A patient with brain stem reflex myoclonus due to a massive midbrain infarct was studied electrophysiologically. Myoclonic jerks were elicited at variable latencies by tapping anywhere on the body or by acoustic stimuli, and mainly involved flexor muscles of upper extremities. The existence of convergence of somatosensory and acoustic inputs in the brain stem was suggested. This myoclonus seemed to be mediated by a mechanism similar to the spino-bulbo-spinal reflex.
.A
Shibasaki H; Kakigi R; Oda K; Masukawa S.
.I 90640
.U
88244741
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):576-8
.M
Amyloidosis/*GE/PA; Case Report; Female; Heterozygote Detection/*; Human; Microscopy, Electron; Middle Age; Pedigree; Polyneuritis/*GE/PA; Prealbumin/*GE; Radioimmunoassay; Sural Nerve/PA.
.T
Familial amyloidotic polyneuropathy without familial occurrence: carrier detection by the radioimmunoassay of variant transthyretin.
.P
JOURNAL ARTICLE.
.W
A 47 year old woman with familial amyloidotic polyneuropathy (FAP) is reported, without familial occurrence of the disease. Her 81 year old mother and 53 year old sister were proved to be asymptomatic carriers for variant transthyretin (TTR) by means of the radioimmunoassay. It is suggested that unknown factor(s) may play a role in preventing or delaying the onset of the disease, producing variations in sex and family incidence. In order to establish the diagnosis of non-hereditary primary amyloidotic polyneuropathy, it must be confirmed that variant TTR is absent in the serum of relatives.
.A
Tanaka M; Hirai S; Matsubara E; Okamoto K; Morimatsu M; Nakazato M.
.I 90641
.U
88244742
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):579-81
.M
Aged; Case Report; Cerebral Hemorrhage/*PA/PX; Delusions/*PA/PX; Follow-Up Studies; Frontal Lobe/*PA; Human; Male; Neuropsychological Tests/*; Organic Mental Disorders/*PA/PX; Tomography, X-Ray Computed/*.
.T
Reduplicative paramnesia: possible anatomical and neuropsychological mechanisms.
.P
JOURNAL ARTICLE.
.W
A patient is reported who presented with reduplicative paramnesia following a vascular lesion in the right frontal region. Neuropsychological examination revealed significant memory impairment, perservation on a problem solving task and marked left-sided inattention. Recovery from the paramnesic episode was accompanied by selective resolution of the original cognitive deficits. It is suggested that focal right frontal pathology may represent a sufficient condition for the occurrence of reduplicative paramnesia, and that the underlying mechanisms may be dependent on a particular combination and severity of memory, visuospatial and conceptual deficits.
.A
Kapur N; Turner A; King C.
.I 90642
.U
88244743
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):582-5
.M
Aged; Biopsy; Case Report; Dementia, Senile/*DT; Female; GABA/*AA/AE/TU; Human; Liver/DE/PA; Microscopy, Electron; Pantothenic Acid/*AA/AE/*AI/TU; Reye's Syndrome/*CI/PA.
.T
Reye-like syndrome following treatment with the pantothenic acid antagonist, calcium hopantenate.
.P
JOURNAL ARTICLE.
.W
Three senile patients developed fatal acute encephalopathy while receiving calcium hopantenate. The clinical, biochemical, and pathological picture was similar to Reye's syndrome. Calcium hopantenate is a pantothenic acid antagonist. The serum levels of calcium hopantenate were high in coma, and that of pantothenic acid examined in one patient was lowered. Evidence obtained indicated that the Reye-like syndrome might be caused by calcium hopantenate possibly due to the induction of pantothenic acid deficiency.
.A
Noda S; Umezaki H; Yamamoto K; Araki T; Murakami T; Ishii N.
.I 90643
.U
88244744
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):586-8
.M
Anticonvulsants/TU; Case Report; Cerebral Cortex/PP; Electroencephalography/*; Epilepsy, Temporal Lobe/DT/*PP; Evoked Potentials/DE; Female; Human; Middle Age; Organic Mental Disorders/PP; Status Epilepticus/DT/*PP.
.T
Prolonged complex partial status epilepticus: a case report [letter]
.P
LETTER.
.A
Roberts MA; Humphrey PR.
.I 90644
.U
88244745
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):588-90
.M
Aged; Akinetic Mutism/*PA; Alcohol Amnestic Disorder/*PA; Atrophy; Brain/PA; Case Report; Female; Human; Tomography, X-Ray Computed/*; Wernicke's Encephalopathy/*PA.
.T
Akinetic mutism in Wernicke-Korsakoff disease: a case report [letter]
.P
LETTER.
.A
Mann MW; Degos JD.
.I 90645
.U
88244746
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):590-1
.M
Case Report; Caudate Nucleus/*PA; Cerebral Infarction/*PA/PX; Chorea/*PA/PX; Denial (Psychology)/*; Human; Magnetic Resonance Imaging/*; Male; Middle Age.
.T
Hemichorea and its denial in a case of caudate infarction diagnosed by magnetic resonance imaging [letter]
.P
LETTER.
.A
Kawamura M; Takahashi N; Hirayama K.
.I 90646
.U
88244747
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):591-2
.M
Case Report; Cerebral Infarction/*PA; Human; Male; Middle Age; Thalamic Diseases/*PA; Thalamic Nuclei/PA; Tomography, X-Ray Computed; Tremor/*PA.
.T
Essential tremor cured by infarction adjacent to the thalamus [letter]
.P
LETTER.
.A
Duncan R; Bone I; Melville ID.
.I 90647
.U
88244748
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):592
.M
Aged; Bromocriptine/*TU; Case Report; Human; Levodopa/TU; Male; Nerve Degeneration/*DE; Parkinson Disease, Symptomatic/*DT; Putamen/*DE; Substantia Nigra/*DE.
.T
Bromocriptine therapy in striatonigral degeneration [letter]
.P
LETTER.
.A
Van Leeuwen RB; Perquin WV.
.I 90648
.U
88244749
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):593-6
.M
Aphasia, Acquired/PP; Apraxia/*PP; Cerebral Cortex/*PP; Human; Motor Skills/*PH; Muscles/IR; Neural Pathways/PP; Neuropsychological Tests.
.T
Ideomotor apraxia: evidence for the preservation of axial commands.
.P
JOURNAL ARTICLE.
.A
Howes DH.
.I 90649
.U
88244750
.S
J Neurol Neurosurg Psychiatry 8809; 51(4):596-7
.M
Epilepsy/*CO; Headache/*ET; Human; Migraine/*ET.
.T
Post epileptic headache and migraine [letter]
.P
LETTER.
.A
D'Alessandro R; Sacquegna T; Pazzaglia P; Lugaresi E.
.I 90650
.U
88244796
.S
J Neurosurg 8809; 69(1):104-9
.M
Animal; Arterioles/AH/DE; Calcium Channel Blockers/*PD; Cerebrovascular Circulation/*DE; Dose-Response Relationship, Drug; Hydrogen-Ion Concentration; Rats; Rats, Inbred Strains; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Time Factors; Vasodilation.
.T
Effects of calcium antagonists on intracerebral penetrating arterioles in rats.
.P
JOURNAL ARTICLE.
.W
There is no direct information on the effect of calcium antagonists on intracerebral penetrating arterioles, which are responsible for a significant part of total cerebrovascular resistance. In a study on rats, the effects of four calcium antagonists (diltiazem, verapamil, nifedipine, and nimodipine) on isolated intracerebral penetrating arterioles with mean resting diameters (+/- standard error of the mean) of 52.3 +/- 3.0 micron were investigated. Vessel diameters were monitored in vitro by means of a video microscope dimensional analyzer under constant transmural pressure (60 mm Hg) after cannulation. Each calcium antagonist produced maximal dilation of about 50% (diltiazem 46.4% +/- 5.6%, verapamil 53.1% +/- 6.0%, nifedipine 46.9% +/- 6.1%, and nimodipine 47.1% +/- 5.4%) with varied sensitivity (median effective dose (ED50): diltiazem 1.52 X 10(-6) M, verapamil 1.08 X 10(-7) M, nifedipine 8.65 X 10(-9) M, and nimodipine 1.62 X 10(-9) M). Dilation effects persisted for a significantly longer time after washout with calcium antagonists such as diltiazem (15.5 +/- 1.8 minutes), nifedipine (19.0 +/- 3.9 minutes), and nimodipine (30.0 +/- 1.6 minutes) than after washout with adenosine (8.5 +/- 1.0 minutes). It appeared that the magnitude of vasodilation was greater and the duration of dilation after washout longer in intracerebral penetrating arterioles than that reported for pial arterioles, although sensitivity to each calcium antagonist was quite similar to that reported for larger cerebral arteries. These data provide a possible explanation for the apparent disparity between clinical efficacy and angiographically determined vessel diameter when patients with cerebral vasospasm are treated with calcium antagonists. These agents may have a greater effect on intracerebral penetrating arterioles than on angiographically visible larger arteries.
.A
Takayasu M; Bassett JE; Dacey RG Jr.
.I 90651
.U
88244797
.S
J Neurosurg 8809; 69(1):110-4
.M
Abscess/*CO/PA/RA; Angiography/*; Animal; Epidural Space; Laminectomy; Neovascularization/ET; Osteomyelitis/ET/RA; Paraplegia/ET; Spinal Cord/*BS; Spinal Cord Compression/ET; Spinal Diseases/*CO/PA/RA; Staphylococcal Infections/*CO/PA/RA.
.T
The pathogenesis of spinal epidural abscess: microangiographic studies in an experimental model.
.P
JOURNAL ARTICLE.
.W
An experimental model of spinal epidural abscess was developed in rabbits by injecting Staphylococcus aureus into the posterior thoracolumbar epidural space. This model has been shown to reproduce the neurological, bacteriological, and radiological aspects of the human disease. In this study, the effect of the infectious epidural mass on the vasculature of the spinal cord in paraplegic rabbits was studied using microangiographic techniques. The normal vascular anatomy of the rabbit spinal cord was defined in control experiments. Vascular proliferation was demonstrated in the epidural space surrounding the abscesses. Anterior and paired posterior spinal arteries remained patent in paraplegic rabbits with mild or moderate spinal cord compression and in some cases of severe compression. In animals with severe compression, the anterior epidural venous plexus remained patent, but the dorsal spinal vein was occluded. Occlusion of perforating arteries occurred only with extreme spinal cord compression. These data indicate that the initial neurological deficit associated with experimental spinal epidural abscess is not due to vascular thrombosis.
.A
Feldenzer JA; McKeever PE; Schaberg DR; Campbell JA; Hoff JT.
.I 90652
.U
88244799
.S
J Neurosurg 8809; 69(1):121-6
.M
Acetylcholinesterase/ME; Animal; Brain/CY/EN; Cell Count/DE; Cyclosporins/*PD; Graft Survival/*DE; Neurons/EN/*TR; Transplantation, Heterologous/*.
.T
Brain xenografts: the effect of cyclosporin A on graft survival.
.P
JOURNAL ARTICLE.
.W
Animal models of Parkinson's disease and Alzheimer's disease have shown dramatic functional improvement after transplantation of embryonic neurons into denervated regions of the adult brain. Because of the ethical and logistic problems associated with the use of human embryonic brain tissue, cross-species transplants are an attractive alternative. An experimental model of cross-species brain transplantation was developed to evaluate cell survival in untreated and cyclosporin A (CyA)-treated animals. Cholinergic ventral neurons from embryonic mice were transplanted into the frontal lobes of 18 adult Sprague-Dawley rats using a cell suspension technique. Nine animals were treated for 13 days with CyA (10 mg/kg/day) and nine were not treated. Twelve weeks after transplantation, frozen sections through the transplant volume were obtained. Alternate sections were prepared with hematoxylin and eosin and acetylcholine esterase stains. Cell counts through a 2-cu mm volume incorporating the transplant were compared to a contralateral control volume. Eight of the nine untreated transplants were successful (mean transplant cells +/- standard error of the mean: 90.7 +/- 19.4/2 cu mm). All of the nine CyA-treated transplants survived, with mean transplant count 28.7 cells/2 cu mm greater than untreated transplants (mean increase 28.7: p less than or equal to 0.05, Wilcoxon matched-pairs signed ranks test). It is concluded that: 1) this model is useful for quantitating transplant cell survival; 2) untreated xenografts survive well; and 3) a 13-day course of CyA improved long-term graft survival.
