.I 274229
.U
91000001
.S
Am J Emerg Med 9101; 8(5):373-8
.M
Abdominal Pain/ET; Adolescence; Adult; Aged; Aged, 80 and over; Appendicitis/CO/*RI/US; Child; Female; Human; Leukocytes/*; Middle Age; Predictive Value of Tests; Support, Non-U.S. Gov't; Technetium Tc 99m Aggregated Albumin/*DU.
.T
Evaluation of women with possible appendicitis using technetium-99m leukocyte scan.
.P
JOURNAL ARTICLE.
.W
The authors evaluated the use of technetium-99m albumin colloid white blood cell (TAC-WBC) scan in women with possible appendicitis. One hundred and nine women underwent 110 TAC-WBC scans. One woman had a second scan on a separate admission and was considered two individual patients in the analysis. Twenty-six women had appendicitis, 10 of whom had a perforated appendix at surgery. The TAC-WBC scan was indeterminate (abnormal but nondiagnostic for appendicitis) in 52 women (47%), nine of whom had appendicitis. Fifty-eight scans were read as positive or negative for appendiceal pathology. There were 16 true positives, 5 false positives, 36 true negatives, and 1 false negative. The predictive value of a positive scan was 76%, and the predictive value of a negative scan was 97%. The TAC-WBC scan was positive in 62% of patients with appendicitis and negative in 43% of the patients without appendicitis resulting in an overall accuracy of 47% in the 109 women. The main value of TAC-WBC scan in women with possible appendicitis is its high negative predictive value and the main problem with the TAC-WBC scan is its high indeterminate rate.
.A
Henneman PL; Marcus CS; Butler JA; Hall TA; Koci TM; Worthen N; Wilson SE.
.I 274230
.U
91000002
.S
Am J Emerg Med 9101; 8(5):379-84
.M
Accidents/SN; Adolescence; Adult; Aged; California; Case Report; Cause of Death/*; Child; Child, Preschool; Coronary Disease/MO; Emergency Service, Hospital/*SN; Female; Heart Diseases/MO; Homicide/SN; Human; Infant; Male; Middle Age; Retrospective Studies; Suicide/SN; Survival Rate.
.T
Cause of death in an emergency department [see comments]
.P
JOURNAL ARTICLE.
.W
A retrospective review was done of 601 consecutive emergency department deaths. Nontrauma causes accounted for 77% of the deaths and this group had an average age of 64 years and a male to female ratio of 1.9:1. Trauma caused 23% of the fatalities and this group had a younger average age of 29 years and a male to female ratio of 4.6:1. The most common causes of nontrauma death were sudden death of uncertain cause (34%), coronary artery disease (34%), cancer (5%), other heart disease (4%), chronic obstructive lung disease (3%), drug overdose (3%), and sudden infant death syndrome (2%). The most common causes of trauma death were motor vehicle accidents (61%) and gunshot wounds (16%). The overall autopsy rate was 40%. Death certificates were often in error.
.A
Cummings P.
.I 274231
.U
91000003
.S
Am J Emerg Med 9101; 8(5):385-7
.M
Case Report; Gangrene/TH; Genital Diseases, Male/PA/TH; Human; Hyperbaric Oxygenation/*; Male; Middle Age; Scrotum/*PA.
.T
Treatment of Fournier's gangrene with adjunctive hyperbaric oxygen therapy.
.P
JOURNAL ARTICLE.
.W
Fournier's gangrene is a devastating infection and often is associated with a high morbidity and mortality. Surgical debridement and antibiotics are the cornerstones of therapy. This case describes the use of hyperbaric oxygen as an adjunct in the treatment of Fournier's gangrene.
.A
Lucca M; Unger HD; Devenny AM.
.I 274232
.U
91000004
.S
Am J Emerg Med 9101; 8(5):388-90
.M
Aged; Case Report; Female; Hernia, Hiatal/*CO/RA; Human; Intestinal Obstruction/*CO/RA; Stomach/*RA.
.T
Intermittent obstruction of an incarcerated hiatal hernia with a total thoracic stomach.
.P
JOURNAL ARTICLE.
.W
A case of intermittent obstruction of a sliding hiatal hernia is presented. The obstruction occurred when the patient's stomach was totally above the diaphragm. The anatomy of sliding hiatal hernias is discussed, as well as the presenting signs and symptoms of obstruction in sliding hiatal hernias.
.A
Bozzuto TM.
.I 274233
.U
91000005
.S
Am J Emerg Med 9101; 8(5):391-3
.M
Aged; Aged, 80 and over; Arrhythmia/*DI/TH; Case Report; Electrocardiography/*MT; Emergency Service, Hospital; Female; Human; Male; Middle Age; Monitoring, Physiologic/MT.
.T
Cases in electrocardiography.
.P
JOURNAL ARTICLE.
.A
Zimmers T; Geninatti M.
.I 274234
.U
91000006
.S
Am J Emerg Med 9101; 8(5):394-442
.M
Adolescence; Adult; Aged; Aged, 80 and over; Case Report; Child; Child, Preschool; Female; Human; Infant; Male; Middle Age; Poison Control Centers/*; Poisoning/*EP/MO; Population Surveillance; Prevalence; Suicide, Attempted/SN; Survival Rate; United States/EP.
.T
1989 annual report of the American Association of Poison Control Centers National Data Collection System.
.P
JOURNAL ARTICLE.
.A
Litovitz TL; Schmitz BF; Bailey KM.
.I 274235
.U
91000007
.S
Am J Emerg Med 9101; 8(5):443-5
.M
Adolescence; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Emergency Service, Hospital/*; Female; Human; Infant; Japan; Male; Middle Age; Reproducibility of Results; Ultrasonography/*MT.
.T
Ultrasonography in Japanese emergency departments.
.P
JOURNAL ARTICLE.
.W
This is a review of 50 consecutive cases where ultrasound was performed in the emergency department of a general hospital demonstrating the efficacy of its usage by "nonspecialists." This study demonstrates that in the Japanese model of emergency care delivery, abdominal ultrasound has been shown to be used in the emergency department with accuracy and safety.
.A
Shapiro RA; Nakamoto M.
.I 274236
.U
91000008
.S
Am J Emerg Med 9101; 8(5):446-62
.M
Wounds and Injuries/*.
.T
Trauma: an annotated bibliography of the recent literature.
.P
BIBLIOGRAPHY; JOURNAL ARTICLE.
.A
McCabe CJ.
.I 274237
.U
91000009
.S
Am J Emerg Med 9101; 8(5):466-7
.M
Administration, Inhalation; Adult; Case Report; Cocaine/*; Human; Male; Pneumothorax/*ET/TH; Substance Abuse/*CO.
.T
Bilateral spontaneous pneumothorax after cocaine inhalation [letter]
.P
LETTER.
.A
Lieberman ME; Shepard H; Reynolds F; Christopher T.
.I 274238
.U
91000010
.S
Am J Emerg Med 9101; 8(5):467-8
.M
Adolescence; Case Report; Ethchlorvynol/*PO; Human; Male; Necrosis/ET; Overdose/PA; Pressure/AE; Skin Diseases, Vesiculobullous/*ET/PA.
.T
Pressure necrosis following ethchlorvynol overdose [letter]
.P
LETTER.
.A
Chamberlain JM; Klein-Schwartz W; Gorman R.
.I 274239
.U
91000011
.S
Am J Emerg Med 9101; 8(5):468-9
.M
Aged; Case Report; Cervical Vertebrae/*IN; Human; Male; Resuscitation/*MT; Wounds, Nonpenetrating/*DI.
.T
Mismanagement of a potential cervical spine injury [letter; comment]
.P
COMMENT; LETTER.
.A
Abarbanell NR.
.I 274240
.U
91000012
.S
Am J Emerg Med 9101; 8(5):469-70
.M
Emergency Service, Hospital/*; Female; Gallbladder Diseases/US; Human; Predictive Value of Tests; Pregnancy; Pregnancy, Ectopic/US; Retrospective Studies; Ultrasonography/*MT.
.T
Emergency department sonography by emergency physicians [letter; comment]
.P
COMMENT; LETTER.
.A
Kellermann AL; Holley J.
.I 274241
.U
91000013
.S
Am J Emerg Med 9101; 8(5):470-1
.M
Amputation/*; Case Report; Compartment Syndromes/*ET/SU; Human; Infant; Infusions, Parenteral/*AE/MT; Ischemia/*ET/SU; Male; Tibia/*BS/SU.
.T
Compartment syndrome with resultant amputation following intraosseous infusion [letter]
.P
LETTER.
.A
Moscati R; Moore GP.
.I 274242
.U
91000014
.S
Am J Emerg Med 9101; 8(5):472-3
.M
Emergencies; Female; Human; Hypertension/*DT; Labetalol/*TU; Male; Middle Age; Pilot Projects; Prospective Studies.
.T
Ineffectiveness of oral labetalol for hypertensive urgency [letter]
.P
LETTER.
.A
Wright SW; Hedges JR; Wright MB; Chudnofsky CR; MacCarthy EP.
.I 274243
.U
91000015
.S
Pediatr Neurol 9101; 6(4):219-28
.M
Age Factors; Amino Acids/*PH; Animal; Brain/*PP; Brain Damage, Chronic/*PP; Cerebral Anoxia/PP; Female; Human; Infant, Newborn; Nerve Regeneration/*PH; Neural Transmission/*PH; Neuronal Plasticity/*PH; Pregnancy; Rats; Receptor, N-Methyl-D-Aspartate/PH; Receptors, Endogenous Substances/*PH; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Excitatory amino acids in the developing brain: ontogeny, plasticity, and excitotoxicity.
.P
JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL.
.W
Besides their role as neurotransmitters, excitatory amino acids (EAAs) in the developing brain are crucially involved in plasticity and excitotoxicity which are modified by their distinct ontogeny. Along with incomplete neuritogenesis and synaptogenesis, presynaptic markers of the EAA system are immature in the developing brain; however, postsynaptic EAA system activities, particularly of the N-methyl-D-aspartate and quisqualate receptors, are transiently enhanced early in life. This transient enhancement is presumably beneficial to the immature brain because physiologic activation of the EAA system plays a critical role in plasticity of early learning and morphogenesis. At the same time, this transient hypersensitivity renders the immature brain vulnerable to pathologic excitation of the EAA system (excitotoxicity) as observed during neonatal hypoxia-ischemia.
.A
Hattori H; Wasterlain CG.
.I 274244
.U
91000016
.S
Pediatr Neurol 9101; 6(4):229-32
.M
Asphyxia Neonatorum/DI; Cerebral Hemorrhage/DI; Cerebral Palsy/DI; Cerebral Ventricles/*PA; Follow-Up Studies; Human; Infant; Infant, Newborn; Leukomalacia, Periventricular/*DI; Magnetic Resonance Imaging/*; Meningitis/DI; Sleep Apnea Syndromes/DI; Tomography, X-Ray Computed.
.T
Periventricular hyperintensity detected by magnetic resonance imaging in infancy.
.P
JOURNAL ARTICLE.
.W
Twenty-one infants younger than 12 months of age were diagnosed as having periventricular hyperintensity (PVH) on T2-weighted magnetic resonance imaging. Ten infants had experienced neonatal asphyxia, 6 intracranial hemorrhage, 2 bacterial meningitis, and 3 apnea. PVH was classified according to its extent. Round foci of PVH surrounding the frontal and occipital horns of the lateral ventricles were observed in 4 infants (PVH pattern I). Continuous PVH was observed in 17 infants (PVH patterns II and III). Fourteen infants with continuous PVH had spastic diplegia or quadriplegia. Developmental delay was demonstrated in 15 infants with continuous PVH. No PVH pattern I infants had cerebral palsy; only 1 such infant had mild developmental delay. Our study suggests that the extent of PVH reflects the severity of brain damage in neonates with cerebral injuries.
.A
Konishi Y; Kuriyama M; Hayakawa K; Konishi K; Yasujima M; Fujii Y; Sudo M.
.I 274245
.U
91000017
.S
Pediatr Neurol 9101; 6(4):233-9
.M
Anencephaly/*PA; Brain/PA; Brain Death/DI/*PA; Human; Infant, Newborn; Neurologic Examination/*; Neurons/PA.
.T
Anencephaly: clinical determination of brain death and neuropathologic studies.
.P
JOURNAL ARTICLE.
.W
Twelve liveborn anencephalic infants were serially examined to determine if they would meet our clinical criteria for whole brain death within a 7-day period: Protocol 1 infants (6) received intensive care including intubation from birth; and Protocol 2 infants (6) received intensive care during the period in which death was imminent. Brain death was determined by absence of brainstem function, including loss of all cranial nerve responses and sustained apnea (PCO2 greater than 60 torr) for 48 hours with confirmation of findings by an outside consulting child neurologist. The initial examinations of these 12 infants revealed spontaneous movements and startle myoclonus (12), suck, root, and gag responses (7), increased tone (8), deep tendon reflexes (9), absent pupillary responses (9), absent oculocephalic and corneal responses (6), absent auditory/Moro responses (7), and nonvisualization of the optic nerve (8). Mild depression of neurologic function occurred during the first several days of life; subsequently, the infants' responses were easier to elicit and more sustained. Only 2 infants met the clinical criteria for brain death. Neuropathologic findings indicated that observed complex motor responses were not based upon cortical activity because no infant had a normally-formed cerebrum. Brainstem neuronal activity may have accounted for these motor responses in some patients but even at this level neurons were scanty or absent. Our findings suggest that, although rare, clinical brain death can be determined in liveborn anencephalic infants; ophthalmologic and otologic developmental abnormalities may confound examination of cranial nerve function; and absence of cortical neurons supports the widely held opinion that these infants do not experience sensation.
.A
Ashwal S; Peabody JL; Schneider S; Tomasi LG; Emery JR; Peckham N.
.I 274246
.U
91000018
.S
Pediatr Neurol 9101; 6(4):240-4
.M
Adrenocorticotropic Hormone/*AD; Child, Preschool; Dose-Response Relationship, Drug; Electroencephalography/DE; Evoked Potentials/DE; Follow-Up Studies; Human; Infant; Spasms, Infantile/*DT.
.T
ACTH therapy in infantile spasms: relationship between dose of ACTH and initial effect or long-term prognosis.
.P
JOURNAL ARTICLE.
.W
The relationship between the dose of ACTH and the initial effect was investigated in 41 children with infantile spasms. More than 0.015 mg (0.6 IU)/kg/day of ACTH was needed for a good initial response of seizures and electroencephalographic abnormalities. The relationship between the dose of ACTH and long-term prognosis was investigated in 29 patients. There was no relationship between the daily or total ACTH dosage, provided the dose was greater than 0.015 mg (0.6 IU)/kg/day, and the outcome of seizures and electroencephalographic abnormalities; however, ACTH 0.04-0.06 mg (1.6-2.4 IU)/kg/day and a total ACTH dose of 1.1-1.5 mg (44-60 IU)/kg resulted in better mental development than smaller doses of ACTH. Side effects of ACTH increased with dosage. Too small or too large a dose of ACTH does not lead to better mental development. The proper dose of ACTH should be used with careful attention to potential side effects.
.A
Ito M; Okuno T; Fujii T; Mutoh K; Oguro K; Shiraishi H; Shirasaka Y; Mikawa H.
.I 274247
.U
91000019
.S
Pediatr Neurol 9101; 6(4):245-50
.M
Cerebral Palsy/DI/*PP; Child, Preschool; Female; Follow-Up Studies; Human; Locomotion/*PH; Male; Motor Skills/*PH; Muscle Spasticity/DI/PP; Muscles/PP; Neurologic Examination/*.
.T
Gross motor patterns in children with cerebral palsy and spastic diplegia.
.P
JOURNAL ARTICLE.
.W
Rolling, sitting, and crawling patterns were motoscopically analyzed in 72 children with cerebral palsy and spastic diplegia; the relation between these patterns and the severity of the locomotive disability was studied. In rolling, trunk rotation and elbow support were difficult for the most severely diplegic children. When sitting, most patients had a between-heel sitting pattern in which the thighs were adducted and the knees were flexed. When crawling, the reciprocal thigh movements were insufficient and accompanied by lateral bending of the trunk in many patients. In the more impaired patients, the thighs supported the weight in flexion and did not move reciprocally. Creeping on the elbows without reciprocal leg movements was demonstrated in the most severely affected children after 2 years of age.
.A
Yokochi K; Hosoe A; Shimabukuro S; Kodama K.
.I 274248
.U
91000021
.S
Pediatr Neurol 9101; 6(4):257-9
.M
Arthrogryposis/DI; Case Report; Child, Preschool; Diagnostic Errors; Electromyography/*; Fasciculation/*DI/GE; Female; Human; Muscles/IR; Myotonia/*DI/GE; Peripheral Nerve Diseases/*DI/GE; Peripheral Nerves/PP; Reaction Time/PH; Syndrome; Tetany/*DI/GE.
.T
Mistaken diagnoses in continuous muscle fiber activity of peripheral nerve origin.
.P
JOURNAL ARTICLE.
.W
The syndrome of continuous muscle fiber activity of peripheral nerve origin has manifestations that resemble those of many other more common neurologic disorders during childhood and infancy. This similarity often leads to misdiagnosis when an adequate index of suspicion is not entertained and a comprehensive electromyographic examination is not performed. Two affected patients from 1 family are reported to illustrate the type of diagnostic errors that were made before the establishment of the correct diagnosis.
.A
Subramony SH; Parker CC; Evans OB; Hanson RR.
.I 274249
.U
91000022
.S
Pediatr Neurol 9101; 6(4):260-4
.M
Brain/PA; Brain Damage, Chronic/*ET; Brain Edema/ET; Cerebral Ventricles/PA; Child; Child, Preschool; Epilepsy/*ET; Female; Follow-Up Studies; Haemophilus influenzae/*PY; Human; Male; Meningitis, Haemophilus/*CO; Tomography, X-Ray Computed/*.
.T
Haemophilus influenzae meningitis with prolonged hospital course.
.P
JOURNAL ARTICLE.
.W
A retrospective evaluation of Haemophilus influenzae type b meningitis observed over a 2-year period documented 86 cases. Eight of these patients demonstrated an unusual clinical course characterized by persistent fever (duration: greater than 10 days), cerebrospinal fluid pleocytosis, profound meningeal enhancement on computed tomography, significant morbidity, and a prolonged hospital course. The mean age of these 8 patients was 6 months, in contrast to a mean age of 14 months for the entire group. Two patients had clinical evidence of relapse. Four of the 8 patients tested for latex particle agglutination in the cerebrospinal fluid remained positive after 10 days. All patients received antimicrobial therapy until they were afebrile for a minimum of 5 days. Subsequent neurologic examination revealed a persistent seizure disorder in 5 patients (62.5%), moderate-to-profound hearing loss in 2 (25%), mild ataxia in 1 (12.5%), and developmental delay with hydrocephalus which required shunting in 1 (12.5%). One patient had no sequelae.
.A
Martin LD; Kaplan AM; Rudinsky MF; Frost MD.
.I 274250
.U
91000023
.S
Pediatr Neurol 9101; 6(4):265-8
.M
Biopsy; Case Report; Child; Child, Preschool; Chromosome Abnormalities/DI/*GE; Diagnosis, Differential; Dystrophin/*AN; Fluorescent Antibody Technique; Genes, Recessive/*GE; Human; Male; Muscles/*PA; Muscular Dystrophy/DI/*GE; Support, Non-U.S. Gov't.
.T
Dystrophin analysis in the differential diagnosis of autosomal recessive muscular dystrophy of childhood and Duchenne muscular dystrophy.
.P
JOURNAL ARTICLE.
.W
We report 2 patients with childhood autosomal recessive muscular dystrophy. Both patients had slight muscle weakness without enlargement of the calf muscles or involvement of the facial muscles. Their clinical courses are static. Muscle histology revealed characteristic features of muscular dystrophy. Dystrophin was identifiable in the sarcolemma of both patients by immunocytochemical staining with an antidystrophin antibody. At an early age, immunocytochemical analysis with antidystrophin antibody was useful in distinguishing between childhood autosomal recessive and Duchenne muscular dystrophies.
.A
Tachi N; Tachi M; Sasaki K; Nagata N; Chiba S.
.I 274251
.U
91000024
.S
Pediatr Neurol 9101; 6(4):269-71
.M
Case Report; Cerebral Cortex/PP; Electroencephalography/*; Evoked Potentials/PH; Female; Follow-Up Studies; Hemolytic-Uremic Syndrome/PP/*TH; Human; Infant; Plasma/*; Status Epilepticus/PP/*TH.
.T
EEG correlation of improvement in hemolytic-uremic syndrome after plasma infusion.
.P
JOURNAL ARTICLE.
.W
We report a previously undescribed electroencephalographic pattern of epochs of diffuse delta background (85-240 sec) alternating with epochs of classic "burst suppression" (90-270 sec) in a 13-month-old girl with hemolytic-uremic syndrome. A dramatic electroencephalographic improvement was evident on continuous monitoring of cerebral function 3 hours after initiating fresh frozen plasma infusion, well before any clinical improvement was apparent. This patient, in addition to the unusual electroencephalographic findings, illustrates the role of continuous electrophysiologic monitoring of cerebral function and supports the use of fresh frozen plasma in hemolytic-uremic syndrome.
.A
Pascual-Leone A; Dhuna AK; Janousek ST; Talwar D.
.I 274252
.U
91000025
.S
Pediatr Neurol 9101; 6(4):272-4
.M
Adolescence; Biopsy; Case Report; Cerebellar Neoplasms/*DI/PA; Cerebellopontine Angle/*PA; Craniotomy; Female; Human; Lipoma/*DI/PA; Magnetic Resonance Imaging/*; Tomography, X-Ray Computed/*.
.T
Cerebellopontine angle lipoma in a teenager.
.P
JOURNAL ARTICLE.
.W
Lipomas of the cerebellopontine angle are very rare lesions. To date, 18 patients have been reported, 17 of whom were adults. A second child is described with cerebellopontine angle lipoma.
.A
Ashkenasi A; Royal SA; Cuffe MJ; Aronin PA; Tenorio GM; Benton JW.
.I 274253
.U
91000026
.S
Pediatr Neurol 9101; 6(4):275-6
.M
Adolescence; Case Report; Child; Electromyography/DE; Female; Human; Hypertension, Renal/*DT; Kidney Failure, Acute/CO; Kidney Failure, Chronic/CO; Kidney Transplantation; Labetalol/AD/*AE; Male; Neuromuscular Diseases/*CI; Postoperative Complications/DT.
.T
Reversible myopathy due to labetalol.
.P
JOURNAL ARTICLE.
.W
A severe, generalized myopathy developed in 2 children treated with labetalol. An 11-year-old girl and a 14-year-old boy demonstrated proximal weakness and markedly elevated creatine kinase levels during labetalol therapy. Clinical improvement began immediately when labetalol administration was halted; muscle strength was normal within 2 months. Muscle biopsies were consistent with rhabdomyolysis.
.A
Willis JK; Tilton AH; Harkin JC; Boineau FG.
.I 274254
.U
91000027
.S
Pediatr Neurol 9101; 6(4):277-8
.M
Blood Coagulation Tests; Case Report; Cerebral Hemorrhage/*BL/DI; Child, Preschool; Factor XIII Deficiency/*CO/DI; Follow-Up Studies; Hematoma, Subdural/BL; Human; Infant; Male; Subarachnoid Hemorrhage/BL; Tomography, X-Ray Computed.
.T
Factor XIII deficiency and intracranial hemorrhages in infancy.
.P
JOURNAL ARTICLE.
.W
We report an infant with Factor XIII deficiency who had 2 seemingly spontaneous intracranial hemorrhages. It is important to consider Factor XIII deficiency as a possible cause of unexplained intracranial hemorrhages in infancy. Ongoing factor replacement therapy is recommended to prevent further bleeding episodes.
.A
Larsen PD; Wallace JW; Frankel LS; Crisp D.
.I 274255
.U
91000028
.S
Pediatr Neurol 9101; 6(4):279-81
.M
Case Report; Cerebral Angiography; Cerebral Artery Diseases/RA; Chickenpox/*CO/RA; Child; Child, Preschool; Female; Follow-Up Studies; Hemiplegia/*ET/RA; Herpes Zoster Ophthalmicus/CO; Human; Infant; Male; Tomography, X-Ray Computed.
.T
Varicella with delayed hemiplegia.
.P
JOURNAL ARTICLE.
.W
We report 4 children who developed acute hemiplegia 7 weeks to 4 months after varicella infection. In 2 patients, carotid angiography demonstrated segmental narrowing and occlusion of the middle cerebral artery. Their clinical and angiographic features were similar to those associated with contralateral hemiplegia after herpes zoster ophthalmicus, the pathogenesis of which comprises cerebral angiitis due to varicella zoster viral infection. We believe that our patients had the same pathogenesis. In a survey of infectious diseases in our region, the frequency of varicella with delayed hemiparesis was roughly 1:6,500 varicella patients.
.A
Ichiyama T; Houdou S; Kisa T; Ohno K; Takeshita K.
.I 274256
.U
91000029
.S
Pediatr Neurol 9101; 6(4):282
.M
Cell Line/*; Cerebellar Neoplasms/*PA; Child; Human; Medulloblastoma/*PA; Platelet-Derived Growth Factor/*AN; Radioligand Assay; Tumor Markers, Biological/*AN.
.T
Medulloblastoma cell line [letter; comment]
.P
COMMENT; LETTER.
.A
Whelan HT.
.I 274257
.U
91000031
.S
Pediatr Neurol 9101; 6(4):283
.M
Brain/PA; Child, Preschool; Diagnosis, Differential; Encephalitis Periaxialis/*DI; Human; Infant; Magnetic Resonance Imaging; Male; Multiple Sclerosis/*DI.
.T
Infantile MS and Schilder disease [letter; comment]
.P
COMMENT; LETTER.
.A
Stenager E.
.I 274258
.U
91000541
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1126,1128
.M
Animal; Bone Development/*/DE/PH; Bone Transplantation/*; Glycoproteins/PD/PH; Human; Proteins/PD/PH; Rats; Skull/*SU; Transforming Growth Factor beta/PD/PH.
.T
Osteoinductive implants in head and neck surgery [news]
.P
NEWS.
.A
Toriumi DM; Larrabee WF Jr.
.I 274259
.U
91000542
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1128
.M
Face/SU; Human; Lasers/*TU; Surgery, Plastic; Wound Healing/*RE.
.T
Lasers and wound healing [news]
.P
NEWS.
.A
Meyers AD.
.I 274260
.U
91000543
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1135-6
.M
Communicative Disorders; Deafness; Human; National Institutes of Health (U.S.)/*; Research; United States.
.T
Message from the National Institutes of Health. The state of the National Institute on Deafness and Other Communication Disorders.
.P
JOURNAL ARTICLE.
.A
Snow JB Jr.
.I 274261
.U
91000544
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1137-42
.M
Aged; Aging/*PA; Forehead/PA/*SU; Human; Middle Age; Rhytidoplasty/AE/*MT.
.T
Management of the aging forehead.
.P
JOURNAL ARTICLE.
.W
Browlifting and forehead procedures are a critical element in the contemporary surgical management of the aging face. Esthetics of the upper third of the face will dictate brow position and its relationship to the supraorbital rim and eyes. Treatment of deformities of the upper third of the face can be varied according to the sex and age of the patient as well as contour of the hairline and forehead. The indications, advantages, disadvantages, and techniques of the coronal forehead, modified pretrichal forehead, midforehead, and direct browlifting procedures are discussed.
.A
Kerth JD; Toriumi DM.
.I 274262
.U
91000545
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1143-6
.M
Adult; Bacterial Adhesion/*; Child; Epithelium/MI; Haemophilus influenzae/IM/PH; Human; IgA, Secretory/AN; Nasopharynx/*MI; Otitis Media with Effusion/IM/*MI; Streptococcus pneumoniae/IM/PH; Support, Non-U.S. Gov't.
.T
The role of bacterial adherence in otitis media with effusion.
.P
JOURNAL ARTICLE.
.W
Adherence of nontypable Haemophilus influenzae and Streptococcus pneumoniae to nasopharyngeal epithelial cells was investigated in vitro. Both strains had higher affinity to the epithelial cells of children than to those of adults. In children, the adherence was significantly greater in patients with otitis media with effusion than in normal subjects. Secretory IgA in nasopharyngeal secretions was found to have antibody activity against the bacteria. Adherence of both bacteria was significantly smaller in the group having secretory IgA antibody activity than in the group having no activity. These results suggest that bacterial adherence to the nasopharynx may play an important role in the pathogenesis of otitis media with effusion in children, and that secretory IgA in nasopharyngeal secretions may be related to the decrease of adherence.
.A
Shimamura K; Shigemi H; Kurono Y; Mogi G.
.I 274263
.U
91000546
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1147-53
.M
Head/*SU; Human; Neck/*SU; Postoperative Complications; Skin/SU; Tissue Expanders; Tissue Expansion/*/AE/MT.
.T
Tissue expansion of the head and neck. Indications, technique, and complications.
.P
JOURNAL ARTICLE.
.W
Tissue expansion is indicated in the reconstruction of various defects of the head and neck in instances where there is inadequate adjacent tissue to allow either primary closure of the defect or repair with a local flap. It may also be indicated in instances where repair of a defect by an alternative method such as a local, regional, or distant flap will result in an unacceptable donor or recipient site deformity. Although tissue expansion is simplistic in concept, it does require judgment and indepth preoperative planning to ensure optimal results. The complication rate is high for tissue expansion in the head and neck, particularly in the cheek and neck area. Despite the frequency of complications, in the vast majority of cases the intended reconstruction is successful.
.A
Baker SR; Swanson NA.
.I 274264
.U
91000547
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1154-8
.M
Adult; Chin/*SU; Female; Human; Implants, Artificial/*; Male; Middle Age; Phthalic Acids; Polyethylene Glycols; Postoperative Complications; Surgery, Plastic/IS/*MT; Surgical Mesh/*; Surgical Wound Infection.
.T
Augmentation mentoplasty using Mersilene mesh.
.P
JOURNAL ARTICLE.
.W
Many different materials are available for augmentation mentoplasty. However, the optimal implant material for chin implantation has yet to be found. During the past several years, a number of experienced surgeons have turned to the use of Mersilene mesh. Mersilene mesh is a non-absorbable Dacron polyester fiber that can be conformed easily into layers to achieve tailored dimensions and shape. At the McCollough Plastic Surgery Clinic PA, Birmingham, Ala, 277 patients over a 10-year period underwent chin augmentation with Mersilene mesh implants. The material provides excellent tensile strength, durability, and surgical adaptability. The overall complication rate was 3.2% (nine patients); infection rate, 2.5% (seven patients); and removal secondary to infection, 1.7% (five patients). Based on this 10-year experience, Mersilene mesh remains our material of choice for chin augmentation.
.A
McCollough EG; Hom DB; Weigel MT; Anderson JR.
.I 274265
.U
91000549
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1163-6
.M
Alcohol Drinking/AE; Case-Control Studies; Female; Hair Dyes/AE; Human; Male; Middle Age; Mouthwashes/AE; Radiotherapy/AE; Risk Factors; Salivary Gland Neoplasms/*ET; Smoking/AE; Socioeconomic Factors.
.T
Salivary gland cancer. A case-control investigation of risk factors.
.P
JOURNAL ARTICLE.
.W
Unlike most upper aerodigestive tract cancers, salivary gland cancers are relatively infrequent, are characterized by a diversity of histologic subtypes, and have never been etiologically associated with tobacco exposure. We present the results of a case-control study of risk factors for these cancers, with risk estimates derived from self-administered comprehensive risk-factor questionnaires distributed to patients at The University of Texas M. D. Anderson Cancer Center, Houston. Cases were 64 patients with histologically confirmed salivary gland cancer. Control subjects, randomly selected from the same patient population excluding patients with cancer of the head and neck or nonmelanoma skin cancer, were frequency-matched to the cases by age, sex, and ethnicity to achieve a 2:1 control subjects/cases ratio. On multivariate analysis, prior radiotherapy was a significant risk factor for both men (odds ratio [OR] = 2.1) and women (OR = 2.3). Among women, higher educational attainment (OR = 2.4), alcohol use (OR = 2.0), and hairdye use (OR = 2.5) were also significantly associated with risk. There were no significant differences between cases and control subjects with respect to tobacco exposure or specific occupational or leisure-time exposures. There is biological plausibility for associations with hairdye use and alcohol exposure.
.A
Spitz MR; Fueger JJ; Goepfert H; Newell GR.
.I 274266
.U
91000550
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1167-71
.M
Cell Division; Cell Transformation, Neoplastic/PA; Human; Immunoblotting; Intermediate Filament Proteins/AN; Keratin/ME; Laryngeal Neoplasms/ME/MI/*PA; Neoplasm Proteins/ME; Papilloma/ME/MI/*PA; Papillomaviruses/*; Protein Precursors/ME; Stains and Staining; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Thymidine/PK; Tumor Virus Infections/ME/*PA; Uridine/PK.
.T
Abnormal differentiation of human papillomavirus-induced laryngeal papillomas.
.P
JOURNAL ARTICLE.