.A
Howard MA 3d; Dacey RG Jr; Winn HR.
.I 90653
.U
88244800
.S
J Neurosurg 8809; 69(1):127-31
.M
Adult; Angiography; Human; Neck/*; Postoperative Period; Rotation/*AE; Vertebral Artery/RA/*SU; Vertebrobasilar Insufficiency/*ET/RA/SU.
.T
Decompression of the vertebral artery for bow-hunter's stroke. Case report.
.P
JOURNAL ARTICLE.
.W
A case of cerebellar infarction induced by repeated neck rotation ("bow-hunter's stroke") is reported. The most likely mechanism is that repeated rotational neck movement brings about thickening of the atlanto-occipital membrane, fixing the vertebral artery in the vascular groove of the atlas. The vertebral artery is thus pinched at the time of neck rotation, leading to thrombus formation. Embolization results in cerebellar infarction. Surgical decompression of the vertebral artery at the level of the atlas in this case relieved the symptoms, and postoperative angiography demonstrated good flow within the vertebral artery even when the neck was rotated. It was not necessary to restrict the patient's neck movement postoperatively.
.A
Shimizu T; Waga S; Kojima T; Niwa S.
.I 90654
.U
88244801
.S
J Neurosurg 8809; 69(1):132-3
.M
Angiography; Arteries; Arteriovenous Fistula/*TH; Case Report; Embolization, Therapeutic/*; Female; Human; Jugular Veins/*; Middle Age; Pharynx/*BS; Support, Non-U.S. Gov't.
.T
Therapeutic embolization of an ascending pharyngeal artery-internal jugular vein fistula. Case report.
.P
JOURNAL ARTICLE.
.W
The authors report a case of an arteriovenous fistula between the ascending pharyngeal artery and the internal jugular vein. The importance of an exact diagnosis and some precautions to be taken during therapeutic embolization are emphasized, as well as the need for superselective cannulation of the feeding artery. The problem of differential diagnosis with glomus tumors is discussed, and a brief mention is made of the anatomy of the jugular foramen and embryology of these tumors. Only one similar case treated by embolization with solid particles was found in the literature. To date, embolization using solid particles rather than liquid agents appears to be the best treatment of fistulas of this type.
.A
Guglielmi G; Guidetti G; Mori S; Silipo P.
.I 90655
.U
88244802
.S
J Neurosurg 8809; 69(1):134-6
.M
Adult; Case Report; Cervical Vertebrae; Deglutition Disorders/DI; Diagnosis, Differential; Esophageal Neoplasms/*DI; Human; Intervertebral Disk Displacement/*DI/RA/SU; Male; Postoperative Period; Spinal Osteophytosis/ET/SU.
.T
Anterior cervical disc herniation. Case report.
.P
JOURNAL ARTICLE.
.W
A 39-year-old man with an extrinsic esophageal lesion was found to have an anterior herniation of a soft degenerated cervical disc. Only two cases of symptomatic anterior cervical disc herniation have been reported previously. Dysphagia produced by anterior cervical osteophytes is more common and is a recognized clinical entity. Asymptomatic anterior cervical disc herniation may play a key role in the pathogenesis of anterior cervical osteophytes.
.A
Bernardo KL; Grubb RL; Coxe WS; Roper CL.
.I 90656
.U
88244803
.S
J Neurosurg 8809; 69(1):137-9
.M
Adult; Case Report; Cysts/*DI/RA; Diagnosis, Differential; Human; Intervertebral Disk/*/RA; Intervertebral Disk Displacement/*DI/SU; Lumbar Vertebrae; Male; Microsurgery; Recurrence; Reoperation; Spinal Diseases/DI/RA; Tomography, X-Ray Computed.
.T
Intervertebral disc space cyst simulating a recurrent herniated nucleus pulposus. Case report.
.P
JOURNAL ARTICLE.
.W
The case presented is of a patient with an intervertebral disc space cyst producing recurrent radicular pain following microdiscectomy in the lumbar region. Difficulties with the preoperative diagnosis of this and other recurrent radicular syndromes are discussed, and a review of the relevant literature is presented.
.A
Grabel JC; Davis R; Zappulla R.
.I 90657
.U
88244804
.S
J Neurosurg 8809; 69(1):140-1
.M
Equipment Design; Human; Microsurgery/IS; Neoplasms/*SU; Suction/*IS.
.T
A serrated suction tip for tumor removal. Technical note.
.P
JOURNAL ARTICLE.
.W
A serrated suction tip with a variety of diameters and serrations has been developed for the microsurgical removal of tumors. These tips can dissect and aspirate tumor tissue, cerebrospinal fluid, or blood simultaneously, and the degree of suction can be controlled by the pressure of the tip against the tumor.
.A
Shibuya M; Suzuki Y; Nakane T.
.I 90658
.U
88244805
.S
J Neurosurg 8809; 69(1):142
.M
Carotid Arteries/*; Carotid Artery Diseases/*SU; Cerebral Aneurysm/*SU; Constriction/IS; Equipment Design; Human; Surgical Instruments/*.
.T
Carotid control for intracranial aneurysms. Technical note.
.P
JOURNAL ARTICLE.
.W
A new clamp with a flexible cable control mechanism for temporary intraoperative occlusion of the cervical internal carotid artery is described.
.A
Heifetz MD.
.I 90659
.U
88244806
.S
J Neurosurg 8809; 69(1):148-9
.M
Case Report; Human; Male; Middle Age; Myelography/*AE; Nervous System Diseases/*ET.
.T
Acute postmyelographic neurological deterioration [letter]
.P
LETTER.
.A
Willis BK; Benzel EC.
.I 90660
.U
88244807
.S
J Neurosurg 8809; 69(1):149-50
.M
Cerebral Hemorrhage/*RA; Hematoma/*RA; Human; Tomography, X-Ray Computed.
.T
Resolution of intracranial hematoma [letter]
.P
LETTER.
.A
Lax F.
.I 90661
.U
88244810
.S
J Neurosurg 8809; 69(1):150-2
.M
Adrenal Medulla/*TR; Human; Parkinson Disease/*SU.
.T
Adrenal medullary tissue grafting in Parkinson's disease [letter]
.P
LETTER.
.A
Fiandaca MS; Kordower JH; Hansen JT; Gash DM.
.I 90662
.U
88244811
.S
J Neurosurg 8809; 69(1):152
.M
Arnold-Chiari Deformity/*DI; Human; Magnetic Resonance Imaging/*.
.T
MR imaging and the Chiari II malformation [letter]
.P
LETTER.
.A
Wolpert SM.
.I 90663
.U
88244814
.S
J Neurosurg 8809; 69(1):35-8
.M
Arteries; Capillaries/SU; Face/IR; Human; Nerve Compression Syndromes/CO; Nervous System Diseases/ET; Pain; Palliative Treatment; Postoperative Complications; Recurrence; Reoperation; Retrospective Studies; Sensation; Support, U.S. Gov't, P.H.S.; Trigeminal Nerve/*BS; Trigeminal Neuralgia/ET/PP/*SU.
.T
Long-term efficacy of microvascular decompression in trigeminal neuralgia.
.P
JOURNAL ARTICLE.
.W
Forty patients were followed for an average period of 8 1/2 years after 44 consecutive suboccipital craniotomies for trigeminal neuralgia. Among these patients, 36 had microvascular decompression (MVD) of the nerve, four had repeat trigeminal rhizotomy after MVD was not successful in controlling their pain, and four had primary trigeminal rhizotomies. Of the 36 patients undergoing MVD, 17 (47%) experienced recurrent postoperative neuralgic pain: in 11 (31%) pain recurrence was major, and in six (17%) it was minor. Among the eight patients undergoing rhizotomy, four (50%) had major pain recurrences and one (13%) had a minor recurrence, for a 63% total recurrence rate. There was a strong statistical relationship between an operative finding of arterial cross-compression of the nerve and long-term complete pain relief. Patients with other compressive pathology (related to veins or bone structures) did not on the average fare as well. Despite this, there appeared to be no point in time in the postoperative interval when the patient could be considered "cured." Major recurrences averaged 3.5% annually, and minor recurrences averaged 1.5% annually. The implications of these findings for the treatment of trigeminal neuralgia and the current understanding of the mechanism of MVD for this disorder are discussed.
.A
Burchiel KJ; Clarke H; Haglund M; Loeser JD.
.I 90664
.U
88244815
.S
J Neurosurg 8809; 69(1):39-45
.M
Adult; Aged; Aged, 80 and over; Female; Fluoroscopy; Follow-Up Studies; Glycerin/*TU; Human; Injections; Male; Metrizamide/DU; Middle Age; Pain; Palliative Treatment; Recurrence; Trigeminal Nerve/*DE/RE/SU; Trigeminal Neuralgia/*DT/RT/SU.
.T
Glycerol rhizolysis for treatment of trigeminal neuralgia.
.P
JOURNAL ARTICLE.
.W
Percutaneous retrogasserian glycerol instillation was performed under local anesthesia for treatment of trigeminal neuralgia in 162 patients. A simplified technique that did not involve cisternography was used. Initial pain relief was achieved in 146 patients (90.1%). Recurrent pain was noted in 27 patients (18.5%) and was more frequent (50%) in patients who had undergone surgical treatments prior to glycerol injection than in those who had no previous surgical treatment (12.3%). A second glycerol injection was carried out in nine patients and a third injection in two patients. The follow-up period extended from 6 to 67 months and 77.8% of patients are totally pain-free after one or more glycerol injections. Another 8.6% experienced good pain relief with the addition of small doses of pharmacological agents. Thus, 140 (86.4%) of the original 162 patients experienced satisfactory pain control following glycerol rhizolysis. Initial sensory loss on the face occurred in 117 patients (71.6%) but at last follow-up examination only 46 patients (28%) experienced mild orofacial hypalgesia and 13 patients (8%) noted analgesia. The corneal reflex was absent in three patients (1.8%) and reduced in five (3.1%). No patients noted corneal ulceration or anesthesia dolorosa. Percutaneous retrogasserian glycerol rhizolysis offers a rapid, safe, reliable, and relatively inexpensive surgical approach to treatment of trigeminal neuralgia.
.A
Young RF.
.I 90665
.U
88244816
.S
J Neurosurg 8809; 69(1):46-51
.M
Adult; Aged; Aged, 80 and over; Arterial Occlusive Diseases/SU; Carotid Artery Diseases/SU; Cerebral Angiography/*; Cerebral Revascularization/*; Cerebrovascular Disorders/ET; Collateral Circulation; Female; Human; Male; Middle Age; Postoperative Complications; Postoperative Period.
.T
Superficial temporal-middle cerebral artery bypass: clinical pre- and postoperative angiographic correlation.
.P
JOURNAL ARTICLE.
.W
Between 1974 and 1982, an anastomosis between a pedicle of the superficial temporal artery (STA) and a cortical branch of the middle cerebral artery (MCA) was performed in 163 carotid systems in 157 patients for internal carotid artery occlusion in whom postoperative angiograms were available for analysis. The angiographic opacification of the arterial system was correlated with the patient's preoperative neurological function and stroke in the follow-up period. From this analysis, the following observations were made: 1) 96% of bypasses were patent; 2) 80% of bypasses achieved a high or medium MCA filling score; 3) there was hypertrophy of the STA in 70% of the cases; 4) greater bypass filling occurred in hemispheres with nonvisualized preoperative collateral circulation than in those with readily visualized collateral flow; 5) a meaningful correlation between angiographically assessed postoperative bypass function and stroke rate was not possible because only four patients suffered an ipsilateral hemispheric stroke in the 8-year follow-up period; and 6) patients who were neurologically unstable before the procedure were at greatest risk for a stroke in the follow-up period. It is apparent that objective analysis of the effectiveness of an STA-MCA bypass, or any other form of extracranial bypass, must await the development of new diagnostic studies in which high-resolution three-dimensional quantification of cerebral blood flow is possible. These studies will necessarily be correlated with preoperative and follow-up clinical data.
.A
Jack CR JR; Sundt TM Jr; Fode NC; Gehring DG.
.I 90666
.U
88244818
.S
J Neurosurg 8809; 69(1):58-60
.M
Adult; Craniotomy; Cysticercosis/CO/*RA/SU; Female; Human; Male; Middle Age; Nervous System Diseases/ET; Pituitary Diseases/CO/*RA/SU; Postoperative Complications; Sella Turcica; Vision Disorders/ET.
.T
Intrasellar cysticercosis.
.P
JOURNAL ARTICLE.
.W
Eight patients with cysticerci located inside the sella turcica are presented, and the clinical and radiological features of this rare form of neurocysticercosis are discussed. Clinical features included nonspecific ophthalmological and endocrinological disturbances similar to those produced by other sellar lesions. Computerized tomography (CT) usually showed a hypodense mass that simulated either a cystic tumor or an arachnoid cyst. Cerebrospinal fluid (CSF) findings were also nonspecific, as immunological reactions to cysticercosis were most often negative when inflammation was limited to suprasellar and intrasellar regions. An incorrect diagnosis of tumor was frequent in these cases. In contrast, when intrasellar cysticercosis was associated with other forms of neurocysticercosis, proper integration of CT and CSF data permitted an accurate diagnosis. Cysticercosis should be suspected in patients with hypodense juxtasellar lesions living in geographical areas where this disease is endemic. Prompt surgical resection of cysticerci will avoid irreversible damage to visual function.
.A
Del Brutto OH; Guevara J; Sotelo J.
.I 90667
.U
88244819
.S
J Neurosurg 8809; 69(1):61-71
.M
Adjustment Disorders/CO; Adult; Aged; Backache/*ET/RA/TH; Chronic Disease; Decision Making; Female; Human; Intervertebral Disk Displacement/CO/SU; Leg/*/RA; Male; Medical Records; Mental Disorders/CO; Middle Age; Narcotics; Pain/*/ET/TH; Personality Disorders/CO; Reoperation; Spinal Stenosis/CO/SU; Substance Abuse/CO; Syndrome.
.T
Clinical features of the failed-back syndrome.
.P
JOURNAL ARTICLE.
.W
This study comprises 78 patients who were treated for chronic back pain at a multidisciplinary, multimodal pain treatment center. These patients were selected from 494 patients examined by the authors because all of their previous medical records, operative notes, and imaging studies were available for review. The records and imaging studies were reviewed independently by a neurosurgeon and an orthopedist, and a retrospective decision was made concerning the historical and physical findings correlated with imaging studies in order to provide justification for the intervention. At the time of admission to the pain treatment center, 16 patients had no physical abnormalities that would explain their back complaint and 16 patients exhibited minor postoperative changes insufficient to cause disabling pain. Twenty-seven patients suffered from a complication of previous surgery, 13 had spondylotic disease, and in six a new diagnosis was established. Comprehensive psychiatric evaluation of the 78 patients revealed that 10 patients had a definitive psychiatric diagnosis, 34 were diagnosed as having a maladaptive personality disorder, and 34 had a normal pre-pain personality. Sixty-seven patients suffered from reactive depression. Fifty-four patients were taking medications at doses higher than usually prescribed, 58 misused narcotics, nine had drug addiction, and 54 were suffering withdrawal symptoms. Of the 78 patients, 64 underwent a total of 171 operations, an average of 2.6 per patient. The authors applied the clinical criteria approved by the American Association of Neurological Surgeons and the American Academy of Orthopedic Surgeons for selection of surgery or chemonucleolysis in the treatment of the herniated disc to these patients. Preoperative imaging studies were normal or demonstrated nonspecific degenerative disc disease in 52 patients. Twenty-six patients had a diagnosis based on radiological findings that warranted surgery. Clinical criteria justifying intervention were met in 25 patients and not met in 53. Imaging and clinical criteria for a second operation were met in 18 (40%) of the patients. After the second operation all patients met the criteria: subsequent surgery was necessary to treat effects of an earlier operation in 73%. These data indicate that many of these patients with failed-back syndrome underwent an original operation based on a persistent complaint of pain, frequently coupled with an underlying psychiatric abnormality, although they did not meet the criteria generally accepted by neurosurgeons for intervention at the time of first surgery.
.A
Long DM; Filtzer DL; BenDebba M; Hendler NH.
.I 90668
.U
88244820
.S
J Neurosurg 8809; 69(1):72-81
.M
Animal; Blood Viscosity; Cerebral Ischemia/BL/PP/*TH; Cerebrovascular Circulation/*; Fibrinogen/AN; Hematocrit; Hemodilution/*MT; Hemodynamics/*; Intracranial Pressure/*; Support, U.S. Gov't, P.H.S..
.T
Isovolemic hemodilution in experimental focal cerebral ischemia. Part 1: Effects on hemodynamics, hemorheology, and intracranial pressure.
.P
JOURNAL ARTICLE.
.W
A total of 76 splenectomized dogs were entered in a study of the value and effects of isovolemic hemodilution. Of these, seven were not included in the analysis because of technical errors. Of the remaining 69 dogs, 35 were treated with hemodilution; 28 were subjected to a 6-hour period of temporary occlusion of the distal internal carotid artery and the proximal middle cerebral artery, and seven underwent a sham operation only, with arterial manipulation but no occlusion. The other 34 dogs were not subjected to hemodilution; 26 of these underwent temporary arterial occlusion and eight had a sham operation only. In each group the animals were about equally divided into 1) an acute protocol with regional cerebral blood flow measurements by a radioactive microsphere technique and sacrifice at the end of the acute experiment, and 2) a chronic protocol with survival for 1 week to permit daily neurological assessment and final histopathological examination but without blood flow measurements. Isovolemic hemodilution was performed about 1 hour after the arterial occlusion or sham operation and was accomplished by phlebotomy and infusions of low molecular weight dextran to bring the hematocrit to a level of 30% to 32%. This treatment resulted in a very significant reduction in viscosity and fibrinogen levels. The decrease in hematocrit lasted throughout the week in the animals in the chronic protocol. The decrease in viscosity correlated almost linearly with the decrease in hematocrit. There was a slight decrease in systemic arterial pressure with hemodilution but there were no significant changes in central venous pressure or in pulmonary arterial or wedge pressure. There was a slight decrease in cardiac index in both the hemodilution and control groups, which may have been due to the effects of barbiturate anesthesia. There was a slight increase in the measured blood volume in both groups, which was probably artifactual and related to the method of calculation. Intracranial pressure increased significantly with time in all animals subjected to arterial occlusion, but this increase was less severe in the hemodilution group. There was no significant change in intracranial pressure in sham-operated animals, whether hemodiluted or not. The results of cerebral blood flow measurements, assessment of neurological conditions, and measurement of infarct size are given in Part 2 of this report.
.A
Tu YK; Heros RC; Candia G; Hyodo A; Lagree K; Callahan R; Zervas NT; Karacostas D.
.I 90669
.U
88244821
.S
J Neurosurg 8809; 69(1):82-91
.M
Animal; Cerebral Infarction/ET/ME/*PA; Cerebral Ischemia/CO/PP/*TH; Cerebrovascular Circulation/*; Hemodilution/*MT; Nervous System/PP; Stains and Staining; Support, U.S. Gov't, P.H.S.; Tetrazolium Salts/DU.
.T
Isovolemic hemodilution in experimental focal cerebral ischemia. Part 2: Effects on regional cerebral blood flow and size of infarction.
.P
JOURNAL ARTICLE.
.W
Seventy-six splenectomized dogs were entered in a study of the value and effects of isovolemic hemodilution. Of these, seven were not included in the analysis because of technical errors. Of the remaining 69 dogs, 35 were treated with hemodilution; 28 were subjected to a 6-hour period of temporary occlusion of the distal internal carotid artery and the proximal middle cerebral artery, and seven underwent a sham operation only, with arterial manipulation but no occlusion. The other 34 dogs were not subjected to hemodilution; 26 of these underwent temporary arterial occlusion and eight had a sham operation only. In each group the animals were about equally divided into 1) an acute protocol with regional cerebral blood flow measurements by a radioactive microsphere technique and sacrifice at the end of the acute experiment, and 2) a chronic protocol with survival for 1 week to permit daily neurological assessment and final histopathological examination but without blood flow measurements. The general experimental protocol, the hemodynamic and rheological measurements, and the changes in intracranial pressure are described in Part 1 of this report. In the animals with arterial occlusion, blood flow decreased significantly in the territory of the ischemic middle cerebral artery. This decrease was partially reversed by hemodilution in the animals so treated. When the changes in blood flow before and after hemodilution in treated animals are compared with the changes at equivalent times in animals without hemodilution, the increases in flow in the gray matter of the ischemic hemisphere brought about by hemodilution are statistically significant. The neurological condition of the animals in the chronic protocol (sacrificed 1 week after occlusion) with hemodilution, as evaluated by daily neurological assessment, was significantly better than that of the control animals. In the animals sacrificed acutely (8 hours after arterial occlusion), the volume of infarction as estimated by the tetrazolium chloride histochemical method was 7.36% of the total hemispheric volume in the control animals and 1.09% in the hemodiluted animals, showing a statistically significant difference (p less than 0.005). In the chronic animals these values were 9.84% and 1.26%, respectively (p less than 0.005), as calculated by fluorescein staining. By histopathological examination the volume of infarction in the chronic animals was calculated as 10.92% in the control animals and 1.20% in the hemodiluted animals (p less than 0.005).(ABSTRACT TRUNCATED AT 400 WORDS)
.A
Tu YK; Heros RC; Karacostas D; Liszczak T; Hyodo A; Candia G; Zervas NT; Lagree K.
.I 90670
.U
88244822
.S
J Neurosurg 8809; 69(1):92-7
.M
Animal; Aorta/DE/PA/PP; Cells, Cultured; Muscle, Smooth, Vascular/*DE/PP/UL; Oxyhemoglobins/*PD; Support, Non-U.S. Gov't; Vasoconstriction/DE.
.T
Experimental vasospasm in cultured arterial smooth-muscle cells. Part 1: Contractile and ultrastructural changes caused by oxyhemoglobin.
.P
JOURNAL ARTICLE.
.W
Smooth-muscle cells were cultured from rat aortic media, then oxyhemoglobin and other agents including serotonin, norepinephrine, and angiotensin II were added separately to the medium. Contractile and ultrastructural changes of the cells were examined with electron microscopy during the first 2 weeks of incubation. Oxyhemoglobin not only produced progressive contraction of the arterial smooth-muscle cells, but it also caused ultrastructural changes that resembled myonecrosis. In contrast, there was no evidence of progressive contraction or ultrastructural changes either in control cultures or in cultures with the other vasoactive agents. Although washout of oxyhemoglobin 3 hours after administration prevented continued contraction of the cells, washout 24 hours or longer after administration had no preventive effect. Judging from these results and from the fact that the culture medium was changed every 2 days, it is unlikely that accumulation of exogenous vasoactive agents caused these changes. The contraction and suggestive myonecrosis of the arterial smooth-muscle cells are probably caused by some intrinsic process initiated by oxyhemoglobin. The culture of cerebral arterial smooth-muscle cells requires further technical improvement; nevertheless, these results obtained with the smooth-muscle cells of rat aortic media indicate that arterial smooth-muscle cells in culture provide a promising new experimental model for chronic in vitro study of cerebral arterial spasm. It is suggested from these results that cerebral arteries are particularly prone to vasospasm because of structural differences as compared to noncerebral arteries.
.A
Fujii S; Fujitsu K.
.I 90671
.U
88244849
.S
J Gen Intern Med 8809; 3(3):218-23
.M
Adaptation, Psychological; Affect; Aged; Attitude to Health/*; Critical Care/*PX; Female; Human; Interviews; Male; Personal Satisfaction; Quality of Life/*; Social Adjustment; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Quality of life following intensive care.
.P
JOURNAL ARTICLE.
.W
Evaluations of intensive care have largely focused on survival, cost, or functional status; however, these may not be the only outcomes of interest to patients, families, and health care providers. Quality of life is an important consideration in evaluating intensive care because it influences decisions about the use of life-sustaining treatment. A study was conducted to assess the quality of life of survivors of intensive care to determine the relationship of perceived quality of life to other outcomes of intensive care. Patients at least 55 years old who received medical intensive care during 1983 (n = 69) were interviewed to determine social characteristics, functional status, psychological well-being, and their perceived quality of life using a new 11-item Perceived Quality of Life scale. Functional status correlated only moderately with perceived quality of life (r = 0.49, p = 0.0001). Objective measures of patients' material and social resources did not predict satisfaction. To evaluate outcome adequately, it is necessary to assess perceptions of life quality from patients who have received life-sustaining treatment.
.A
Patrick DL; Danis M; Southerland LI; Hong G.