.W
We studied the proliferation and differentiation of human laryngeal papillomas, which are benign tumors induced by human papillomaviruses. Immunofluorescent stains of tissues for a number of differentiation-specific proteins showed abnormal differentiation. Papilloma tissue fragments in vitro showed a slightly decreased fraction of proliferating cells that incorporated tritiated thymidine and a markedly reduced incorporation of tritiated uridine when compared with normal tissue. We propose that papillomavirus infection results in normal basal cell proliferation but abnormal terminal differentiation and that this abnormality significantly contributes to the hyperplasia of the papillomas.
.A
Steinberg BM; Meade R; Kalinowski S; Abramson AL.
.I 274267
.U
91000551
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1172-6
.M
Animal; Antineoplastic Agents, Combined/*TU; Carcinoma, Squamous Cell/*DT/PA; Cisplatin/AD; Drug Administration Schedule; Drug Interactions; Female; Fluorouracil/AD; Human; Male; Mice; Mice, Inbred BALB C; Neoplasm Transplantation; Support, Non-U.S. Gov't.
.T
Cisplatin-fluorouracil interaction in a squamous cell carcinoma xenograft.
.P
JOURNAL ARTICLE.
.W
Patients with squamous cell carcinoma of the head and neck are treated with cisplatin and fluorouracil according to a schedule based on the findings of clinical studies. A similar schedule showed a supra-additive effect in the treatment of xenografted human squamous cell carcinoma of the head and neck. We sought to ascertain whether this schedule was optimal. A single intraperitoneal injection of cisplatin (7.5 mg/kg) was combined with three injections of fluorouracil given during a 24-hour period (total dose, 150 or 80 mg/kg) before, during, or after cisplatin administration. The combined effect of cisplatin and fluorouracil on tumor growth and toxic effects was schedule dependent. Consideration of both toxic effects and tumor growth inhibition, as assessed by reduction of the area under the growth curve, the optimal administration interval was found to be fluorouracil given 3 days after cisplatin administration.
.A
Rydell R; Wennerberg J.
.I 274268
.U
91000552
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1177-80
.M
Animal; Hematoporphyrins/TU; Papillomaviruses/*; Photochemotherapy/*; Porphyrins/TU; Rabbits; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Tumor Virus Infections/*DT/PA; Warts/*DT/MI/PA.
.T
Laser photodynamic therapy for papilloma viral lesions.
.P
JOURNAL ARTICLE.
.W
Photodynamic therapy was tested for its therapeutic efficacy in eradicating rabbit papilloma warts. The wild-type viral warts suspension was used to induce treatable papilloma warts in the cutaneous tissue of Dutch Belted rabbits. The photosensitizing agents used intravenously were Photofrin II at 10 mg/kg of body weight and Chlorin e6 monoethylene diamine monohydrochloric acid (Chlorin e6 med HCl) at 1 mg/kg of body weight. The lasers used were an argon-dye laser at 628 and 655 nm and a gold vapor laser at 628 nm. The irradiances of 25 to 180 mW/cm2 were applied topically with an end-on lens optical fiber with total radiant doses of 7.5 to 54 J/cm2. Photofrin II and the argon-dye laser at the highest light dosage (54 J/cm2) and Chlorin e6 monoethylene diamine monohydrochloride administered 2 hours before argon-dye laser irradiation at 655 nm at the highest light dosage (54 J/cm2) produced wart regression. Total wart regression without recurrence was achieved with Photofrin II and the gold vapor laser at all light dosages. The difference observed between the argon-dye laser and the gold vapor laser might be explained by the pulsed nature of the gold vapor laser, with its high-peak powers, some 5000 x the average measured light dose. In this model, the smaller, less cornified lesions were more effectively treated with photodynamic therapy.
.A
Go PM; Reed RN; Straight RC; Waner M.
.I 274269
.U
91000553
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1181-5
.M
Adult; Aged; Carcinoma, Squamous Cell/*IM/PA; Female; Head and Neck Neoplasms/*IM/PA; Histocompatibility Antigens Class I/*AN; Human; HLA-D Antigens/*AN; Immunoenzyme Techniques; Male; Middle Age; Mucous Membrane/IM.
.T
HLA class I and class II antigen expression on squamous cell carcinoma of the head and neck.
.P
JOURNAL ARTICLE.
.W
We compared human major histocompatibility (HLA) class I and class II antigen expression on squamous cell carcinoma of the head and neck with that on normal mucosa. Frozen sections of a consecutive series of 30 squamous cell carcinomas were stained with the monoclonal antibodies W6/32 (class I) and anti-DR (class II) using an immunoperoxidase technique. Normal mucosa showed class I and class II expression in the basal layers only. Class I expression on tumors was diffuse in 87%, patchy in 10%, and scattered in 3%. Class II expression on tumors was diffuse in 20%, patchy in 53%, scattered in 20%, and absent in 7%. Patterns of expression did not correlate significantly with clinical parameters, including survival, except that class II diffuse and patchy patterns were found to correlate with more poorly differentiated tumors.
.A
Houck JR; Sexton FM; Zajdel G.
.I 274270
.U
91000554
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1186-9
.M
Child; Child, Preschool; Ear, Middle/*PA; Endoscopy/*; Eustachian Tube/PA; Female; Human; Male; Middle Ear Ventilation; Mucous Membrane/PA; Otitis Media with Effusion/*PA/SU; Tympanic Membrane/PA.
.T
Transtympanic endoscopic findings in patients with otitis media with effusion.
.P
JOURNAL ARTICLE.
.W
Using a fine, rigid endoscope (Olympus, SES-1711K), we examined the middle ear, including the tympanic orifice of the eustachian tube, of children with otitis media with effusion (OME) in its active stage (26 ears), in the convalescent stage (13 ears), and during treatment with ventilation tubes for 10 days to 6 months (five ears) through myringotomy with the patients under general anesthesia. Several color photographs of representative ears are shown. In the active stage of OME, edema (73.1%) and hyperemia (23.1%) were characteristic features of the middle ear mucosa, and normal mucosa was seen in only one ear (3.1%). The tympanic orifice of the eustachian tube, which could be examined in 12 ears, were stenosed with edema in four ears (33.3%) or plugged with effusion in three ears (25.0%) in this group. In the convalescent stage of OME, dilated vessels were most often seen (69.2%), but the rest of the patients had normal mucosa (30.8%) in the middle ear, and none of them had edema nor hyperemia. The tympanic orifice of the eustachian tube, which could be examined in five ears, was clearly patent in all the patients in this group. One ear that was treated with a ventilation tube for 1 month showed dilated vessels and less severe inflammation than did ears that were in the active stage of OME, and three ears that were treated for more than 3 months showed almost normal middle ear mucosa.
.A
Takahashi H; Honjo I; Fujita A; Kurata K.
.I 274271
.U
91000555
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1190-3
.M
Comparative Study; False Negative Reactions; False Positive Reactions; Head and Neck Neoplasms/PA; Human; Lymph Nodes/PA/*RA; Lymphatic Metastasis/PA/*RA; Neck; Retrospective Studies; Tomography, X-Ray Computed/*.
.T
Computed tomography of metastatic cervical lymph nodes. A clinical, computed tomographic, pathologic correlative study.
.P
JOURNAL ARTICLE.
.W
A retrospective comparative study of 63 neck dissections was undertaken to evaluate further the accuracy of high-resolution computed tomography (CT) in the detection of nodal metastases, as previous studies have indicated a trend toward the superiority of CT scanning over palpation. The respective values of neck examination, CT scanning, and histopathologic examination were assessed in 51 patients with head and neck cancer who underwent a total of 63 neck dissections. The overall agreement between clinical examination findings and histopathologic findings was 92% vs 81% for CT scanning. A retrospective analysis of the CT findings failed to reveal greater accuracy. We found nodes measuring 10 mm or more with central low density always to be malignant. Because CT scanning seems to offer little advantage over palpation in the nonirradiated neck, it should not be regarded as an essential tool in the staging of nodal disease. After radiation therapy, as neck dissection is only performed because of clinical or radiologic suspicion, CT scanning is of utmost importance.
.A
Moreau P; Goffart Y; Collignon J.
.I 274272
.U
91000556
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1194-6
.M
Adolescence; Child; Ear, External/*AB; Female; Human; Male; Pedigree.
.T
A survey of accessory auricle anomaly. Pedigree analysis of seven cases.
.P
JOURNAL ARTICLE.
.W
We performed an investigation of 50 accessory auricles on subjects encountered during 1983 through 1985. Fifteen of the families were found to have the same accessory auricular deformity among the probands' family members. From these 15 families, we selected seven pedigrees that were not accompanied by auricular deformities who had filial generations for analysis. Pedigrees 1 through 6 showed autosomal dominant inheritance; two also had irregular dominant properties (pedigrees 4 and 7), and one (pedigree 7) could not be excluded from the possibility of having an X-linked recessive inheritance. During the investigation, there were latent accessory auricles in which the cartilages were seen to be subcutaneous only or protruding slightly. Genetically, the pathogenesis of an accessory auricle should be related to the accessory auricular gene.
.A
Gao JZ; Chen YM; Gao YP.
.I 274273
.U
91000557
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1197-201
.M
Adult; Case Report; Female; Human; Implants, Artificial/*; Lip/PA/*SU; Male; Nose/PA; Rhinoplasty/MT; Surgery, Plastic/*MT.
.T
Significant premaxillary augmentation.
.P
JOURNAL ARTICLE.
.W
Substantial premaxillary augmentation is necessary as an adjunctive treatment in most cleft rhinoplasties and in those patients exhibiting an acute nasolabial angle due to retrusion of the premaxila. We describe our technique of evaluation and treatment of this condition using a custom-carved piece of material made from a woven combination of Teflon and organic fibers (Proplast). Detailed technical illustrations as well as patient results are demonstrated. We have found this technique in our hands to be a simple, safe, and effective means of correction of significant premaxillary retrusion.
.A
Cook TA; Wang TD; Brownrigg PJ; Quatela VC.
.I 274274
.U
91000558
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1202-4
.M
Adult; Case Report; Cysts/*/PA/TH; Ear Diseases/PA/TH; Ear, External/*; Human; Male.
.T
Pseudocyst of the auricle. Case report and world literature review [see comments]
.P
JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL.
.W
We treated a patient with pseudocyst of the auricle and reviewed the 113 cases previously published in the world literature. Pseudocyst of the auricle is an asymptomatic, noninflammatory cystic swelling that involves the anthelix of the ear, results from an accumulation of fluid within an unlined intracartilaginous cavity, and occurs predominantly in men (93% of patients). Characteristically, only one ear is involved (87% of patients), and the lesion is usually located within the scaphoid or triangular fossa of the anthelix. Previous trauma to the involved ear is uncommon. The diagnosis may be suggested by the clinical features, and analysis of the aspirated cystic fluid and/or histologic examination of a lesional biopsy specimen will confirm the diagnosis. Therapeutic intervention that maintains the architecture of the patient's external ear should be used in the treatment of this benign condition.
.A
Cohen PR; Grossman ME.
.I 274275
.U
91000560
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1208-9
.M
Adolescence; Airway Obstruction/DI/*PX; Case Report; Child; Conversion Disorder/*/DI; Female; Human; Male; Respiratory Sounds/ET.
.T
Functional upper airway obstruction in adolescents.
.P
JOURNAL ARTICLE.
.W
Functional upper airway obstruction is an uncommon manifestation of a conversive reaction characterized by recurrent stridor attacks caused by adduction of the vocal cords during inspiration. The oxygen saturation never drops to pathologic levels. The stridor is not accompanied by an appropriate degree of anxiety and is not associated with other symptoms. Patients benefit from verbal reassurance and speech therapy, but stridor attacks tend to recur and psychiatric consultation seems necessary in most cases. We present the case histories of three adolescent patients with nonorganic upper airway obstruction and describe the features that may facilitate the diagnosis of this condition. Early diagnosis and intervention may prevent unnecessary and potentially harmful investigations and therapy.
.A
Ophir D; Katz Y; Tavori I; Aladjem M.
.I 274276
.U
91000561
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1210-3
.M
Adult; Brain Diseases/*ET/MI/RA; Case Report; Human; Hyphomycetes/*; Male; Mucocele/*ET/MI/RA; Mycoses/*CO/RA; Sinusitis/*CO/MI/RA; Tomography, X-Ray Computed.
.T
Multiple intracranial mucoceles associated with phaeohyphomycosis of the paranasal sinuses.
.P
JOURNAL ARTICLE.
.W
The purpose of this article is to alert clinicians to a new pathogenic fungus of the paranasal sinuses called Exserohilum rostratum. Exserohilum species are one of the etiologic agents of phaeohyphomycosis, a constellation of entities caused by dematiaceous fungi. This class of fungal sinus infection has emerged only in the past decade; it occurs primarily in immunocompetent individuals and produces a tenacious, progressive pansinusitis. To our knowledge, this study describes the first case of multiple intracranial mucoceles secondary to E rostratum. The diagnostic workup includes computed tomography and magnetic resonance imaging followed by direct microscopic examination of tissue biopsy specimens. A craniotomy followed by a bilateral external ethmoidectomy was necessary for complete extirpation of the infected mucoceles. Aggressive surgical management of this mycotic infection is described.
.A
Aviv JE; Lawson W; Bottone EJ; Sachdev VP; Som PM; Biller HF.
.I 274277
.U
91000562
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1214-6
.M
Case Report; Child; Cholesteatoma/CN/CO/RA; Ear Diseases/CN/CO/RA; Ear Neoplasms/*/CO/PA/RA; Ear, Middle/*; Human; Male; Osteoma/*/CO/PA/RA; Skull Neoplasms/CO/PA/RA; Temporal Bone/PA/RA.
.T
Osteoma of the middle ear. Report of a case.
.P
JOURNAL ARTICLE.
.W
Osteomas of the middle ear are rare. We report a case of a 7-year-old boy with osteoma originating from the pyramidal eminence, combined with congenital cholesteatoma. The osteoma and cholesteatoma were successfully removed by tympanomastoidectomy. The long process of the incus and the superstructure of the stapes disappeared. The body of the incus was sculpted and used as a columella. Histopathologically, the osteoma was much the same as an external auditory canal osteoma. The possibility of a primary congenital origin of this neoplasm is suggested.
.A
Yamasoba T; Harada T; Okuno T; Nomura Y.
.I 274278
.U
91000563
.S
Arch Otolaryngol Head Neck Surg 9101; 116(10):1217
.M
Human; Otosclerosis/*DT; Sodium Fluoride/AE/*TU.
.T
Fluoride therapy for otosclerosis [letter]
.P
LETTER.
.A
Shambaugh GE Jr.
.I 274279
.U
91000699
.S
J Am Soc Echocardiogr 9101; 3(4):255-65
.M
Echocardiography/*/*MT; Heart Diseases/*US; Human; Image Processing, Computer-Assisted/*; Observer Variation; Support, U.S. Gov't, P.H.S..
.T
Ultrasonic integrated backscatter two-dimensional imaging: evaluation of M-mode guided acquisition and immediate analysis in 55 consecutive patients.
.P
JOURNAL ARTICLE.
.W
We have shown previously that cardiac cycle-dependent integrated backscatter characterizes the physical state of myocardium in patients with ischemic heart disease and cardiomyopathy. In the present study the clinical applicability of M-mode guided two-dimensional integrated backscatter imaging was defined in evaluation of 55 nonselected patients. The mean amplitude of cyclic variation of integrated backscatter in normal segments (long-axis view) was as follows: basal septum, 4.2 +/- 1.3 dB (mean +/- SD; n = 27), mid-septum, 4.5 +/- 1.0 dB (n = 26), basal posterior, 4.8 +/- 1.0 dB (n = 30), and mid-posterior, 4.8 +/- 1.2 decibels (n = 27). The respective mean delay values (R wave to nadir) were as follows: 0.89 +/- 0.09, 0.84 +/- 0.09, 0.86 +/- 0.09, and 0.85 +/- 0.12. At least one cardiac cycle could be analyzed fully in 62% of patients. Limitations included technically difficult two-dimensional echocardiography, inadequate M-line orientation, technically remediable errors, or poor quality integrated backscatter images. In abnormal segments (n = 13) cyclic variation was reduced and delay was prolonged (1.2 +/- 1.1 dB and 1.21 +/- 1.1, respectively). Intraobserver and interobserver variability for amplitude measurements were modest, with respective correlation coefficients of r = 0.93; r = 0.72. The findings demonstrate that M-mode--assisted integrated backscatter is a practical approach for characterization of regional myocardial properties promptly and at the bedside in a large portion of patients with cardiac disease.
.A
Loomis JF Jr; Waggoner AD; Schechtman KB; Miller JG; Sobel BE; Perez JE.
.I 274280
.U
91000700
.S
J Am Soc Echocardiogr 9101; 3(4):266-75
.M
Algorithms/*; Echocardiography/*/*MT; Human; Image Processing, Computer-Assisted/*; Myocardial Contraction/*PH; Support, U.S. Gov't, P.H.S..
.T
Applications of cross-correlation techniques to the quantitation of wall motion in short-axis two-dimensional echocardiographic images.
.P
JOURNAL ARTICLE.
.W
Echocardiography is now a mainstay in the diagnosis of cardiovascular disease. Rapid methods for quantitation of the images would provide an effective tool for the diagnosis of change in left ventricular function. The purpose of this article is to show the feasibility of using the cross-correlation technique to quantify change in left ventricular function over time in two-dimensional short-axis echocardiographic images. Radial histograms of radial distance versus the number of probable specular targets are formed in eight sectors on each frame during the cardiac cycle. These histograms are then shifted to a position of best correlation. The number of radial bins through which the histograms at end systole are shifted to correlate with those of the frame at end diastole defines the regional motion. The methods are described and preliminary findings are presented.
.A
Geiser EA; Wilson DC; Gibby GL.
.I 274281
.U
91000701
.S
J Am Soc Echocardiogr 9101; 3(4):276-84
.M
Adult; Analysis of Variance; Comparative Study; Echocardiography/*; Echocardiography, Doppler/*; Female; Graft Rejection; Heart Transplantation/*PH; Human; Male; Observer Variation; Reference Values; Regression Analysis; Reproducibility of Results; Ventricular Function, Left/*PH.
.T
Variability of Doppler echocardiographic indexes of left ventricular filling in transplant recipients and in normal subjects.
.P
JOURNAL ARTICLE.
.W
This study examines the reproducibility and variability of pulsed wave Doppler versus continuous wave Doppler ultrasound indexes of left ventricular filling in cardiac allograft recipients and in normal subjects. The following indexes were studied: isovolumic relaxation time, pressure half-time, peak early mitral flow velocity, and peak mitral flow velocity after atrial systole. Intraobserver and interobserver variability were assessed by regression analysis. Individual components of variance (subject, reader, beat, day, and tracing) were estimated in a subset of five patients and five normal subjects, and estimated total variance defined for each group. Temporal (day-to-day) variability for 95% confidence was estimated for these patients and for normal subjects. Temporal variability in the group from which the subsets were drawn was measured from absolute and percent change in values on two occasions. Estimated and observed 95% confidence limits were compared. Intersubject variability was the largest component of variance in both transplant recipients and in normal subjects. For all indexes in transplant recipients (in the absence of rejection) and normal subjects, observed absolute mean differences (+/- 2 standard deviations) between values from recordings taken on two different days were larger than the 95% confidence limits estimated from the components of variance analysis. The observed 95% limits for transplant recipients versus normal subjects were as follows: isovolumic relaxation time, 20 msec versus 6 msec; pressure half-time, 16 msec versus 9 msec; peak early mitral flow velocity, 32 cm per second versus 17 cm per second; and peak mitral flow velocity after atrial systole, 28 cm per second versus 10 cm per second.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Valantine HA; Hatle LK; Appleton CP; Gibbons R; Popp RL.
.I 274282
.U
91000702
.S
J Am Soc Echocardiogr 9101; 3(4):285-93
.M
Aortic Valve Insufficiency/DI/*US; Cardiac Output/PH; Cold/DU; Comparative Study; Echocardiography, Doppler/*; Exercise Test; Female; Human; Male; Middle Age; Nifedipine/DU; Stroke Volume/PH; Support, Non-U.S. Gov't; Vasodilation/DE; Ventricular Function/*PH.
.T
Left and right ventricular flows by Doppler echocardiography: serial measurements in patients with aortic regurgitation during exercise, cold pressor stimulation, and vasodilation.
.P
JOURNAL ARTICLE.
.W
To test the practicality of Doppler echocardiography to measure serial change, biventricular outputs were measured in 15 patients with aortic regurgitation during control periods and during interventions of bicycle exercise, cold pressor stimulation, and vasodilation. Biventricular stroke volumes were measured in 10 normal subjects for validation of methods and differed by 2.8%. Reading errors were 3.7%. Signal quality improved between the first and last observation (p less than 0.05). Velocity signals were corrected for intercept angles, which averaged 12 and 19 degrees for right heart flows and 31 and 32 degrees for the left side of the heart in all subjects. Negative correlations occurred between intercept angles and the chronologic order in which the patients were studied for left (p = 0.02) and right (p = 0.05) flows. Mean flow areas varied 9% in the left ventricle and 20% in the right ventricle. Total variability for measuring flow determined from control values was 11% to 13%. When twice the variability was used as the detectable level of change, only exercise provoked real increases in biventricular flows in the majority of patients. We conclude that serial measurements of flow by Doppler echocardiographic methods had to exceed 20% to 25% to achieve significant change. Measuring intercept angle, resolving flow area, and learning are variables that need greater emphasis.
.A
Wong M; Matsumura M; Omoto R.
.I 274283
.U
91000703
.S
J Am Soc Echocardiogr 9101; 3(4):294-302
.M
Adult; Aged; Blood Flow Velocity/PH; Cardiomyopathy, Congestive/*US; Comparative Study; Coronary Circulation/PH; Echocardiography; Echocardiography, Doppler/*MT; Human; Middle Age; Support, Non-U.S. Gov't.
.T
Flow patterns in dilated cardiomyopathy: a pulsed-wave and color flow Doppler study.
.P
CLINICAL TRIAL; JOURNAL ARTICLE.
.W
In 48 patients with dilated cardiomyopathy, pulsed-wave and color Doppler examination were performed. In addition, 14 normal patients served as control subjects. Peak inflow velocity at the level of the mitral valve, middle left ventricle, and apex and outflow velocity at the level of the apex, middle left ventricle, and subaortic area were measured. In normal patients there was brisk propagation of inflow velocity to the apex. Patients with dilated cardiomyopathy demonstrated delayed propagation and prolongation of the duration of inflow compared with control subjects (p less than 0.04). Continuous apical flow was visualized in 25% of dilated cardiomyopathies and in no normal patients. Apical velocities were significantly increased in cardiomyopathies with significant mitral regurgitation. Outflow velocities were decreased in dilated cardiomyopathy. In patients with dilated cardiomyopathy and apical dyskinesis, flow directed toward the base was measured in the middle left ventricle during isovolumic relaxation secondary to dyskinetic rebound. Patterns of abnormal flow in dilated cardiomyopathies are readily apparent by color M-mode and two-dimensional color Doppler.
.A
Jacobs LE; Kotler MN; Parry WR.
.I 274284
.U
91000704
.S
J Am Soc Echocardiogr 9101; 3(4):303-9
.M
Blood Flow Velocity/PH; Coronary Circulation/PH; Echocardiography, Doppler/*MT; Human; Hypertension, Pulmonary/SU/*US; Mitral Valve/*US; Pulmonary Embolism/SU/*US; Ventricular Function, Left/PH.
.T
Influence of Doppler sample volume location on the assessment of changes in mitral inflow velocity profiles.
.P
JOURNAL ARTICLE.
.W
Previous studies that have validated Doppler indexes of mitral inflow have used pulsed wave sample volume locations either at the level of the mitral valve anulus or at the tips of the mitral valve leaflets. Although significant differences between absolute values for peak velocities and velocity time integrals at these sample volume locations have previously been reported, no information exists that has compared changes in inflow profiles after an intervention to improve left ventricular filling. To address this question, 13 patients with severe pulmonary hypertension (mean pulmonary artery pressure, 50 +/- 13 mm Hg) caused by chronic thromboembolic disease were studied with use of Doppler echocardiography immediately before and after surgical reduction of pulmonary hypertension (pulmonary vascular resistance decreased from 916 +/- 413 to 233 +/- 89 dynes.sec.cm5). This clinical model has been shown to have abnormal mitral inflow velocity profiles that improve markedly after surgery. Doppler measures of early and late peak velocities were significantly lower both before and after surgery when sampling at the mitral anulus compared with the leaflet tips, although late filling parameters and the deceleration of early flow velocity tended to differ little. With surgery, the significant increase in peak early velocity and the ratio of early to late velocity was present regardless of the sample volume location (peak E at leaflet tips, 47.1 +/- 16.0 to 68.9 +/- 15.4 [p less than 0.001], and at anulus, 40.7 +/- 11.3 to 56.2 +/- 14.6 cm/sec [p less than 0.001]; peak E/A at leaflet tips, 0.95 +/- 0.4 to 1.55 +/- 0.9, and at anulus, 0.78 +/- 0.3 to 1.32 +/- 0.7 [both p less than 0.02]).(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Dittrich HC; Blanchard DG; Wheeler KA; McCann HA; Donaghey LB.
.I 274285
.U
91000705
.S
J Am Soc Echocardiogr 9101; 3(4):310-5
.M
Algorithms/*; Blood Flow Velocity; Comparative Study; Computer Graphics/*; Echocardiography, Doppler/*/IS; Human; Image Processing, Computer-Assisted/*.
.T
Do Doppler color flow algorithms for mapping disturbed flow make sense?
.P
JOURNAL ARTICLE.
.W
It has been suggested that a major advantage of Doppler color flow mapping is its ability to visualize areas of disturbed ("turbulent") flow, for example, in valvular stenosis or regurgitation and in shunts. To investigate how various color flow mapping instruments display disturbed flow information, color image processing was used to evaluate the most common velocity-variance color encoding algorithms of seven commercially available ultrasound machines. In six of seven machines, green was reportedly added by the variance display algorithms to map areas of disturbed flow. The amount of green intensity added to each pixel along the red and blue portions of the velocity reference color bar was calculated for each machine. In this study, velocities displayed on the reference color bar ranged from +/- 46 to +/- 64 cm/sec, depending on the Nyquist limit. Of note, changing the Nyquist limits depicted on the color reference bars did not change the distribution of the intensities of red, blue, or green within the contour of the reference map, but merely assigned different velocities to the pixels. Most color flow mapping algorithms in our study added increasing intensities of green to increasing positive (red) or negative (blue) velocities along their color reference bars. Most of these machines also added increasing green to red and blue color intensities horizontally across their reference bars as a marker of increased variance (spectral broadening). However, at any given velocity, marked variations were noted between different color flow mapping instruments in the amount of green added to their color velocity reference bars.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Gardin JM; Lobodzinski SM.
.I 274286
.U
91000706
.S
J Am Soc Echocardiogr 9101; 3(4):316-9
.M
Aorta/US; Aortic Valve/US; Aortic Valve Insufficiency/*EP/US; Echocardiography, Doppler/*; Human.
.T
Prevalence of aortic regurgitation by color flow Doppler in relation to aortic root size.
.P
JOURNAL ARTICLE.
.W
To determine whether there is a correlation between aortic root size and the prevalence of aortic regurgitation, we performed color flow Doppler echocardiographic studies on 1015 consecutive patients during a 3-month period. Patients were grouped according to their M-mode aortic root diameter as measured in the left parasternal position. The measured groups ranged from 2.0 to 4.5 cm, grouped at 0.1 cm intervals. As the aortic root size enlarged, the prevalence of aortic regurgitation increased linearly (p less than 0.001; correlation coefficient, r = 0.75). At an aortic root size in the "small normal" range of 2.0 to 2.4 cm, the prevalence of aortic regurgitation was 0% to 15%. In the "intermediate" and "top normal" ranges of 2.9 to 3.7 cm, the prevalence of aortic regurgitation increased linearly from 15% to 47%. With aortic root dilation, the prevalence of aortic root regurgitation was generally more than 50%. The severity of aortic regurgitation was semiquantified. Aortic root size was not a good indicator for the severity of aortic regurgitation. Patients with moderate and severe aortic regurgitation had variable aortic root sizes. Throughout the range of aortic root sizes, mild aortic regurgitation predominated. We conclude that aortic regurgitation is a common finding in patients with aortic roots that are dilated or are in the "top normal" size range, that the prevalence of aortic regurgitation increases linearly with aortic root size, and that aortic root size does not correlate with the severity of aortic regurgitation.
.A
Seder JD; Burke JF; Pauletto FJ.
.I 274287
.U
91000707
.S
J Am Soc Echocardiogr 9101; 3(4):320-5
.M
Case Report; Double Outlet Right Ventricle/*US; Echocardiography/*; Female; Human; Infant, Newborn.
.T
Two-dimensional echocardiographic features of double outlet left ventricle.
.P
JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED CASES.
.W
In a cyanotic newborn infant, the diagnosis of double outlet left ventricle was made from the two-dimensional echocardiographic examination. The diagnosis was later confirmed at cardiac catheterization and surgery. The parasternal and subcostal views were especially useful for identification of the origin of both great arteries from the morphologic left ventricle. A review of the medical literature since 1967 revealed 77 cases of double outlet left ventricle, most of which were diagnosed only at surgery or postmortem examination. The anatomic features demonstrated with two-dimensional echocardiography in this case are representative of the findings cited most often in the cases reported in the medical literature.
.A
Bengur AR; Snider AR; Peters J; Merida-Asmus L.
.I 274288
.U
91000708
.S
J Am Soc Echocardiogr 9101; 3(4):326-30
.M
Aortic Valve Stenosis/*US; Echocardiography, Doppler/*MT; Human.
.T
Evolution of the continuity equation in the Doppler echocardiographic assessment of the severity of valvular aortic stenosis.
.P
JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL.
.W
The use of Doppler techniques has greatly enhanced the noninvasive ultrasound technique for evaluation of valvular aortic stenosis. M-mode and two-dimensional echocardiography could not reliably distinguish patients with severe aortic stenosis from those with milder obstructions. The hemodynamic information offered by Doppler complemented echocardiographic imaging and provided an alternative modality for evaluation of patients with aortic stenosis. By application of the modified Bernoulli equation, the pressure gradient across the stenotic aortic valve could be estimated by Doppler echocardiography. Though helpful and widely used, the information provided by the pressure gradient across the valve about the severity of the obstruction was not complete. The assessment of valvular aortic stenosis therefore includes an estimation of the valve area by application of the continuity equation. This review examines the maturation of the continuity equation by Doppler techniques and discusses the implications of the procedure.
.A
Taylor R.
.I 274289
.U
91000709
.S
J Am Soc Echocardiogr 9101; 3(4):331-5
.M
Aortic Valve/*US; Aortic Valve Stenosis/US; Blood Flow Velocity/PH; Cardiac Output; Comparative Study; Echocardiography/*; Heart Catheterization; Human; Indicator Dilution Techniques.
.T
The determination of aortic valve area by the Gorlin formula: what the cardiac sonographer should know.
.P
JOURNAL ARTICLE.
.W
The application of the Gorlin formula in the cardiac catheterization laboratory is the standard of reference for the determination of aortic valve area. The continuity equation now enables the cardiac sonographer to determine aortic valve area noninvasively in the echocardiography laboratory. The comparison of the results obtained by the two methods is inevitable. The cardiac sonographer should have a basic understanding of the theory and pitfalls of the Gorlin formula so that when conflicting results are obtained, the possible reasons why will be clear.
.A
Reynolds T.
.I 274290
.U
91000710
.S
J Am Soc Echocardiogr 9101; 3(4):336-46
.M
Aneurysm, Dissecting/US; Aorta, Abdominal/*US; Aortic Aneurysm/US; Aortic Diseases/*US; Blood Vessel Prosthesis; Echocardiography/*; Human.
.T
The evaluation of the abdominal aorta: a "how-to" for cardiac sonographers.
.P
JOURNAL ARTICLE.
.W
A thorough evaluation of the abdominal aorta can be readily achieved by use of the standard views of the echocardiographic examination. The ultrasound evaluation of the abdominal aorta represents a logical extension of the standard echocardiographic examination of the adult patient. This article provides the information needed to carry out a complete ultrasound examination of the abdominal aorta including the anatomy, the vascular disease, and the steps involved in accomplishing the ultrasound examination of the abdominal aorta.
.A
Reynolds T; Santos T; Weidemann J; Langenfeld K; Warner MG.
.I 274291
.U
91001032
.S
Br Heart J 9101; 64(3):174-6
.M
Adult; Arrhythmia/PC/PP; Electrocardiography/*; Human; Myocardial Infarction/*DT/PP; Risk Factors; Thrombolytic Therapy/*.
.T
Late potentials as predictors of risk after thrombolytic treatment? [published erratum appears in Br Heart J 1991 Feb;65(2):113]
.P
JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL.
.A
Breithardt G; Borggrefe M; Karbenn U.
.I 274292
.U
91001034
.S
Br Heart J 9101; 64(3):182-5
.M
Adult; Age Factors; Aged; Aged, 80 and over; Aspartate Aminotransferase/BL; Creatine Kinase/BL; Electrocardiography; Female; Heart Enlargement/ET; Human; Lactate Dehydrogenase/BL; Logistic Models; Male; Middle Age; Multivariate Analysis; Myocardial Infarction/CO/EN/*MO/PP; Prognosis; Prospective Studies; Risk Factors; Stroke Volume.
.T
Multivariate analysis in the prediction of death in hospital after acute myocardial infarction.
.P
JOURNAL ARTICLE.
.W
Prognostic factors in patients with acute myocardial infarction based on clinical and investigative data on admission were evaluated prospectively in 111 consecutive patients. Seventeen patients (15.3%) died during hospital stay. Age, a previous infarct, high Killip class, cardiomegaly, high serum concentrations of cardiac enzymes, a low ejection fraction, and a high wall motion score index correlated significantly with in-hospital mortality; whereas sex, risk factors, and pericardial effusion did not. Multivariate analysis showed that age and the wall motion score index were the best predictors of death in hospital. Wall motion detected by cross sectional echocardiography may reflect the extent of myocardial involvement. Age and wall motion score index predicted in-hospital mortality with a sensitivity of 76.5%, a specificity of 91.5%, and a predictive accuracy of 89.2%. Age and the wall motion score index can be determined on admission and are useful for identifying patients at high risk of cardiac death who might benefit from early intervention.
.A
Sahasakul Y; Chaithiraphan S; Panchavinnin P; Jootar P; Thongtang V; Srivanasont N; Charoenchob N; Kangkagate C.
.I 274293
.U
91001035
.S
Br Heart J 9101; 64(3):186-9
.M
Adrenergic Beta Receptor Agonists/*TU; Adult; Aged; Comparative Study; Double-Blind Method; Exercise; Female; Heart Failure, Congestive/*DT/PP; Heart Rate; Human; Male; Middle Age; Propanolamines/*TU; Stroke Volume; Time Factors.
.T
Ischaemic left ventricular failure: evidence of sustained benefit after 18 months' treatment with xamoterol.
.P
JOURNAL ARTICLE.
.W
The long term effects of treatment with xamoterol in 14 patients aged 44-73 with mild to moderate heart failure as a result of ischaemic heart disease are reported. After 18 months' treatment with xamoterol, patients were assessed in a randomised double blind crossover comparison of xamoterol (200 mg twice a day) and placebo, each given for one month. Compared with placebo, xamoterol significantly increased exercise duration and work done on a bicycle ergometer and reduced the maximum exercise heart rate. Assessment of symptoms and activities at 12 months by visual analogue and Likert scales showed a trend towards the relief of symptoms of breathlessness and tiredness and an improvement in activity. There was an improvement in the clinical signs of heart failure and no haemodynamic deterioration over a 12 month period as assessed by ejection fraction. The improvement in exercise tolerance, symptoms, and activities was sustained for 18 months without side effects or development of tolerance.
.A
Vigholt-Sorensen E; Faergeman O.
.I 274294
.U
91001036
.S
Br Heart J 9101; 64(3):190-4
.M
Adult; Aged; Carcinoid Heart Disease/DI/PA/*US; Echocardiography, Doppler/*; Female; Human; Male; Middle Age; Mitral Valve/PA; Myocardium/PA; Prospective Studies; Support, Non-U.S. Gov't; Tricuspid Valve/PA; Tricuspid Valve Insufficiency/DI/US.
.T
Transoesophageal echocardiography improves the diagnostic value of cardiac ultrasound in patients with carcinoid heart disease.
.P
JOURNAL ARTICLE.
.W
Transthoracic and transoesophageal cardiac echocardiography and Doppler investigations were performed in 31 consecutive patients with malignant midgut carcinoid tumours. The transoesophageal images allowed measurement of the thickness of the atrioventricular valve leaflets and the superficial wall layers on the cavity side of both atria. The mean thickness of the anterior tricuspid leaflet was significantly greater than that of the mitral valve--a difference not seen in a control group of age-matched patients without carcinoid tumours and with normal cardiac ultrasound findings. In addition, the edges of the tricuspid leaflets were thickened giving them a clubbed appearance. Tricuspid incompetence was detected transoesophageally in 71% of the patients with carcinoid compared with 57% by transthoracic investigation. The inner layer of the right atrial wall in the carcinoid patients was significantly thicker than that of the left atrium and that of both atria in the controls. Furthermore, patients with other signs of severe carcinoid heart disease had significantly thicker mean right atrial luminal wall layer than those with less or no signs of right heart disease. Transoesophageal cardiac ultrasound investigation improved the diagnostic accuracy and seemed to show the structural changes typical of carcinoid heart disease established by histopathological investigations.
.A
Lundin L; Landelius J; Andren B; Oberg K.
.I 274295
.U
91001037
.S
Br Heart J 9101; 64(3):195-8
.M
Adult; Aortic Rupture/CO/*US; Echocardiography/*; Echocardiography, Doppler; Female; Heart Catheterization; Heart Septal Defects, Ventricular/CO/DI; Human; Male; Sinus of Valsalva/*.
.T
Echocardiographic diagnosis of a ruptured aneurysm of the sinus of Valsalva: operation without catheterisation in seven patients.
.P
JOURNAL ARTICLE.
.W
A ruptured aneurysm of the sinus of Valsalva was diagnosed by Doppler, colour, and cross sectional echocardiography in a consecutive series of seven patients. The diagnoses were confirmed at operation without cardiac catheterisation. Examination by pulsed and continuous Doppler echocardiography showed continuous turbulence in six patients with aneurysms rupturing into the right ventricular outflow tract and in the patient with rupture of an aneurysm of the non-coronary sinus into the right atrium. Colour Doppler echocardiography showed turbulent flow across the defects in all seven patients. A ventricular septal defect with aortic regurgitation was detected in one patient and an associated ventricular septal defect in another. Doppler, colour, and cross sectional echocardiography were useful non-invasive techniques for diagnosing a ruptured aneurysm of the sinus of Valsalva without the need for cardiac catheterisation.
.A
Sahasakul Y; Panchavinnin P; Chaithiraphan S; Sakiyalak P.
.I 274296
.U
91001038
.S
Br Heart J 9101; 64(3):199-203
.M
Adult; Alcohol Drinking; Blood Pressure; Cholesterol/BL; Cluster Analysis; Coronary Disease/BL/*EP/PP; Cross-Sectional Studies; Diet; Female; Human; Lipoproteins, HDL Cholesterol/BL; Male; Middle Age; Risk Factors; Scotland/EP; Smoking/AE; Socioeconomic Factors; Support, Non-U.S. Gov't.
.T
Geographical clustering of risk factors and lifestyle for coronary heart disease in the Scottish Heart Health Study.
.P
JOURNAL ARTICLE.
.W
A large cross sectional study, the Scottish Heart Health Study, of 10,359 men and women from 22 districts of Scotland was undertaken to try to explain the geographical variation of coronary heart disease mortality. Analysis by district showed that of the classic risk factors only cigarette smoking was strongly associated with heart disease mortality among both men and women. Mean diastolic blood pressure was weakly associated with rates among men and high density lipoprotein cholesterol showed a strong negative association among women. Total cholesterol showed a weak negative association with heart disease mortality, but, because the serum concentrations of cholesterol were uniformly high in all districts, a strong association with mortality would not be expected. In both men and women many dietary factors showed moderate or strong associations with mortality from coronary heart disease in a district--of these a low consumption of vitamin C was most notable. Other factors associated with heart disease included alcohol consumption and serum triglycerides among men, and obesity, physical activity, and serum triglycerides among women. Many factors associated with heart disease showed strong intercorrelations. Clustering of risk factors (including smoking, alcohol, and diet among men, and smoking, diet, and obesity among women) was associated with much of the regional variation in heart disease mortality in Scotland.
.A
Crombie IK; Smith WC; Tavendale R; Tunstall-Pedoe H.
.I 274297
.U
91001039
.S
Br Heart J 9101; 64(3):204-5
.M
Aortic Valve; Aortic Valve Insufficiency/ET/*SU; Arthritis, Infectious/CO; Case Report; Endocarditis, Bacterial/*CO; Female; Heart Valve Prosthesis/*; Human; Infant, Newborn; Staphylococcal Infections/CO.
.T
Replacement of an aortic valve cusp after neonatal endocarditis.
.P
JOURNAL ARTICLE.
.W
Septic arthritis developed in a neonate after an infection of her hand. Despite medical and surgical treatment endocarditis of her aortic valve developed and the resultant regurgitation required emergency surgery. At operation a new valve cusp was fashioned from preserved calf pericardium. Nine years later she was well and had full exercise tolerance with minimal aortic regurgitation.
.A
Tulloh RM; Silove ED; Abrams LD.
.I 274298
.U
91001040
.S
Br Heart J 9101; 64(3):206-7
.M
Adult; Cardiac Tamponade/*CO/TH; Case Report; Drainage; Human; Hyponatremia/*ET; Inappropriate ADH Syndrome/*CO; Male; Paraplegia/CO; Pulmonary Embolism/PC; Warfarin/TU.
.T
Hyponatraemia secondary to an inappropriately high release of antidiuretic hormone in cardiac tamponade.
.P
JOURNAL ARTICLE.
.W
A spontaneous intrapericardial haemorrhage caused cardiac tamponade in a 29 year old paraplegic man who was being treated with warfarin. The associated persistent hyponatraemia, which was believed to be caused by an inappropriately high release of antidiuretic hormone, rapidly resolved after pericardiocentesis.
.A
Groves PH; Shah AM; Hutchison SJ.
.I 274299
.U
91001041
.S
Br Heart J 9101; 64(3):208-10
.M
Aged; Case Report; Coronary Vessel Anomalies/CO/*SU/US; Death, Sudden/*ET; Echocardiography; Human; Male; Mitral Valve Prolapse/CO/SU; Resuscitation.
.T
Aberrant origin of the right coronary artery as a potential cause of sudden death: successful anatomical correction.
.P
JOURNAL ARTICLE.
.W
A man with an aberrant right coronary artery and haemodynamically important prolapse of the mitral valve was successfully resuscitated. The aberrant right coronary artery was thought to be a possible cause of the cardiopulmonary arrest in this patient. Both lesions were corrected at a single operation.
.A
Nelson-Piercy C; Rickards AF; Yacoub MH.
.I 274300
.U
91001042
.S
Br Heart J 9101; 64(3):211-3
.M
Angina Pectoris/ET; Coronary Vessels/*RA; Female; Heart Arrest/ET; Heart Catheterization/AE/*IS; Human; Male; Middle Age.
.T
Cardiac catheterisation with 5 French catheters.
.P
JOURNAL ARTICLE.
.W
From the beginning of November 1987 to the end of January 1989, 526 coronary arteriograms and left ventricular angiograms were performed with 5 French coronary catheters. In 448 (85%) patients diagnostic pictures were obtained with three standard types of 5 French catheters (No 4 Judkins): that is, left coronary, right coronary, and pigtail catheters. In 60 patients (11.4%) various other 5 French catheters were required to complete the study. In nine patients (1.7%), a 7 or 8 French catheter was used. Major complications causing cardiac arrest or requiring urgent operation developed in five patients. Sixty two patients (11.77%) had minor complications that required sublingual nitrates or a single bolus of atropine, or developed a haematoma that did not need intervention or had a mild reaction to the contrast material. Complications of moderate severity developed in 17 patients (3.2%): severe chest pain, arrhythmia requiring a temporary pacemaker, contrast reaction associated with hypotension, haematoma requiring blood transfusion, or a transient ischaemic episode. There were no deaths. 5 French catheters were used for routine coronary angiography and left ventriculography in 98.3% of patients. There were no major complications related to femoral artery puncture. The routine use of 5 French coronary catheters should increase the feasibility of safe coronary angiography in outpatients and should reduce the cost of this investigation.
.A
O'Sullivan JJ; McDonald K; Crean PA; Walsh MJ; McCarthy C; Erwin RJ; Maurer BJ.
.I 274301
.U
91001043
.S
Br Heart J 9101; 64(3):214-8
.M
Adolescence; Adult; Aged; Cardiomyopathy, Congestive/PP/US; Child; Comparative Study; Echocardiography/*; Echocardiography, Doppler/*; Female; Heart Enlargement/PP/US; Human; Male; Middle Age; Mitral Valve/PP/US; Mitral Valve Stenosis/PP/US; Myocardial Infarction/PP/*US; Phonocardiography; Time Factors.
.T
Discrepancies in the measurement of isovolumic relaxation time: a study comparing M mode and Doppler echocardiography.
.P
JOURNAL ARTICLE.
.W
Mitral valve cusp separation on M mode echogram, the mitral valve opening artefact, and the onset of forward transmitral flow recorded by Doppler echocardiography have all been taken to mark the end of isovolumic relaxation, while its onset has been taken either as the aortic closure sound (A2) recorded phonocardiographically or the aortic closure artefact determined by Doppler technique. Possible differences in the measurement of the isovolumic relaxation time were studied when these landmarks were used in 44 healthy people, 14 patients with mitral stenosis, 21 patients with left ventricular hypertrophy, and 24 patients with dilated cardiomyopathy by recording M mode echograms of the mitral valve, and pulsed and continuous wave Doppler spectra of transmitral flow, with simultaneous electrocardiograms and phonocardiograms. A2 was effectively synchronous with the aortic artefact. However, when the onset of Doppler flow was regarded as the end of isovolumic relaxation, the interval was significantly longer than when mitral cusp separation on M mode echograms was used: by 25 (10) ms in healthy individuals, by 25 (15) ms in patients with left ventricular hypertrophy, and by 50 (35) ms in patients with dilated cardiomyopathy. In patients with mitral stenosis the interval was only 5 (5) ms longer. The mitral valve opening artefact consistently followed the onset of flow and corresponded much more closely to the E point on the M mode echogram. This shows that it occurred during the rapid filling period and well beyond isovolumic relaxation by any definition. Thus isovolumic relaxation time measured from A2 to the onset of transmitral flow or the mitral valve opening artefact differs from that derived from A2 to mitral valve cusp separation. These intervals cannot be used interchangeably to measure "isovolumic relaxation time".
.A
Lee CH; Vancheri F; Josen MS; Gibson DG.
.I 274302
.U
91001044
.S
Br Heart J 9101; 64(3):219-22
.M
Aged; Cardiology/*/EC; Great Britain; Health Care Rationing/*EC; Health Resources/SD; Heart Surgery/EC; Human; State Medicine.
.T
Can rationing of cardiological services be rational?
.P
JOURNAL ARTICLE.
.A
Chamberlain D; Alderslade R.
.I 274303
.U
91001045
.S
Br Heart J 9101; 64(3):223-6
.M
Correspondence; Electrocardiography/HI; England; Germany; History of Medicine, 20th Cent.; Netherlands; Physiology/*HI; USSR.
.T
The last portrait of Willem Einthoven: newly discovered links between Sir Thomas Lewis and Alexander Samojloff.
.P
HISTORICAL ARTICLE; HISTORICAL BIOGRAPHY; JOURNAL ARTICLE.
.A
Krikler DM; Hollman A.
.I 274304
.U
91001046
.S
Br Heart J 9101; 64(3):227
.M
Human; Middle Age; Myocardial Infarction/*MO; Risk Factors; Systole/PH; Time Factors.
.T
Estimation of the risk of death after acute myocardial infarction from systolic time intervals [letter; comment]
.P
COMMENT; LETTER.
.A
Weissler AM.
.I 274305
.U
91002375
.S
Br J Dermatol 9101; 123(3):283-9
.M
Administration, Topical; Adolescence; Adult; Epidermis/*DE/ME; Human; Immunoblotting; Immunoenzyme Techniques; Interleukin-1/*ME; Middle Age; Protein Precursors/ME; Support, Non-U.S. Gov't; Tretinoin/AD/*PD.
.T
Effect of topical retinoic acid on the interleukin 1 alpha and beta immunoreactive pool in normal human epidermis.
.P
JOURNAL ARTICLE.
.W
The topical application of 0.1% retinoic acid (RA) on human skin over a period of 4 days, whether or not under occlusion, did not increase either IL-1 alpha or beta immunoreactivity as determined by a sensitive enzymoimmunoassay. No down modulation was seen following the application of a potent topical corticosteroid. Occlusion increased the yield of IL-1 beta immunoreactivity. Immunoblot patterns of epidermal extracts revealed both the mature form of IL-1 (17 kDa) and the precursor (36 kDa) and were identical in amounts whether the specimens were from controls or from RA- or corticosteroid-treated skin. There was a slight modification in the pattern of high molecular weight proteins (52 kDa) probed by the anti-IL-1 alpha and beta sera. It appears that the IL-1 epidermal immunoreactive pools are barely amenable to modulation because they represent a storage form linked to end-stages of keratinocyte differentiation.
.A
Gruaz DC; Didierjean L; Gumowski-Sunek D; Saurat JH.
.I 274306
.U
91002376
.S
Br J Dermatol 9101; 123(3):291-5
.M
Adult; Aged; Antibodies, Monoclonal/ME; Betamethasone/*TU; Calcitriol/*AA/TU; Comparative Study; Double-Blind Method; DNA/*AN; Female; Fluorescent Antibody Technique; Human; Keratin/IM/*ME; Male; Middle Age; Psoriasis/*DT/ME; Skin/ME.
.T
DNA content and Ks8.12 binding of the psoriatic lesion during treatment with the vitamin D3 analogue MC903 and betamethasone.
.P
CLINICAL TRIAL; JOURNAL ARTICLE.
.W
Twenty patients with psoriasis were treated with the vitamin D3 analogue MC903 and betamethasone ointment in a double-blind trial with a left-right comparison. In addition to the clinical severity scores, Ks8.12 binding which detects keratin 16 expression and the DNA synthesis were quantified using flow cytometry. Both markers decreased significantly with treatment, but remained above the normal range even in those who had total clearance of the lesions. Treatment with MC903 with regard to Ks8.12 binding was significantly better than with betamethasone.
.A
de Mare S; de Jong EG; van de Kerkhof PC.
.I 274307
.U
91002377
.S
Br J Dermatol 9101; 123(3):297-304
.M
Adult; Aged; Aged, 80 and over; Cell Movement/DE; Cytokines/*AN; Exudates and Transudates/*IM; Female; Human; Interleukin-1/*AN/PD; Interleukin-6/*AN; Lymphocytes/DE; Male; Middle Age; Mycosis Fungoides/*IM; Skin Neoplasms/*IM; Support, Non-U.S. Gov't.
.T
Skin exudate levels of interleukin 6, interleukin 1 and other cytokines in mycosis fungoides.
.P
JOURNAL ARTICLE.
.W
The role of locally released cytokines in inducing lymphocyte activation and infiltration in the skin lesions of mycosis fungoides has been investigated. The levels of selected cytokines were measured in chamber fluid samples from lesional and control skin. Biologically active interleukin 6 was significantly elevated in lesional samples and a recombinant form of this cytokine was shown to induce lymphocyte migration in an in vitro assay. Biologically active interleukin 1 was detected in all control chamber fluid samples. Significantly reduced levels of this cytokine were present in lesional samples, which may be the result of the release of preformed material. Interleukin 2 and tumour necrosis factor activity, and gamma interferon and granulocyte macrophage colony-stimulating factor immunoreactivity, were not detectable in any of the samples. Interleukins 1 and 6 may play a role in the pathogenesis of the lesional lymphocyte infiltrates in mycosis fungoides.
.A
Lawlor F; Smith NP; Camp RD; Bacon KB; Black AK; Greaves MW; Gearing AJ.
.I 274308
.U
91002378
.S
Br J Dermatol 9101; 123(3):305-12
.M
Adult; Aged; Arthritis, Rheumatoid/DT/PA; Drug Administration Schedule; Elastic Tissue/*DE/PA; Female; Human; Joints/DE; Male; Middle Age; Penicillamine/AD/*AE/TU; Prevalence; Pseudoxanthoma Elasticum/CI/PA; Skin/DE/PA.
.T
Elastic fibre damage induced by low-dose D-penicillamine.
.P
JOURNAL ARTICLE.
.W
We have studied 23 patients receiving penicillamine for the treatment of rheumatoid arthritis to determine the prevalence of penicillamine-induced elastosis. One female patient had pseudoxanthoma elasticum-like skin changes and bramble-bush elastosis without calcification in the involved skin. Penicillamine elastosis was present in the joint capsule in 62% of eight patients or 64% of II joints examined and was detected in joint capsules after as little as I year of treatment.
.A
Dalziel KL; Burge SM; Frith PA; Ryan TJ; Mowat A.
.I 274309
.U
91002379
.S
Br J Dermatol 9101; 123(3):313-8
.M
Basement Membrane; Cell Movement/PH; Chemotaxis/PH; Connective Tissue; Fibroblasts/CY; Human; Male; Neoplasm Invasiveness; Sarcoma, Kaposi's/*PA; Skin Neoplasms/*PA; Support, Non-U.S. Gov't; Tumor Cells, Cultured/DE/PA; Tumor Necrosis Factor/PD.
.T
Invasive migration of epidemic Kaposi's sarcoma cells in vitro.
.P
JOURNAL ARTICLE.
.W
Kaposi's sarcoma (KS) is a low grade malignant neoplasm which shows invasive growth and often occurs in immunosuppressed patients with the Acquired Immune Deficiency Syndrome (AIDS; epidemic KS). It is also found in elderly men where it is usually limited to the skin (classic KS). The present study investigated the chemotaxis and invasive migration of epidemic KS cells in vitro and compared them to cells grown from classic KS lesions and to fibroblasts. Epidemic KS cells demonstrated invasive migration through reconstituted basement membrane (Matrigel) as well as through interstitial connective tissue (collagen I) in early passages, whereas fibroblasts did not invade either barrier. Epidemic KS cells in late passages did not show any invasive migration. Following pretreatment with tumour necrosis factor alpha (TNF-alpha) there was no enhanced migration through the Matrigel and collagen I for epidemic KS cells, whereas classic KS cells showed an increased migration through the type I collagen barrier.
.A
Schirren CG; Roth WK; Hein R; Werner S; Krieg T; Braun-Falco O.
.I 274310
.U
91002380
.S
Br J Dermatol 9101; 123(3):319-23
.M
Adult; Aged; Comparative Study; Female; Human; Male; Middle Age; Neutrophils/*CH; Psoriasis/BL/*ME; Seborrhea/BL/*ME; Support, Non-U.S. Gov't; Zinc/*AN/BL.
.T
Neutrophil zinc levels in psoriasis and seborrhoeic dermatitis.
.P
JOURNAL ARTICLE.
.W
The median zinc content of neutrophils was significantly reduced in 16 patients with psoriasis in comparison to both normal controls and six patients with seborrhoeic dermatitis (P less than 0.05). This reduction was unrelated to the extent of skin involvement. Plasma and erythrocyte zinc levels were unchanged.
.A
Leung RS; Turnbull AJ; Taylor JA; Russell-Jones R; Thompson RP.
.I 274311
.U
91002381
.S
Br J Dermatol 9101; 123(3):325-31
.M
Culture Media; Dermatitis, Atopic/IM; Human; Immunity, Cellular/IM; Leukocyte Culture Test, Mixed/*; Psoriasis/*IM; Support, Non-U.S. Gov't; T-Lymphocytes/*IM.
.T
Autologous mixed lymphocyte reaction is reduced in patients with psoriasis.
.P
JOURNAL ARTICLE.
.W
The autologous mixed lymphocyte reaction (auto-MLR) was studied to test the interactions between immunocompetent cells in patients with psoriasis. The auto-MLR in 20 patients with psoriasis was significantly lower than in 16 normal controls. Lower values were found in untreated psoriatic patients than in those in remission following treatment. The values in the latter group were significantly lower than in controls and in six patients with atopic dermatitis in remission. The tendency for an increase in the auto-MLR with a decrease in disease activity was further confirmed in five patients studied before and after treatment. In contrast, the allogeneic lymphocyte reaction (allo-MLR) in psoriatics was similar to that in normal controls.
.A
Terui T; Rokugo M; Aiba S; Kato T; Tagami H.
.I 274312
.U
91002383
.S
Br J Dermatol 9101; 123(3):339-46
.M
Cell Division/DE; Collagen/BI; Depression, Chemical; Fibroblasts/DE/ME; Fibronectins/BI; Glycosaminoglycans/BI; Human; Keloid/ME; Pentoxifylline/*PD; Scleroderma, Circumscribed/ME; Scleroderma, Systemic/ME; Skin/*DE/ME; Skin Diseases/*ME; Support, U.S. Gov't, Non-P.H.S..
.T
Pentoxifylline inhibits the proliferation of human fibroblasts derived from keloid, scleroderma and morphoea skin and their production of collagen, glycosaminoglycans and fibronectin.
.P
JOURNAL ARTICLE.
.W
Pentoxifylline, an analogue of the methylxanthine theobromine, inhibits the proliferation and certain biosynthetic activities of fibroblasts derived from normal human skin. Fibroblasts from the skin of patients with keloids, scleroderma and morphoea were cultured in vitro in the presence and absence of pentoxifylline (100-1000 micrograms/ml) to determine whether it inhibits fibroblast proliferation and the production of collagen, glycosaminoglycans (GAG), fibronectin and collagenase activity. The exposure of subconfluent fibroblast cultures to pentoxifylline resulted in non-lethal, dose-dependent reductions in serum-driven fibroblast proliferation, with 1000 micrograms/ml pentoxifylline virtually negating the proliferative effect of serum on the cells. The fibroblasts assayed as confluent cultures produced reduced amounts, by up to 95%, of collagen and GAG, dependent on the concentration of pentoxifylline, both in the presence and absence of serum. Pentoxifylline similarly inhibited the fibronectin production by keloid and scleroderma fibroblasts, but had no effect on collagenase activity.
.A
Berman B; Duncan MR.
.I 274313
.U
91002384
.S
Br J Dermatol 9101; 123(3):347-53
.M
Alkaline Phosphatase/BL; Creatinine/BL; Cyclosporins/AD/*AE; Dose-Response Relationship, Drug; Drug Administration Schedule; Human; Hypertension/*CI; Kidney/*DE; Middle Age; Psoriasis/BL/*DT/EN; Time Factors.
.T
Analysis of side-effects of medium- and low-dose cyclosporin maintenance therapy in psoriasis.
.P
JOURNAL ARTICLE.
.W
The side-effects of long-term cyclosporin A (CyA) treatment in 26 patients with severe psoriasis were evaluated. These patients had a mean PASI score of 30.2 and were treated with CyA for between 7 and 37 months (mean 19.5 months). There were three groups according to the dose of CyA, less than 2 mg/kg per day, 2-3 mg/kg per day and greater than 3 mg/kg per day. In all three groups, CyA was found to be equally effective. Treatment with CyA was discontinued in 12 of the 26 patients because of nephrotoxicity and/or development of hypertension. One was in the less than 2 mg/kg per day group, three were in the 2-3 mg/kg per day group and eight in the greater than 3 mg/kg per day group. There was no hepatotoxicity with CyA treatment. One patient developed two squamous cell carcinomas of the skin.
.A
de Rie MA; Meinardi MM; Bos JD.
.I 274314
.U
91002386
.S
Br J Dermatol 9101; 123(3):365-73
.M
Adult; Female; Human; Male; Nails/AH/*US; Ultrasonics; Water/*.
.T
Ultrasound velocity in human fingernail and effects of hydration: validation of in vivo nail thickness measurement techniques.
.P
JOURNAL ARTICLE.
.W
Distal nail thickness was measured using an electronic micrometer and both distal and proximal nail ultrasound times were recorded in 20 volunteers (10 male, 10 female), aged 20-39. The fingernail ultrasound velocity was 2.26 X 10(3) m/s (subject range 2.03-2.69) (analysis of variance technique). The proximal ultrasound transit time was greater than distal ultrasound transit time. In three volunteers, five micrometer and one distal midline ultrasound measurement of five nails were repeated on 10 occasions over 2 weeks. For the micrometer readings the average coefficient of variation was 5.3% (SD +/- 2.4%), and for the ultrasound reading the average coefficient of variation was 4.0% (SD +/- 1.3%). To assess the influence of hydration, in five volunteers the distal nail micrometer thickness and the distal nail ultrasound transit time were measured on five nails before and after 30 min of immersion in water initially at 37 degrees C. The mean distal ultrasound transmission time increased from 0.20 +/- 0.04 microseconds to 0.22 +/- 0.04 microseconds (P less than 0.001) after water immersion. The micrometer measurements and ultrasound velocity did not change significantly (mean ultrasound velocity = 2.01 X 10(3) m/s before, 2.04 X 10(3) m/s after immersion).
.A
Finlay AY; Western B; Edwards C.
.I 274315
.U
91002388
.S
Br J Dermatol 9101; 123(3):381-7
.M
Adult; Arginine/*AD/TU; Feces/CH; Female; Heme/*AD/TU; Human; Infusions, Intravenous; Photosensitivity Disorders/DT; Porphyria/BL/*DT; Protoporphyrins/AN/BL; Skin/DE; Skin Diseases/*DT; Support, Non-U.S. Gov't.
.T
Effects of haem arginate on variegate porphyria.
.P
JOURNAL ARTICLE.
.W
Four patients with variegate porphyria (VP) were treated with repeated haem arginate infusions daily for 4 days and then weekly for 4 weeks. After the initial four daily doses of haem arginate (haem 3 mg/kg), the excretion of faecal protoporphyrin (mean 579 nmol/g dry wt) fell to an almost normal level (mean 123 nmol/g dry wt), and that of coproporphyrin (mean 162 nmol/g dry wt) to the normal level (mean 21 nmol/g dry wt) in all patients. However, during the period of the four weekly infusions of haem the excretion of porphyrins increased almost to the pretreatment level. Phototesting showed no changes in the photoreactivity of the skin, and no improvement in skin lesions was seen during the treatment. Except for one case of thrombophlebitis no side-effects occurred. In a child with homozygous VP, four daily infusions of haem arginate (2 mg/kg) normalized the faecal protoporphyrin content, but had no effect on the increased erythrocyte protoporphyrin concentration.
.A
Timonen K; Mustajoki P; Tenhunen R; Lauharanta J.
.I 274316
.U
91002389
.S
Br J Dermatol 9101; 123(3):389-93
.M
Case Report; Drug Therapy, Combination; Gangrene; Human; Injections, Intravenous; Male; Mezlocillin/*AD/TU; Middle Age; Pyoderma/*DT; Vancomycin/*AD/TU.
.T
Successful treatment of eruptive pyoderma gangrenosum with intravenous vancomycin and mezlocillin.
.P
JOURNAL ARTICLE.
.A
Kang S; Dover JS.
.I 274317
.U
91002390
.S
Br J Dermatol 9101; 123(3):395-401
.M
Adult; Case Report; Female; Gangrene; Human; Male; Metabolism, Inborn Errors/*PA; Receptors, Leukocyte-Adhesion/*DF; Skin/PA; Skin Ulcer/*ME/PA.
.T
Skin manifestations in congenital deficiency of leucocyte-adherence glycoproteins (CDLG).
.P
JOURNAL ARTICLE.
.W
In congenital deficiency of leucocyte-adherence glycoproteins (CDLG) there is an immunodeficiency with impaired leucocyte function and cutaneous and extracutaneous infections occur. In more than 30% of cases the condition has a fatal course. We report the skin manifestations of three siblings with CDLG in which areas of skin necrosis occurred that resembled pyoderma gangrenosum.
.A
van de Kerkhof PC; Weemaes CM.
.I 274318
.U
91002391
.S
Br J Dermatol 9101; 123(3):403-7
.M
Adolescence; Argyria/*ET/PA; Case Report; Female; Foreign Bodies/*CO; Human; Skin/*PA/UL.
.T
An unusual case of acquired localized argyria.
.P
JOURNAL ARTICLE.
.W
We report an unusual cause of localized cutaneous argyria, due to the cutaneous implantation of a silver earring back.
.A
Shall L; Stevens A; Millard LG.
.I 274319
.U
91002392
.S
Br J Dermatol 9101; 123(3):409-12
.M
Case Report; Colon/PA; Crohn Disease/*CO/IM/PA; Female; Human; HLA Antigens/AN; Lip/PA; Melkersson-Rosenthal Syndrome/*CO/IM/PA; Middle Age; Rectum/PA.
.T
Granulomatous cheilitis and Crohn's disease.
.P
JOURNAL ARTICLE.
.A
Kano Y; Shiohara T; Yagita A; Nagashima M.
.I 274320
.U
91002393
.S
Br J Dermatol 9101; 123(3):413-4
.M
Adult; Case Report; Human; Male; Mucocutaneous Lymph Node Syndrome/*PA; Perineum/*PA; Skin/*PA.
.T
Kawasaki disease in a young adult with a perineal rash [letter]
.P
LETTER.
.A
Machet L; Vaillant L; Goutal H; Lanternier G; Khallouf R; Chagnon JL; Lorette G.
.I 274321
.U
91002394
.S
Br J Dermatol 9101; 123(3):414-5
.M
Baths/AE; Case Report; Human; Male; Middle Age; Myelodysplastic Syndromes/*CO; Pruritus/*ET; Water/*AE.
.T
Aquagenic pruritus and the myelodysplastic syndrome [letter]
.P
LETTER.
.A
McGrath JA; Greaves MW.
.I 274322
.U
91002395
.S
Br J Dermatol 9101; 123(3):415-6
.M
Adult; Alopecia/DT; Case Report; Cyclopropanes/*AE; Human; Male; Vitiligo/*CI.
.T
Persistent vitiligo induced by diphencyprone [letter]
.P
LETTER.
.A
Duhra P; Foulds IS.
.I 274323
.U
91002875
.S
Blood 9101; 76(7):1267-8
.M
Bleomycins/TO/TU; Cyclophosphamide/TO/TU; Etoposide/TO/TU; Human; Lymphoma, Large-Cell, Diffuse/*DT/MO; Prednisone/TO/TU; Procarbazine/TO/TU.