.I 90672
.U
88244850
.S
J Gen Intern Med 8809; 3(3):224-9
.M
Attitude to Health/*; Behavior Therapy/*; Coronary Disease/*PC; Female; Health Promotion; Human; Life Style/*; Male; Middle Age; Patient Participation/*; Physician-Patient Relations; Risk Factors; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Patient priorities for behavioral change: selecting from multiple coronary disease risk factors.
.P
JOURNAL ARTICLE.
.W
When a physician advises a patient to modify unhealthy behaviors, the physician may be tempted to prescribe a target for change by selecting the single "risk factor" that poses the greatest threat to health. The present study was conducted to determine how frequently a statistical approach to health risk appraisal would conflict with a patient's priorities for lifestyle change, even when the patient was fully informed of the rationale for the advice. Coronary artery disease (CAD) risk factor assessment was performed using the American Heart Association's RISKO scale, a validated health risk appraisal instrument. Two hundred forty-one patients were seen in an ambulatory clinic that specialized in heart disease prevention. Risk of CAD was estimated based on age, sex, smoking status, blood pressure, body weight, and serum cholesterol. Using RISKO, patients were told which single risk factor posed the greatest threat to health; patients then selected a personal priority for risk factor intervention. The overall rate of agreement between the patients' priorities and RISKO targets was 63%. If weight loss is considered a nonpharmacologic "target" for controlling hypertension, then the agreement rate rises to 70%. Disagreement was observed even though patients were fully informed of the relative importance of all possible risk factor choices. Since risk factor intervention efforts are less successful unless the target of the intervention is negotiated with the patient, these data should be of clinical importance in devising plans for behavioral change interventions by practitioners.
.A
Levenkron JC; Greenland P.
.I 90673
.U
88244851
.S
J Gen Intern Med 8809; 3(3):230-8
.M
Adult; Algorithms/*; Backache/*ET; Clinical Protocols; Female; Human; Male; Neoplasms/*CO/DI; Outpatient Clinics, Hospital; Probability; Statistics; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S..
.T
Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies.
.P
JOURNAL ARTICLE.
.W
Back pain is very common. Rarely, it may be the first manifestation of cancer. Although many advocate selective use of laboratory and x-ray tests for back pain patients, the early detection of cancer may be an important reason to obtain such tests. To develop a diagnostic approach that would identify malignancies while remaining parsimonious, the authors evaluated 1,975 walk-in patients with a chief complaint of back pain. Thirteen patients (0.66%) proved to have underlying cancer. Findings significantly associated with underlying cancer (p less than 0.05)  were: age greater than or equal to 50 years, previous history of cancer, duration of pain greater than 1 month, failure to improve with conservative therapy, elevated erythrocyte sedimentation rate (ESR), and anemia. Combining historical features and ESR results led to an algorithm that would have limited x-ray utilization to just 22% of subjects while recommending an x-ray for every cancer patient. It would further suggest which patients with negative x-ray findings require further work-up.
.A
Deyo RA; Diehl AK.
.I 90674
.U
88244852
.S
J Gen Intern Med 8809; 3(3):239-44
.M
Boston; Coronary Care Units; Costs and Cost Analysis; Electrocardiography; Exercise Test; Female; Hospitals, Teaching/*UT; Human; Length of Stay/*; Male; Middle Age; Monitoring, Physiologic; Myocardial Infarction/*; Patient Discharge/*EC; Patient Transfer; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Lengths of stay of patients with uncomplicated acute myocardial infarction at three Boston hospitals: impact of pre-discharge tactics.
.P
JOURNAL ARTICLE.
.W
Variability in length of stay (LOS) and its determinants were studied in 60 patients without complications after acute myocardial infarction (AMI) at three teaching hospitals. The patients at the three hospitals had similar clinical presentations and in-hospital courses. However, 81% of patients admitted to the intensive care unit (ICU) at one hospital were transferred to lower levels of care within 48 hours, compared with 40% and 56% at the other two hospitals (p less than 0.05). Patients who underwent pre-discharge exercise tests (ETT) had a longer total LOS than patients who did not (11.9 +/- 4.3 vs 9.2 +/- 2.9 days; p less than 0.01). Similarly, patients who underwent 24-hour ambulatory monitoring (AMB-MON) had a longer total LOS than patients who did not (12.3 +/- 4.3 vs 9.1 +/- 2.8 days; p less than 0.001). No differences in clinical characteristics or in survival at six months were detected between patients who did and did not undergo ETT or AMB-MON. Total LOS correlated with whether patients underwent 0, 1, or both of these tests (p less than 0.0001); each test was associated with a 2.3-day increase in the duration of hospitalization. The authors conclude that such tests may prolong total LOS of patients without complications after AMI.
.A
Lee TH; Gottlieb LK; Weitzman LJ; Mulley AG; Pauker SG; McNeil BJ.
.I 90675
.U
88244853
.S
J Gen Intern Med 8809; 3(3):245-9
.M
Aged; Attitude to Health; Comparative Study; Female; Human; Male; Middle Age; Patient Acceptance of Health Care/*; Patients/*PX; Physicians/*PX; Questionnaires; Socioeconomic Factors; Support, Non-U.S. Gov't; Time Factors.
.T
Urgency in seeking medical care for specific symptoms: perceptions of physicians and patients.
.P
JOURNAL ARTICLE.
.W
A patient's appraisal of symptom significance is important to the timeliness with which care is sought. Little is known, however, about the variations in patients' responses to symptoms and the factors determining variations. To assess lay individuals' perception of the importance of symptoms, 75 private and 75 clinic outpatients and 73 inpatients were surveyed on 13 sets of hypothetical symptoms to determine whether they would seek care immediately, call for an appointment, or wait and see. All sets of symptoms were adjudged to be clinically significant by a panel of three physicians. Twenty-one other physicians were surveyed using the same questionnaire. Weighted mean responses of patients and physicians differed on seven symptoms. Physicians recommended more immediate care for symptoms suggestive of impending heart attack and stroke than did patients, and patients indicated that they would seek care earlier than physicians for less serious symptoms. Clinic patients would seek immediate care for symptoms more often than other patient groups. Nonwhites and those with less formal education reported greater urgency in seeking care for six symptoms. The results indicate that patients may not agree with physicians in the way they interpret symptoms of disease and that symptom appraisal may differ depending on patients' sociodemographic characteristics.
.A
Turner BJ; Nido RM.
.I 90676
.U
88244857
.S
J Gen Intern Med 8809; 3(3):267-76
.M
Adult; Case Report; Female; Human; Life Style; Mitral Valve Prolapse/*DI; Physician-Patient Relations; Prognosis; Reference Values; Risk Factors; Syndrome.
.T
The medicalization of normal variants: the case of mitral valve prolapse.
.P
JOURNAL ARTICLE.
.W
Mild mitral valve prolapse, hypoglycemia, irritable colon, and premenstrual syndrome are examples of anatomico-physiologic phenomena that largely overlap with normal. Such "overlap syndromes" become labeled disease entities by the medical community through a process called medicalization. This report uses mitral valve prolapse (MVP) to exemplify the effects of medicalization on patients, physicians, and society. Ascertainment bias and insufficient controlled clinical studies have led to the description of a clinical entity replete with false associations (e.g., mitral valve prolapse syndrome) and overly pessimistic prognostication (e.g., risk of sudden death or endocarditis), leading to clinical overreaction, overtreatment, and unnecessary induction of disability. Though some physical complications may be prevented by recognizing severe MVP, there is substantial risk of iatrogenic harm by attributing complex symptoms and illness behavior to mild MVP, which is probably a normal variant. A three-dimensional analysis of illness experience is presented that may be of use in conceptualizing the clinical approach to overlap syndromes such as mild MVP. Conservative criteria for the diagnosis of significant MVP have been developed at the National Institutes of Health. Treatment of patients with mild MVP must emphasize that it is a normal variant without serious consequences. Because the risks of overmedicalization are so substantial, the impact of diagnostic labels on individual patients and society must be analyzed continually.
.A
Quill TE; Lipkin M Jr; Greenland P.
.I 90677
.U
88244860
.S
J Gen Intern Med 8809; 3(3):294-6
.M
Diagnosis/*; Human; Physician-Patient Relations/*; Telephone/*.
.T
The practice of medicine on the telephone.
.P
JOURNAL ARTICLE.
.A
Curtis P.
.I 90678
.U
88244862
.S
J Gen Intern Med 8809; 3(3):298-9
.M
Clinical Trials/*ST; Epidemiologic Methods/*; Human; Research Design/*ST; Statistics/*.
.T
Epidemiologic methods and methodologic vigilance [editorial]
.P
EDITORIAL.
.A
Horwitz RI; Ransohoff DF.
.I 90679
.U
88244864
.S
J Gen Intern Med 8809; 3(3):302
.M
Human; Probability; Septicemia/*.
.T
The likelihood of bacteremia [letter]
.P
LETTER.
.A
Engel W.
.I 90680
.U
88244865
.S
J Gen Intern Med 8809; 3(3):302-3
.M
Attitude of Health Personnel/*; Euthanasia/*; Euthanasia, Passive/*; Human; Resuscitation/*.
.T
"Do not resuscitate" decisions [letter]
.P
LETTER.
.A
Quill TE.
.I 90681
.U
88244866
.S
J Gen Intern Med 8809; 3(3):303-4
.M
Human; Medical History Taking/*; Physician-Patient Relations/*; Self Disclosure/*.
.T
Information obtained from patients [letter]
.P
LETTER.
.A
Jackson TC; Steele DJ.
.I 90682
.U
88244867
.S
J Gen Intern Med 8809; 3(3):304
.M
Human; Probability/*.
.T
Dynamic pretest probability [letter]
.P
LETTER.
.A
Whalen JP.
.I 90683
.U
88244869
.S
J Gen Intern Med 8809; 3(3):304-5
.M
International System of Units/*; Periodicals/*; Publishing/*; Weights and Measures/*.
.T
Phasing in SI units [letter]
.P
LETTER.
.A
Matz R.
.I 90684
.U
88245137
.S
J Rheumatol 8809; 15(3):387-8
.M
Arthritis, Rheumatoid/PP; Human; Medicine in Art; Physician-Patient Relations; Quality of Life/*.
.T
The quality of life [editorial]
.P
EDITORIAL.
.A
Ehrlich GE.
.I 90685
.U
88245138
.S
J Rheumatol 8809; 15(3):389-90
.M
Anti-Inflammatory Agents/AE; Evaluation Studies/*; Gastrointestinal Diseases/CI/MO; Human; Product Surveillance, Postmarketing/*.
.T
Postmarketing drug surveillance: are our priorities right? [editorial]
.P
EDITORIAL.
.A
Fries JF.
.I 90686
.U
88245140
.S
J Rheumatol 8809; 15(3):395-9
.M
Antigenic Determinants/*GE; Arthritis, Rheumatoid/DT/*IM/PP; Chromosome Mapping; Genetic Code/*; Gold/AE; Human; HLA-D Antigens/*GE; HLA-DR Antigens/*GE; Penicillamine/AE.
.T
Adult rheumatoid arthritis is associated with MC1, a new HLA-D encoded determinant.
.P
JOURNAL ARTICLE.
.W
We evaluated the association of a new HLA-D encoded determinant, MC1, with adult rheumatoid arthritis (RA). This determinant associates with DR1 and DR4 and can be defined by serological typing. We found MC1 in 83% of 80 patients with RA vs 43% of controls. Although the frequencies of DR1 and DR4 were both significantly increased in patients with RA compared with controls, MC1 had the highest relative risk (6.2) of any HLA-DR antigen tested. MC1 negative and positive populations were not significantly different in any of a variety of clinical and laboratory variables including age, sex, disease duration, age at onset, hours of morning stiffness, functional class, joint count, presence of subcutaneous nodules or bony erosions, frequency of side effects to gold or D-penicillamine, sedimentation rate, and antinuclear antibody.
.A
Carpenter AB; Kahl LE; Bartkowiak CD; Duquesnoy RJ; Eisenbeis CH Jr.
.I 90687
.U
88245141
.S
J Rheumatol 8809; 15(3):400-4
.M
Anti-Inflammatory Agents/TU; Arthritis, Rheumatoid/DT/*GE/IM/PP; Comparative Study; Disability Evaluation; Female; Human; Male; Middle Age; Pain; Rheumatoid Factor/AN; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Familial vs sporadic rheumatoid arthritis: a comparison of the demographic and clinical characteristics of 956 patients.