.T
Salvage therapy for diffuse large-cell lymphoma [editorial]
.P
EDITORIAL.
.A
Chabner BA.
.I 274324
.U
91002876
.S
Blood 9101; 76(7):1269-80
.M
Human; Immunogenetics; Minor Histocompatibility Antigens/AN/*IM/PH; Support, Non-U.S. Gov't; Transplantation Immunology.
.T
Minor histocompatibility antigens.
.P
JOURNAL ARTICLE; REVIEW; REVIEW, ACADEMIC.
.A
Perreault C; Decary F; Brochu S; Gyger M; Belanger R; Roy D.
.I 274325
.U
91002877
.S
Blood 9101; 76(7):1281-6
.M
Antigens, Differentiation/*AN; Blood Cells/CH/MI; Bone Marrow/CH/CY/MI; Cell Count; DNA, Viral/AN; Hematopoietic Stem Cells/CH/*IM/MI; Human; HIV-1/GE/*IP; Polymerase Chain Reaction; Support, Non-U.S. Gov't.
.T
CD34+ hematopoietic progenitor cells are not a major reservoir of the human immunodeficiency virus.
.P
JOURNAL ARTICLE.
.W
Hematologic abnormalities occur in the majority of patients with acquired immunodeficiency syndrome (AIDS). Infection of the hematopoietic progenitor cells has been proposed as a potential explanation. In this study, different bone marrow cell populations, including the CD34+ hematopoietic progenitor cells, were purified by a fluorescence-activated cell sorter (FACS) and analyzed for the presence of human immunodeficiency virus-1 (HIV-1) proviral DNA using the polymerase chain reaction. A group of 14 patients with AIDS or AIDS-related complex (ARC) was studied (11 with peripheral blood cytopenias). The CD4+ helper cells in the bone marrow were found positive for HIV-1 DNA in all patients. In contrast, CD34+ progenitor cells were positive in only one patient. Two monocyte samples and two samples of CD4-/CD34- lymphocytes/blasts (mainly B and CD8 lymphocytes) were positive. Proviral DNA could not be detected in granulocytes. FACS analysis showed that the percentage of CD34+ hematopoietic progenitor cells was not altered in the bone marrow of AIDS patients in comparison with the HIV-1 seronegative controls. In contrast, the number of CD4+ lymphocytes was markedly reduced in the bone marrow of AIDS patients. These results show that the hematologic abnormalities in AIDS patients are neither explained by direct infection of the hematopoietic progenitor cells with HIV-1 nor by a depletion of progenitor cells.
.A
von Laer D; Hufert FT; Fenner TE; Schwander S; Dietrich M; Schmitz H; Kern P.
.I 274326
.U
91002878
.S
Blood 9101; 76(7):1287-92
.M
Adolescence; Adult; Anemia, Aplastic/*DT; Blood Cell Count/DE; Bone Marrow/DE; Drug Evaluation; Female; Hematopoiesis/DE; Human; Injections, Subcutaneous; Interleukin-3/AD/AE/*TU; Male; Middle Age; Recombinant Proteins/AD/AE/TU.
.T
Effects of recombinant human interleukin-3 in aplastic anemia.
.P
JOURNAL ARTICLE.
.W
In a phase I/II study, nine patients with aplastic anemia were treated with recombinant human interleukin-3 (rhIL-3) to assess the toxicity and biologic effects of this multipotential hematopoietic growth factor. Doses ranging from 250 micrograms/m2 to 500 micrograms/m2 were administered as subcutaneous bolus injections daily for 15 days. An increase in platelet counts from 1,000/microL to 31,000/microL was induced by rhIL-3 in one patient, and an increase in reticulocyte counts by more than 10,000/microL in four patients. The blood leukocyte counts temporarily increased in eight patients 1.5- to 3.3-fold (median, 1.8-fold), mainly due to an increase in the number of neutrophils, eosinophils, lymphocytes, and monocytes. In two patients, bone marrow cellularity increased from 7% to 33% and from 10% to 80%, respectively, but without resulting in a substantial improvement of peripheral blood counts. Mild side effects (headache and flushing) were observed in some patients, while low-grade fever occurred in all patients. Transient thrombocytopenia necessitating discontinuation of rhIL-3 treatment occurred in one patient. In conclusion, rhIL-3 can stimulate hematopoiesis in patients with aplastic anemia; however, no lasting effects were obtained.
.A
Ganser A; Lindemann A; Seipelt G; Ottmann OG; Eder M; Falk S; Herrmann F; Kaltwasser JP; Meusers P; Klausmann M; et al.
.I 274327
.U
91002879
.S
Blood 9101; 76(7):1293-8
.M
Adult; Aged; Aged, 80 and over; Antineoplastic Agents, Combined/AE/TO/*TU; Cyclophosphamide/AD; Etoposide/AD; Human; Injections, Intravenous; Lymphoma, Non-Hodgkin's/*DT/MO/PA; Middle Age; Prednisone/AD; Procarbazine/AD; Remission Induction; Support, U.S. Gov't, P.H.S..
.T
CEPP(B): an effective and well-tolerated regimen in poor-risk, aggressive non-Hodgkin's lymphoma.
.P
JOURNAL ARTICLE.
.W
Eighty-three patients with intermediate- or high-grade non-Hodgkin's lymphoma were treated with CEPP(B) (cyclophosphamide, etoposide [VP-16], procarbazine, and prednisone with or without bleomycin) chemotherapy at Stanford University Medical Center (Stanford, CA) from January 1982 through June 1989. Sixty-nine received CEPP(B) as second-line or subsequent therapy after relapse from previous combination chemotherapy, and 14 patients received CEPP(B) as first-line therapy. Of 75 patients evaluable for response, 30 patients (40%) achieved a complete response (CR) and 24 patients (32%) achieved a partial response (PR), providing an overall response rate of 72%. Complete responses were recorded on 21 of 61 (34%) patients with recurrent disease and 9 of the 14 patients who received CEPP(B) as first line therapy (64%). Myelosuppression was the major side effect of treatment, resulting in eight neutropenic-febrile episodes from a total of 253 courses. A single fatal toxic event occurred on a patient who developed adult respiratory distress syndrome. Overall, CEPP(B) was well-tolerated and proved to be effective palliative therapy for patients with non-Hodgkin's lymphoma after relapse. As such, CEPP(B) may be considered for cytoreduction before ablative therapy and bone marrow transplantation. CEPP(B) may also be considered for initial therapy in selected patients who cannot tolerate doxorubicin-containing regimens.
.A
Chao NJ; Rosenberg SA; Horning SJ.
.I 274328
.U
91002880
.S
Blood 9101; 76(7):1299-307
.M
Aged; Aged, 80 and over; Bone Marrow/DE/*PA; Cell Differentiation/DE; Cell Division/DE; Cells, Cultured; Comparative Study; Evaluation Studies; Female; Granulocyte Colony-Stimulating Factor/PD/TU; Granulocyte-Macrophage Colony-Stimulating Factor/PD/TU; Hematopoiesis/*DE; Human; Karyotyping; Male; Middle Age; Myelodysplastic Syndromes/DT/GE/*PA; Recombinant Proteins/PD/TU; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Impact of marrow cytogenetics and morphology on in vitro hematopoiesis in the myelodysplastic syndromes: comparison between recombinant human granulocyte colony-stimulating factor (CSF) and granulocyte-monocyte CSF.
.P
JOURNAL ARTICLE.
.W
Marrow cells from 36 patients with myelodysplastic syndromes (MDS) (13 refractory anemia [RA], 14 refractory anemia with excess of blasts [RAEB], 9 RAEB in transformation [RAEB-T]) were evaluated for their in vitro proliferative and differentiative responsiveness to recombinant human granulocyte colony-stimulating factor (G-CSF) or granulocyte-monocyte CSF (GM-CSF). GM-CSF exerted a stronger proliferative stimulus than G-CSF for marrow myeloid clonal growth (CFU-GM) in these patients (44 v 12 colonies per 10(5) nonadherent buoyant bone marrow cells [NAB], respectively, P less than .025). GM-CSF stimulated increased CFU-GM growth in the 16 patients with abnormal marrow cytogenetics in comparison with the 20 patients who had normal cytogenetics (52 and 30 colonies per 10(5) NAB, respectively, P less than .05), whereas no such difference could be demonstrated with G-CSF (11 and 16 colonies per 10(5) NAB, respectively). In contrast, granulocytic differentiation of marrow cells was induced in liquid culture by G-CSF in 15 of 32 (47% patients), while GM-CSF did so in only 4 of 18 (22%) patients (P less than .025) including, for RAEB/RAEB-T patients: 9 of 18 versus 0 of 9, respectively (P less than .025). For MDS patients with normal cytogenetics, G-CSF- and GM-CSF-induced marrow cell granulocytic differentiation in 12 of 18 (67%) versus 3 of 11 (27%), respectively (P less than .025), contrasted with granulocytic induction in only 3 of 14 (21%) and 1 of 7 (14%) patients with abnormal cytogenetics, respectively. We conclude that G-CSF has greater granulocytic differentiative and less proliferative activity for MDS marrow cells than GM-CSF in vitro, particularly for RAEB/RAEB-T patients and those with normal cytogenetics.
.A
Nagler A; Binet C; Mackichan ML; Negrin R; Bangs C; Donlon T; Greenberg P.
.I 274329
.U
91002881
.S
Blood 9101; 76(7):1308-14
.M
Animal; Bone Marrow/DE/ME/*UL; Cells, Cultured; Fibroblasts/DE/ME/*UL; Gene Expression; Human; Macrophage Colony-Stimulating Factor/*ME/PD; Macrophages/DE/ME/UL; Membrane Proteins/GE/ME/PH; Mice; Mice, Inbred BALB C; Protein Precursors/GE/*ME/PH; Receptor, Macrophage Colony-Stimulating Factor/GE/*ME/PH; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Direct stimulation of cells expressing receptors for macrophage colony-stimulating factor (CSF-1) by a plasma membrane-bound precursor of human CSF-1.
.P
JOURNAL ARTICLE.
.W
Secreted forms of macrophage colony-stimulating factor (M-CSF or CSF-1) are generated by proteolytic cleavage of membrane-bound glycoprotein precursors. Alternatively spliced transcripts of the human CSF-1 gene encode at least two different transmembrane precursors that are differentially processed in mammalian expression systems. The larger precursor rapidly undergoes proteolysis to yield the secreted growth factor and does not give rise to forms of CSF-1 detected on the cell surface. By contrast, the smaller human CSF-1 precursor is stably expressed on the plasma membrane where it is inefficiently cleaved to release a soluble molecule. To determine whether the smaller precursor is biologically active on the cell surface, mouse NIH-3T3 fibroblasts expressing the different forms of human CSF-1 were killed by chemical fixation and tested for their ability to support the proliferation of cells that require this growth factor. Only fixed cells expressing human CSF-1 precursors on their surface stimulated the growth in vitro of a murine macrophage cell line or normal mouse bone marrow-derived mononuclear phagocytes. The ability of these nonviable fibroblasts to induce the proliferation of CSF-1-dependent cells was not mediated by release of soluble growth factor, required direct contact with the target cells, and was blocked by neutralizing antiserum to CSF-1. These results demonstrate that the cell surface form of the human CSF-1 precursor is biologically active and indicate that plasma membrane-bound growth factors can functionally interact with receptor-bearing targets by direct cell-cell contact.
.A
Stein J; Borzillo GV; Rettenmier CW.
.I 274330
.U
91002882
.S
Blood 9101; 76(7):1315-22
.M
Animal; Bone Marrow/*CY/DE/ME; Cell Differentiation/DE; Cell Division/DE; Cell Line; Cells, Cultured; Granulocyte-Macrophage Colony-Stimulating Factor/*ME; Hematopoiesis/*DE; Hematopoietic Stem Cells/DE; Interleukin-1/PD; Interleukin-6/*ME; Leukemia, Myeloid/ME/*PA; Lipopolysaccharides/PD; Mice; Support, Non-U.S. Gov't; Transcription Factors/ME; Transforming Growth Factor beta/*PD.
.T
Selective regulation of the activity of different hematopoietic regulatory proteins by transforming growth factor beta 1 in normal and leukemic myeloid cells.
.P
JOURNAL ARTICLE.
.W
The viability of normal bone marrow myeloid precursor cells induced by interleukin-6 (IL-6) or IL-1 alpha and the ability of IL-6 and IL-1 alpha to induce the formation of colonies of granulocytes, macrophages, or megakaryocytes in densely seeded bone marrow cultures was suppressed by transforming growth factor-beta 1 (TGF-beta 1). Induction of normal bone marrow colony formation by IL-3 was much less sensitive to TGF-beta 1, and there was little or no effect of TGF-beta 1 on colony formation induced by macrophage colony-stimulating factor (M-CSF) or granulocyte-macrophage CSF (GM-CSF). In different clones of myeloid leukemic cells, TGF-beta 1 suppressed differentiation induced with IL-6, IL-1 alpha, or lipopolysaccharide (LPS), but did not suppress differentiation induced with IL-3 or GM-CSF. The effect of TGF-beta 1 on differentiation of the leukemic cells can be dissociated from its effect on cell growth. TGF-beta 1 suppressed the production of IL-6 in normal bone marrow cells cultured with IL-1 alpha and the production of IL-6 and GM-CSF in leukemic cells cultured with IL-1 alpha or LPS. The suppression of IL-6 production can explain the suppression by TGF-beta 1 of the effects of IL-1 alpha and LPS that are mediated by IL-6. TGF-beta 1 also suppressed differentiation in clones of myeloid leukemic cells induced with differentiation factor/leukemia inhibitory factor and tumor necrosis factor. In different leukemic clones TGF-beta 1 suppressed or enhanced induction of differentiation with dexamethasone. The results show that TGF-beta 1 can selectively control the activity of different molecular regulators of normal and leukemic hematopoiesis.
.A
Lotem J; Sachs L.
.I 274331
.U
91002883
.S
Blood 9101; 76(7):1323-9
.M
Antibodies, Monoclonal/DU/IM; Antibody Affinity/IM; Biological Assay/*MT; Comparative Study; Enzyme-Linked Immunosorbent Assay; Erythropoietin/AN/*BL/IM; Hematologic Diseases/BL; Human; Magnetics; Plasma/*CH; Radioimmunoassay; Spleen/CY; Support, Non-U.S. Gov't.
.T
A specific in vitro bioassay for measuring erythropoietin levels in human serum and plasma.
.P
JOURNAL ARTICLE.
.W
The accurate measurement of biologically active erythropoietin (Ep) in human serum and plasma using present in vivo and in vitro bioassays is difficult because of the presence of both inhibitors and non-Ep stimulators of erythropoiesis. We have developed a simple procedure to quantitatively purify Ep from serum and plasma for subsequent testing in the phenylhydrazine-treated mouse spleen cell assay. The method involves absorption of Ep to an immobilized high-affinity anti-Ep monoclonal antibody and acid elution of the antibody-bound material. After neutralization, the eluted EP is then tested directly in the in vitro bioassay without interference by other serum proteins. By using magnetic beads as a solid support for the antibody, washing and elution steps can be performed rapidly and efficiently. Recoveries of Ep after this procedure show very little sample-to-sample variation and are consistently between 45% and 55%, which is close to the maximum binding expected for the anti-Ep antibody. Coupled with the 7.4-fold concentration that this procedure affords, there is an overall increase in sensitivity of three- to fourfold, which makes this assay suitable for accurately measuring Ep levels in patients with below-average titers. Results with this magnetic bead assay indicate that accurate and reproducible estimates for Ep levels in the serum and plasma from healthy donors as well as from patients with hematologic disorders can be obtained. Titers of biologically active Ep in the sera from a group of patients with either leukemia or lymphoma were found to be elevated, and the values correlated well with titers of immunoreactive Ep measured in the Ep radioimmunoassay. Because of its specificity and high sensitivity, the magnetic bead assay is a valuable alternative to immunoassays for the measurement of elevated, normal, and even subnormal Ep levels in human serum and plasma.
.A
Wognum AW; Lam V; Goudsmit R; Krystal G.
.I 274332
.U
91002884
.S
Blood 9101; 76(7):1330-5
.M
Animal; Antibodies/IM/PD; Blast Crisis/*PA; Bone Marrow/CY; Cells, Cultured; Cholesterol/AN/PD; Culture Media/AN/PD; Dose-Response Relationship, Drug; Erythrocytes/*CY; Erythroid Progenitor Cells/DE; Erythropoiesis/DE; Erythropoietin/IM/*PD; Female; Hematopoiesis/DE; Hematopoietic Stem Cells/*DE; Lymphocyte Depletion; Megakaryocytes/*CY; Mice; Phosphatidylcholines/AN/PD; Recombinant Proteins/IM/PD; Support, Non-U.S. Gov't.
.T
Induction of mixed erythroid-megakaryocyte colonies and bipotential blast cell colonies by recombinant human erythropoietin in serum-free culture.
.P
JOURNAL ARTICLE.
.W
The effects of recombinant human erythropoietin (rEp) on murine hematopoietic progenitors were studied using a serum-free culture. A high concentration of rEp stimulated the formation of mixed erythroid-megakaryocyte colonies (EM colonies) and blast cell colonies, as well as erythroid colonies, erythroid bursts, and megakaryocyte colonies from normal mouse bone marrow cells. Direct effects of rEp on EM colony, megakaryocyte colony, and erythroid burst formation were confirmed by depletion of accessory cells such as T cells, B cells, and macrophages from crude bone marrow cells, and inhibition of the colonies by the addition of rabbit anti-rEp antibody to the culture in a dose-dependent fashion. Replating experiments were performed to confirm the differentiating ability of blast cell colonies grown in the presence of rEp. Most of the blast cell colonies yielded not only secondary erythroid colonies but also megakaryocyte colonies in the presence of 2 IU/mL rEp. Some of the blast cell colonies produced secondary EM colonies in the presence of 16 IU/ml rEp of 2 IU/mL rEp plus interleukin-3, although no granulocyte-macrophage colonies were found in the secondary culture. These results suggest that Ep acts not only as a late-acting factor that is specific for erythroid progenitors, but also as a bipotential EM-stimulating factor for murine hematopoietic cells.
.A
Nishi N; Nakahata T; Koike K; Takagi M; Naganuma K; Akabane T.
.I 274333
.U
91002885
.S
Blood 9101; 76(7):1336-40
.M
von Willebrand Factor/*ME/PH; Blood Platelets/CY/*PH; Cell Adhesion/DE/PH; Endothelium, Vascular/CY; Human; Platelet Adhesiveness/DE/PH; Platelet Membrane Glycoproteins/*ME/PH; Support, Non-U.S. Gov't; Uremia/*BL/ME/PP.
.T
Uremic platelets have a functional defect affecting the interaction of von Willebrand factor with glycoprotein IIb-IIIa.
.P
JOURNAL ARTICLE.
.W
Uremic patients have an impaired platelet function that has been related to membrane glycoprotein (GP) abnormalities. Using a perfusion system, we have studied the interaction of normal and uremic platelets with vessel subendothelium (SE) under flow conditions. Reconstituted blood containing washed platelets, purified von Willebrand factor (vWF) (1 U/mL), and normal washed red blood cells was exposed to de-endothelialized rabbit segments for 10 minutes at two different shear rates (800 and 1,600 seconds-1). In some experiments a monoclonal antibody to the GPIIb-IIIa complex (EDU3) was added to the perfusates. With normal platelets, the percentage of the vessel covered by platelets (%CS) was 23.1% +/- 3.7% at 800 seconds-1 and 30% +/- 4.3% at 1,600 seconds-1. Platelets were observed in contact or forming monolayers on vessel SE. EDU3 inhibited the spreading of normal platelets. The %CS (11.1% +/- 3.3%) was statistically decreased (P less than .01) and most of the platelets were observed in contact with the vessel surface. These data indicate that, under flow conditions, the interaction of vWF with GPIIb-IIIa can support the spreading of normal platelets in the absence of exogenous fibrinogen. Under the same experimental conditions, the interaction of uremic platelets with SE was markedly impaired at both shear rates studied (P less than .01 v normal platelets). The presence of EDU3 did not modify the interaction of uremic platelets. These results confirm the impairment of the platelet adhesion observed in uremic patients. Furthermore, they indicate the presence of a functional defect in the interaction of vWF with GPIIb-IIIa. The fact that perfusions with normal and uremic platelets in the presence of an antibody to the GPIIb-IIIa complex did not show any differences gives indirect evidence on a functionally normal interaction vWF/GPIb in uremic patients.
.A
Escolar G; Cases A; Bastida E; Garrido M; Lopez J; Revert L; Castillo R; Ordinas A.
.I 274334
.U
91002887
.S
Blood 9101; 76(7):1349-54
.M
Cells, Cultured; Human; Interleukin-2/PD; Killer Cells, Lymphokine-Activated/ME/*PA/PH; Leukemia, B-Cell, Chronic/ME/*PA/PP; Leukemia, Hairy Cell/ME/PA/PP; Leukemia, T-Cell, Chronic/ME/*PA/PP; Lymphoproliferative Disorders/ME/PA/PP; Support, Non-U.S. Gov't.
.T
Lymphokine-activated killer (LAK) cell activity in B and T chronic lymphoid leukemia: defective LAK generation and reduced susceptibility of the leukemic cells to allogeneic and autologous LAK effectors.
.P
JOURNAL ARTICLE.
.W
The capacity to generate lymphokine-activated killer (LAK) cells and the susceptibility of the neoplastic cells to both allogeneic and autologous LAK effectors were studied in B and T chronic lymphoproliferative disorders. While in B-cell chronic lymphocytic leukemia (B-CLL) the depressed natural killer function could be restored after a 7-day incubation with recombinant interleukin (IL-2), B-CLL mononuclear cells showed a reduced LAK activity compared with normal LAK cells. Furthermore, in all but 1 of the 20 B-CLL samples tested the leukemic cells were totally resistant to autologous LAK effectors. In most cases the leukemic cells were also resistant to normal allogeneic LAK cells. Competition experiments demonstrated that the patients' LAK cells, as well as normal LAK effectors, were capable of recognizing B-CLL cells, pointing, therefore, to a postbinding cytolytic defect. In hairy cell leukemia (HCL) an overall reduced LAK activity against allogeneic targets was documented, but, at variance from B-CLL, hairy cells were often susceptible to the lytic effect of normal LAK cells, and in half of the cases tested the neoplastic population was also sensitive in an autologous system. Similarly to B-CLL, in the great majority of T chronic lymphoproliferative disorders studied, the pathologic cells were resistant to normal and autologous LAK effectors and a defective LAK generation was found. These results demonstrate that in most B and T chronic leukemias the LAK function is defective and, when inducible, does not appear directed against the leukemic population. The possibility of exploiting an immunotherapeutic approach with IL-2/LAK cells in the management of chronic lymphoproliferative disorders does not gain support by these findings.
.A
Foa R; Fierro MT; Raspadori D; Bonferroni M; Cardona S; Guarini A; Tos AG; di Celle PF; Cesano A; Matera L.
.I 274335
.U
91002888
.S
Blood 9101; 76(7):1355-60
.M
Antigens, CD/IM; Antigens, Surface/IM; Blood Proteins/PD; Cell Adhesion/DE; Cell Differentiation/DE; Cell Division/DE; Cytotoxicity, Immunologic/IM; Female; Human; Killer Cells, Lymphokine-Activated/IM/*PA/PH; Leukemia, B-Cell, Chronic/BL/*PA/PP; Male; Receptors, Interleukin-2/AN; Stem Cells/PA/PH/UL; Support, Non-U.S. Gov't.
.T
Distinct characteristics of lymphokine-activated killer (LAK) cells derived from patients with B-cell chronic lymphocytic leukemia (B-CLL). A factor in B-CLL serum promotes natural killer cell-like LAK cell growth.
.P
JOURNAL ARTICLE.
.W
We show that lymphokine-activated killer (LAK) cell precursors derived from patients with B-cell chronic lymphocytic leukemia (B-CLL) and cultured in the presence of recombinant interleukin-2 and normal human serum (NHS), develop into primarily NK cell-like (CD 57+) LAK cells, whereas identically prepared LAK cell precursors from normal subjects develop into mainly T cell-like (CD 3+, CD 8+) LAK cells. B-CLL LAK cells exhibited greater proliferative capacity than did normal LAK cells. When normal LAK cells were grown in B-CLL serum instead of NHS, their proliferation increased; NK cell levels also increased to those found in B-CLL LAK cells, suggesting that B-CLL serum contains a factor that promotes NK cell-like growth, LAK cells derived from normal or B-CLL patients demonstrated similar lytic activity toward K562 and Raji cells. Growth in B-CLL serum did not reduce their lytic potential. Thus, the altered phenotype and growth exhibited by B-CLL LAK cells and normal LAK cells grown in B-CLL serum does not lead to abnormalities in their cytolytic functions. We propose instead that the predominance of NK-like cells in B-CLL LAK cell populations and the presence of an NK cell-like growth factor in B-CLL serum reflect abnormalities related to NK cell-mediated B-cell regulation; ie, either inhibition of normal B-cell growth and/or growth stimulation of the leukemic clone in B-CLL.
.A
Santiago-Schwarz F; Panagiotopoulos C; Sawitsky A; Rai KR.
.I 274336
.U
91002889
.S
Blood 9101; 76(7):1361-8
.M
Antibodies, Monoclonal/*IM; Antigens, Differentiation, T-Lymphocyte/*IM; Cell Line; Cell Transformation, Neoplastic/IM/PA; Cells, Cultured; Human; Leukemia-Lymphoma, T-Cell, Acute, HTLV-I-Associated/IM/*PA; Microscopy, Electron; Neoplasm Circulating Cells/*IM; Phenotype; Sezary Syndrome/IM/*PA; Stem Cells/IM/UL; Support, Non-U.S. Gov't; T-Lymphocyte Subsets/*IM; Tumor Markers, Biological/AN.
.T
A new monoclonal antibody (CH-F42) recognizes a CD7- subset of normal T lymphocytes and circulating malignant cells in adult T-cell lymphoma-leukemia and Sezary syndrome.
.P
JOURNAL ARTICLE.
.W
We describe a new rat immunoglobulin M monoclonal antibody (CH-F42) that recognizes a subset (1.5% to 8%) of normal peripheral blood T lymphocytes. The phenotype of these cells was determined, using dual-color immunofluorescence, to be CD2+, CD3+, CD4+, CD5+, CD7-, CD8-. They do not express T-cell activation markers, and are positive for UCHL1 (CD45RO), but negative for 2H4 (CD45RA). The antigen was expressed on circulating malignant cells in Sezary syndrome (four of four cases) and adult T-cell lymphoma-leukemia (ATLL) (four of six cases) and negative in a variety of other hematologic malignancies tested. These included chronic and acute lymphoid leukemias of B and T lineage, together with chronic and acute myeloid leukemias. However, normal CH-F42+ cells do not display any of the ultrastructural features associated with Sezary or ATLL cells. The marked similarities between these conditions together with the shared expression of an otherwise very restricted surface antigen (CH-F42) provide strong evidence for the existence of a common normal counterpart. Preliminary characterization studies of the antigen, which is also expressed by K562 and Jurkat cells, suggest the CH-F42 antigen is an O-linked, sialated glycan on a glycoprotein.
.A
Labastide WB; Rana MT; Barker CR.
.I 274337
.U
91002890
.S
Blood 9101; 76(7):1369-74
.M
Acute Disease; Aged; Antigens, Differentiation, T-Lymphocyte/IM; Case Report; Cell Transformation, Neoplastic/DE/PA; Chromosomes, Human, Pair 3/*; Female; Granulocyte-Macrophage Colony-Stimulating Factor/PD; Hematopoiesis/DE; Hematopoietic Stem Cells/DE/PA; Human; Interleukin-3/PD; Interleukin-4/PD; Interleukin-6/PD/PH; Leukemia/GE/IM/*PA; Macrophage Colony-Stimulating Factor/PD; Megakaryocytes/PA; Phenotype; Support, U.S. Gov't, P.H.S.; Translocation (Genetics)/*GE; Tumor Cells, Cultured.
.T
Characterization of a factor-dependent acute leukemia cell line with translocation (3;3)(q21;q26).
.P
JOURNAL ARTICLE.
.W
A strictly factor-dependent cell line (UCSD/AML1) was established from a patient with the syndrome of multilineage acute leukemia with high platelets. The patient's cells and the cell line karyotype were 45,XX,-7,t(3;3)(q21;q26), typical of the syndrome of acute leukemia with high platelets. The cell line expresses CD34, CD7, TdT, and myeloid (CD13, CD14, CD33) and megakaryocyte/platelet (CD36, CD41, CD42b, CDw49b) antigens. In short-term culture, UCSD/AML1 cells proliferate in response to interleukin-3 (IL-3), IL-4, IL-6, macrophage colony-stimulating factor (M-CSF), and granulocyte-macrophage CSF (GM-CSF), but not IL-1, IL-2, IL-5, or G-CSF. In long-term culture, proliferation can be sustained by GM-CSF, IL-6, or M-CSF. When maintained in GM-CSF, a small percentage of cells form multinucleated megakaryocyte-like giant cells. Culture with GM-CSF combined with IL-6, but not with IL-6 alone, increased giant cell formation fourfold to sevenfold. IL-6 alone or in combination with GM-CSF increased expression of platelet-related antigens. In contrast, culture with phorbol ester induced formation of macrophage-like cells. UCSD/AML1 is the first human acute nonlymphocytic leukemia cell line established from a patient with an acute leukemia syndrome associated with a specific chromosome abnormality.
.A
Oval J; Jones OW; Montoya M; Taetle R.
.I 274338
.U
91002892
.S
Blood 9101; 76(7):1380-6
.M
Cell Division/DE; Cell Line; Cell Membrane/ME/UL; Cell Transformation, Neoplastic/DE/ME; Cobalt Radioisotopes/DU; Cytarabine/PD; Dose-Response Relationship, Drug; Down-Regulation (Physiology)/GE; Gene Expression; Human; Leukemia, Erythroblastic, Acute/ME/*PA; Leukemia, Experimental/ME/*PA; Leukemia, Myeloid/ME/*PA; Receptors, Endogenous Substances/DE/GE/*ME; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Transcobalamins/ME/PD; Trypsin/PD; Up-Regulation (Physiology)/GE; Vitamin B 12/DU.
.T
Expression of transcobalamin II receptors by human leukemia K562 and HL-60 cells.
.P
JOURNAL ARTICLE.
.W
Plasma membrane receptors for the serum cobalamin-binding protein transcobalamin II (TCII) were identified on human leukemia K562 and HL-60 cells using immunoaffinity-purified human TCII labeled with [57Co]cyanocobalamin. The Bmax values for TCII receptors on proliferating K562 and HL-60 cells were 4,500 and 2,700 per cell, respectively. Corresponding dissociation constants (kd) were 8.0 x 10(-11) mol/L and 9.0 x 10(-11) mol/L. Rabbit TCII also bound to K562 and HL-60 cells but with slightly reduced affinities. Calcium was required for the binding of transcobalamin II to K562 cells. Brief treatment of these cells with trypsin resulted in almost total loss of surface binding activity. After removal of trypsin, surface receptors for TCII slowly reappeared, reaching pretrypsin treatment densities only after 24 hours. Reappearance of receptors was blocked by cycloheximide. TCII receptor densities on K562 and HL-60 cells correlated inversely with the concentration of cobalamin in the culture medium. This suggests that intracellular stores of cobalamin may affect the expression of transcobalamin receptors. Nonproliferating stationary-phase K562 cells had low TCII receptor densities (less than 1,200 receptors/cell). However, the density of TCII receptors increased substantially when cells were subcultured in fresh medium. Up-regulation of receptor expression coincided with increased 3H-thymidine incorporation, which preceded the resumption of cellular proliferation as measured by cell density. In the presence of cytosine arabinoside, which induces erythroid differentiation, K562 cells down-regulated expression of TCII receptors. When HL-60 cells were subcultured in fresh medium containing dimethysulfoxide to induce granulocytic differentiation, the up-regulation of TCII receptors was suppressed. This event occurred well before a diminution of 3H-thymidine incorporation and cessation of proliferation. Thus, changes in the regulation of expression of TCII receptors correlate with both the proliferative and differentiation status of cells.
.A
Amagasaki T; Green R; Jacobsen DW.
.I 274339
.U
91002893
.S
Blood 9101; 76(7):1387-91
.M
Blotting, Southern; Chromosome Mapping; Chromosomes, Human, Pair 11/CH/UL; DNA, Neoplasm/AN/GE/IM; Gene Rearrangement/GE; Genotype; Human; Lymphoma, Small Cleaved-Cell, Follicular/*GE/UL; Proto-Oncogene Proteins/GE; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Genotypic characterization of centrocytic lymphoma: frequent rearrangement of the chromosome 11 bcl-1 locus.
.P
JOURNAL ARTICLE.
.W
Centrocytic lymphomas are defined in the Kiel classification as B-cell lymphomas composed exclusively of cells resembling cleaved follicular center cells (FCC). These lymphomas have been shown to be histologically, immunophenotypically, and clinically distinct from other cleaved FCC lymphomas. DNA from 18 centrocytic lymphomas (14 patients) was analyzed using Southern blotting and probes for immunoglobulin heavy (JH) and kappa light chain (JK) joining gene, T-cell receptor beta chain constant gene (CB), bcl-1, bcl-2, and c-myc gene rearrangements. All of the lymphomas had JH and JK rearrangements, confirming their B-cell origin. None of the specimens had detectable CB, bcl-2, or c-myc rearrangements. However, 4 of 14 patients (28.6%) had rearrangement of the chromosome 11 bcl-1 locus. Therefore, centrocytic lymphomas are genotypically distinguishable from the majority of other small cleaved FCC lymphomas by their lack of demonstrable bcl-2 rearrangements. This supports the distinct nature of centrocytic lymphomas and suggests the lack of importance for the putative oncogene bcl-2 in these cases. Furthermore, the frequent rearrangement of bcl-1 suggests a possible role for this locus in the pathogenesis of at least some centrocytic lymphomas.
.A
Williams ME; Westermann CD; Swerdlow SH.
.I 274340
.U
91002895
.S
Blood 9101; 76(7):1398-404
.M
Animal; Antibodies/DU/IM; Blotting, Northern; Bone Marrow/CY/DE; Cell Differentiation/DE; Cell Line; Flow Cytometry; Granulocyte Colony-Stimulating Factor/PD; Interleukin-3/PD; Laminin/GE/IM/*ME; Mice; Microscopy, Electron; Neuraminidase/PD; Neutrophils/CY/*ME/UL; Peptide Fragments/GE/*ME; Precipitin Tests; RNA, Messenger/GE/*ME; Stem Cells/CY/DE; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Production of laminin B2 chain protein and messenger RNA by a murine neutrophil precursor cell line, 32Dc13 [see comments]
.P
JOURNAL ARTICLE.
.W
Laminin is a heterotrimeric glycoprotein that plays a central role in promoting neutrophil chemotaxis, motility, and attachment to basement membrane. Rabbit peritoneal exudate neutrophils stain positively for laminin, which is presumed to be of exogenous origin and bound to laminin receptors on the cell surface. We examined 32Dc13 cells, a murine neutrophil precursor cell line, by immunoprecipitation. Northern blot analysis, flow cytometry, and electron microscopy for the endogenous production of laminin. Our results demonstrate that 32Dc13 cells endogenously produce a laminin B2 chain protein and messenger RNA (mRNA) without producing any detectable A or B1 chain protein or mRNA. The B2 chain protein was not secreted by the cells; rather it could be detected on the cell surface after treatment of cells with neuraminidase. These findings suggest the possibility of a novel role for the laminin B2 chain in myeloid development and function.
.A
Tweardy DJ; Sasaki M; Cardamone JJ Jr; McCoy JP Jr; Bonidie MJ; Signorella AP.
.I 274341
.U
91002896
.S
Blood 9101; 76(7):1405-9
.M
Candida albicans/PH; Escherichia coli/ME; Human; Lipopolysaccharides/ME/PD; Neutrophils/*ME; Support, U.S. Gov't, P.H.S.; Time Factors; Transcription, Genetic/GE; Tumor Necrosis Factor/GE/*ME.
.T
Release of tumor necrosis factor by human polymorphonuclear leukocytes.
.P
JOURNAL ARTICLE.
.W
Evidence is presented that human polymorphonuclear neutrophils (PMN) can be induced to produce tumor necrosis factor (TNF). Other investigators have previously reported that TNF has been induced from macrophages by bacteria and, more recently, from natural killer cells by certain tumor cells. Our laboratory has reported that the opportunistic fungi, Candida albicans, can induce TNF, not only from human monocytes, but also from Percoll-fractionated large granular lymphocytes. We now report that incubation of PMN with C albicans for 3 hours was sufficient for detection of TNF release, and peak induction was observed at 8 to 18 hours. This release was inhibitable by actinomycin D, an inhibitor of RNA synthesis, as well as by emetine and cycloheximide, which block protein synthesis. The TNF produced by PMN was neutralized by specific monoclonal antibodies against human TNF. These results represent an important finding that TNF production is a normal response of PMN to stimulation by fungi such as C albicans and suggest that the release of TNF may be related to autocrine activation of PMN effector function to control Candida growth.
.A
Djeu JY; Serbousek D; Blanchard DK.
.I 274342
.U
91002897
.S
Blood 9101; 76(7):1410-8
.M
Adult; Antibody Formation/*PH; ABO Blood-Group System/IM; Blood Transfusion; Bone Marrow Transplantation/*IM/PA; Centrifugation/MT; Hemagglutinins/AN/ME; Histocompatibility; Human; Isoantibodies/IM; Isoantigens/IM; Lymphocyte Depletion; Reference Standards; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Transplantation, Homologous/IM/PA.
.T
Reconstitution of antibody response after allogeneic bone marrow transplantation: effect of lymphocyte depletion by counterflow centrifugal elutriation on the expression of hemagglutinins.
.P
JOURNAL ARTICLE.
.W
The generation of ABO hemagglutinins was used as a model to assess the tempo of reconstitution of antibody responses in recipients of elutriated (CCE) and nonelutriated (nonCCE) HLA matched bone marrow allografts. The study included 29 CCE recipients (10 major, 6 minor, and 1 major/minor ABO-mismatched, and 12 ABO-matched) and 40 nonCCE recipients (14 major, 12 minor, 2 major/minor, and 12 matched). Plasma volume in the graft and in blood product transfusions was uncorrelated with changes in hemagglutinin titers and therefore was excluded as a significant source of antibody. Removal of graft lymphocytes by CCE did not result in prolongation of host-derived hemagglutinins in recipients of major ABO-mismatched grafts. However, CCE resulted in a complete abrogation of the adoptive transfer of donor-derived antibody as detected in recipients of minor ABO-mismatched grafts. Despite the absence of adoptively transferred donor immunity in recipients of CCE grafts, they had hemagglutinin levels comparable with those of recipients of nonCCE grafts by 6 months after transplantation. This demonstrates that recipients of elutriated marrow were competent to mount de novo responses at that time. The strong correlation between donor pretransplant hemagglutinin titer and recipient titer 1 year after bone marrow transplantation in recipients of nonCCE grafts suggests that even late after transplant, antibody remains the product of adoptively transferred memory cells in recipients of grafts containing large numbers of mature lymphocytes.
.A
Bar BM; Santos GW; Donnenberg AD.
.I 274343
.U
91002898
.S
Blood 9101; 76(7):1419-30
.M
Animal; Bone Marrow/CY; Bone Marrow Transplantation/IM/*MO/PH; G(M1) Ganglioside/*IM; Graft Survival/*DE/RE; Hematopoiesis/DE/RE; Immune Sera/*IM; Immunization, Passive; Killer Cells, Natural/DE/PH/RE; Lymphocyte Depletion; Male; Mice; Mice, Inbred BALB C; Radiation Chimera; Spleen/CY; Support, Non-U.S. Gov't.
.T
Anti-asialo GM1 antiserum treatment of lethally irradiated recipients before bone marrow transplantation: evidence that recipient natural killer depletion enhances survival, engraftment, and hematopoietic recovery.
.P
JOURNAL ARTICLE.
.W
Natural killer (NK) cells are reported to have an important role in the resistance of lethally irradiated recipients to bone marrow transplantation (BMT). Therefore, we investigated the effects of recipient NK depletion on survival, chimerism, and hematopoietic reconstitution after lethal irradiation and the transplantation of limiting amounts of T-cell-deficient bone marrow (BM). When administered before BMT, anti-asialo GM1 (ASGM1) antiserum treatment, effective in depleting in vivo NK activity, was associated with a marked increase in survival in 3 of 3 allogeneic combinations (BALB/c into C3H/HeN, C57B1/6, or C3B6F1). This enhanced survival was independent of the susceptibility of each recipient strain to accept BALB/c BM. Moreover, recipient anti-ASGM1 treatment was also effective in increasing survival in recipients of syngeneic BM, suggesting that NK cells can adversely affect engraftment independent of genetically controlled polymorphic cell surface determinants. Analysis of chimerism in surviving animals 2 months post-BMT showed that recipient NK depletion significantly increased the level of donor engraftment when high doses of BM were transplanted. These studies also demonstrated that anti-ASGM1 pretreatment mainly resulted in an increase in extramedullary hematopoiesis in the second and third week after irradiation. Anti-ASGM1 treatment also dramatically accelerated the rate of appearance of donor-derived cells with a higher level of donor-cell engraftment apparent at a time when the differences in survival between NK-depleted and control BMT recipients became significant. Peripheral cell counts were also affected by NK depletion, with significantly enhanced platelet and red blood cell recovery and a moderate increase in granulocyte recovery. The overall favorable influence of anti-ASGM1 recipient treatment on hematopoietic events post-BMT suggests that, in humans, pretransplant regimens aimed toward NK depletion should be evaluated.
.A
Tiberghien P; Longo DL; Wine JW; Alvord WG; Reynolds CW.
.I 274344
.U
91002899
.S
Blood 9101; 76(7):1431-7
.M
Adolescence; Adult; Age Factors; Anemia, Sickle Cell/EP/IM/PP/*SU; Blood Transfusion/*; Child; Child, Preschool; Cross-Sectional Studies; Female; Hemoglobins/GE; Human; Immunity, Cellular/*PH; Immunization/*; Incidence; Isoantibodies/*IM; Isoantigens/*IM; Male; Phenotype; Sex Factors.
.T
Transfusion and alloimmunization in sickle cell disease. The Cooperative Study of Sickle Cell Disease.
.P
JOURNAL ARTICLE.
.W
In 1,814 patients with sickle cell disease who had been transfused, the overall rate of alloimmunization to erythrocyte antigens was 18.6%. The rate of alloimmunization in this group appears to be an explicit function of the number of transfusions received because it increases exponentially with increasing numbers of transfusions. Alloimmunization usually occurred with less than 15 transfusions, although the rate of alloimmunization continued to increase when more transfusions were given. The rate of alloimmunization was less in patients with hemoglobin SC disease and sickle-beta+ thalassemia because these patients had received fewer transfusions. Children less than 10 years old had a slightly lower rate of alloimmunization than patients in other age groups even after correction for the number of transfusions given. Women were more frequently alloimmunized than men; this was largely due to the fact that women received more transfusions than men, but in the age group 16 to 20 years the increase may have been due in part to alloimmunization owing to pregnancy. Forty-five percent of those alloimmunized made antibodies of only one specificity; 17% made four or more antibodies reacting with different antigens. Antibodies to the C and E antigens of the Rh group, the Kell antigen, and the Lewis antigens were most commonly made. These findings may be important in formulating a rational transfusion policy in sickle cell disease.
.A
Rosse WF; Gallagher D; Kinney TR; Castro O; Dosik H; Moohr J; Wang W; Levy PS.
.I 274345
.U
91002900
.S
Blood 9101; 76(7):1438-44
.M
Agglutinins/IM; Animal; Antibodies/AD/IM; Blood Transfusion/*AE; Disease Models, Animal; Female; Lung/BS/*IN; Male; Neutrophils/IM; Perfusion; Pulmonary Edema/ET; Rabbits; Respiratory Insufficiency/ET; Support, Non-U.S. Gov't; Syndrome.
.T
Reproduction of transfusion-related acute lung injury in an ex vivo lung model [see comments]
.P
JOURNAL ARTICLE.
.W
Leukoagglutinins are implicated in transfusion-related acute lung injury (TRALI). In the present study, severe lung vascular leakage was reproduced by application of a leukoagglutinating antibody of anti-5b specificity in an ex vivo lung model. The antibody originated from a multiparous donor-plasma, observed to cause noncardiogenic edema during transfusion therapy. Heated full plasma (anti-5b-titer 1/128) or purified immunoglobulin G fraction was used for the studies. Ex vivo isolated rabbit lungs were perfused with albumin buffer, and human granulocytes (PMN) were admixed to the recirculating perfusate. In presence of anti-5b antibody plus 5b-positive PMN plus rabbit plasma as complement-source, severe lung edema occurred after a latent period of 3 to 6 hours. Pulmonary artery pressure was only transiently and moderately increased, and the leakage reaction could be traced back to a several-fold increase in lung vascular permeability. In contrast, no vascular leakage was noted in lungs perfused in the absence of anti-5b antibody, PMN, or rabbit plasma. Moreover, no permeability increase occurred on use of 5b-negative PMN. This reproduction of TRALI in an ex vivo lung model corroborates the role of leukoagglutinating antibodies in initiating PMN-dependent respiratory distress and suggests a contribution of concomitant complement activation.
.A
Seeger W; Schneider U; Kreusler B; von Witzleben E; Walmrath D; Grimminger F; Neppert J.
.I 274346
.U
91002901
.S
Blood 9101; 76(8):1449-63
.M
Child; Chromosome Abnormalities/*; Human; Leukemia, Lymphocytic, Acute/*GE; Neoplasm Recurrence, Local/GE; Philadelphia Chromosome; Ploidies; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Translocation (Genetics); Tumor Cells, Cultured.
.T
Biology and clinical significance of cytogenetic abnormalities in childhood acute lymphoblastic leukemia.
.P
JOURNAL ARTICLE; REVIEW; REVIEW, ACADEMIC.
.W
Virtually all cases of childhood ALL have chromosomal abnormalities and half contain translocations, which are nearly equally divided between random and nonrandom rearrangements. Nonrandom chromosomal abnormalities have been correlated with leukemic cell lineage, the degree of cell differentiation, and the specific gene involved at the molecular level. Many cytogenetic findings have prognostic significance; however, the adverse influence of certain changes, including most chromosomal translocations, may in fact be offset by the greater cytoreductive effects of intensified therapy. Table 4 summarizes the relation of selected karyotypic findings to treatment outcome in patients treated on contemporary protocols. Among all of the chromosomal abnormalities identified in childhood ALL, hyperdiploidy greater than 50 has been associated with the most favorable prognosis. At the opposite end of the spectrum, the treatment outcome for patients with classical Ph+ or hypodiploid ALL is very poor even in programs of intensive chemotherapy; alternative treatment such as bone marrow transplantation should be considered for such patients. Cases with the t(4;11)(q21;q23) also have a very poor clinical outcome, but the adverse prognosis may be limited to the infant or adolescent age groups. The prognostic significance of other nonrandom translocations, such as t(1;19)(q23;p13) and several other abnormalities, needs to be further assessed in larger numbers of patients. Finally, as more is learned about the molecular pathology underlying these rearrangements, it may be possible to develop new therapeutic agents that are specifically targeted to interfere with the aberrant gene products expressed by human leukemic cells.
.A
Pui CH; Crist WM; Look AT.
.I 274347
.U
91002902
.S
Blood 9101; 76(8):1464-72
.M
Antibodies, Monoclonal/TU; Antilymphocyte Serum/TU; Bone Marrow Transplantation/*AE; Cyclosporins/TU; Glucocorticoids/TU; Graft vs Host Disease/PC/*TH; Human; Intestinal Diseases/ET/TH; Liver Diseases/ET/TH; Methotrexate/TU; Multivariate Analysis; Retrospective Studies; Skin Diseases/ET/TH; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
A retrospective analysis of therapy for acute graft-versus-host disease: initial treatment.
.P
JOURNAL ARTICLE.
.W
We have reviewed results of therapy in 740 patients with grades II-IV acute graft-versus-host disease (GVHD) after allogeneic marrow transplantation. At the beginning of therapy, 597 patients (81%) had rash, 369 (50%) had liver dysfunction and 396 (54%) had gut dysfunction. Initial treatment was with glucocorticoids (n = 531), cyclosporine (n = 170), antithymocyte globulin (ATG) (n = 156) or monoclonal antibody (n = 3) either singly (n = 633) or in combination (n = 107). Parameters of GVHD severity in each organ were recorded weekly, and evaluation of response was made using values at the initiation of secondary treatment or, for patients without such treatment, using values on day 29 of primary treatment or the last recorded value before death, whichever occurred first. Minimal criteria for improvement or progression were defined for each organ, but no attempt was made to define liver or gut outcome if another complication such as venocclusive disease or infectious enteritis was present. Improvement rates were 43% for skin disease, 35% for evaluable liver disease and 50% for evaluable gut disease. Overall complete or partial responses were seen in 44% of patients. Multivariate analyses were carried out to identify patient, disease or treatment factors associated with likelihood of overall improvement and likelihood of response in at least one organ. A similar analysis was also carried out to identify covariates associated with time to treatment failure (defined as initiation of secondary therapy or death not due to relapse of malignancy). In all three models, GVHD prophylaxis using cyclosporine combined with methotrexate was associated with favorable GVHD treatment outcome compared to prophylaxis with either agent alone, and treatment with glucocorticoids or cyclosporine was more successful than treatment with ATG. Other factors associated with unfavorable outcome in the model of time to treatment failure and also entered in one of the response models were recipient HLA disparity with the donor, presence of a liver complication other than GVHD, and early onset of GVHD. Results of this analysis indicate that glucocorticoids represent the best initial therapy available for treatment of acute GVHD, although much room for improvement remains.
.A
Martin PJ; Schoch G; Fisher L; Byers V; Anasetti C; Appelbaum FR; Beatty PG; Doney K; McDonald GB; Sanders JE; et al.
.I 274348
.U
91002903
.S
Blood 9101; 76(8):1473-80
.M
Animal; Bone Marrow; Dose-Response Relationship, Drug; Granulocyte-Macrophage Colony-Stimulating Factor/AD/*PD; Hematopoiesis/*; Hematopoietic Stem Cells/CY; Leukocyte Count; Male; Megakaryocytes/*CY; Mice; Mice, Inbred CBA; Platelet Count; Recombinant Proteins; Spleen/CY; Support, Non-U.S. Gov't.
.T
In vivo stimulation of megakaryocytopoiesis by recombinant murine granulocyte-macrophage colony-stimulating factor.
.P
JOURNAL ARTICLE.
.W
Murine recombinant granulocyte-macrophage colony-stimulating factor (rGM-CSF) was injected in mice, and the effects on bone marrow, splenic megakaryocytes, megakaryocyte precursors (megakaryocyte colony-forming units [CFU-Meg]) were evaluated. In mice injected three times a day for 6 days with 12,000 to 120,000 U rGM-CSF, no significant modification of both platelet levels and mean platelet volume was observed, while there was a twofold increase in blood neutrophils. However, the rate of platelet production, as assessed by the measurement of 75selenomethionine incorporation into blood platelets, was On the contrary, administration of up to 384,000 U rGM-CSF two times a day for 2 days, as for a typical "thrombopoietin assay," failed to modify platelet production. A significant dose-related increase in the number of splenic megakaryocytes occurred in mice receiving 60,000 to 120,000 U rGM-CSF, while a slight increase in the number of bone marrow megakaryocytes was observed in mice injected with 120,000 U rGM-CSF. The proportion of bone marrow megakaryocytes with a size less than 18 microns and greater than 35 microns resulted significantly higher in mice receiving rGM-CSF in comparison with controls; an increase in the percentage of splenic megakaryocytes greater than 35 microns was also observed. A statistically significant increase in the total spleen content of CFU-Meg was observed after administration of 90,000 and 120,000 U rGM-CSF three times a day for 6 days, while no effect on bone marrow CFU-Meg was recorded, irrespective of the dose delivered. Finally, 24 hours after a single intravenous injection of rGM-CSF, there was a significant increase in the proportion of CFU-Meg in S-phase, with the splenic progenitors being more sensitive than bone marrow-derived CFU-Meg. These data indicate that rGM-CSF has in vivo megakaryocyte stimulatory activity, and are consistent with previous in vitro observations. However, an effective stimulation of megakaryocytopoiesis in vivo, bringing about an increase in the levels of blood platelets, may require interaction of rGM-CSF with other cytokines.
.A
Vannucchi AM; Grossi A; Rafanelli D; Ferrini PR.
.I 274349
.U
91002904
.S
Blood 9101; 76(8):1481-9
.M
Antibodies/PD; Enzyme-Linked Immunosorbent Assay; Granulocyte-Macrophage Colony-Stimulating Factor/*BL/GE/IM; Human; Interleukin-1/BL/PD/*PH; Leukemia, Myelocytic, Acute/*BL/PA; RNA, Messenger/ME; Support, Non-U.S. Gov't; Tumor Cells, Cultured.
.T
Coordinate secretion of interleukin-1 beta and granulocyte-macrophage colony-stimulating factor by the blast cells of acute myeloblastic leukemia: role of interleukin-1 as an endogenous inducer.
.P
JOURNAL ARTICLE.
.W
Acute myeloblastic leukemia (AML) blasts have been shown to produce a variety of cytokines in culture such as interleukin-1 (IL-1), IL-6, granulocyte-, macrophage-, and granulocyte-macrophage colony-stimulating factor (GM-CSF), and tumor necrosis factor-alpha (TNF alpha). Using two sensitive and specific enzyme-linked immunosorbent assays for IL-1 beta and GM-CSF, we document in the present study that the production of the two cytokines by AML blasts in culture is coordinated. First, we observe a striking correlation between the levels of GM-CSF and IL-1 beta released by the cells. Thus, a high production of IL-1 beta is always concordant with a high production of GM-CSF and, conversely, low production of IL-1 beta is concordant with low levels of GM-CSF. Second, neutralization of intrinsic IL-1 using antibodies that are specific for IL-1 alpha and -1 beta suppresses the release of GM-CSF by the cells. Third, neutralization of the endogenous source of IL-1 also results in an abrogation of GM-CSF mRNA. Fourth, the production of both IL-1 beta and GM-CSF is up-regulated by exposing AML blasts to an exogenous source of IL-1, suggesting a positive regulation of autocrine growth factor production. Taken together, our results indicate that GM-CSF production by AML blasts is mediated by endogenously produced IL-1. Both IL-1 beta and -1 alpha are produced by AML blasts, although IL-1 beta appears to be more abundant. Spontaneous colony formation by AML blasts is abrogated by the addition of neutralizing antibodies against IL-1 beta and GM-CSF, whereas each antibody alone has little effect on blast proliferation. Taken together, our results are consistent with the view that the production of IL-1 beta by AML blasts supports autocrine growth in culture, through induction of CSFs or other cytokines that stimulate blast proliferation.
.A
Rodriguez-Cimadevilla JC; Beauchemin V; Villeneuve L; Letendre F; Shaw A; Hoang T.
.I 274350
.U
91002905
.S
Blood 9101; 76(8):1490-3
.M
Cell Division; Cells, Cultured; Human; HIV/DE/*PH; Interleukin-3/*PD; Monocytes/*CY/MI; Support, Non-U.S. Gov't; Virus Replication/DE; Zidovudine/*PD.
.T
Induction of monocyte proliferation and HIV expression by IL-3 does not interfere with anti-viral activity of zidovudine.
.P
JOURNAL ARTICLE.
.W
Myelosuppression is a major symptom in the acquired immunodeficiency syndrome (AIDS). Moreover zidovudine, an anti-retroviral drug used to treat AIDS patients has myelosuppressive side effects. Therefore treatment with IL-3, a multi-lineage hemopoietic growth factor may be beneficial for zidovudine-treated individuals. In this study we examined the effect of IL-3 on human immunodeficiency virus (HIV) expression. The proliferative response to rIL-3 and the effects on the replication of the monocytotropic HIV variant, HTLV-III Ba-L, in the absence or presence of the anti-retroviral drug zidovudine was studied in purified human peripheral blood monocytes. Zidovudine concentrations sufficient for complete inhibition of HIV replication did not affect rIL-3 induced monocyte proliferation. Although rIL-3, like rGM-CSF, was able to augment HIV expression in monocytes, it did not interfere with the anti-retroviral activity of zidovudine. These data indicate that rIL-3 is a potential candidate for use in myelosupportive therapy in AIDS patients treated with anti-retroviral drugs.
.A
Schuitemaker H; Kootstra NA; van Oers MH; van Lambalgen R; Tersmette M; Miedema F.
.I 274351
.U
91002906
.S
Blood 9101; 76(8):1494-502
.M
Adult; Aged; Bone Marrow/CY; Bone Marrow Diseases/DT/PA; Cell Division; DNA/BI; Erythroid Progenitor Cells/CY; Female; Granulocytes/CY; Hematopoiesis; Hematopoietic Stem Cells/*CY/ME; Human; Interleukin-3/*PD/TU; Leukocyte Count; Macrophages/CY; Male; Middle Age; Neoplasms/DT/PA; Recombinant Proteins/PD.
.T
Effects of recombinant human interleukin-3 on human hematopoietic progenitor and precursor cells in vivo.
.P
CLINICAL TRIAL; JOURNAL ARTICLE.
.W
DNA-synthesis rates and concentrations of bone marrow (BM) and peripheral blood (PB) progenitor cells were studied in 22 patients treated with recombinant human interleukin-3 (rhIL3) as part of a clinical phase I/II study. Recombinant hIL3 at doses of 60 to 500 micrograms/m2 was administered by subcutaneous bolus injection for 15 days to 13 patients with solid tumors and preserved hematopoietic function and to nine patients with bone marrow failure, including five with myelodysplastic syndromes. Following treatment with rhIL3, the percentage of actively cycling BM erythroid (BFU-E) and multilineage (CFU-GEMM) progenitors in patients with preserved hematopoietic function increased from 16% to 36% (P less than .05) and from 10% to 40% (P less than .01), respectively. The DNA-synthesis rates of early and late granulocyte macrophage progenitor cells increased from 11% to 26% (CFU-GM day 14; P less than .02) and from 13% to 30% (CFU-GM day 7; P less than .05). There was an increase in BM cellularity from 37% to 58%, and of the myeloid to erythroid ratio from 1.4 to 3.2, while the concentration of marrow progenitors on a per cell basis was unchanged or slightly decreased. The frequencies of blast cells in the BM were unchanged. Mean levels of PB CFU-GM day 14 and CFU-GEMM were 100% and 72% above baseline values after 7 days of rhIL3 but only 25% and 28% above initial levels at the end of treatment. Peripheral blood BFU-E were reduced in the majority of patients with normal marrow after both 7 and 15 days of rhIL3. No augmentation of circulating BFU-E and CFU-GEMM was seen in 5 patients with MDS who had few or no PB BFU-E or CFU-GEMM initially. Total leukocyte, neutrophil, and eosinophil counts increased significantly (P less than .01) in 21 of 22 patients with a peak response after a median of 13 days of rhIL3. While a small increase in reticulocytes was not accompanied by an elevation of the hemoglobin or hematocrit, platelet counts increased by 50% in patients with preserved marrow function. Thus, rhIL3 induces a multilineage response in vivo, apparently by stimulating proliferation of multipotential and lineage-restricted progenitors. It remains to be determined whether this is due to direct or indirect effects on the progenitor cells.
.A
Ottmann OG; Ganser A; Seipelt G; Eder M; Schulz G; Hoelzer D.
.I 274352
.U
91002907
.S
Blood 9101; 76(8):1503-13
.M
Adenosine Diphosphate/PD; Blood Platelets/DE/*ME; Calcimycin/PD; Cell Membrane/DE/ME; Fixatives; Flow Cytometry; Fluorescent Antibody Technique; Formaldehyde; Human; Immunohistochemistry; Macromolecular Systems; Microscopy, Electron; Microscopy, Electron, Scanning; Platelet Membrane Glycoproteins/*ME; Polyethylene Glycols; Polymers; Support, Non-U.S. Gov't; Thrombin/*PD.
.T
Thrombin induces a rapid redistribution of glycoprotein Ib-IX complexes within the membrane systems of activated human platelets.
.P
JOURNAL ARTICLE.
.W
Previous studies have shown a decreased binding of monoclonal antibodies (MoAbs) to glycoprotein (GP) Ib-IX complexes on thrombin-stimulated platelets, but the reason for this is poorly understood. We have used (1) immunofluorescence procedures and flow cytometry, and (2) immunogold staining and electron microscopy to investigate this phenomenon. Washed platelets were incubated with alpha-thrombin, adenosine diphosphate, or ionophore A23187 for increasing lengths of time. For alpha-thrombin, but not the other agonists, flow cytometry confirmed a dose- and time-dependent decrease in the binding of MoAbs specific for GP Ib alpha (AP-1, Bx-1), GP IX (FMC 25), or to the complex itself (SZ 1). Immunoglold staining performed using standard transmission or scanning electron microscopy high-lighted surface areas devoid of bound antibody. However, a quantitatively normal immunofluorescence was restored if paraformaldehyde-fixed, thrombin-stimulated platelets were permeabilized with Triton X-100 (Sigma Chemical Co, St Louis, MO) before MoAb addition, while immunogold staining was now seen to be concentrated within the interior of the platelet. Glutaraldehyde-fixed samples were then embedded in the resin Lowicryl K4M (Taab Laboratories Equipment Ltd, Aldermaston, England) and immunogold staining performed on thin sections using a polyclonal antibody to glycocalicin. An increased presence of GP Ib-IX complexes within surface-connected membrane systems of the thrombin-stimulated platelets was confirmed. Interestingly, GP Ib-IX movement was opposite to the thrombin-induced externalization of internal pools of GP IIb-IIIa complexes and of the alpha-granule membrane GP, GMP-140.
.A
Hourdille P; Heilmann E; Combrie R; Winckler J; Clemetson KJ; Nurden AT.
.I 274353
.U
91002908
.S
Blood 9101; 76(8):1514-20
.M
Animal; Fibrosarcoma/ME; Glycosylation; Guanidines/PD; Half-Life; Human; Metabolic Clearance Rate; Plasminogen Inactivators/BL/*PK; Rabbits; Tissue Distribution; Tumor Cells, Cultured.
.T
The pharmacokinetics of plasminogen activator inhibitor-1 in the rabbit.
.P
JOURNAL ARTICLE.
.W
The pharmacokinetics of the activated and latent forms of plasminogen activator inhibitor-1 (PAI-1) isolated from HT1080 fibrosarcoma cells (HT1080 PAI-1) and a nonglycosylated form of human PAI-1 isolated from a yeast expression system (rPAI-1) were followed in the rabbit. As assessed by an immunologic assay specific for human PAI-1, guanidine HCI activated HT1080 PAI-1 and rPAI-1 entered the total plasma volume following intravenous bolus administration and exhibited a biphasic clearance pattern. The t1/2s of HT1080 PAI-1 for the initial and beta phases equalled 6.0 and 24.8 minutes, respectively. The t1/2s of rPAI-1 for the initial and beta phases equalled 8.8 and 34.0 minutes, respectively. Similar results were obtained by measuring PAI-1 activity in plasma and with trace amounts of 125I-rPAI-1, suggesting that the above pharmacokinetic behavior could also apply to endogenous PAI-1. The liver was the main site of rPAI-1 clearance. Unactivated, latent PAI-1 exhibited a very different pharmacokinetic profile. Over 80% of latent rPAI-1 cleared from the circulation within 10 minutes (t1/2 = 1.7 minutes). The difference in clearance behavior between activated and latent PAI-1 may be related to the ability of activated PAI-1, but not latent PAI-1, to rapidly form high-molecular-weight complexes with plasma binding factors which were observed in vitro and in vivo. Because PAI-1 could potentially tilt the fibrinolytic balance toward a prothrombotic state, its rapid clearance may represent an important control mechanism governing the circulating levels of this key component of the fibrinolytic pathway.
.A
Mayer EJ; Fujita T; Gardell SJ; Shebuski RJ; Reilly CF.
.I 274354
.U
91002909
.S
Blood 9101; 76(8):1521-9
.M
Animal; Antithrombin III/*GE/ME; Cell-Free System; Chromatography; Cloning, Molecular; DNA/GE; Electrophoresis, Polyacrylamide Gel; Gene Expression/*; Heparin/*ME; Human; Immunosorbent Techniques; Molecular Weight; Mutagenesis, Site-Directed; Rabbits; RNA, Messenger/GE; Signal Peptides/GE; Support, Non-U.S. Gov't; Thrombin/*ME; Translation, Genetic.
.T
Expression in a cell-free system of normal and variant forms of human antithrombin III. Ability to bind heparin and react with alpha-thrombin.
.P
JOURNAL ARTICLE.
.W
Human antithrombin III (AT-III) cDNA was cloned into the cell-free expression phagemid vector pGEM-3Zf(+) and site-directed mutagenesis was used to remove nucleotides encoding the signal peptide. AT-III messenger RNA (mRNA) transcripts derived from this construct were translated in an mRNA-dependent rabbit reticulocyte lysate (RRL) system containing (35S)methionine. Immunoprecipitation of the cell-free translation mixture with rabbit polyclonal antibodies to AT-III showed, by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), a 47-Kd polypeptide which is the non-glycosylated mature form of plasma AT-III. Densitometric scanning showed that this polypeptide constitutes greater than 90% of the radiolabeled polypeptides produced in this system. Heparin-Sepharose chromatography resulted in the elution of cell-free derived AT-III as a broad peak between 0.2 and 0.7 mol/L NaCl. The cell-free derived AT-III also reacted with human alpha-thrombin. In 2 minutes approximately 20% of the AT-III was found associated with a higher molecular weight species, consistent with the formation of a 1:1 stoichiometric covalent complex between alpha-thrombin and AT-III. Unfractionated heparin accelerated the rate of formation of such complexes. When Ser394 was mutated to Leu to form the AT-III Denver mutant, the cell-free translation product of this mutation did not show any significant complex formation when reacted with alpha-thrombin. A truncated form of AT-III (Met251-Lys432), containing only the putative thrombin-binding domain, was synthesized independently. This 21-Kd polypeptide did not bind heparin; however, it was cleaved by alpha-thrombin presumably at the reactive center Arg393-Ser394. When Ser394 was mutated to Leu the cell-free translation product of this truncated AT-III mutation did not react with alpha-thrombin at the reactive center. This simple cell-free approach, along with site-directed mutagenesis, should allow for the rapid and accurate mapping of the functional domains of human AT-III.