.P
JOURNAL ARTICLE.
.W
We studied the demographic, clinical, and disease severity characteristics of 96 patients with rheumatoid arthritis (RA) from multicase families (familial RA+) and 860 nonfamilial RA cases (familial RA-) seen consecutively in an outpatient rheumatic disease clinic between April, 1976 and August, 1986. Familial RA (+) and (-) cases were similar in essentially all demographic, clinical, and disease severity characteristics. Subgroups of 2nd generation patients with familial RA and sib-sib patients were similar, and neither group differed from the set of familial RA (-) individuals. The failure to find differential severity in these groups indicates that inferences from studies of families with RA may be extrapolated safely to patients with RA at large, but differences between rheumatoid factor positive (RF+) and RF (-) patients suggest that RA (+) and RF (-) patients should be analyzed separately.
.A
Wolfe F; Kleinheksel SM; Khan MA.
.I 90688
.U
88245142
.S
J Rheumatol 8809; 15(3):405-8
.M
Adolescence; Adult; Arthritis, Rheumatoid/*EP; Female; Health Surveys; Hospitals; Human; Male; Medicine, Traditional; Middle Age; Rural Population/*; South Africa.
.T
The prevalence of rheumatoid arthritis in a rural African population.
.P
JOURNAL ARTICLE.
.W
We report the findings of an epidemiological study of the prevalence of rheumatoid arthritis (RA) in a rural population. The study was conducted in Venda, a very remote part of South Africa. Much of the population still follows an age old traditional lifestyle. A detailed hut-to-hut survey of 543 respondents comprising 97% of the population of one village was conducted. This included clinical, serological and radiological studies. This was supplemented by questioning local traditional doctors and showing them photographs of typical hand deformities to ascertain if they knew of any cases with these deformities. The 3 hospitals draining the area were also surveyed. The detailed survey of 543 respondents revealed no cases of definite or probable RA using a modification of the Rome criteria. No cases were recognized by the traditional doctors. The 3 hospitals together had 14 cases of definite RA out of a population of about 520,000. This gave a prevalence of 0.0026%. The marked difference in the prevalence of RA in this population as opposed to other Southern African studies as well as American and European studies is discussed.
.A
Brighton SW; de la Harpe AL; van Staden DJ; Badenhorst JH; Myers OL.
.I 90689
.U
88245145
.S
J Rheumatol 8809; 15(3):427-32
.M
Arthritis/*PX; Helplessness, Learned/*; Human; Middle Age; Psychiatric Status Rating Scales/*; Statistics; Support, U.S. Gov't, P.H.S..
.T
Factor structure of the Arthritis Helplessness Index.
.P
JOURNAL ARTICLE.
.W
The factor structure of the Arthritis Helplessness Index (AHI) was examined using principal components factor analysis with varimax rotation. Data for the initial factor analysis came from a longitudinal study of 368 patients with rheumatoid arthritis (RA). Two slightly negatively correlated (r = -0.21) subscales emerged: internality and helplessness. This analysis was cross-validated twice. Findings reveal that the 2 subscales of the AHI are more reliable and valid than the total score. The 5 item helplessness subscale, in particular, appears to be a highly valid indicator of the degree to which patients with RA feel overwhelmed by their disease.
.A
Stein MJ; Wallston KA; Nicassio PM.
.I 90690
.U
88245146
.S
J Rheumatol 8809; 15(3):433-7
.M
Arthritis, Rheumatoid/*PP/PX; Human; Middle Age; Pain/*; Pain Measurement/MT; Questionnaires; Regression Analysis; Support, U.S. Gov't, P.H.S..
.T
Pain in rheumatoid arthritis: relationship to demographic, medical, and psychological factors.
.P
JOURNAL ARTICLE.
.W
Our purpose was to investigate the relationship among demographic, medical, and psychological factors and self-reported pain in 135 patients with classic or definite rheumatoid arthritis (RA). Patients were examined using the systemic index, articular index, McGill Pain Questionnaire, Symptom Checklist-90-R, and a pain visual analogue scale. Multiple regression analyses found no significant relationships between pain and the medical variables. However, age, income, and selected psychological variables were significantly correlated with pain reports. The greatest pain management challenge occurred in patients who were middle-aged, living on limited incomes, and experiencing major stresses in everyday life. These high risk pain patients were also worry-prone and felt isolated and lacking in social support. Attention to these related psychosocial problems is recommended as an important pain management strategy in RA.
.A
Parker J; Frank R; Beck N; Finan M; Walker S; Hewett JE; Broster C; Smarr K; Smith E; Kay D.
.I 90691
.U
88245149
.S
J Rheumatol 8809; 15(3):454-9
.M
Color/*; Cyanosis/DI/ET; Erythema/ET; Female; Fingers/*; Human; Male; Raynaud's Disease/CO/*DI/PA; Support, U.S. Gov't, P.H.S..
.T
Diagnosis of Raynaud's phenomenon assisted by color charts.
.P
JOURNAL ARTICLE.
.W
A simple questionnaire, combined with color charts consisting of a 12-point color scale and a series of photographs illustrating blanching and cyanosis, has been developed to assist in the diagnosis of Raynaud's phenomenon (RP). The value of the color charts alone was first tested on a group of 48 patients with RP in whom the RP attacks were witnessed by the investigators (gold standard) and on a group of 246 RP negative subjects; the results showed a sensitivity of 90% and a specificity of 100%. A short RP diagnostic test was then devised by combining the questionnaire and color chart responses, which increased the sensitivity to 100% in our gold standard group of RP positive subjects. Further evaluation of this RP diagnostic test on a sample of 325 subjects whose RP status was unknown demonstrated that the majority could be classified as clearly RP positive or negative with only 4 subjects in the intermediate category.
.A
Maricq HR; Weinrich MC.
.I 90692
.U
88245151
.S
J Rheumatol 8809; 15(3):468-74
.M
Antigens/AN; Cell Movement; Cytotoxicity, Immunologic; Endothelium, Vascular/CY/*IM/ME/PH; Factor VII/AN/IM; Fibronectins/AI/BI; Human; Molecular Weight; Scleroderma, Systemic/*BL; Support, Non-U.S. Gov't.
.T
Pathophysiological effects of endothelial cytotoxic activity derived from sera of patients with progressive systemic sclerosis.
.P
JOURNAL ARTICLE.
.W
Endothelial cytotoxic activity prepared from sera of patients with progressive systemic sclerosis (PSS) causes changes in endothelial cell physiology in vitro and in vivo. In the presence of endothelial cytotoxic activity human endothelial cell migration and fibronectin production in vitro were strongly reduced. Repeated intravenous injection of 1 ml partially purified endothelial cytotoxic activity IV once a week into rabbits caused a significant increase of serum FVIIIR: Ag, changes in endothelial cells morphology, and generalized dilatation of capillaries. Taken together, these results support the hypothesis that endothelial cytotoxic activity is a slow acting material which may initiate the obliterative vasculopathy in PSS by chronic damage of endothelial cells.
.A
Drenk F; Deicher HR.
.I 90693
.U
88245152
.S
J Rheumatol 8809; 15(3):475-8
.M
Animal; Coxsackie B Viruses; Coxsackievirus Infections/*; Disease Susceptibility; Lymphocytes/*PH; Mice; Mice, Inbred Strains; Muscles/PA/PP; Myositis/*ET/PA/PP; Necrosis; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Thymectomy.
.T
T cells are required for coxsackievirus B1 induced murine polymyositis.
.P
JOURNAL ARTICLE.
.W
Murine polymyositis (PM) induced by coxsackievirus B1 (CVB1) has been used as a model of human PM. Our study was undertaken to investigate the role of T cells in CVB1 induced PM by examining disease development in neonatally thymectomized mice. Clinical weakness and histological inflammatory myositis occurred in 42.7% of sham operated animals but only 7.7% of thymectomized mice. These experiments demonstrate the importance of T cells in the pathogenesis of this virus induced autoimmune disorder.
.A
Ytterberg SR; Mahowald ML; Messner RP.
.I 90694
.U
88245153
.S
J Rheumatol 8809; 15(3):479-82
.M
Aged; Antibodies, Viral/AN; Blood Sedimentation; Chronic Disease; Epstein-Barr Virus/IM; Fatigue/CO; Headache/CO; Human; Infectious Mononucleosis/BL/*CO/IM/PP; Muscles/PP; Pain; Polymyalgia Rheumatica/BL/*CO/IM/PP; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Syndrome.
.T
"Chronic Epstein-Barr virus infection" syndrome and polymyalgia rheumatica [see comments]
.P
JOURNAL ARTICLE.
.W
Twenty-three patients with polymyalgia rheumatica (PMR) followed in an academic rheumatology practice frequently reported symptoms commonly found in the recently described "chronic fatigue syndrome" or "chronic Epstein-Barr infection syndrome." These symptoms persisted for months after treatment had reduced the severity of the myalgias and lowered the sedimentation rate: periodically disabling fatigue (33%), recurrent pharyngitis (30%), sleep disorder (65%) and arthralgias (70%). However, antibody titers to Epstein-Barr virus in the patients with PMR were not significantly different from those in age and sex matched control subjects.
.A
Buchwald D; Sullivan JL; Leddy S; Komaroff AL.
.I 90695
.U
88245154
.S
J Rheumatol 8809; 15(3):483-5
.M
Animal; Antibodies/*AN; Antigens/IM; Arthritis/*IM/PA; Collagen/*IM; Female; Male; Rabbits; Serum Albumin/IM.
.T
Antibodies to collagen in experimental antigen induced arthritis of the rabbit.
.P
JOURNAL ARTICLE.
.W
Fifteen rabbits with antigen (bovine serum albumin) induced arthritis had antibodies to collagens type I, II and III detected weekly by passive hemagglutination. Antitype I collagen antibodies were detected in 80% of the animals in the 3rd week of arthritis; antitypes II and III were found less frequently. No anticollagen antibody was detected after the 6th week of arthritis. Although the appearance of these antibodies was clearly related to the induction of arthritis, results indicate that humoral immunity to collagen is unable to initiate or contribute to the perpetuation of synovitis in this experimental model. Antibodies to collagen are probably an epiphenomenon of articular damage in the antigen induced arthritis of the rabbit.
.A
de Brum-Fernandes AJ; Lazzari AA; de Oliveira RM; Bueno C.
.I 90696
.U
88245155
.S
J Rheumatol 8809; 15(3):486-91
.M
Animal; Anti-Inflammatory Agents, Non-Steroidal/*PD; Bone and Bones/*ME; Bone Resorption/*DE; Calcium/ME; Comparative Study; Dose-Response Relationship, Drug; Organ Culture; Prostaglandins/*BI; Skull/DE/ME; Support, Non-U.S. Gov't; Thrombin/PD.
.T
Comparison of the inhibitory effect of nonsteroidal antiinflammatory drugs on bone prostaglandin synthesis and resorption.
.P
JOURNAL ARTICLE.
.W
The biopotency of various nonsteroidal antiinflammatory drugs (NSAID) in inhibiting prostaglandin (PG) mediated bone resorption was evaluated in a neonatal mouse calvaria organ culture system. Thrombin stimulated formation of the osteolytic PG, PGE2 and PGI2 (measured as 6-keto-PGF1 alpha) and the concomitant stimulation of calcium release from cultured bone were inhibited by diclofenac much greater than indomethacin much greater than flurbiprofen greater than piroxicam greater than acemetacin much greater than acetylsalicylic acid. The relative potencies of the NSAID on PG synthesis in bone differs from that observed previously in other model systems.
.A
Klaushofer K; Hoffmann O; Czerwenka E; Leis HJ; Gleispach H; Koller K; Peterlik M.
.I 90697
.U
88245156
.S
J Rheumatol 8809; 15(3):492-4
.M
Analysis of Variance; Arthritis, Rheumatoid/*PP; Human; Joints/*PP; Pain Measurement/*MT; Support, Non-U.S. Gov't.
.T
An experiment in reducing interobserver variability of the examination for joint tenderness.
.P
JOURNAL ARTICLE.
.W
This experiment was designed to test the feasibility of reducing interobserver variability of the joint examination by agreement on a standard examination. Six rheumatologists independently examined 6 patients with rheumatoid arthritis (RA) in predetermined order, before and after a standardization of examination techniques. Results of an analysis of variance showed a reduction of the percent of variability due to observers from 13.8%, before standardization, to 3.2% after standardization, and an improvement in the percent variability related to patient differences from 70.7%, before standardization, to 86.3% after standardization. Such a reduction in observer variability has a potential for allowing a reduction in sample sizes required for RA clinical trials.