.A
Austin RC; Rachubinski RA; Fernandez-Rachubinski F; Blajchman MA.
.I 274355
.U
91002910
.S
Blood 9101; 76(8):1530-7
.M
Alanine/*; Amino Acid Sequence; Base Sequence; Deoxyribonucleases, Type II Site-Specific/ME; DNA/GE/ME; DNA Restriction Enzymes/ME; Epidermal Growth Factor-Urogastrone/*; Exons; Factor IX/CH/*GE/PD; Factor IXa/ME; Genetic Markers; Hemophilia/*BL; Human; Molecular Sequence Data; Mutation/*; Partial Thromboplastin Time; Polymerase Chain Reaction; Proline/*; Promoter Regions (Genetics); Protein Conformation; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Factor IXHollywood: substitution of Pro55 by Ala in the first epidermal growth factor-like domain.
.P
JOURNAL ARTICLE.
.W
Factor IX is a multidomain protein essential for hemostasis. We describe a mutation in a patient affecting the first epidermal growth factor (EGF)-like domain of the protein. All exons and the promoter region of the gene were amplified by the polymerase chain reaction method, and sequenced. Only a single mutation (C----G), that predicts the substitution of Pro55 by Ala in the first EGF domain was found in the patient's gene. This mutation leads to new restriction sites for four enzymes. One new site (Nsi) was tested in the amplified exon IV fragment and was shown to provide a rapid and reliable marker for carrier detection and prenatal diagnosis in the affected family. The factor IX protein, termed factor IXHollywood (IXHW), was isolated to homogeneity from the patient's plasma. As compared with normal factor IX (IXN), IXHW contained the same amount of gamma-carboxy glutamic acid but twice the amount of beta-OH aspartic acid. Both IXHW and IXN contained no detectable free -SH groups. Further, IXHW could be readily cleaved to yield a factor IXa-like molecule by factor Xla/Ca2+. However, IXaHW (compared with IXaN) activated factor X approximately twofold slower in the presence of Ca2+ and phospholipid (PL), and 8- to 12-fold slower in the presence of Ca2+, PL, and factor VIIIa. Additionally, IXaHW had only approximately 10% of the activity of IXaN in an aPTT assay. In agreement with the nuclear magnetic resonance-derived structure of EGF, the Chou-Fasman algorithm strongly predicted a beta turn involving residues Asn-Pro55-Cys-Leu in IXN. Replacement of Pro55 by Ala gave a fourfold decrease in the beta turn probability for this peptide, suggesting a change(s) in the secondary structure in the EGF domain of IXHW. Since this domain of IXN is thought to have one high-affinity Ca2+ binding site and may be involved in PL and/or factor VIIIa binding, the localized secondary structural changes in IXHW could lead to distortion of the binding site(s) for the cofactor(s) and, thus, a dysfunctional molecule.
.A
Spitzer SG; Kuppuswamy MN; Saini R; Kasper CK; Birktoft JJ; Bajaj SP.
.I 274356
.U
91002911
.S
Blood 9101; 76(8):1538-45
.M
Animal; Blood Coagulation/DE; Blood Coagulation Disorders/CI/*PC; Comparative Study; Factor VII/*AI/TU; Fibrinogen/ME; Human; Lipoproteins/*TU; Partial Thromboplastin Time; Protease Inhibitors/*TU; Prothrombin Time; Rabbits; Recombinant Proteins/TU; Thromboplastin/*/*AI/PD/TU.
.T
Recombinant lipoprotein-associated coagulation inhibitor inhibits tissue thromboplastin-induced intravascular coagulation in the rabbit.
.P
JOURNAL ARTICLE.
.W
Lipoprotein-associated coagulation inhibitor produces feed-back inhibition of tissue factor (tissue thromboplastin)-induced coagulation in the presence of factor Xa Recombinant lipoprotein-associated coagulation inhibitor (rLACI) was tested for its ability to modify thromboplastin-induced intravascular coagulation in a rabbit model that allows monitoring of iodine-125 fibrin accumulation/disappearance in the lung and sampling of blood for the measurement of coagulation parameters. Infusion of thromboplastin into the rabbit caused a rapid increase of radioactivity over the lungs, possibly due to the accumulation of 125I fibrin in the lungs, followed by a rapid decline of radioactivity, suggestive of removal of fibrin from the lungs. Thromboplastin also caused a rapid decrease of systemic fibrinogen that was accompanied by a lengthening of the activated partial thromboplastin time and prothrombin time. The effect of coinfusion of rLACI with thromboplastin or bolus injection of rLACI before thromboplastin infusion was studied. At a high dose of rLACI (800 micrograms/kg body weight), the thromboplastin-induced radioactivity increase in the lungs and the systemic fibrinogen decrease were completely suppressed. The activated partial thromboplastin time and prothrombin time of the plasma samples lengthened, possibly due to the presence of thromboplastin in circulation. The thromboplastin-induced radioactivity increase over the lungs was not completely suppressed by lower doses of rLACI (135 to 270 micrograms/kg body weight), but these doses of rLACI prevented systemic fibrinogen decrease. At a bolus dose of 23 micrograms/kg body weight, rLACI provided 50% protection of the fibrinogen consumption (fibrinogen decreased to 82% compared with 65% in rabbits treated with thromboplastin alone). These results show that rLACI is effective in the inhibition of thromboplastin-induced coagulation in vivo.
.A
Day KC; Hoffman LC; Palmier MO; Kretzmer KK; Huang MD; Pyla EY; Spokas E; Broze GJ Jr; Warren TG; Wun TC.
.I 274357
.U
91002914
.S
Blood 9101; 76(8):1564-71
.M
Adenosine Diphosphate/PD; Antibodies, Monoclonal/*PD; Blood Platelets/DE/*PH/UL; Cytoskeleton/ME; Human; Immunohistochemistry; Microscopy, Electron; Microscopy, Electron, Scanning; Platelet Aggregation/DE/*PH; Platelet Membrane Glycoproteins/IM/*PH; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Thrombin/PD.
.T
Monoclonal antibodies bound to subunits of the integrin GPIIb-IIIa are internalized and interfere with filopodia formation and platelet aggregation.
.P
JOURNAL ARTICLE.
.W
The monoclonal antibodies Tab and AP3 are directed, respectively, against GPIIb and GPIIIa, the subunits of the platelet fibrinogen receptor. When added together to platelets, these antibodies prevent adenosine diphosphate (ADP)-induced platelet aggregation, despite normal fibrinogen binding (Newman et al, Blood 69:668, 1987). To explore the cellular requirements of aggregation after fibrinogen binding, we used several techniques to study platelets treated with Tab and AP3, then stimulated with ADP. We used scanning and transmission electron microscopy to evaluate platelet morphology, immunolabel-surface replication to determine whether individual GPIIb-IIIa complexes clustered, immunocytochemistry on frozen thin sections to study the subcellular distribution of the integrin GPIIb-IIIa and fibrinogen, and biochemical methods to assess the activation of the platelet cytoskeleton. We found that the treated cells had short, blunted projections instead of normal filopodia. Other morphologic abnormalities, apparent in thin section, were aberrantly placed alpha-granules and microtubules, and a prominent, worm-like, fibrinogen-filled surface-connected canalicular system. Biochemical analysis suggested that such platelets undergo massive actomyosin-controlled membrane flow, which serves to sequester GPIIb-IIIa and makes the platelets refractory to aggregation. We conclude that aggregation requires the formation of long, slender filopodia, probably directed by cytoskeletal rearrangements after activation, and that the transmembrane GPIIb-IIIa complex may play a role in signaling these events.
.A
Isenberg WM; Bainton DF; Newman PJ.
.I 274358
.U
91002916
.S
Blood 9101; 76(8):1580-5
.M
Adolescence; Adult; Aged; Anemia, Aplastic/BL/*DT; Antigens, CD/AN; Antigens, Differentiation/AN; B-Lymphocyte Subsets/IM/PA; Cell Division; Granulocyte-Macrophage Colony-Stimulating Factor/*TU; Human; HLA-DR Antigens/AN; Killer Cells, Natural/IM; Leukocyte Count; Lymphocyte Subsets/IM/PA; Lymphocyte Transformation; Middle Age; Receptors, Transferrin/AN; Recombinant Proteins/TU; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; T-Lymphocyte Subsets/IM/PA.
.T
Effect of recombinant human granulocyte-macrophage colony-stimulating factor administration on the lymphocyte subsets of patients with refractory aplastic anemia.
.P
JOURNAL ARTICLE.
.W
Human recombinant granulocyte-macrophage colony-stimulating factor (rhGM-CSF) was administered to 14 patients with refractory aplastic anemia (AA). The effect of rhGM-CSF therapy on the lymphocyte phenotype; on the proliferative responses to the mitogen phytohemagglutinin, Candida albicans, and tetanus toxoid antigens; and on the natural killer (NK) activity of the circulating lymphocytes was studied. Samples were collected before (baseline) and twice during the rhGM-CSF administration. The absolute number of circulating lymphocytes remained relatively constant during the first period, but experienced a significant increase (P less than .001) during the second period. The increase was most prominent in the B cells (P less than .001), but the T cells (P less than .016) also increased. Detailed investigation of lymphocyte subsets showed an increase of the markers CD38 (Leu17), HLA-DR, and the transferrin receptor throughout the treatment course giving evidence of lymphoid cell activation. The NK cell activity was suppressed (P less than .008) throughout the treatment. However, proliferative responses to phytohemagglutinin, Candida antigen, and tetanus toxoid were unaffected. Although the mechanism is not yet defined, GM-CSF does induce activation and increase in absolute lymphoid cell number, especially B cells, together with a decrease in NK cytotoxicity. The implication of these immune cell changes in relation to host resistance to microorganisms remains to be established.
.A
Faisal M; Cumberland W; Champlin R; Fahey JL.
.I 274359
.U
91002921
.S
Blood 9101; 76(8):1614-21
.M
Acute Disease; Adult; Aged; Female; Gene Rearrangement, T-Lymphocyte; Histocytochemistry; Human; Immunophenotyping; Leukemia/DT/*GE/PA; Leukemia, Lymphocytic, Acute/GE/PA; Leukemia, Myelocytic, Acute/GE/PA; Male; Middle Age; Prognosis; Stains and Staining; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Trisomy/*.
.T
Trisomy 13: a new recurring chromosome abnormality in acute leukemia.
.P
JOURNAL ARTICLE.
.W
A new recurring chromosome abnormality was identified in 8 of 621 consecutive successfully karyotyped adults with de novo acute leukemia. These eight patients had trisomy 13 as the sole cytogenetic abnormality. On central morphologic review, five cases were classified as subtypes of acute myeloid leukemia, one as acute mixed lymphoid and myeloid leukemia, one as acute lymphoid leukemia, and one as acute undifferentiated leukemia. Blasts of all eight cases expressed one or more myeloid differentiation antigens. Three also expressed T-lineage-associated antigens; however, none of these had rearrangement of the T-cell receptor beta, gamma, or delta genes. Four of six cases tested were TdT positive. All eight patients with trisomy 13 were treated with intensive induction chemotherapy; only three entered a short-lived complete remission. Survival of patients with trisomy 13 ranged from 0.5 to 14.7 months, and was significantly shorter than that of the remaining patients (median 9.5 v 16.2 months, P = .007). We conclude that trisomy 13 is a rare, recurring clonal chromosome abnormality in acute leukemia associated with a poor prognosis. Malignant transformation of an immature hematopoietic precursor cell is suggested by the expression of antigens characteristic of both the myeloid and lymphoid lineage, the high incidence of TdT positivity, and the morphologic heterogeneity in these leukemias.
.A
Dohner H; Arthur DC; Ball ED; Sobol RE; Davey FR; Lawrence D; Gordon L; Patil SR; Surana RB; Testa JR; et al.
.I 274360
.U
91002922
.S
Blood 9101; 76(8):1622-5
.M
Benzimidazoles/ME; Cell Fractionation; Cell Nucleus/ME/*UL; Chromomycins/ME; Comparative Study; DNA/ME; Fixatives; Fluorescent Dyes/ME; Histological Techniques/*; Human; Lymphocytes/UL; Methacrylates/*; Propidium; Stains and Staining; Support, U.S. Gov't, P.H.S.; Tonsil/UL.
.T
Recovery of nuclei from glycol-methacrylate-embedded tissue.
.P
JOURNAL ARTICLE.
.W
The analysis of antigens, enzyme histochemical markers, and DNA has become an important part of the classification of some leukemias, lymphomas, and other neoplastic diseases. Many of the relevant antigens and most of the relevant enzyme histochemical activities are destroyed and others are less than optimally preserved in tissues embedded in hot paraffin. Most enzymatic activities and antigens are well preserved in tissues embedded at 4 degrees C in glycol methacrylate (GMA). The measurement of DNA content in neoplastic cells with the most commonly employed techniques depended on the availability of fresh suspensions of cells until the development by Hedley of methods that permit the recovery of nuclei from paraffin blocks for this purpose. In order to facilitate the analysis of antigens, enzymatic markers, and DNA from the same sample of tissue, we have developed a means of recovery of nuclei from GMA-embedded tissues. Twenty-microns-thick sections of GMA-embedded tonsil were either pretreated with an organic solvent (absolute ethanol or 2-ethoxyethanol) followed by rehydration in phosphate buffered saline (PBS) or directly rehydrated in PBS. The suspensions were formed mechanically by gentle sonication. The type of fixative and length of PBS rehydration were varied. Tissue fixed in 100% acetone, embedded in GMA, and rehydrated directly in PBS for six days gave the highest average yield of nuclei, 3.7 x 10(7) nuclei per gram tissue. In order to assess DNA binding of fluorescent dyes, 2-microns-thick GMA sections were stained with chromomycin, Hoechst 33342 (Sigma Chemical, St Louis, MO), and propidium iodide. Hoechst 33342 bound specifically to the nuclei with low background staining.
.A
Wright ET; Jacobberger JW; Pretlow TP; Pretlow TG.
.I 274361
.U
91002923
.S
Blood 9101; 76(8):1626-30
.M
Child; Chromosome Abnormalities/*; Chromosome Banding; Chromosome Deletion; Chromosomes, Human, Pair 6/*; Genotype; Human; Immunophenotyping; Leukemia, Lymphocytic, Acute/*GE; Ploidies; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Translocation (Genetics).
.T
Abnormalities of the long arm of chromosome 6 in childhood acute lymphoblastic leukemia.
.P
JOURNAL ARTICLE.
.W
To determine the biologic significance of the structural rearrangements of the long arm of chromosome 6(6q) in acute lymphoblastic leukemia (ALL) at diagnosis, we studied 412 consecutive children whose leukemic cell chromosomes had been completely banded and identified 45 (11%) children with this abnormality. The 45 cases were divided into del(6q) only (n = 11), del(6q) and numerical abnormalities (n = 4), del(6q) and structural abnormalities (n = 23), and 6q translocations (n = 7). The breakpoints of del(6q) were subgrouped: del(6)(q15q21) in 11 cases, del(6) (q13q21) in six, del(6)(q21q23) in four, del(6)(q15) in four, del(6)(q15q23) in three, and other deletions in 10 cases. Notably, all these deletions encompassed the 6q21 band, suggesting that this might be the locus of a recessive tumor suppressor gene, the absence of which contributes to malignant transformation or proliferation. Among the seven children with 6q translocations, a previously unidentified nonrandom translocation, t(6;12)(q21;p13) was noted in two cases with an early pre-B immunophenotype. Clinical features and event-free survival were similar among children with or without 6q abnormalities. Overall, children with 6q abnormalities were less likely than those without the abnormality to have a pre-B immunophenotype (P = .03). T-cell immunophenotypes were equally represented in cases with or without 6q abnormalities. However, all four children with del(6q) and a 12p abnormality had early pre-B ALL and all three children with del(6q) and a 9p abnormality had a T-cell immunophenotype. The lack of specificity for a particular immunophenotype may imply that the gene or genes affected by 6q abnormalities are broadly active in the multistep process of lymphoid leukemogenesis. The relatively high frequency of microscopically visible del(6q) indicates the need for molecular studies to identify cases with submicroscopic deletions.
.A
Hayashi Y; Raimondi SC; Look AT; Behm FG; Kitchingman GR; Pui CH; Rivera GK; Williams DL.
.I 274362
.U
91002924
.S
Blood 9101; 76(8):1631-8
.M
Complement 5a/*PD; Gene Expression; Human; Interleukin-1/BI/*GE/PD; Lipopolysaccharides/*PD; N-Formylmethionine Leucyl-Phenylalanine/PD; Recombinant Proteins/PD; RNA, Messenger/BI; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Tetradecanoylphorbol Acetate/PD; Transcription, Genetic/*; Translation, Genetic/*; Tumor Necrosis Factor/BI/*GE.
.T
Recombinant C5a stimulates transcription rather than translation of interleukin-1 (IL-1) and tumor necrosis factor: translational signal provided by lipopolysaccharide or IL-1 itself.
.P
JOURNAL ARTICLE.
.W
We investigated the effects of recombinant C5a (rC5a) on gene expression and synthesis of interleukin-1 beta (IL-1 beta) and tumor necrosis factor (TNF) in fresh human peripheral blood mononuclear cells (PBMC). Total (cell-associated and secreted) cytokine synthesis was measured. In the strict absence of endotoxin (lipopolysaccharide [LPS]), rC5a resulted in a small but statistically insignificant increase in immunoreactive IL-1 beta and TNF, as well as in IL-1 and IL-6 bioactivity. On the other hand, rC5a induced marked transcriptional activation of IL-1 beta and TNF in a dose-dependent fashion with an optimal concentration of 50 ng/mL. The rC5a-induced cytokine messenger RNA (mRNA) was not spontaneously translated into protein. At 50 ng/mL, rC5a induced the same levels of mRNA for IL-1 beta and TNF as 1 ng/mL of LPS, whereas LPS induced 12 times more IL-1 beta protein and 70 times more TNF protein than rC5a alone. The C5a-induced mRNA half-life was the same as that induced by LPS. Formyl-Meth-Leu-Phe (fMLP) did not induce cytokine transcription. Pretreatment with rC5a enhanced cytokine synthesis induced by other stimuli. After 2 hours of preincubation with rC5a, PBMC synthesized 3 to 10 times more IL-1 beta and TNF on subsequent stimulation by LPS or IL-1 itself. We conclude that rC5a provides primarily a transcriptional but not translational signal for IL-1 beta and TNF; the half-life of the untranslated mRNA is the same as that of translated message; rC5a-induced transcription upregulates PBMC for enhanced synthesis of these cytokines; and a translational signal can be provided by LPS or IL-1 itself.
.A
Schindler R; Gelfand JA; Dinarello CA.
.I 274363
.U
91002925
.S
Blood 9101; 76(8):1639-46
.M
Antigens, Surface/AN; Bone Marrow/CY; Cell Survival; Cells, Cultured; Flow Cytometry; Fluorescent Antibody Technique; Histocytochemistry; Human; Immunoenzyme Techniques; Immunophenotyping; Leukemia, Promyelocytic, Acute/IM/PA; Neutrophils/*CY/IM; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Tumor Cells, Cultured.
.T
The role of cellular maturation in neutrophil heterogeneity.
.P
JOURNAL ARTICLE.
.W
Previous studies have shown that many neutrophil (PMN) characteristics are heterogeneous but the origin of PMN heterogeneity is unknown. It is unclear if PMN functional heterogeneity is secondary to maturational differences or due to distinct subpopulations of cells that possess different functional capacities. The PMN 31D8 antigen is a useful probe for evaluation of PMN subpopulations. The majority of PMNs (approximately 85%) exhibit a high intensity fluorescence after 31D8 monoclonal antibody (MoAb) labeling (31D8 enriched or "bright" PMNs) as determined by flow cytometric analysis. These cells are more functional than cells with low intensity fluorescence (31D8 diminished or "dull" PMNs). Various immunologic, clonogenic and functional techniques were used to study the expression of the 31D8 antigen in HL-60 cells and myeloid cells in order to evaluate antigenic and functional heterogeneity during morphologic maturation. The results of this study indicate that the percentage of 31D8 antigen positive (31D8 antigen enriched and diminished) bone marrow cells increases from 20 +/- 11% in myeloblast cells to 68 +/- 10% in promyelocytes, 93 +/- 2% in myelocytes and 99 +/- 1% in bands and PMNs. 31D8 antigen enriched cells first appear at the myelocyte stage (32 +/- 10%) and increase in bands (52 +/- 13%), marrow PMNs (62 +/- 13%) and peripheral blood PMNs (88 +/- 4%). These data indicate that the heterogeneous expression of 31D8 antigen in PMNs is due, at least in part, to maturational differences within the PMN population and raise the possibility that other heterogeneously expressed PMN characteristics are also maturationally derived. They also suggest that 31D8 antigenic expression may be a more precise indicator of myeloid functional maturation than maturation as identified by cellular morphology.
.A
Krause PJ; Todd MB; Hancock WW; Pastuszak WT; Maderazo EG; Hild DH; Kosciol CM.
.I 274364
.U
91002926
.S
Blood 9101; 76(8):1647-56
.M
Adult; Aging; Antigens, CD/AN; Antigens, Differentiation, B-Lymphocyte/AN; B-Lymphocytes/*CY/IM; Bone Marrow Transplantation/*; Cell Differentiation; Child; Child, Preschool; Comparative Study; Graft vs Host Disease/BL; Human; HLA-DR Antigens/AN; IgG/BI; IgM/BI; Immunophenotyping; Infant, Newborn; Leukocyte Count; Lymphocyte Transformation; Staphylococcus aureus/IM; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; T-Lymphocytes/*PH.
.T
B-cell differentiation following autologous, conventional, or T-cell depleted bone marrow transplantation: a recapitulation of normal B-cell ontogeny.
.P
JOURNAL ARTICLE.
.W
The circulating lymphocytes of 88 consecutive patients following autologous, conventional, or T-cell depleted bone marrow transplantation were serially analyzed for B-cell surface antigen expression and function. In the majority of patients, except for those who developed chronic graft-versus-host disease, the number of circulating CD20+ B cell normalized by the fourth posttransplant month. The earliest detectable B cells normally expressed HLA-DR, CD19, surface immunoglobulin (slg), CD21, Leu-8, and lacked expression of CD10 (CALLA). In addition, the circulating B cells expressed CD1c, CD38, CD5, and CD23 for the first year following transplant, antigens that are normally expressed on a small percentage of circulating B cells in normal adults, but highly expressed on cord blood B cells. Similar to cord blood B cells, patient B cells isolated during the first year following transplant, proliferated normally to Staphylococcus aureus Cowan strain I (SAC), and produced IgM, but minimal or no IgG when stimulated with pokeweed mitogen and SAC, unlike normal adult B cells that produce both. The similar phenotype and function of posttransplant and cord blood B cells, and their similar rate of decline in patients and normal children adds further evidence to support the hypothesis that B-cell differentiation posttransplant is recapitulating normal B-cell ontogeny.
.A
Small TN; Keever CA; Weiner-Fedus S; Heller G; O'Reilly RJ; Flomenberg N.
.I 274365
.U
91002927
.S
Blood 9101; 76(8):1657-61
.M
Animal; Blood Transfusion/*; Blotting, Western; Cell Line; Female; HTLV Antibodies/AN; HTLV-I/IM/IP; HTLV-I Infections/MI/PC/*TM; Immunization, Passive/*; Interleukin-2/PD; Male; Microscopy, Electron; Rabbits; Support, Non-U.S. Gov't; T-Lymphocytes/MI.
.T
Transmission of HTLV-I by blood transfusion and its prevention by passive immunization in rabbits.
.P
JOURNAL ARTICLE.
.W
To determine the minimum volume of blood required to transmit human T-cell leukemia virus type I (HTLV-I), heparinized blood was collected from a virus-infected female rabbit and aliquots of 10, 5, 1, 0.5, 0.1, and 0.01 mL were transfused into groups of two male rabbits each. All 10 rabbits transfused with 10 to 0.1 mL and 1 of 2 rabbits transfused with 0.01 mL seroconverted for HTLV-I after 2 to 4 weeks. HTLV-I-producing lymphoid cell lines of recipient origin were established from one seroconverted rabbit of each aliquot group. To determine the ability of passive immunization to protect against HTLV-I infection, two groups of three rabbits were first transfused with 5 mL of blood from the same virus-infected rabbit and then infused after 24 or 48 hours with 10 mL of HTLV-I immune globulin (77 mg/mL of IgG) prepared from seropositive healthy persons. None of the 24-hour immunization group seroconverted for HTLV-I during the observation period of six months; however, all of the 48-hour immunization group became seropositive after 2 to 4 weeks. These results indicate that HTLV-I can be transmitted with as little as 0.01 mL of virus-infected blood, and that passive immunization is effective in preventing cell-to-cell infection of HTLV-I when given within 24 hours of transfusion of virus-infected blood.
.A
Kataoka R; Takehara N; Iwahara Y; Sawada T; Ohtsuki Y; Dawei Y; Hoshino H; Miyoshi I.
.I 274366
.U
91002928
.S
Blood 9101; 76(8):1663
.M
beta 2-Microglobulin/*ME; Adult; Female; Human; Male; Multiple Myeloma/BL/ET; Plasmacytoma/*BL/CO.
.T
Serum beta 2 microglobulin in solitary plasmocytomata [letter; comment]
.P
COMMENT; LETTER.
.A
Aviles A; Huerta J; Zepeda G; Diaz-Maqueo JC.
.I 274367
.U
91002929
.S
Blood 9101; 76(8):1663-5
.M
Aged; Base Sequence; Case Report; Female; Genes, abl/*GE; Human; Leukemia, Myeloid, Chronic/*GE; Molecular Sequence Data; Proto-Oncogene Proteins/*GE; Support, Non-U.S. Gov't; Transcription, Genetic/*.
.T
Alternative BCR/ABL transcripts in chronic myeloid leukemia [letter; comment]
.P
COMMENT; LETTER.
.A
Zaccaria A; Tassinari A; Testoni N; Lauria F; Tura S; Algeri R; Guerrasio A; Rosso C; Saglio G.
.I 274368
.U
91002930
.S
Blood 9101; 76(8):1665-6
.M
Histiocytes/PA; Hodgkin's Disease/*PA; Human; Lymphocytes/PA.
.T
More on the origin of the Reed-Sternberg cell [letter; comment]
.P
COMMENT; LETTER.
.A
Drexler HG.
.I 274369
.U
91002931
.S
Blood 9101; 76(8):1666-8
.M
Blood Platelets/*ME; Cell Adhesion; Drug Contamination/*; Glycoproteins/*AN; Human; Platelet Membrane Glycoproteins/*IP; Receptors, Immunologic/PH.
.T
Contamination of thrombospondin with vitronectin [letter; comment]
.P
COMMENT; LETTER.
.A
Sun X; Mosher DF.
.I 274370
.U
91003016
.S
BMJ 9101; 301(6750):453-4
.M
Asbestosis/*DI/EC; Great Britain; Human; Male; Workmen's Compensation/*/LJ.
.T
Asbestos diseases and compensation [editorial] [see comments]
.P
EDITORIAL.
.A
Seaton A.
.I 274371
.U
91003017
.S
BMJ 9101; 301(6750):454-5
.M
Aspirin/TU; Erythromelalgia/*DI/ET/TH; Human; Rest.
.T
Three types of erythromelalgia [editorial] [see comments]
.P
EDITORIAL.
.A
Drenth JP; Michiels JJ.
.I 274372
.U
91003018
.S
BMJ 9101; 301(6750):455-6
.M
Family Practice/*/OG; Female; Great Britain; Human; Male; Personnel Staffing and Scheduling/*; Salaries and Fringe Benefits; Sex Factors; Time and Motion Studies.
.T
General practitioners' workload [editorial]
.P
EDITORIAL.
.A
Ridsdale L.
.I 274373
.U
91003019
.S
BMJ 9101; 301(6750):461-6
.M
Adult; Aged; Blood Pressure; Calcium/BL; Cardiovascular Diseases/BL/*ET; Cholesterol/*BL; Human; Longitudinal Studies; Male; Middle Age; Risk Factors; Sleep Disorders/*PX; Stress, Psychological/BL; Support, Non-U.S. Gov't; Sweden; Unemployment/*PX.
.T
Threat of unemployment and cardiovascular risk factors: longitudinal study of quality of sleep and serum cholesterol concentrations in men threatened with redundancy.
.P
JOURNAL ARTICLE.
.W
OBJECTIVE--To assess whether the threat of unemployment affects risk factors for cardiovascular disease. DESIGN--Longitudinal study of a cohort of middle aged shipyard workers followed up for a mean of 6.2 (SD 1.9) years and a group of controls observed for the same period. The first investigation took place during a period of relative economic stability for the shipyard and the second during the phase of its closure. SETTING--An age cohort health screening programme in Malmo, Sweden. PARTICIPANTS--715 Male shipyard workers and 261 age matched male controls. MAIN OUTCOME MEASURES--Changes in 19 variables related to the risk of cardiovascular disease, and psychological variables, alcohol consumption, smoking, and dietary habits as assessed by questionnaire. RESULTS--Serum cholesterol concentrations increased more (mean 0.25 (SD 0.68) mmol/l v 0.08 (0.66) mmol/l) and serum calcium concentrations decreased less (-0.06 (0.10) mmol/l v -0.08 (0.09) mmol/l) in the shipyard workers than in the controls. A correlation was found between scores for sleep disturbance and changes in serum cholesterol concentration. In the whole series there was a greater increase in serum cholesterol concentrations among men threatened with unemployment (437/976; 44.8%) than among those who were not. In stepwise regression analysis the change in serum cholesterol concentration was correlated with changes in haemoglobin concentration, body weight, and serum triglyceride and calcium concentrations. A positive correlation was found between change in cholesterol concentration and change in blood pressure, indicating that the overall risk profile had worsened among men with increased serum cholesterol concentrations. CONCLUSIONS--Risk of unemployment increases the serum cholesterol concentration in middle aged men, the increase being more pronounced in those with sleep disturbance. The increase in serum cholesterol is related to changes in other established risk factors for cardiovascular disease. These findings might partly explain the excessive mortality due to cardiovascular disease recorded among the unemployed and people with sleep disturbance.
.A
Mattiasson I; Lindgarde F; Nilsson JA; Theorell T.
.I 274374
.U
91003020
.S
BMJ 9101; 301(6750):466-70
.M
Adolescence; Adult; Animal; Antimalarials/*TU; Chloroguanide/AD; Chloroquine/AD; Comparative Study; Dapsone/AD; Drug Therapy, Combination; Female; Human; Intervention Studies; Malaria/BL/*DT; Plasmodium falciparum/*; Pregnancy; Pregnancy Complications, Infectious/*DT; Prospective Studies; Pyrimethamine/AD; Sulfadoxine/AD.
.T
Comparison of chloroquine, pyrimethamine and sulfadoxine, and chlorproguanil and dapsone as treatment for falciparum malaria in pregnant and non-pregnant women, Kakamega District, Kenya.
.P
CLINICAL TRIAL; JOURNAL ARTICLE.
.W
OBJECTIVE--To compare treatment and protection against falciparum malaria in pregnant and non-pregnant women with three drug regimens. DESIGN--Prospective intervention study with six weeks' follow up. Patients received one of three drug regimens in order of entry. SETTING--Primary care hospital and secondary girls' school in rural western Kenya. PATIENTS--158 of 988 pregnant women (89 primigravid and 69 multigravid) in the third trimester and 105 of 1488 non-pregnant schoolgirls of reproductive age were parasitaemic (more than 500 asexual forms/microliter. These women were divided into three treatment groups by gravid state. INTERVENTIONS--Women were treated with chloroquine base 25 mg/kg over three days or pyrimethamine 75 mg and sulfadoxine 1500 mg as a single dose or chlorproguanil 1.2 mg/kg and dapsone 2.4 mg/kg as a single dose. MAIN OUTCOME MEASURES--Parasitaemia and haemoglobin concentrations measured at seven day intervals for six weeks. RESULTS--Primigravid women were more likely to be parasitaemic on follow up than multigravidas or nulligravidas, whose response was about the same. Parasites did not clear by day 7 in primigravidas in six (20%) of 30 who received chloroquine, three (8%) of 35 treated with pyrimethamine and sulfadoxine, and none of 23 treated with chlorproguanil and dapsone. At day 28, 83%, 19%, and 67% of primigravidas in these treatment groups were parasitaemic. Haemoglobin concentrations rose in all women, but improvement was sustained only in women who remained free of parasites. CONCLUSIONS--Clearance of parasites was better with either pyrimethamine and sulfadoxine or chlorproguanil and dapsone than with chloroquine. Longest protection was obtained with pyrimethamine and sulfadoxine.
.A
Keuter M; van Eijk A; Hoogstrate M; Raasveld M; van de Ree M; Ngwawe WA; Watkins WM; Were JB; Brandling-Bennett AD.
.I 274375
.U
91003021
.S
BMJ 9101; 301(6750):470-3
.M
Appointments and Schedules; Correspondence/*; Education, Medical, Continuing; England; Human; Interprofessional Relations; Orthopedics/*/ED/ST; Outpatient Clinics, Hospital/*ST; Referral and Consultation/*SN; Retrospective Studies; Support, Non-U.S. Gov't; Time Factors.
.T
Referral letters and replies from orthopaedic departments: opportunities missed [see comments]
.P
JOURNAL ARTICLE.
.W
OBJECTIVE--To study delays between sending referral letters and the outpatient appointment and to assess the content of referral and reply letters, their educational value, and the extent to which questions asked are answered by reply letters. DESIGN--Retrospective review of referrals to 16 consultant orthopaedic surgeons at five hospitals, comprising 288 referral letters with corresponding replies, by scoring contents of letters. SETTING--Orthopaedic teaching hospitals in Nottingham, Derby, and Mansfield. MAIN OUTCOME MEASURES--Weighted scores of contents of referral and reply letters, assessment of their educational value, and responses to questions in referral letters. RESULTS--Median outpatient delay was 23.4 weeks. There was no significant decrease in waiting time if the referral letter was marked "urgent" but a significantly greater delay (p less than 0.01) if referrals were directed to an unnamed consultant. The content score was generally unsatisfactory for both referrals and replies, and there was no correlation for the content scores of the referral letter and its reply (r = 0.13). Items of education were rare in the referral letters (8/288; 3%) and significantly more common in replies (75/288; 26%) (p much less than 0.001). Senior registrars were significantly more likely to attempt education than other writers (p less than 0.02). Education in replies was significantly related to increased length of the letter (p less than 0.05) and was more likely to occur if the referral was addressed to a named consultant (p less than 0.03). 48 (17%) Referral letters asked questions, of which 21 (44%) received a reply. No factor was found to influence the asking of or replying to questions. CONCLUSIONS--The potential for useful communication in the referral letter and in the reply from orthopaedic surgeons is being missed at a number of levels. The content is often poor, the level of mutual education is low, and the use of the referral letter to determine urgency is deficient. Most questions asked by general practitioners are not answered.
.A
Jacobs LG; Pringle MA.
.I 274376
.U
91003022
.S
BMJ 9101; 301(6750):473-6
.M
Adult; Asthma/*BL/DT/PP; Atropine/TU; Circadian Rhythm; Double-Blind Method; Epinephrine/*BL/TU; Female; Human; Male; Middle Age; Peak Expiratory Flow Rate/DE; Time Factors.
.T
Adrenaline and nocturnal asthma.
.P
CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL.
.W
OBJECTIVE--To determine whether the nocturnal fall in plasma adrenaline is a cause of nocturnal asthma. DESIGN--Double blind placebo controlled cross-over study. In the first experiment the nocturnal fall in plasma adrenaline at 4 am was corrected in 10 asthmatic subjects with an infusion of adrenaline after parasympathetic blockade with 30 micrograms/kg intravenous atropine. In the second experiment 11 asthmatic subjects showing similar variations in peak expiratory flow rate had the nocturnal fall in plasma adrenaline corrected by infusion before atropine was given. PATIENTS--Asthmatic subjects with a diurnal variation in home peak expiratory flow rate of greater than 20% for at least 75% of the time in the two weeks before the study. MAIN OUTCOME MEASURES--Peak expiratory flow rate and plasma adrenaline. RESULTS--Correction of the nocturnal fall in plasma adrenaline at 4 am to resting 4 pm levels did not alter peak expiratory flow rate either before or after parasympathetic blockade with atropine. CONCLUSION--A nighttime fall in plasma adrenaline is not a cause of nocturnal asthma.
.A
Morrison JF; Teale C; Pearson SB; Marshall P; Dwyer NM; Jones S; Dean HG.
.I 274377
.U
91003023
.S
BMJ 9101; 301(6750):476-7
.M
Anemia/*DT/ET; Case Report; Erythropoietin/*TU; Female; Hemodialysis; Hemoglobins/AN; Human; Kidney Failure, Chronic/CO/TH; Male; Middle Age; Multiple Myeloma/BL/*CO; Support, Non-U.S. Gov't.
.T
Effect of erythropoietin on anaemia in patients with myeloma receiving haemodialysis.
.P
JOURNAL ARTICLE.
.A
Taylor J; Mactier RA; Stewart WK; Henderson IS.
.I 274378
.U
91003024
.S
BMJ 9101; 301(6750):478-80
.M
Attitude of Health Personnel; Clinical Competence; England; Family Practice/*; Female; Human; Male; Physical Examination/*; Questionnaires; Rectal Diseases/*DI; Sex Factors; Support, Non-U.S. Gov't.
.T
Rectal examination in general practice [see comments]
.P
JOURNAL ARTICLE.
.W
OBJECTIVE--To investigate factors influencing a general practitioner's decision to do a rectal examination in patients with anorectal or urinary symptoms. DESIGN--Postal questionnaire survey. SETTING--General practices in inner London and Devon. SUBJECTS--859 General practitioners, 609 (71%) of whom returned the questionnaire. MAIN OUTCOME MEASURES--Number of rectal examinations done each month; the indication score, derived from answers to a question asking whether the respondent would do a rectal examination for various symptoms; and the confidence score, which indicated the respondent's confidence in the diagnosis made on rectal examination. RESULTS--279 General practitioners did five or fewer rectal examinations each month and 96 did more than 10 each month. Factors significantly associated with doing fewer rectal examinations were a small partnership and being a female general practitioner, and the expectation that the examination would be repeated. Lack of time in the surgery, and a waiting time of less than two weeks for an urgent outpatient appointment were also important. General practitioners were deterred from doing rectal examinations by reluctance of the patient (278), the expectation that the examination would be repeated (141), and lack of time (123) or a chaperone (39). Confidence in diagnosis was significantly associated with doing more rectal examinations, the perception of having been well taught to do a rectal examination at medical school, and being a male general practitioner. CONCLUSIONS--Factors other than clinical judgment influence the frequency of rectal examination in general practice. Rectal examination may become commoner with the trend towards larger group practices and if diagnostic confidence is increased and greater emphasis put on rectal examination in undergraduate and postgraduate teaching.
.A
Hennigan TW; Franks PJ; Hocken DB; Allen-Mersh TG.
.I 274379
.U
91003025
.S
BMJ 9101; 301(6750):481-4
.M
Forecasting; Great Britain; Policy Making; Public Health Administration/*TD; State Medicine/*OG; Support, Non-U.S. Gov't.
.T
What future for the Department of Health?
.P
JOURNAL ARTICLE.
.A
Klein R.
.I 274380
.U
91003026
.S
BMJ 9101; 301(6750):485-8
.M
Adult; Child; Hematuria/ET; Human; Kidney/*IN/RA; Nephrectomy; Wounds, Nonpenetrating/*/SU; Wounds, Penetrating/*/SU.
.T
ABC of major trauma. Trauma of the upper urinary tract.
.P
JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL.
.A
Terry T.
.I 274381
.U
91003027
.S
BMJ 9101; 301(6750):489-90
.M
Case Report; Gastrinoma/*PA/SU; Glucagonoma/PA; Human; Male; Middle Age; Neoplasms, Multiple Endocrine/*PA/SU; Pancreatic Neoplasms/*PA/SU; Support, Non-U.S. Gov't.
.T
Gastrinoma syndrome in multiple endocrine neoplasia [clinical conference]
.P
CLINICAL CONFERENCE; JOURNAL ARTICLE.
.A
Wynick D; Dollery CT; Bloom SR; Polak JM; Lynn JA.
.I 274382
.U
91003028
.S
BMJ 9101; 301(6750):492
.M
Formularies/*; Great Britain; Prescriptions, Drug/*EC.
.T
Interpretation and management of PACT (prescribing analysis and cost) data on formularies [letter] [see comments]
.P
LETTER.
.A
Anderson ML; Barrett CW; Kopelman PG.
.I 274383
.U
91003029
.S
BMJ 9101; 301(6750):492-4
.M
Bedding and Linens/*; Human; Infant; Posture; Sleep/*PH; Sudden Infant Death/*ET.
.T
Bedding and sleeping position in the sudden infant death syndrome [letter] [published erratum appears in BMJ 1990 Oct 10;301(6756):875]
.P
LETTER.
.I 274384
.U
91003030
.S
BMJ 9101; 301(6750):494-5
.M
Bleeding Time/*; Hemorrhage/PC; Human; Liver Cirrhosis/*BL; Risk Factors.
.T
Bleeding time in patients with hepatic cirrhosis [letter; comment]
.P
COMMENT; LETTER.
.A
Burroughs AK; Blake J.
.I 274385
.U
91003031
.S
BMJ 9101; 301(6750):495
.M
Child; Human; Lidocaine/*AE; Methemoglobinemia/*CI; Ointments; Prilocaine/*AE.
.T
Methaemoglobinaemia in children treated with prilocaine-lignocaine cream [letter; comment]
.P
COMMENT; LETTER.
.A
Radford M; Pinder AM.
.I 274386
.U
91003032
.S
BMJ 9101; 301(6750):495-6
.M
Anesthesia, Local; Colles' Fracture/*TH; Fracture Fixation/MT; Human.
.T
Colles' fracture [letter; comment]
.P
COMMENT; LETTER.
.I 274387
.U
91003033
.S
BMJ 9101; 301(6750):496
.M
Adult; Animal; Athletic Injuries/*EP; Great Britain/EP; Horses/*; Human; Risk Factors.
.T
Safety of horseriding [letter]
.P
LETTER.
.A
Nicholl JP.
.I 274388
.U
91003035
.S
BMJ 9101; 301(6751):502-3
.M
Child; Child Health Services/*ST; Diabetes Mellitus, Insulin-Dependent/CO/*TH; Great Britain; Human; Quality of Health Care/SN.
.T
Children with diabetes [editorial]
.P
EDITORIAL.
.A
Baum JD.
.I 274389
.U
91003036
.S
BMJ 9101; 301(6751):503-4
.M
Aged; Arthritis/DI; Human; Joint Diseases/DI/PP/TH; Pain/*ET; Shoulder Joint/*.
.T
Shoulder pain in the elderly [editorial] [see comments]
.P
EDITORIAL.
.A
O'Reilly D; Bernstein RM.
.I 274390
.U
91003037
.S
BMJ 9101; 301(6751):504-6
.M
Child, Preschool; Cognition Disorders/ET; Environmental Exposure/*; Human; Infant; Lead/*/BL; Lead Poisoning/BL/CO/*ET.
.T
Low level exposure to lead [editorial] [see comments]
.P
EDITORIAL.
.A
Lee WR; Moore MR.
.I 274391
.U
91003038
.S
BMJ 9101; 301(6751):506
.M
Allied Health Personnel/*ED; Educational Measurement; Great Britain; State Medicine; Vocational Education/*MT.
.T
Training for care assistants [editorial] [see comments]
.P
EDITORIAL.
.A
Murphy E.
.I 274392
.U
91003040
.S
BMJ 9101; 301(6751):513-5
.M
Adult; Age Factors; Aged; Dyspepsia/*ET; Gastroscopy; Human; Middle Age; Neoplasm Staging; Precancerous Conditions/DI; Prospective Studies; Stomach Neoplasms/CO/*DI/PA; Support, Non-U.S. Gov't.
.T
Early detection of gastric cancer [see comments]
.P
CLINICAL TRIAL; JOURNAL ARTICLE.
.W
OBJECTIVE--To see whether investigation of dyspeptic patients aged over 40 after their first consultation with the general practitioner would increase the proportions with early and operable gastric cancers. DESIGN--Prospective study of gastric cancer in dyspeptic patients aged over 40 from a defined population. SETTING--10 General practices (six in central Birmingham, four in Sandwell); the Queen Elizabeth Hospital, Birmingham; and Sandwell District General Hospital. PATIENTS--2659 Patients aged 40 or over referred with dyspepsia. MAIN OUTCOME MEASURE--Increase in early and operable gastric cancers detected in middle aged patients with dyspepsia. RESULTS--Disease was identified in 1992 patients (75%). Fifty seven were found to have gastric cancer, 36 being treated by potentially curative resection, including 15 with early cancer. CONCLUSIONS--The investigation of dyspeptic patients over 40 at first attendance can increase the proportion of early gastric cancers detected to 26% and the proportion of operable cases to 63%. Such a policy has the potential to reduce mortality from gastric cancer in the population.
.A
Hallissey MT; Allum WH; Jewkes AJ; Ellis DJ; Fielding JW.
.I 274393
.U
91003041
.S
BMJ 9101; 301(6751):516-8
.M
Adult; Amenorrhea/*PA; Bone Density/*; Comparative Study; Cross-Sectional Studies; Dancing; Exercise/*; Female; Human; Lumbar Vertebrae/*PA; Muscle Contraction; Sports/*; Support, Non-U.S. Gov't.
.T
Menstrual state and exercise as determinants of spinal trabecular bone density in female athletes.
.P
JOURNAL ARTICLE.
.W
OBJECTIVE--To study the effects of amenorrhoea and intensive back exercise on the bone mineral density of the lumbar spine in female athletes. DESIGN--Cross sectional study comparing amenorrhoeic with eumenorrhoeic athletes and rowers with non-rowers. SETTING--The British Olympic Medical Centre, Northwick Park Hospital. PATIENTS--46 Elite female athletes comprising 19 rowers, 18 runners, and nine dancers, of whom 25 were amenorrhoeic and 21 eumenorrhoeic. MAIN OUTCOME MEASURE--Trabecular bone mineral density of the lumbar spine measured by computed tomography. RESULTS--Mean trabecular bone mineral density was 42 mg/cm3 (95% confidence interval 22 to 62 mg/cm3) lower in the amenorrhoeic than the eumenorrhoeic athletes; this difference was highly significant (p = 0.0002). Mean trabecular bone mineral density was 21 mg/cm3 (1 to 41 mg/cm3) lower in the non-rowers than the rowers; this was also significant (p = 0.05). There was no interaction between these two effects (p = 0.28). CONCLUSION--The effect of intensive exercise on the lumbar spine partially compensates for the adverse effect of amenorrhoea on spinal trabecular bone density.
.A
Wolman RL; Clark P; McNally E; Harries M; Reeve J.
.I 274394
.U
91003042
.S
BMJ 9101; 301(6751):518-20
.M
Acquired Immunodeficiency Syndrome/*EP/PC/TM; Adult; Female; Human; HIV Seropositivity/*EP; HIV-1/*; Mass Screening/MT; Middle Age; Pregnancy; Pregnancy Complications, Infectious/*EP; Prenatal Care/*; Retrospective Studies; Risk Factors; Scotland/EP.
.T
Prevalence of HIV antibody and pregnancy in Tayside, 1984-9: background to screening.
.P
JOURNAL ARTICLE.
.W
OBJECTIVE--To determine age specific prevalence of HIV antibody, incidence of pregnancy, and likelihood of detection and correct assignment to risk category by antenatal screening of women known to be positive for HIV antibody, from 1984 to 1989. DESIGN--Retrospective analysis of reproductive history and risk behaviour of women positive for HIV antibody and prediction of detection by screening on the basis of blood group samples, Guthrie tests, and rubella tests. SETTING--City of Dundee, where the prevalence of HIV is high, since the appearance of HIV in 1984, predominantly among heterosexual intravenous drug users. PATIENTS--All (61) women known to be positive for HIV antibody who had had clinically indicated tests, for whom case notes were available for 60. MAIN OUTCOME MEASURES--Risk assessment according to case notes and reported to the laboratory, incidence of infection, geographical location, age, date of positive test result, and reproductive history. RESULTS--With 61 infected women the overall minimum prevalence among women within the city of Dundee was 0.67/1000 and 2.9/1000 among women in their third decade. Of the 60 women whose reproductive history was available, 35 had 57 pregnancies, 36 of which occurred after seroconversion was known to have taken place, representing 8.7% of the total number of affected pregnancies reported for the United Kingdom. If antenatal screening for HIV had been performed between 1984 and 1989 it could not have detected positivity for HIV antibody in 25 (42%) women who had no pregnancies during this time. Among the remaining 35 women, screening samples taken for blood grouping could have identified a maximum of 34 (57%), samples taken to check rubella susceptibility a maximum of 22 (37%), and blood spots on Guthrie cards a maximum of 19 (32%). Retesting would have occurred in 14 women 33 times with samples taken for blood grouping, but three and four women would have been tested twice using samples taken for rubella testing and Guthrie cards respectively. Anonymous screening would have been unable to determine risk category as a history of intravenous drug use was known in 47 (79%) women before testing but this was increased by a further 5 (8%) who admitted to it after the test result was known. CONCLUSION--Interpreting the results of antenatal screening programmes will be complex and will underestimate overall prevalence of HIV antibody among women; this will be exaggerated by strategies based on anonymous testing with Guthrie cards or on samples taken for rubella testing, which do not include women who have had an earlier loss of pregnancy. Only open testing with consent will permit satisfactory attribution to
.A
Smith R; Patel NB; Urquhart GE; McFaul P; Neven P; Howie PW.
.I 274395
.U
91003043
.S
BMJ 9101; 301(6751):521-3
.M
Adult; Cholesterol/BL; Double-Blind Method; Drug Combinations; Female; Human; Hypertension/BL/*DT; Magnesium Chloride/AD/*TU; Male; Middle Age; Potassium Chloride/AD/*TU.
.T
Efficacy of potassium and magnesium in essential hypertension: a double-blind, placebo controlled, crossover study [see comments]
.P
CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL.
.W
OBJECTIVE--To evaluate the antihypertensive activity of potassium given alone or in combination with magnesium in patients with mild hypertension. DESIGN--A double blind, randomised, placebo controlled, crossover trial of 32 weeks' duration. SETTINGS--Cardiology outpatient department, Sassoon General Hospitals, Pune, India. PATIENTS--37 Adults with mild hypertension (diastolic blood pressure less than 110 mm Hg). INTERVENTION--Patients received either placebo or potassium 60 mmol/day alone or in combination with magnesium 20 mmol/day in a crossover design. No other drug treatment was allowed. MEASUREMENTS--Blood pressure and heart rate assessed at weekly intervals and biochemical parameters at monthly intervals. RESULTS--Potassium alone or in combination with magnesium produced a significant reduction in systolic and diastolic blood pressures (p less than 0.001) and a significant reduction in serum cholesterol concentration (p less than 0.05); other biochemical variables did not change. Magnesium did not have an additional effect. Urinary potassium excretion increased significantly in the groups who received potassium alone or in combination with magnesium. The drug was well tolerated and compliance was satisfactory. CONCLUSION--Potassium 60 mmol/day lowers arterial blood pressure in patients with mild hypertension. Giving magnesium as well has no added advantage.
.A
Patki PS; Singh J; Gokhale SV; Bulakh PM; Shrotri DS; Patwardhan B.
.I 274396
.U
91003044
.S
BMJ 9101; 301(6751):523-4
.M
Adolescence; Anemia, Sickle Cell/IM/TH; Blood Transfusion/*AE; Cameroon; Case-Control Studies; Child; Child, Preschool; Hepatitis B/*TM; Hepatitis B Surface Antigens/AN; Human; Infant; Support, Non-U.S. Gov't.
.T
Transmission of hepatitis B virus by blood transfusion in Yaounde, Cameroon.
.P
JOURNAL ARTICLE.
.A
Ndumbe PM; Nyouma E.
.I 274397
.U
91003045
.S
BMJ 9101; 301(6751):524-5
.M
Adult; Aged; Aged, 80 and over; Female; Human; Middle Age; Ovarian Neoplasms/*ET/PA/PP; Ovulation/*PH.
.T
Aetiological importance of ovulation in epithelial ovarian cancer: a population based study [published erratum appears in BMJ 1990 Sep 29;301(6753):646] [see comments]
.P
JOURNAL ARTICLE.
.A
Cruickshank DJ.
.I 274398
.U
91003046
.S
BMJ 9101; 301(6751):525
.M
Acquired Immunodeficiency Syndrome/*TM; Adolescence; Adult; Contraceptive Devices, Male; Equipment Failure; Female; Human; Male; Middle Age; Prostitution/*; Risk Factors; Scotland; Sex Behavior; Support, Non-U.S. Gov't.
.T
Risk of HIV infection among clients of the sex industry in Scotland.
.P
JOURNAL ARTICLE.
.A
Thomas RM; Plant MA; Plant ML; Sales J.
.I 274399
.U
91003047
.S
BMJ 9101; 301(6751):526-9
.M
Attitude of Health Personnel; Evaluation Studies; Hospital Bed Capacity, 500 and over; London; Medical Audit/*OG; Medical Records/ST; Medical Staff, Hospital/*ST; Questionnaires; Random Allocation; Statistics.
.T
What did audit achieve? Lessons from preliminary evaluation of a year's medical audit [see comments]
.P
JOURNAL ARTICLE.
.W
OBJECTIVE--To evaluate the experience of a year's audit of care of medical inpatients. DESIGN--Audit of physicians by monthly review of two randomly selected sets of patients' notes by 12 reviewers using a detailed questionnaire dedicated to standards of medical records and to clinical management. Data were entered into a database and summary statistics presented quarterly at audit meetings. Assessment by improvement in questionnaire scores and by interviewing physicians. SETTING--1 District general hospital. PARTICIPANTS--About 40 consultant physicians, senior registrars, and junior staff dealing with 140 inpatient records. MAIN OUTCOME MEASURES--Median scores (range 1 to 9) for each item in the questionnaire; two sets of notes were discussed monthly at "general" audit meetings and clinical management of selected common conditions at separate monthly meetings. RESULTS--A significant overall increase in median scores for questions on record keeping occurred after the start of the audit (p less than 0.01), but interobserver variation was high. The parallel audit meetings on clinical management proved to be more successful than the general audits in auditing medical care and were also considered to be more useful by junior staff. CONCLUSIONS AND ACTION--Medical audit apparently resulted in appreciable improvements in aspects of care such as clerking and record keeping. Analysis of the scores of the general audits has led to the introduction of agreed standards that can be objectively measured and are being used in a further audit, and from the results of the audits of clinical management have been developed explicit guidelines, which are being further developed for criterion based audit.
.A
Gabbay J; McNicol MC; Spiby J; Davies SC; Layton AJ.
.I 274400
.U
91003048
.S
BMJ 9101; 301(6751):529-31
.M
Communication; Emergency Service, Hospital/*OG; England; Human; Medical Staff, Hospital/*; Outcome and Process Assessment (Health Care)/*SN; Patient Admission/*; Support, Non-U.S. Gov't; Telephone; Time Factors; Wales.
.T
How easy is it to contact the duty medical doctor responsible for acute admissions? [see comments]
.P
JOURNAL ARTICLE.
.W
OBJECTIVE--To ascertain ease or difficulty of contacting duty junior doctors responsible for acute medical admissions by telephone. DESIGN--Telephone survey of hospitals in six health regions in England and Wales. SETTING--70 Randomly selected hospitals, 15 of which were excluded because of non-acceptance of acute medical admissions. PARTICIPANTS--71 Duty doctors (duty house physicians, senior house officers, or registrars responsible for acute medical admissions) in 48 hospitals; seven duty doctors in seven hospitals were excluded (four declined to participate and three required a written explanation of the survey). 67 Doctors gave full information to all questions. MAIN OUTCOME MEASURES--Time taken for hospital switchboards and duty doctors to reply to telephone call, diagnoses of patients recently admitted, and on call rotas and hours of sleep of duty doctors. RESULTS--Hospital switchboards responded within 30 seconds in 87 (74%) calls, and in 76 calls (64%) the duty doctor requested was contacted within a further two minutes. Chest pain, possibly due to myocardial infarction, was the most common reason for acute medical admissions. Nearly half (48%) of the duty doctors in larger hospitals reported having 4-5 hours sleep or less on their nights on call. Most (30) were on a one in three rota; two were on a one in two rota. CONCLUSIONS--Despite impressions to the contrary contacting the duty medical team by telephone seemed fairly easy. Although most junior doctors were on a rota of one in three or better, insufficient recognition may be given to their deprivation of sleep during nights on duty.
.A
Bakhai A; Goodman F; Juchniewichz H; Martin A; Porter G; White C; Williams L; Hopkins A.
.I 274401
.U
91003049
.S
BMJ 9101; 301(6751):531-2
.M
Great Britain; Health Services Research; Human; Patient Admission/*; Physician's Practice Patterns/*; Quality of Health Care/*ST; United States.
.T
Variations in hospital admissions and the appropriateness of care: American preoccupations?
.P
JOURNAL ARTICLE.
.A
Bunker JP.
.I 274402
.U
91003050
.S
BMJ 9101; 301(6751):535-40
.M
Adolescence; Adult; Aged; Child; Child, Preschool; Comparative Study; Diabetes Mellitus/MO; Diabetic Neuropathies/MO/*TH; England/EP; Graft Survival; Human; Kidney Failure, Chronic/MO/*TH; Kidney Transplantation/*; Middle Age; Pancreas Transplantation; Peritoneal Dialysis, Continuous Ambulatory/*; Postoperative Complications; Retrospective Studies; Support, Non-U.S. Gov't; Survival Rate.
.T
Renal replacement treatment for diabetic patients in Newcastle upon Tyne and the Northern region, 1964-88.
.P
CLINICAL TRIAL; JOURNAL ARTICLE.
.W
OBJECTIVES--To review the experience of renal replacement treatment in diabetic patients treated in Newcastle upon Tyne and the Northern region from 1964 to 1988, and to compare the morbidity and mortality of diabetic patients treated with dialysis or transplantation with those of matched controls of non-diabetic patients. DESIGN--Retrospective study of clinical case notes. SETTING--Renal units of the Northern region, particularly that in Newcastle upon Tyne. PATIENTS--All 65 diabetic patients treated by renal replacement treatment in Newcastle upon Tyne from 1964 to 1987; 42 diabetic patients were matched with 42 non-diabetic patients according to age, sex, year of starting treatment, and type of treatment (dialysis or transplantation). MAIN OUTCOME MEASURES--Sex, age, renal biopsy findings, blood pressure, history of diabetic treatment, and plasma creatinine concentration at the start of renal replacement treatment. History of renal replacement treatments, suitability for transplantation, history of transplantation, cumulative survival, and cause of death during follow up. Survival of technique, cumulative survival of the first peritoneal catheter and history of peritonitis in patients treated with continuous ambulatory peritoneal dialysis; source of graft, histocompatibility antigens, duration of associated stay in hospital, and graft survival in patients receiving renal or pancreatic transplant. RESULTS--1259 Patients with chronic renal failure were accepted for renal replacement treatment in Newcastle upon Tyne, of whom 65 (5%) had diabetes. The first was accepted in 1974, and between 1974 and 1980 another 15 were treated (mean age 42 years; 4% of new patients). From 1981 to 1987, 49 diabetic patients (mean age 44; 9% of new patients) were treated. Fifty patients (77%) had insulin dependent diabetes and the remaining 15 (23%) non-insulin dependent diabetes. On average, the patients were aged 25 (range 5-57) when diabetes was first diagnosed and 44 (range 24-70) at the start of renal replacement treatment. The mean age at the start of treatment was 40 for patients with non-insulin dependent diabetes and 58 for patients with non-insulin dependent diabetes. Transplantation was performed in 33 of the diabetic patients, whose mean age was lower than that of those who did not receive a transplant (41 v 48 respectively, p less than 0.05). Comparison between the 42 diabetic patients and matched controls showed that the overall survival at five years was 46% and 77% respectively. The three year survival of the diabetic patients who did not receive a transplant was poor (41% v 79% respectively). Of patients transplanted, survival at five years was 73% in the diabetic patients and 90% in the controls. However, there was no significant difference in the five year graft survival (64% v 46% respectively). CONCLUSIONS--Diabetes adversely affects morbidity and mortality in patients having renal replacement treatment, but renal transplantation seems to be the best option for treating diabetic patients with end stage renal failure.
.A
Catalano C; Goodship TH; Tapson JS; Venning MK; Taylor RM; Proud G; Tunbridge WM; Elliot RW; Ward MK; Alberti KG; et al.
.I 274403
.U
91003051
.S
BMJ 9101; 301(6751):540-4
.M
Adult; Aged; Coronary Disease/CO; Diabetes Mellitus, Insulin-Dependent/MO; Diabetes Mellitus, Non-Insulin-Dependent/MO; Diabetic Angiopathies/CO; Diabetic Neuropathies/MO/*TH; Female; Graft Survival; Human; Kidney Failure, Chronic/CO/MO/*TH; Kidney Transplantation/*/UT; Male; Middle Age; Outcome and Process Assessment (Health Care)/*SN; Peritoneal Dialysis, Continuous Ambulatory/*/UT; Retrospective Studies; Scotland/EP; Survival Rate.
.T
Outcome of renal replacement treatment in patients with diabetes mellitus.
.P
CLINICAL TRIAL; JOURNAL ARTICLE.
.W
OBJECTIVE--To compare the outcome of renal replacement treatment in patients with diabetes mellitus and in non-diabetic patients with end stage renal failure. DESIGN--Retrospective comparison of cases and matched controls. SETTING--Renal unit, Western Infirmary, Glasgow, providing both dialysis and renal transplantation. PATIENTS--82 Diabetic patients starting renal replacement treatment between 1979 and 1988, compared with 82 matched non-diabetic controls with renal failure and 39 different matched controls undergoing renal transplantation. MAIN OUTCOME MEASURES--Patient characteristics, history of smoking, prevalence of left ventricular hypertrophy and myocardial ischaemia at start of renal replacement treatment; survival of patients with renal replacement treatment and of patients and allografts with renal transplantation. RESULTS--The overall survival of the diabetic patients during the treatment was 83%, 59%, and 50% at one, three, and five years. Survival was significantly poorer in the diabetic patients than the controls (p less than 0.001). Particularly adverse features for outcome at the start of treatment were increasing age (p less than 0.01) and current cigarette smoking (relative risk (95% confidence interval) 2.28 (0.93 to 4.84), p less than 0.05). Deaths were mainly from cardiac and vascular causes. The incidence of peritonitis in patients on continuous ambulatory peritoneal dialysis was the same in diabetic patients and controls (49% in each group remained free of peritonitis after one year), and the survival of renal allografts was not significantly worse in diabetic patients (p less than 0.5). CONCLUSIONS--Renal replacement treatment may give good results in diabetic patients, although the outlook remains less favourable than for non-diabetic patients because of coexistent, progressive vascular disease, which is more severe in older patients.
.A
McMillan MA; Briggs JD; Junor BJ.
.I 274404
.U
91003052
.S
BMJ 9101; 301(6751):545-7
.M
Bladder/IN; Bulbourethral Glands/IN; Emergencies; Female; Genitalia, Male/IN; Human; Male; Urethra/IN; Urinary Tract/*IN; Wounds and Injuries/TH.
.T
ABC of major trauma. Trauma of the lower urinary tract.
.P
JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL.
.A
Deane A.
.I 274405
.U
91003053
.S
BMJ 9101; 301(6751):551
.M
Child; Drug Information Services/*; Great Britain; Human; Risk Factors; Vaccination/*.
.T
Vaccinations and professional confusion [letter]
.P
LETTER.
.A
Elliman D.
.I 274406
.U
91003054
.S
BMJ 9101; 301(6751):551-2
.M
Adult; Birth Weight/*; Female; Human; Hypertension/*ET; Infant, Newborn; Placenta/*AH; Pregnancy; Risk Factors.
.T
Fetal and placental size and risk of hypertension in adult life [letter; comment]
.P
COMMENT; LETTER.
.I 274407
.U
91003056
.S
BMJ 9101; 301(6751):555
.M
Acquired Immunodeficiency Syndrome/*PA/US; Biopsy, Needle/IS; Brain/*PA; Echoencephalography; Human.
.T
Cerebral mass lesions in patients with AIDS [letter]
.P
LETTER.
.A
Hately W; Borgstein RL; Hamlyn PJ.
.I 274408
.U
91003057
.S
BMJ 9101; 301(6751):555
.M
Headache/*ET; Human; Nomenclature; Subarachnoid Hemorrhage/*CO.
.T
Warning leak in subarachnoid haemorrhage [letter; comment]
.P
COMMENT; LETTER.
.I 274409
.U
91003058
.S
BMJ 9101; 301(6751):555-6
.M
Female; Glucocorticoids, Topical/TU; Human; Skin Diseases/*TH; Vulva/SU; Vulvar Diseases/*TH.
.T
Treatment for lichen sclerosus [letter]
.P
LETTER.
.A
Neill S.
.I 274410
.U
91003059
.S
BMJ 9101; 301(6751):556
.M
Costs and Cost Analysis/MT; England; Human; Medical Audit/*MT; Otorhinolaryngologic Diseases/SU; Surgery, Operative/*EC.
.T
Caseload or workload? [letter; comment]
.P
COMMENT; LETTER.
.A
George SL; Brazier JE.
.I 274411
.U
91003060
.S
BMJ 9101; 301(6751):556
.M
Electroconvulsive Therapy/*; Human; Nerve Tissue/TR; Parkinson Disease/*TH.
.T
Cell implantation in Parkinson's disease [letter; comment]
.P
COMMENT; LETTER.
.A
Madeley P; Boyd JL; Biggins CA; Mindham RH; Spokes EG.
.I 274412
.U
91003061
.S
BMJ 9101; 301(6751):556
.M
Bacterial Infections/*CO; Female; Human; Urinary Incontinence/*ET/PX; Urinary Tract Infections/*CO.
.T
Psychiatric aspects of urinary incontinence [letter; comment]
.P
COMMENT; LETTER.
.A
Maskell R.