.A
Klinkhoff AV; Bellamy N; Bombardier C; Carette S; Chalmers A; Esdaile JM; Goldsmith C; Tugwell P; Smythe HA; Buchanan WW.
.I 90698
.U
88245160
.S
J Rheumatol 8809; 15(3):510-2
.M
Adult; Biopsy; Bone Diseases/PA/*RA; Case Report; Human; Male; Periosteum/RA; Sarcoidosis/PA/*RA; Tomography, X-Ray Computed.
.T
Aggressive lesion in osseous sarcoidosis.
.P
JOURNAL ARTICLE.
.W
We describe an unusual aggressive lytic bone lesion with "sunburst/hair-on-end" periosteal reaction in a patient with surgically proven osseous sarcoid and review the pertinent literature.
.A
Lesser RS; Dadparvar S; Weiss AA; Silverstein GS; DeHoratius RJ.
.I 90699
.U
88245162
.S
J Rheumatol 8809; 15(3):515-6
.M
Case Report; Child; Female; Homozygote; Human; HLA Antigens/AN/CL/GE; Lupus Erythematosus, Systemic/*CO/GE/IM; Mucocutaneous Lymph Node Syndrome/*CO/DT/GE/IM; Prednisone/TU.
.T
Occurrence of Kawasaki disease and systemic lupus erythematosus in a single patient.
.P
JOURNAL ARTICLE.
.W
A 5-year-old girl who developed systemic lupus erythematosus 3 1/2 years after having had Kawasaki disease was found to be homozygous at both class I and class II MHC loci. This homozygosity suggests that she may also be homozygous for an MHC or non-MHC linked gene that could allow for the appearance of 2 diseases with similar immunoregulatory abnormalities, as occurs in the MRL/1pr/1pr mouse model. Although this is the first report of the occurrence of a second immunologic disorder in a patient with a history of Kawasaki disease, North American children who developed Kawasaki disease early in life are only now reaching the age when other inflammatory disorders become relatively common. Therefore, this group of children will have to be closely observed for the development of other inflammatory disorders.
.A
Laxer RM; Cameron BJ; Silverman ED.
.I 90700
.U
88245165
.S
J Rheumatol 8809; 15(3):523-4
.M
Adult; Apnea/*ET; Autoantibodies/*AN; Brain Diseases/*ET; Cardiolipins/*IM; Case Report; Female; Human; Immunoglobulins/*AN; Lupus Erythematosus, Systemic/*CO/IM; Support, Non-U.S. Gov't.
.T
Cerebral systemic lupus erythematosus with apnea in a patient with cardiolipin antibodies and oligoclonal bands.
.P
JOURNAL ARTICLE.
.W
We describe a patient with cerebral systemic lupus erythematosus (SLE) who had 2 episodes of prolonged apnea in addition to other manifestations of brainstem dysfunction. Oligoclonal bands, uncommonly found in SLE, were detected in the cerebrospinal fluid. Also present in our patient were anticardiolipin antibodies which have often been reported to be associated with neurological events in patients with SLE. With mechanical ventilation and high dose corticosteroid therapy, she recovered with only minimal neurological deficit. Our case stresses the potential reversibility of life threatening cerebral SLE.
.A
Herkes GK; Cohen MG; Podgorski M; Webb J.
.I 90701
.U
88245166
.S
J Rheumatol 8809; 15(3):525-6
.M
Adult; Aneurysm, Dissecting/*CO; Aortic Aneurysm/*CO; Case Report; Female; Human; Lupus Erythematosus, Systemic/*CO.
.T
Dissecting aortic aneurysm in a patient with SLE [letter]
.P
LETTER.
.A
Pazirandeh M; Ziran BH.
.I 90702
.U
88245168
.S
J Rheumatol 8809; 15(3):528-9
.M
Adult; Autonomic Nervous System Diseases/*CI; Case Report; Fasciculation/*CI; Gold/*AE; Human; Male; Middle Age.
.T
Gold neurotoxicity and myokymia [letter]
.P
LETTER.
.A
Caldron PH; Wilbourn AJ.
.I 90703
.U
88245169
.S
J Rheumatol 8809; 15(3):529
.M
Auranofin/*AD; Diarrhea/*CI; Human.
.T
Auranofin dosage and diarrhea [letter]
.P
LETTER.
.A
Bobrove AM; Kaye RL; Britton MC.
.I 90704
.U
88245170
.S
J Rheumatol 8809; 15(3):529-30
.M
Case Report; Dreams/PH; Female; Human; Middle Age; Salicylazosulfapyridine/*AE; Sleep Disorders/CI.
.T
Adverse reaction to sulfasalazine [letter]
.P
LETTER.
.A
Skeith KJ; Russell AS.
.I 90705
.U
88245171
.S
J Rheumatol 8809; 15(3):530
.M
Antioxidants; Arthritis, Rheumatoid/*DT; Human; Hypochlorous Acids/*AI; Tetracyclines/*TU.
.T
Tetracyclines as antioxidants in rheumatoid arthritis: scavenging of hypochlorous acid [letter]
.P
LETTER.
.A
Halliwell B; Wasil M.
.I 90706
.U
88245172
.S
J Rheumatol 8809; 15(3):530-2
.M
Adolescence; Adult; Case Report; Female; Human; Male; Osteomyelitis/*ET; Sports/*; Staphylococcal Infections/*.
.T
Osteomyelitis pubis in athletes [letter]
.P
LETTER.
.A
Lopez-Guerra N; Garcia-Monco JC; Alvarez Lario B; Napal Lecumberri J.
.I 90707
.U
88245173
.S
J Rheumatol 8809; 15(3):532-3
.M
Adolescence; Arthritis, Infectious/*DI; Case Report; Diagnosis, Differential; Female; Human; Lupus Erythematosus, Systemic/*DI; Meningitis, Meningococcal/*.
.T
Neisseria meningitis monoarthritis revealing systemic lupus erythematosus [letter]
.P
LETTER.
.A
Carratala J; Moreno R; Cabellos C; Miquel Nolla J; Pac V; Moga I.
.I 90708
.U
88245397
.S
J Urol 8809; 140(1):101-3
.M
Adult; Aged; Aged, 80 and over; Bladder/SU; Colon/*IN; Female; Human; Iatrogenic Disease/*; Male; Middle Age; Nephrectomy/*AE; Nephrostomy, Percutaneous/*AE; Prostatectomy/*AE; Rectum/*IN; Urinary Catheterization/*AE.
.T
Iatrogenic colon and rectal injuries associated with urological intervention: report of 14 patients.
.P
JOURNAL ARTICLE.
.W
Iatrogenic large bowel injuries are a potential complication of many urological procedures. During the last 6 years we have cared for 14 patients with iatrogenic injuries involving either the colon or rectum. The injuries occurred as a complication of radical prostatectomy, percutaneous stone removal, nephrectomy, urethral catheter placement, percutaneous suprapubic catheter placement and penectomy with associated cystoprostatectomy. One patient died of these complications, while in most instances hospitalization was prolonged and additional operative intervention often was required.
.A
Morse RM; Spirnak JP; Resnick MI.
.I 90709
.U
88245398
.S
J Urol 8809; 140(1):104
.M
Human; Ureteral Calculi; Urine/*.
.T
The ideal urinary strainer.
.P
JOURNAL ARTICLE.
.A
Fagelman M.
.I 90710
.U
88245399
.S
J Urol 8809; 140(1):105-10
.M
Adult; Bladder/IR; Bladder, Neurogenic/*PP; Electromyography; Evoked Potentials; Female; Human; Male; Manometry; Reflex, Abnormal/*PP; Spinal Cord Injuries/PP; Support, Non-U.S. Gov't; Time Factors; Urethra/IR; Urination; Urodynamics.
.T
External sphincter dyssynergia: an abnormal continence reflex.
.P
JOURNAL ARTICLE.
.W
Some of the characteristics of detrusor-external sphincter dyssynergia were examined in 14 patients with traumatic upper motor neuron lesions within 44 weeks of injury. The sacral evoked response latencies of the male patients were shortened at any time after injury. A continence reflex could be demonstrated in most patients at any time after injury. Comparing averaged values for the group at 4-week intervals, resting pressure at the external urethral sphincter and post-void residual volumes reached nadirs at 12 weeks while voiding efficiency peaked at this time. Thus, voiding function appears to be optimal 12 weeks after injury. During reflex detrusor activity, increases in external urethral sphincter electromyographic activity and external urethral sphincter pressure were associated clearly with a positive slope of the intravesical pressure trace, whereas decreases in both parameters were associated with a negative slope. Voiding occurred only during a negative slope. Although propantheline induced detrusor areflexia, episodic peaks in external urethral sphincter pressure and electromyographic activity continued to occur. We propose that external sphincter dyssynergia, which is independent of detrusor contraction, is the continence reflex exaggerated owing to the loss of supraspinal influences. We believe that the multiple patterns of dyssynergia described previously by others are variations, largely owing to technique, of the single pattern we have observed. The observation of synergic-like urethral responses in some patients during a negative slope of the intravesical pressure, even with complete suprasacral spinal lesions, implies existence of a pathway for synergic-like voiding in the spinal cord.
.A
Rudy DC; Awad SA; Downie JW.
.I 90711
.U
88245400
.S
J Urol 8809; 140(1):11-5
.M
Adenoma/BL/*ET; Adrenal Cortex Hormones/*BL; Adrenal Gland Neoplasms/BL/*CO; Androstenedione/BL; Carcinoma/BL/*CO; Cortodoxone/BL; Cushing's Syndrome/BL/*ET; Dehydroepiandrosterone/BL; Female; Human; Hydrocortisone/BL; Hydroxyprogesterones/BL; Male; Progesterone/*BL; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Testosterone/BL.
.T
Steroid content of the peripheral and adrenal vein in Cushing's syndrome due to adrenocortical adenoma and carcinoma.
.P
JOURNAL ARTICLE.
.W
Selective adrenal vein catheterization was done preoperatively in 11 patients with Cushing's syndrome owing to either an adrenal adenoma (6) or an adrenal carcinoma (5). Peripheral and adrenal venous blood (tumor side) was analyzed for progesterone, 17-hydroxyprogesterone, testosterone, delta-4-androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate, cortisol and 11-deoxycortisol. Comparisons were made of the ratios of precursors to products in the androgen and cortisol production pathways. In adrenal vein samples, cortisol levels were higher in the adenoma patients (p equals 0.06). These patients had a higher ratio of 17-hydroxyprogesterone to delta-4-androstenedione (p less than 0.04). The ratio of 11-deoxycortisol to cortisol was higher in the carcinoma patients (p less than 0.02). In the peripheral samples, the carcinoma patients had higher levels of testosterone and 11-deoxycortisol (p less than 0.02) and progesterone (p equals 0.05). The most striking differences were in the peripheral levels of 17-hydroxyprogesterone, delta-4-androstenedione and dehydroepiandrosterone, which were 10 to 20 times higher in the carcinoma group (p less than 0.005). The ratios of progesterone to 17-hydroxyprogesterone and 17-hydroxyprogesterone to 11-deoxycortisol were higher in the adenoma group (p less than 0.005 and p equals 0.06, respectively). The peripheral blood ratio of 11-deoxycortisol to cortisol was higher in the carcinoma group (p less than 0.03). These data indicate that peripheral and adrenal venous steroid levels and ratios of precursors to products are significantly different in the 2 groups. The carcinomas have a block in the conversion of 11-deoxycortisol to cortisol with a subsequent accumulation in androgen and cortisol precursors. The elevations in 17-hydroxyprogesterone, delta-4-androstenedione and dehydroepiandrosterone, and in the ratio of 11-deoxycortisol to cortisol in the carcinoma group are most striking in the periphery. Peripheral blood steroid measurement in patients with Cushing's syndrome and an adrenal mass aids in the preoperative differentiation of carcinoma from adenoma.
.A
Levine AC; Mitty HA; Gabrilove JL.
.I 90712
.U
88245401
.S
J Urol 8809; 140(1):111-6
.M
Administration, Intravesical; Adult; Aged; Alcohol, Ethyl/*AD/TU; Bladder/*PP; Case Report; Female; Follow-Up Studies; Human; Middle Age; Urinary Incontinence, Stress/PP/*TH; Urodynamics.
.T
Extravesical subtrigonal injection of 50 per cent ethanol for detrusor instability.
.P
JOURNAL ARTICLE.
.W
Urinary incontinence with detrusor instability often is refractory to pharmacological therapy as well as other conservative modalities. We report the results obtained from 10 patients with detrusor incontinence who underwent extravesical subtrigonal injection of 50 per cent ethanol. Postoperatively, 9 of the 10 patients had conversion to detrusor stability and 6 had an acontractile bladder. Of the 10 patients 9 had an excellent result for at least 10 months postoperatively with 1 patient requiring 2 additional treatments to convert to detrusor stability. Complications included fistula formation in 3 patients, requiring primary closure in 2 and ileal diversion in 1. Of the 10 patients 7 remain dry or vastly improved at a mean of 24 months of followup.
.A
Harris RG; Constantinou CE; Stamey TA.
.I 90713
.U
88245402
.S
J Urol 8809; 140(1):117-8
.M
Aged; Bladder/*PP; Human; Male; Middle Age; Parkinson Disease/*PP; Prostatectomy/*AE; Prostatic Hypertrophy/SU; Retrospective Studies; Risk Factors; Urethra/*PP; Urinary Incontinence/*ET/PP; Urination; Urodynamics.
.T
Post-prostatectomy continence in the parkinsonian patient: the significance of poor voluntary sphincter control.
.P
JOURNAL ARTICLE.
.W
A retrospective urodynamic study of 50 parkinsonian patients was done to determine the incidence and causes of post-prostatectomy incontinence. At presentation 22 per cent of the patients were incontinent. In 36 patients who underwent transurethral prostatectomy the incontinence rate was 17 per cent preoperatively and 28 per cent postoperatively. There was a clear association between normal voluntary sphincter control and urinary continence. After transurethral prostatectomy 5 of 6 patients continent preoperatively (83 per cent) who had abnormal sphincter control became incontinent compared to 1 of 24 (4.2 per cent) who had normal sphincter control. We conclude that the major risk of incontinence following prostatectomy in the parkinsonian patient is associated with lack of voluntary sphincter control.
.A
Staskin DS; Vardi Y; Siroky MB.
.I 90714
.U
88245403
.S
J Urol 8809; 140(1):119-20
.M
Child; Comparative Study; Female; Human; Male; Urination Disorders/*GE; Urodynamics; Vesico-Ureteral Reflux/*GE.
.T
The relationship of sibling reflux to index patient dysfunctional voiding.
.P
JOURNAL ARTICLE.
.W
The rate of sibling reflux in index patients with and without dysfunctional voiding symptoms was compared. Of the siblings of index patients with reflux and dysfunctional voiding 20 per cent demonstrated reflux compared to 38 per cent of siblings of those without symptom of bladder dysfunction. The difference is significant and suggests an interaction of genetic and environmental factors. These factors are discussed. There remains a need to screen siblings of patients with reflux regardless of symptoms of either the index patient or the sibling.
.A
Noe HN.
.I 90715
.U
88245404
.S
J Urol 8809; 140(1):121-4
.M
Anti-Infective Agents, Urinary/TU; Body Height; Body Weight; Female; Follow-Up Studies; Human; Infant; Infant, Newborn; Kidney/PP; Kidney Function Tests; Male; Time Factors; Urinary Tract Infections/PC; Vesico-Ureteral Reflux/PP/*TH.
.T
Medical treatment of vesicoureteral reflux detected in infancy.
.P
JOURNAL ARTICLE.
.W
Between 1970 and 1982, 41 neonates and infants with grades II and III vesicoureteral reflux (international classification) but with no medical or urological complications were treated medically and followed for an average of 7.5 years. In 33 of the 41 patients the vesicoureteral reflux resolved (group 1) and in 8 it persisted (group 2). The severity and frequency of urinary infection decreased to a greater degree in group 1 (p less than 0.0005) than in group 2 (p less than 0.05). There was no difference in endogenous creatinine clearance between the 2 groups. Comparison of kidney length and bipolar parenchymal thickness revealed that bipolar parenchymal thickness was significantly less in group 2 patients (p less than 0.01). Body weight tended to increase in both groups but it was greater in group 1. In both groups height was lower at the time of detection of reflux and it approached nearly normal values during followup. It is tempting to conclude that early recognition of mild forms of vesicoureteral reflux (grades II and III) and systematic medical treatment can preserve renal function and promote renal and somatic growth. However, this tendency is less pronounced in patients with persistent reflux.
.A
Pinter AB; Jaszai V; Dober I.
.I 90716
.U
88245406
.S
J Urol 8809; 140(1):129-30
.M
Carcinoma, Renal Cell/*SU; Human; Kidney Neoplasms/*SU; Nephrectomy/*MT.
.T
Partial nephrectomy for renal cell carcinoma [editorial]
.P
EDITORIAL.
.A
Montie JE; Novick AC.
.I 90717
.U
88245408
.S
J Urol 8809; 140(1):134-6
.M
Adult; Aneurysm/*CO; Angiomatosis/*CO; Case Report; Female; Hemangioma/*CO; Hematuria/ET; Human; Kidney Neoplasms/*CO; Klippel-Trenaunay Disease/*CO; Renal Artery/*.
.T
Renal hemangioma and renal artery aneurysm in the Klippel-Trenaunay syndrome.
.P
JOURNAL ARTICLE.
.W
We describe a young woman with the Klippel-Trenaunay-Weber syndrome in whom gross unilateral hematuria developed. A renal arteriogram showed a left renal artery aneurysm. Artery reconstruction was impossible and left nephrectomy was performed. Pathological examination showed multiple renal pelvic hemangiomas as the cause of the gross hematuria.
.A
Campistol JM; Agusti C; Torras A; Campo E; Abad C; Revert L.
.I 90718
.U
88245409
.S
J Urol 8809; 140(1):137-8
.M
Alcohol, Ethyl/TU; Case Report; Embolization, Therapeutic/*; Hemangiopericytoma/SU/*TH; Human; Kidney Neoplasms/SU/*TH; Male; Middle Age; Nephrectomy; Preoperative Care.
.T
Hemangiopericytoma of the kidney: a case with preoperative ethanol embolization.
.P
JOURNAL ARTICLE.
.W
We report a case of a giant renal hemangiopericytoma that was embolized preoperatively with ethanol. Ultrasound and computerized tomography showed multiple smooth-walled cysts within the tumor. The tumor itself was hypervascular and a vascular pattern specific for hemangiopericytoma was noted upon reinterpretation of the angiograms. The diagnostic and therapeutic aspects are discussed, and the literature is reviewed.
.A
Siniluoto TM; Paivansalo MJ; Hellstrom PA; Leinonen AS; Kyllonen AP.
.I 90719
.U
88245410
.S
J Urol 8809; 140(1):139-42
.M
Adult; Case Report; Choristoma/*RA; Epididymis/*; Human; Male; Testicular Neoplasms/*RA; Ureter/*/AB.
.T
Ureteral duplication with lower pole ectopia to the epididymis.
.P
JOURNAL ARTICLE.
.W
We report a unique case of a duplex ureter with ureteral ectopia. A 30-year-old man presented with a coliform infection of the epididymis and excretory urography revealed, in addition to a normal-appearing right renal collecting system, a second right ureter that arose from an inferior calix, penetrated the lower pole parenchyma and drained directly into the ipsilateral epididymis. The radiological evaluation and surgical management are discussed, and several embryological explanations for this anomaly are offered.
.A
Brown DM; Peterson NR; Schultz RE.
.I 90720
.U
88245411
.S
J Urol 8809; 140(1):143-4
.M
Adult; Bladder Neoplasms/*CO/RA; Case Report; Female; Human; Leiomyoma/*CO/RA; Ureteral Obstruction/*ET; Urethral Obstruction/*ET; Urography.
.T
Leiomyoma of the bladder causing urethral and unilateral ureteral obstruction: a case report.
.P
JOURNAL ARTICLE.
.W
We report a case of a vesical leiomyoma that obstructed not only the ureter but also the urethra. This entity is rare and to our knowledge it has not been described previously in the urological or gynecological literature.
.A
Bazeed MA; Aboulenien H.
.I 90721
.U
88245412
.S
J Urol 8809; 140(1):145-6
.M
Adult; Carcinoma, Squamous Cell/SU; Case Report; Human; Male; Middle Age; Penile Neoplasms/*SU; Penis/IN/*SU; Surgical Flaps/*.
.T
Preservation of penile length in penile cancer and trauma by use of a pedicled flap.
.P
JOURNAL ARTICLE.
.W
A surgical technique is described for the treatment of carcinoma and injury involving the distal penile shaft in which a standard partial penectomy would leave inadequate penile length for satisfactory voiding. As an alternative to standard total penectomy with perineal urethrostomy that is used in this situation, partial penectomy is performed and a flap of suprapubic and scrotal skin is rolled into a new proximal penile shaft covering. This technique offers the patient the advantage of voiding in the standing position with a penile stump, and the possibility for sexual satisfaction and less physical disfigurement.
.A
Benderev TV.
.I 90722
.U
88245413
.S
J Urol 8809; 140(1):147-8
.M
Case Report; Diagnosis, Differential; Human; Male; Middle Age; Orchiectomy; Orchitis/*PS/SU; Schistosomiasis/*DI; Testicular Neoplasms/*DI.
.T
Schistosomal orchitis simulating malignancy.
.P
JOURNAL ARTICLE.
.W
We report a case of schistosomal orchitis simulating malignancy. The patient presented with a unilateral hydrocele, testicular enlargement and loss of testicular sensation. Orchiectomy was performed because of suspected malignancy. Tissue diagnosis was schistosomiasis. The incidence, pathogenesis and pathology of genital schistosomiasis are discussed, and the literature is reviewed.
.A
Mikhail NE; Tawfic MI; Hadi AA; Akl M.
.I 90723
.U
88245414
.S
J Urol 8809; 140(1):149-50
.M
Adult; Antineoplastic Agents, Combined/TU; Case Report; Human; Male; Neoplasm Circulating Cells/*; Support, Non-U.S. Gov't; Teratoma/DT/*SC; Testicular Neoplasms/*/DT; Vena Cava, Inferior/*.
.T
Metastatic testicular teratoma invading the inferior vena cava.
.P
JOURNAL ARTICLE.
.W
We report a case of a teratoma thrombus within the inferior vena cava subsequent to chemotherapy for embryonal carcinoma of the testis. A review of the literature indicates that intracaval metastases occur in approximately 1 per cent of the patients with bulky retroperitoneal disease. Seminoma and embryonal carcinoma have been identified previously within the inferior vena cava, and teratoma is now added to that list. The potential lethality of teratoma owing to local growth alone is underscored by its intracaval presence in this case. We recommend close inspection of the inferior vena cava at operation for bulky disease to exclude an intracaval thrombus, as well as complete excision of all residual masses following chemotherapy for testis cancer.
.A
Morgentaler A; Garnick MB; Richie JP.
.I 90724
.U
88245415
.S
J Urol 8809; 140(1):151-2
.M
Adult; Case Report; Genital Neoplasms, Male/SU; Histiocytoma/*/SU; Human; Inguinal Canal; Lymphatic Metastasis; Male; Scrotum/*.
.T
Malignant fibrous histiocytoma of the scrotal wall: a case report.
.P
JOURNAL ARTICLE.
.W
We report a rare case of malignant fibrous histiocytoma arising from the scrotal wall. Wide excision of the tumor was followed 9 months later by metastasis to the ipsilateral superficial inguinal nodes. The patient remained well without evidence of disease 15 months after ipsilateral ilioinguinal node dissection.
.A
Watanabe K; Ogawa A; Komatsu H; Yamashita T; Ito N.
.I 90725
.U
88245416
.S
J Urol 8809; 140(1):153-4
.M
Acquired Immunodeficiency Syndrome/*CO; Adult; Case Report; Cystitis/*ET; Cytomegalic Inclusion Disease/*ET; Glomerulosclerosis, Focal/ET; Human; Male; Proteinuria/ET; Urinary Tract Infections/ET.
.T
A report of cytomegalovirus cystitis and a review of other genitourinary manifestations of the acquired immune deficiency syndrome.
.P
JOURNAL ARTICLE.
.W
We report a case of symptomatic cytomegalovirus cystitis associated with the acquired immune deficiency syndrome related complex. The diagnosis of the acquired immune deficiency syndrome was established by bladder biopsy. The hematuria resolved after systemic acyclovir therapy. The other known urological manifestations of the acquired immune deficiency syndrome are discussed.
.A
Benson MC; Kaplan MS; O'Toole K; Romagnoli M.
.I 90726
.U
88245418
.S
J Urol 8809; 140(1):157-9
.M
Adult; Anion Exchange Resins; Bacterial Adhesion/*; Bladder/*MI; Child; Female; Human; Male; Mucins/*PH; Recurrence; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Tissue Extracts; Urinary Tract Infections/*ET.
.T
Defective antiadherence activity of bladder extracts from patients with recurrent urinary tract infection.
.P
JOURNAL ARTICLE.
.W
A substantial body of animal work indicates that the initial first line defense against invading microorganisms in the urinary tract is the antiadherence activity of the surface mucin layer. Previous work has demonstrated that bacterial adherence to anion exchange resin can be used as a model for adherence to the mucin deficient rabbit bladder. This anion exchange resin adherence model can also be used as a rapid screen for potential antiadherence agents. In vitro saline extracts of bladder mucosa from various mammalian species including man have been shown to inhibit bacterial adherence to both anion exchange resin and the mucin deficient rabbit bladder. The present report investigates the ability of in vivo saline bladder washes from several groups of patients to inhibit bacterial adherence to anion exchange resin. This has an advantage over other methods of quantitation or visualization of mucin since it is the ability of the bladder extract to prevent bacterial adherence, and not merely the quantity of mucin, that determines the effectiveness of the mucin lining in preventing bacterial attachment. Bladder washes from patients with recurrent urinary tract infection were significantly less potent at inhibiting bacterial adherence than extracts from other groups of patients. This decreased functional antiadherence activity of bladder extracts may help explain the frequency of urinary tract infection in this group of patients.
.A
Ruggieri MR; Levin RM; Hanno PM; Witkowski BA; Gill HS; Steinhardt GF.
.I 90727
.U
88245419
.S
J Urol 8809; 140(1):16-8
.M
Comparative Study; Hematuria/DI/*ET; Human; Kidney/*IN; Reagent Strips; Urine/CY; Wounds, Nonpenetrating/*UR.
.T
Detection and significance of microscopic hematuria in patients with blunt renal trauma.
.P
JOURNAL ARTICLE.
.W
Detection of hematuria is paramount in establishing injury to the urinary system. In 339 patients with blunt renal trauma in whom radiographic studies defined the severity of injury we compared the degree of microscopic hematuria determined by dipstick and microscopic urinalysis. The overall correlation between the 2 methods was low (Pearson's coefficient 0.41). However, more than 80 per cent of the urine samples with 50 to 100 red blood cells per high power field corresponded to a dipstick result of 3+. The dipstick method had greater than 97.5 per cent sensitivity and specificity for detection of microscopic hematuria. Only 7 of the 339 patients (less than 2 per cent) had a discharge diagnosis of other than renal contusion: 5 had renal artery thrombosis or avulsion of the renal vessels and 2 had minor cortical lacerations that were managed nonoperatively. Although microscopic hematuria may be quantified more accurately by microscopic analysis, it can be detected reliably with a high degree of sensitivity and specificity by dipstick analysis.
.A
Chandhoke PS; McAninch JW.
.I 90728
.U
88245420
.S
J Urol 8809; 140(1):160-4
.M
Aged; Androgens/*ME; Androstenediols/ME; Androstenedione/ME; Human; Male; Middle Age; Negroid Race; Nigeria; Prostate/ME; Prostatic Hypertrophy/EH/*ME; Radioimmunoassay; Stanolone/ME; Testosterone/ME.
.T
Androgen concentration in blacks with benign and malignant prostatic disease.
.P
JOURNAL ARTICLE.
.W
We measured the concentrations of testosterone and its metabolites in serum and prostate glands of Nigerians, a low risk population for prostatic tumours, by means of radioimmunoassay after solvent and chromatographic extractions. Our results show that the values of serum testosterone in normal, elderly Nigerian men (447.0 +/- 112 ng./dl.) and those with benign prostatic hypertrophy (BPH) (430 +/- 112 ng./dl.) were similar (p greater than 0.05) and compare with values reported for Caucasians. In the Nigerian patients with advanced prostatic cancer, the serum testosterone concentrations (314 +/- 202 ng./dl.) were significantly lower (p less than 0.001) than those of Nigerians with normal prostate and BPH. This again is similar to reports in Caucasians with metastatic prostatic cancer. The serum concentrations of testosterone metabolites in our patients were the same in normal BPH and cancer subjects. The ratios of testosterone to its metabolites were similar in our normal and BPH subjects but lower in cancer patients. Also the testosterone concentrations in BPH glands of Nigerians (0.5 +/- 0.03 SEM ng./gm.) compared favourably with those reported from the western world. The testosterone concentrations in malignant prostate gland (7.9 +/- .06 SEM ng./gm.) were significantly higher than those in hypertrophic glands. This again agrees with the pattern in Caucasians. The DHT concentrations (4.9 +/- 0.3 SEM ng./gm.) were considerably higher in BPH than in cancerous glands (1.7 +/- 0.2 SEM ng./gm.). This pattern has been documented elsewhere. Because the concentrations and pattern of distribution of androgens in serum and prostate gland of our patients are comparable to published Caucasian and black American values, any difference in incidence rates of BPH and carcinoma of the prostate between whites, Afro-Americans and indigenous Africans may not be related to androgens.
.A
Osegbe DN; Ogunlewe JO.
.I 90729
.U
88245421
.S
J Urol 8809; 140(1):165-7
.M
Adrenergic Alpha Receptor Blockaders/*PD; Animal; Bladder/*IR; Dogs; Electric Stimulation; Hypogastric Plexus/*PH; Male; Phenoxybenzamine/PD; Phentolamine/PD; Prazosin/PD; Pressure; Receptors, Adrenergic, Alpha/PH; Thymoxamine/PD; Urethra/DE/*IR; Urination Disorders/PP; Yohimbine/PD.
.T
Effects of five alpha-blockers on the hypogastric nerve stimulation of the canine lower urinary tract.
.P
JOURNAL ARTICLE.
.W
Electrical stimulation of the hypogastric nerve increased both urethral and bladder pressures of anaesthetized male dogs, without affecting cardiovascular parameters. Intravenous injections of prazosin, phentolamine, thymoxamine, phenoxybenzamine and yohimbine inhibited the urethral pressure increase in a dose-dependent manner, but the increase in bladder pressure was not modified by these alpha-blockers.
.A
Poirier M; Riffaud JP; Lacolle JY; Dupont C.
.I 90730
.U
88245422
.S
J Urol 8809; 140(1):168-72
.M
Animal; Bladder/*ME/PP; Female; Rats; Rats, Inbred Strains; Substance P/*ME; Urethra/PP; Urethral Obstruction/*ME/PP; Vasoactive Intestinal Peptide/*ME.
.T
Contents and effects of substance P and vasoactive intestinal polypeptide in the bladder of rats with and without infravesical outflow obstruction.
.P
JOURNAL ARTICLE.
.W
The concentrations of substance P and vasoactive intestinal polypeptide (VIP) were determined in the upper, middle, and lower part of the bladder of rats with and without infravesical outflow obstruction. In the obstructed animals there was a significant increase in bladder weight and the total amounts of substance P and VIP were increased. However, the concentrations of substance P were significantly lower than in the control bladders. The concentrations of VIP, on the other hand, were significantly higher in the middle and lower parts of obstructed bladders than in the controls. In isolated strips of the normal and obstructed bladders VIP had neither contractile nor relaxant effects. The peptide had no effect on electrically induced contractions. Substance P produced concentration-dependent contractions in both normal and obstructed bladders. However, obstructed bladders were significantly less sensitive than controls. It is concluded that the bladder instability seen in rats with infravesical outflow obstruction cannot be explained only in terms of changes in the bladder content of substance P or VIP.
.A
Andersson PO; Andersson KE; Fahrenkrug J; Mattiasson A; Sjogren C; Uvelius B.
.I 90731
.U
88245423
.S
J Urol 8809; 140(1):173-5
.M
Adenocarcinoma/*PA; Animal; Biopsy, Needle; Electrophoresis; Male; Membrane Potentials; Neoplasm Metastasis; Prostate/*PA; Prostatic Neoplasms/*PA; Rats; Support, U.S. Gov't, P.H.S.; Surface Properties.
.T
Cell surface charge in predicting metastatic potential of aspirated cells from the Dunning rat prostatic adenocarcinoma model.
.P
JOURNAL ARTICLE.
.W
The transplantable Dunning R-3327 rat prostatic adenocarcinoma model has provided a series of tumor variants with broad ranges of metastatic potential. We tested whether cell surface charge might be related to metastatic potential by measuring the electrophoretic mobility of live tumor cells obtained by needle aspiration. Cells were aspirated from tumors with low metastatic potential (following subcutaneous inoculation of 10(6) tumor cells the H, G and AT-1 variants had less than 5% metastases; AT-2 had 5-20%) and were compared to the electrophoretic mobility of cells aspirated from highly metastatic tumors (MAT-LyLu, MAT-Lu, AT-3 had greater than 90% metastases). Electrophoretic mobility expressed in mu/sec/volt/cm. was measured on 100 cells from each tumor subline, and the cell surface charge expressed as a zeta potential was calculated from electrophoretic mobility using the Helmholtz-Smoluchowski equation. The average zeta potential (+/- S.E.M.) for the four sublines with low metastatic potential was (-17.4 +/- 0.4 mV) compared to the three sublines with high metastatic potential (-26.5 +/- 0.7 mV), and the differences were significant (p less than .01) using the Mann-Whitney Wilcoxon test. Using a zeta potential of -20.5 mV as the cutoff between high and low metastatic potential, the sensitivity and specificity of zeta potential in predicting metastatic potential in 140 determinations on seven tumor lines were 92% and 82.5%, respectively. The predictive value of a positive test (value greater than -20.5 mV) was 80% and the predictive value of a negative test (value less than -20.5 mV) was 93%. The results support a difference in the cell surface charge between these metastatic and nonmetastatic tumors with increasing negativity at the cell surface correlating with increased metastatic potential, but not with tumor growth rates.
.A
Carter HB; Coffey DS.
.I 90732
.U
88245424
.S
J Urol 8809; 140(1):176-82
.M
Adenocarcinoma/AN; Aged; Electrophoresis, Polyacrylamide Gel; Glycoproteins/*AN; Human; Male; Middle Age; Phospholipases/*AI; Phospholipases A/*AI; Prostate/*AN; Prostatic Hypertrophy/ME; Prostatic Neoplasms/AN; Radioimmunoassay; Uteroglobin/*AN/IP.
.T
Expression of a uteroglobin-like protein in human prostate.
.P
JOURNAL ARTICLE.
.W
Phospholipase A2 (PLA2) is a key enzyme that initiates the arachidonic acid cascade responsible for the synthesis of prostaglandins and leukotrienes, compounds well known for their inflammatory properties. Inhibition of this enzyme may modulate prostaglandin and leukotriene tissue levels. Uteroglobin is a potent PLA2 inhibitor found in rabbit uterus, prostate, seminal vesicle, and tracheobronchial tree. Tissue from ten human patients undergoing prostatectomy was examined for presence of a uteroglobin-like protein. Seven patients underwent transurethral resection and three had an open prostatectomy. Preoperative diagnosis in nine of the 10 patients was benign prostatic hypertrophy. One suspected, poorly differentiated, adenocarcinoma was confirmed and one unsuspected, well differentiated, adenocarcinoma was discovered. Specimens were submitted for Western blot, electron microscopy with immunogold staining, radioimmunoassay, and immunofluorescence. Six patients had evidence of uteroglobin-like protein, three with high levels (greater than or equal to 1000 pg./mg. protein), two with moderate levels (75 to 250 pg.), one with a low level (less than or equal to 75 pg.). Uteroglobin-like protein was present in all three patients who underwent open prostatectomy and in three of the seven patients with transurethral resections. The uteroglobin-like protein level was 2.5 to five times greater in both prostatic utricle specimens. All four assays corroborated these results. Because rabbit uteroglobin coats sperm and masks spermatic antigenicity in the rabbit female genital tract, this report of biochemical and immunological evidence for uteroglobin-like protein in the human prostate may have implications for human male fertility.
.A