.I 274413
.U
91003062
.S
BMJ 9101; 301(6751):556-7
.M
Anesthesiology/*/ED; Child; Education, Medical, Continuing; Great Britain; Human; Pediatrics/*/ED; Societies, Medical/*.
.T
Perioperative deaths among children [letter; comment]
.P
COMMENT; LETTER.
.A
Glover WJ.
.I 274414
.U
91003064
.S
BMJ 9101; 301(6751):557
.M
Alanine Aminotransferase/BL; Aspartate Aminotransferase/BL; Human; Liver Diseases/BL; Liver Function Tests/*MT.
.T
Liver function tests [letter; comment]
.P
COMMENT; LETTER.
.A
Cramb R; Florkowski CM.
.I 274415
.U
91003065
.S
BMJ 9101; 301(6751):557
.M
England; Hospital Units; Human; Peptic Ulcer Hemorrhage/*MO.
.T
Mortality in patients with bleeding peptic ulcer [letter; comment]
.P
COMMENT; LETTER.
.A
Clements D; Stamatakis J; Foster D; Wilkins WE; Morris JS.
.I 274416
.U
91003208
.S
Br J Urol 9101; 66(3):225-31
.M
Female; Fetal Diseases/*/US; Human; Pregnancy; Ultrasonography, Prenatal; Urologic Diseases/*EM/US.
.T
Fetal uropathy.
.P
JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL.
.A
Thomas DF.
.I 274417
.U
91003209
.S
Br J Urol 9101; 66(3):232-9
.M
Bladder Calculi/*CH; Human; Spectrometry, Gamma; Spectrometry, X-Ray Emission; Support, Non-U.S. Gov't; Trace Elements/AN.
.T
Nuclear techniques for the analysis of urinary calculi.
.P
JOURNAL ARTICLE.
.W
Sections of urinary calculi were prepared and point-by-point analyses along a line-scan were carried out using the techniques of proton-induced X-ray emission (PIXE) and nuclear reaction analysis (NRA). Correlations between several pairs of elements (including trace elements) were noted and it was also clear that the composition of a stone varied markedly at different stages of development.
.A
Saint A; Dyson NA.
.I 274418
.U
91003210
.S
Br J Urol 9101; 66(3):240-4
.M
Calcium Oxalate/*CH; Citrates/*PD; Crystallization; Mucins/*PD; Pentosan Sulfuric Polyester/*PD; Support, Non-U.S. Gov't.
.T
Study of factors affecting calcium oxalate crystalline aggregation.
.P
JOURNAL ARTICLE.
.W
A study was made of the effects of citrate, pentosan polysulphate (a glycosaminoglycan) and mucin (a mucoprotein) upon crystalline growth and aggregation of calcium oxalate in synthetic urine. It was found that citrate inhibited aggregation. Pentosan polysulphate had no perceptible effect on aggregation but favoured the formation of calcium oxalate dihydrate crystals. Mucin enhanced the formation of large characteristic aggregates and also led to the formation of calcium oxalate dihydrate crystals. Particles of mucin in a solution served as a substrate on which several crystals of calcium oxalate dihydrate were formed by heterogeneous nucleation; the subsequent growth of these crystals resulted in the formation of large agglomerates.
.A
Grases F; Costa-Bauza A.
.I 274419
.U
91003211
.S
Br J Urol 9101; 66(3):245-7
.M
Adult; Aged; Aged, 80 and over; Anesthesia, Local; Cystoscopy/*; Female; Human; Kidney Calculi/*TH; Lithotripsy/*; Male; Methods; Middle Age; Stents/*; Ureter.
.T
Flexible cystoscopy as an adjunct to extracorporeal shockwave lithotripsy.
.P
JOURNAL ARTICLE.
.W
Ancillary procedures associated with extracorporeal shockwave lithotripsy (ESWL) include placement and subsequent removal of double pigtail ureteric stents. A simple new technique has been developed for the insertion of these stents. Using the flexible cystoscope, the procedure is performed on an out-patient basis under local anaesthesia. Placement of the stents was successful in 30/34 patients and removal was successful in 14/14 patients.
.A
Mark SD; Gray JM; Wright WL.
.I 274420
.U
91003212
.S
Br J Urol 9101; 66(3):248-53
.M
Aged; Carcinoma, Renal Cell/*SU; Female; Hemodialysis; Human; Kidney/AB; Kidney Neoplasms/*SU; Male; Middle Age; Nephrectomy/*/MT; Postoperative Complications/TH.
.T
Renal carcinoma in a solitary kidney.
.P
JOURNAL ARTICLE.
.W
We studied the clinical and pathological features of 26 patients with renal carcinoma of a solitary kidney, including 6 treated at this hospital. Four patients had a contracted kidney and 22 had previously undergone nephrectomy. Partial nephrectomy was performed in 16 patients, enucleation of the tumour in 5 and radical nephrectomy in 5 because of the size of the tumour. Ex vivo surgery was carried out in 4 patients. The duration of ischaemia ranged from 15 to 365 min but was longer in those who underwent ex vivo surgery (149 to 365 min). Of the 21 patients who underwent partial nephrectomy or enucleation, the serum creatinine level increased (greater than or equal to 2.0 mg/dl) post-operatively in 16 patients, of whom 9 required temporary haemodialysis. No recurrence has been noted in those who underwent partial nephrectomy, but 1 patient who underwent enucleation of the tumour developed a solitary pancreatic metastasis 2 years 6 months after surgery and was treated by a partial pancreatectomy. Kidney-preserving surgical procedures are considered to improve the quality of life, but careful follow-up is necessary.
.A
Gohji K; Kamidono S; Yamanaka N.
.I 274421
.U
91003213
.S
Br J Urol 9101; 66(3):254-6
.M
Adult; Endoscopy; Female; Human; Male; Retrospective Studies; Stents/*; Ureteral Calculi/*TH.
.T
Use of the double pigtail stent in stone retrieval following unsuccessful ureteroscopy.
.P
JOURNAL ARTICLE.
.W
Insertion of a double pigtail stent is known to cause ureteric dilatation. We analysed the effect of an indwelling double pigtail stent on the success rate of calculus extraction by second ureteroscopy when the initial ureteroscopy fails. Over a 12-month period, a first ureteroscopy failed in 42 patients; 30 were then treated by ureteroscopy combined with a ureteric stent and 12 were treated without a ureteric stent. The group with an indwelling stent had a successful second ureteroscopy or spontaneously passed the calculus in 24 cases (84%) compared with 5 unstented cases (45%). Ureterolithotomy was necessary in 2 patients with a stent and 3 with no stent. It was concluded that following failed ureteroscopic manipulation of calculi, insertion of a double pigtail stent was associated with a higher subsequent success rate for removal of stone by ureteroscopy and a consequent lower rate of ureterolithotomy.
.A
Jones BJ; Ryan PC; Lyons O; Grainger R; McDermott TE; Butler MR.
.I 274422
.U
91003215
.S
Br J Urol 9101; 66(3):265-73
.M
Bladder/IM/PA; Cystitis/*DI/ME/PA; Cystoscopy; Fluorescent Antibody Technique; IgM/AN; Periodic Acid-Schiff Reaction; Support, Non-U.S. Gov't.
.T
Immunofluorescent and histochemical staining confirm the identification of the many diseases called interstitial cystitis.
.P
JOURNAL ARTICLE.
.W
Interstitial cystitis comprises a complex of diseases typified by symptoms of pelvic pain. Functional complaints do not aid the clinician in determining loss of anatomical capacity. Histochemical staining with PAS-colloidal iron/Van Geison's counterstain offers improved diagnostic ability for the pathologist and correlates well with immunofluorescent findings. Four distinct diseases can be identified through immunofluorescent staining, indicating that each is the result of different responses of the urothelium and endothelium to injury. Loss of bladder capacity associated with these diseases can be expected with age, but immunofluorescent staining for IgM within the capillaries of the interstitium is a more sensitive predictor.
.A
Gillespie L; Said J; Sostrin S; Kleiwer K.
.I 274423
.U
91003216
.S
Br J Urol 9101; 66(3):274-8
.M
Adult; Aged; Bladder/*PA; Cell Count; Cystitis/*CO/PA; Female; Human; Mast Cells/*; Middle Age; Urination Disorders/*ET.
.T
Do women with idiopathic sensory urgency have early interstitial cystitis?
.P
JOURNAL ARTICLE.
.W
Interstitial cystitis is rarely considered as a cause of urinary symptoms in referrals to gynaecology clinics. Recent concepts in the diagnosis of this condition mean that it is emerging as a much more common entity, with both early and late forms of the disease being described. Mast cell density in the detrusor muscle has been reported to be useful as a disease marker to substantiate the diagnosis of interstitial cystitis where no classical diagnostic features exist. We assessed mast cell counts in bladder biopsies from 27 women with idiopathic sensory urgency and 10 control patients about to undergo a colposuspension procedure for pure genuine stress incontinence; 30% of the study group had a clear increase in the detrusor muscle mast cell population (detrusor mastocytosis). No control patient showed such an increase. Early interstitial cystitis should be considered as a possible cause of lower urinary tract symptoms in patients with apparently idiopathic sensory urgency.
.A
Frazer MI; Haylen BT; Sissons M.
.I 274424
.U
91003217
.S
Br J Urol 9101; 66(3):279-80
.M
Aged; Catheters, Indwelling; Human; Indicator Dilution Techniques; Male; Middle Age; Support, Non-U.S. Gov't; Urinary Catheterization/*ST; Urine/*.
.T
Assessment of residual urine in men following catheterisation [see comments]
.P
JOURNAL ARTICLE.
.W
There is a certain volume of urine left within the bladder which cannot be drained by a catheter. A dilutional method was used to calculate this residual volume in 15 men; 10 had acute retention secondary to benign prostatic hyperplasia and 5 had permanent indwelling catheters for neurogenic urinary incontinence. The mean catheterised residual volume was 98.53 ml for patients with acute retention and 14.48 ml for patients with long-term catheters. The explanation for higher post-catheterisation volumes in the acute retention group is probably multifactorial; bladder sacculation and diverticula, detrusor tone and reflux may all play a role.
.A
Purkiss SF.
.I 274425
.U
91003218
.S
Br J Urol 9101; 66(3):281-5
.M
Antibodies, Monoclonal/*DU; Bladder Neoplasms/*PA; Carcinoma, Transitional Cell/*PA; Cell Division; Female; Human; Male; Middle Age; Neoplasm Staging; Prognosis.
.T
Cell cycling in bladder carcinoma determined by monoclonal antibody Ki67.
.P
JOURNAL ARTICLE.
.W
Current methods of predicting prognosis in transitional cell carcinoma of the bladder fail to provide consistently reliable information about future tumour behaviour. The monoclonal antibody Ki67 recognises an antigen present in actively dividing cells and Ki67 reactivity has been shown to correlate with conventional prognostic indicators in several tumours. In this study, Ki67 antibody was used to determine the proportions of cells undergoing active division in 26 transitional cell carcinomas of the bladder. The proportion of cells stained in muscle invasive tumours (12.3 +/- 5.4%) was significantly greater than in superficial tumours (4.3 +/- 1.9%) and poorly differentiated tumours showed significantly greater proportions of cells staining compared with well or moderately well differentiated tumours. These results show that Ki67 reactivity correlates with high tumour stage and poor differentiation. Ki67 staining provides an easy method of determining tumour cell turnover that might provide additional prognostic information.
.A
Mellon K; Neal DE; Robinson MC; Marsh C; Wright C.
.I 274426
.U
91003219
.S
Br J Urol 9101; 66(3):286-7
.M
Administration, Intravesical; Adult; Age Factors; Antineoplastic Agents, Combined/*AD/TU; Bladder Neoplasms/*PC; BCG Vaccine/*AD/TU; Carcinoma, Transitional Cell/*PC; Human.
.T
Superficial bladder cancer in patients under 40 years of age. Efficacy of topical prophylaxis.
.P
JOURNAL ARTICLE.
.W
In patients under the age of 40 years with primary superficial bladder cancer the efficacy of adjuvant topical treatment was the same as in elderly patients (recurrences 23%, progression rate 8%). Patients should therefore be treated on the basis of stage and grade of the tumour regardless of their age.
.A
Flamm J.
.I 274427
.U
91003221
.S
Br J Urol 9101; 66(3):294-6
.M
Adult; Case Report; Human; Male; Middle Age; Postoperative Complications/ET; Prostatectomy; Urethral Stricture/*CN/ET.
.T
Cobb's collar--a forgotten entity.
.P
JOURNAL ARTICLE.
.W
Cobb's collar or Moormann's ring is a stricture of the bulbar urethra which is largely unrecognised but has considerable relevance urologically as the site of congenital or post-instrumental strictures. The history, anatomy, embryology and surgical importance are reported.
.A
Cranston D; Davies AH; Smith JC.
.I 274428
.U
91003222
.S
Br J Urol 9101; 66(3):297-302
.M
Adult; Aged; Bladder/*PP; Human; Middle Age; Quadriplegia/*CO/PP; Reflex, Abnormal; Stents/*; Urination Disorders/ET/*TH.
.T
Permanent external striated sphincter stents in patients with spinal injuries.
.P
JOURNAL ARTICLE.
.W
Nine patients with complete quadriplegia underwent external striated sphincter stenting with the Wallstent in place of an external striated sphincterotomy. Although suprapubic catheters were placed to provide an outlet should problems develop with the stent, they were successfully removed within 6 weeks in all but 1 patient. Complete bladder emptying with reduced voiding pressures was achieved, together with a significant reduction in the duration of hyper-reflexic contractions. Epithelialisation of the stent was almost complete within 3 months and intermittent catheterisation or endoscopy (and resection) is possible through the stent. Although this is a preliminary report of this new technique, it is hoped that sphincter stenting will provide a rapid, safe and effective method of treating high pressure hyper-reflexia and detrusor sphincter dyssynergia in quadriplegic patients.
.A
Shaw PJ; Milroy EJ; Timoney AG; el Din A; Mitchell N.
.I 274429
.U
91003223
.S
Br J Urol 9101; 66(3):303-5
.M
Bladder/PP; Bladder Diseases/PP/*SU; Bladder Neck Obstruction/ET/PP; Human; Male; Prostatectomy/*; Prostatic Diseases/CO/SU; Urodynamics/*.
.T
Symptoms versus flow rates versus urodynamics in the selection of patients for prostatectomy.
.P
JOURNAL ARTICLE.
.W
Many prostatectomies are performed on the basis of symptoms alone; 39% of patients referred by their family doctors and 23% of patients who were on waiting lists for prostatectomy of other hospitals, but who had not undergone any urodynamic investigations, were found to be unobstructed on urodynamic criteria. A screening peak urinary flow rate of 12 ml/s or less was associated with urodynamic evidence of obstruction in 95% of cases; 35% of patients with symptoms of outflow obstruction and a flow rate greater than 12 ml/s were also found to be obstructed. One year post-operatively, 84% of patients who were selected for surgery on combined symptomatic and urodynamic criteria were pleased symptomatically with their result. The failure of detrusor instability to resolve following prostatectomy was associated with symptomatic failure of treatment. Residual obstruction was demonstrated in 5 patients who had undergone prostatectomy and were asymptomatic at this time. This study illustrates that objective measures are necessary in the assessment of patients prior to prostatectomy in order to select only patients who are obstructed. The importance of a screening flow rate is emphasised. All patients who underwent surgery had cystometric evidence of obstruction but the symptomatic results of surgery were no better than the results in patients who had been assessed according to non-urodynamic selection criteria. We have thus failed to identify a need for routine cystometry in the pre-operative assessment of these patients. Cystometry does, however, have a role in assessing patients with pre-operative flow rates greater than 12 ml/s and in those who remain symptomatic following prostatectomy.
.A
McLoughlin J; Gill KP; Abel PD; Williams G.
.I 274430
.U
91003224
.S
Br J Urol 9101; 66(3):306-11
.M
Adenocarcinoma/*PA; Adult; Aged; Aged, 80 and over; Follow-Up Studies; Human; Male; Middle Age; Precancerous Conditions/*PA; Prognosis; Prostatic Neoplasms/*PA; Retrospective Studies.
.T
Pathological classification and follow-up of prostatic lesions initially diagnosed as "suspicious of malignancy".
.P
JOURNAL ARTICLE.
.W
Sections from a series of prostatic specimens (n = 44) in which the initial diagnosis implied a suspicion of malignancy were reviewed and the patients followed up (group 1). The aim was to categorise the morphological appearances according to current criteria and to determine the natural history of any pre-malignant lesions within this group. A "control" series of patients (n = 40) in whom the primary diagnosis was benign were also reviewed and their course followed (group 2). The heterogeneity of the abnormalities in group 1 was striking. Of the 44 cases, pre-malignant lesions were seen in 8, microinvasive adenocarcinoma in 11 and lesions not now considered pre-malignant in the remaining 25. None of the 8 patients with pre-malignant lesions developed clinical evidence of carcinoma over a follow-up period of 8 to 12 years. In contrast, 3 of the 11 diagnosed on review as having microscopic invasive adenocarcinoma developed clinically evident tumour within 5 years of surgery. Of the 25 patients whose prostatic lesions were considered benign, 2 developed carcinoma 12 and 13 years after surgery. Only 1 of the 40 patients in group 2 had a pre-malignant lesion and he did not develop tumour within 10 years. However, adenocarcinoma was diagnosed incidentally in 1 patient 3 years after surgery. It was concluded that there is a need to standardise interpretation and reporting of pre-malignant lesions and microscopic foci of adenocarcinoma in the prostate. The limited results on the course of pre-malignant lesions diagnosed incidentally in patients over 60 years of age do not indicate that follow-up would have prompted the early diagnosis of invasive disease.
.A
Keane PF; Ilesley IC; O'Donoghue PN; Parkinson MC.
.I 274431
.U
91003225
.S
Br J Urol 9101; 66(3):312-4
.M
Adult; Aged; Granuloma/*DI/PA; Human; Male; Middle Age; Orchitis/*DI/PA.
.T
Granulomatous orchitis. Review of 15 cases.
.P
JOURNAL ARTICLE.
.W
Granulomatous orchitis is a rare lesion of the testis which can clinically simulate malignancy. The clinical, radiological and pathological features of 15 patients are presented and discussed.
.A
Aitchison M; Mufti GR; Farrell J; Paterson PJ; Scott R.
.I 274432
.U
91003227
.S
Br J Urol 9101; 66(3):318-21
.M
Africa, Southern; Antibiotics/TU; Circumcision/*AE; Culture/*; Human; Male; Penis/*IN/SU; Wound Infection/DT/*ET.
.T
Ritual circumcision (Umkhwetha) amongst the Xhosa of the Ciskei.
.P
JOURNAL ARTICLE.
.W
The Umkhwetha is an ancient custom of ritual circumcision still practised by the Xhosa people of Southern Africa. In 45 consecutive youths who required hospital admission the mortality rate was 9%. The complication seen over the years are reviewed and their management discussed.
.A
Crowley IP; Kesner KM.
.I 274433
.U
91003229
.S
Br J Urol 9101; 66(3):323
.M
Case Report; Child, Preschool; Human; Male; Polyps/*; Urethral Neoplasms/*.
.T
Anterior urethral polyp in a child.
.P
JOURNAL ARTICLE.
.A
Azmy AF.
.I 274434
.U
91003230
.S
Br J Urol 9101; 66(3):323-4
.M
Aged; Case Report; Human; Lipomatosis/*PA; Male; Ureteral Neoplasms/*PA.
.T
Lipomatosis of the ureter.
.P
JOURNAL ARTICLE.
.A
Thorpe AC; Martin JE; Jenkins BJ.
.I 274435
.U
91003231
.S
Br J Urol 9101; 66(3):324-5
.M
Adult; Case Report; Dysgerminoma/*PA; Epididymis/*PA; Human; Male; Testicular Neoplasms/*PA.
.T
Juxtatesticular seminoma.
.P
JOURNAL ARTICLE.
.A
Dichmann O; Engel U; Jensen DB; Bilde T.
.I 274436
.U
91003232
.S
Br J Urol 9101; 66(3):325-6
.M
Aged; Aged, 80 and over; Case Report; Epididymis/*; Human; Male; Prostatic Neoplasms/*PA; Testicular Neoplasms/*SC.
.T
Epididymal metastasis from prostatic carcinoma.
.P
JOURNAL ARTICLE.
.A
Sneiders A; Heller JE.
.I 274437
.U
91003233
.S
Br J Urol 9101; 66(3):326
.M
Aged; Aged, 80 and over; Case Report; Cystadenoma/*CO; Cysts/*CN; Human; Male; Pelvic Neoplasms/*CO; Urinary Retention/*ET.
.T
Recent change in a tailgut cyst presenting as urinary retention.
.P
JOURNAL ARTICLE.
.A
Stephenson BM; Bartlet M; Nirula R; Evans AG; Rees AM.
.I 274438
.U
91003234
.S
Br J Urol 9101; 66(3):327
.M
Aged; Aged, 80 and over; Case Report; Female; Human; Kidney Calculi/*TH; Proteus Infections/DT; Trimethoprim/*TU; Urinary Tract Infections/DT.
.T
Disappearing staghorns [see comments]
.P
JOURNAL ARTICLE.
.A
Griffith-Jones MD.
.I 274439
.U
91003235
.S
Br J Urol 9101; 66(3):328
.M
Foreign-Body Migration/TH; Human; Nephrostomy, Percutaneous/*; Stents/*; Ureter/*.
.T
Minimally invasive removal of retained ureteric stents.
.P
JOURNAL ARTICLE.
.A
White PG; Evans C.
.I 274440
.U
91003236
.S
Br J Urol 9101; 66(3):329
.M
Bladder/*SU; Cystoscopy/*; Human; Suture Techniques/*; Urinary Incontinence, Stress/SU; Video Recording/*.
.T
The endoscopic video camera as an aid to the Stamey procedure.
.P
JOURNAL ARTICLE.
.A
Harrison SC; Abrams PH.
.I 274441
.U
91003237
.S
Br J Urol 9101; 66(3):330-1
.M
Bladder Neoplasms/*RT; Human.
.T
Re: The fate of G3pT1 bladder cancer [letter; comment]
.P
COMMENT; LETTER.
.A
Harland SJ.
.I 274442
.U
91003239
.S
Br J Surg 9101; 77(9):1000-3
.M
Adolescence; Adult; Comparative Study; Female; Human; Male; Middle Age; Pancreatic Neoplasms/*PA/RA/SU/US; Retrospective Studies; Support, Non-U.S. Gov't; Tomography, X-Ray Computed.
.T
Papillary cystic neoplasm of the pancreas: radiological and pathological characteristics in 11 cases.
.P
JOURNAL ARTICLE.
.W
Clinical charts, radiological features, macroscopic and microscopic findings, and clinical follow-up data were retrospectively reviewed in 11 patients with papillary cystic neoplasm of the pancreas (PCNP). The patients were nine women and two men, aged from 13 to 51 years with a mean age of 25 years. The greatest diameter of the PCNPs ranged from 2.5 cm to 14.0 cm with a mean size of 7.5 cm. Six tumours were located in the tail of the pancreas, two in the body and three in the head. Most patients complained of abdominal pain or a mass. Ultrasonographic and/or computed tomography findings showed five solid, four mixed (solid and cystic) and two cystic types of tumour. Angiographically, PCNP was either a hypovascular or mild hypervascular mass with a displacement of the surrounding vessels. No vascular encasement was seen. Macroscopically all 11 tumours consisted of a well defined solid mass with degenerative change of various widths, including haemorrhage, necrosis or dystrophic calcification, and were represented by three radiological types of PCNP. The 11 patients with PCNP survived for from 3 to 253 months after curative resection without any signs of local recurrence or remote metastasis. PCNP usually affects the distal portion of the pancreas of young women. Despite its huge size, PCNP should be explored with aggressive surgical intent because of the inherently good prognosis.
.A
Yamaguchi K; Hirakata R; Kitamura K.
.I 274443
.U
91003240
.S
Br J Surg 9101; 77(9):1004-6
.M
Adolescence; Adult; Aged; Aged, 80 and over; Comparative Study; Duodenal Ulcer/CO/*SU; Emergencies; Female; Gastrectomy; Human; Male; Middle Age; Peptic Ulcer Hemorrhage/*SU; Postoperative Complications/ET; Pylorus/SU; Recurrence; Vagotomy.
.T
Choice of emergency operative procedure for bleeding duodenal ulcer [see comments]
.P
JOURNAL ARTICLE.
.W
In a consecutive series of 201 emergency operations in patients with bleeding duodenal ulcer the size of the ulcer was the only factor that showed a significant correlation with the procedure chosen. Vagotomy, pyloroplasty and underrunning of the bleeding point was performed in 101 cases with ten deaths (10 per cent), partial (Billroth II) gastrectomy in 81 cases with ten deaths (12 per cent), and vagotomy and antrectomy in 16 cases with one death (6 per cent). A patient was more likely to be treated by partial gastrectomy if a giant ulcer with an internal diameter of greater than or equal to 2 cm was found. The results suggest that while vagotomy and pyloroplasty, combined with a direct attack on the bleeding point or excision of an anterior ulcer is an acceptable standard emergency operation for bleeding duodenal ulcer, gastric resection proved to be a satisfactory alternative procedure and should be considered in the technically difficult case with a very large ulcer. A giant ulcer was present in 37 per cent of cases coming to surgery.
.A
Hunt PS; McIntyre RL.
.I 274444
.U
91003241
.S
Br J Surg 9101; 77(9):1006
.M
Adult; Aged; Duodenal Ulcer/CO; Female; Human; Male; Middle Age; Peptic Ulcer Perforation/*SU; Peritoneoscopy/*; Postoperative Complications/PC; Stomach Ulcer/CO.
.T
Laparoscopic treatment of perforated peptic ulcer.
.P
JOURNAL ARTICLE.
.A
Mouret P; Francois Y; Vignal J; Barth X; Lombard-Platet R.
.I 274445
.U
91003242
.S
Br J Surg 9101; 77(9):1007-9
.M
Adult; Chronic Disease; Comparative Study; Diarrhea/ET; Dumping Syndrome/ET; Duodenal Ulcer/*SU; Female; Gastric Acid/SE; Gastric Emptying/PH; Human; Male; Middle Age; Myocardial Infarction/ET; Postoperative Complications/ET; Prospective Studies; Pylorus/SU; Recurrence; Vagotomy, Truncal.
.T
Anterior lesser curve seromyotomy and posterior truncal vagotomy versus truncal vagotomy and pyloroplasty in the treatment of chronic duodenal ulcer.
.P
CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL.
.W
In a prospective randomized controlled clinical trial, anterior lesser curve seromyotomy with posterior truncal vagotomy (AMPT, n = 77) has been compared with truncal vagotomy and pyloroplasty (TVP, n = 69) in 146 patients with chronic duodenal ulcer with a mean duration of symptoms of 7 years. The mean follow-up time was 4.5 years with a range of 2-7 years. One elderly patient died from a myocardial infarction in the TVP group. Acid secretory inhibition in response to insulin and pentagastrin stimuli was equal in both groups, indicating a similar degree of vagal denervation. Recurrent ulcers were more common after AMPT (five) than TVP (two) (P = 0.29, n.s.). Dumping and diarrhoea were significantly commoner (P less than 0.001) after TVP, with 31 instances as opposed to eight with AMPT. The mean operating time was increased by 6 min when AMPT was performed rather than TVP. The results of this study have shown that AMPT is associated with a lower incidence of dumping and diarrhoea and achieves better overall Visick grading. However, continued monitoring is required to assess the long-term incidence of recurrent ulceration after this procedure.
.A
Taylor TV; Lythgoe JP; McFarland JB; Gilmore IT; Thomas PE; Ferguson GH.
.I 274446
.U
91003243
.S
Br J Surg 9101; 77(9):1010-3
.M
Adult; Aged; Aged, 80 and over; Antigens, Tumor-Associated, Carbohydrate/*AN; Carcinoembryonic Antigen/AN; Comparative Study; Female; Human; Lymphatic Metastasis; Male; Middle Age; Neoplasm Staging; Stomach Neoplasms/*IM/PA; Tumor Markers, Biological/*BL.
.T
CA72-4: a new tumour marker for gastric cancer.
.P
JOURNAL ARTICLE.
.W
To date, tumour markers for gastric cancer have proved unreliable. In this study the value of a new serum marker, CA72-4, was compared with the serum activities of carcinoembryonic antigen (CEA) and CA19-9 in a consecutive series of patients with gastric cancer. The results show that the CA72-4 assay is significantly better at separating stage I and II disease from normal controls (P less than 0.01) than CEA (n.s.) or CA19-9 (n.s.). CA72-4 also gave better differentiation between patients with positive and negative nodes (P less than 0.01) and between those who were serosa positive and negative (P less than 0.01). CEA differentiated between patients with positive and negative nodes (P less than 0.05) but CA19-9 could not. CA19-9 and CEA could not discriminate between patients who were serosa positive and negative. In this study, at a specificity of 95 per cent, the sensitivities of CEA, CA19-9 and CA72-4 were 0.25, 0.41 and 0.94 respectively. These preliminary findings indicate that CA72-4 is a reliable tumour marker of disease stage and activity in gastric cancer. Further longitudinal studies are required for full evaluation of its clinical utility.
.A
Byrne DJ; Browning MC; Cuschieri A.
.I 274447
.U
91003244
.S
Br J Surg 9101; 77(9):1013-4
.M
Adult; Aged; Aged, 80 and over; Carcinoid Tumor/*SU; Female; Human; Male; Middle Age; Prognosis; Stomach Neoplasms/*SU.
.T
Primary gastric carcinoids: a view on management [see comments]
.P
JOURNAL ARTICLE.
.A
Davies MG; O'Dowd G; McEntee GP; Hennessy TP.
.I 274448
.U
91003245
.S
Br J Surg 9101; 77(9):1015-7
.M
Adenocarcinoma/SU; Adipose Tissue/CH; Adult; Aged; Body Composition; Body Weight; Caloric Intake; Feces/CH; Female; Gastrectomy/*; Human; Lymphoma/SU; Male; Middle Age; Nutrition Disorders/*ET; Postoperative Complications/*ET; Proteins/AN; Stomach Neoplasms/SU.
.T
Failure of nutritional recovery after total gastrectomy.
.P
JOURNAL ARTICLE.
.W
Malnutrition is reported to be an inevitable consequence of total gastrectomy, although there are few data to support this contention. Six patients of median age 63 years underwent total gastrectomy for malignancy. At follow-up (median 45 months, range 25-60 months) each patient was clinically tumour-free and underwent dietary assessment, faecal fat and nitrogen measurement and routine haematological testing. Protein and fat stores, measured by neutron activation analysis and the tritiated water dilution technique, were compared with the same measurements made before operation and with predicted values. Mean (s.d.) dietary intake (2224(381) kcal day-1 and 81(15)g protein day-1) met the patients' estimated requirements. Mean(s.d.) serum albumin and faecal nitrogen values were normal but there was notable steatorrhoea (21(17) g day-1). Body composition measurements revealed profound deficiencies of body-weight (P less than 0.02), protein (P less than 0.01) and fat (P less than 0.02) before operation which were not corrected by an apparently curative total gastrectomy (P less than 0.05), although further deterioration was prevented.
.A
Curran FT; Hill GL.
.I 274449
.U
91003247
.S
Br J Surg 9101; 77(9):1020-3
.M
Adenocarcinoma/*DT/PA/RT/SU; Antineoplastic Agents, Combined/*TU; Cardia; Cisplatin/AD; Combined Modality Therapy; Fluorouracil/AD; Human; Palliative Treatment; Prognosis; Stomach Neoplasms/*DT/PA/RT/SU; Support, Non-U.S. Gov't.
.T
Treatment of adenocarcinoma of the cardia with synchronous chemotherapy and radiotherapy.
.P
CLINICAL TRIAL; JOURNAL ARTICLE.
.W
Twenty-nine evaluable patients with adenocarcinoma of the cardia were treated with synchronously administered chemotherapy (two cycles of 5-fluouracil and cisplatin and 30-36 Gy of radiation to determine whether these tumours are responsive to such treatment. Complete regression of tumour was observed endoscopically in 19 patients, and partial regression in four. Fourteen patients had their tumours resected and in six no microscopic tumour was found in the specimen. Nine patients received additional radiotherapy to a total dose of 54-60 Gy instead of surgery. Tumour response was associated with rapid reversal of dysphagia. Only one patient required subsequent intervention for relief of dysphagia due to fibrous stricture. Enhanced survival was associated with a complete endoscopic response to initial chemotherapy and radiotherapy, and a tumour of less than 5 cm in length. The median survival of responding patients was 15 months. Synchronous chemotherapy and radiotherapy was of major palliative benefit in this series and merits further evaluation.
.A
Gill PG; Jamieson GG; Denham J; Devitt PG; Ahmad A; Yeoh E; Jones AM.
.I 274450
.U
91003248
.S
Br J Surg 9101; 77(9):1023-4
.M
Adenocarcinoma/CO; Adult; Aged; Aged, 80 and over; Duodenal Neoplasms/CO; Duodenal Ulcer/*CO; Female; Human; Male; Middle Age; Prospective Studies; Pyloric Stenosis/*ET; Stomach Neoplasms/*CO/DI.
.T
Gastric outlet obstruction now predicts malignancy.
.P
JOURNAL ARTICLE.
.A
Johnson CD; Ellis H.
.I 274451
.U
91003249
.S
Br J Surg 9101; 77(9):1025-9
.M
Aged; Anastomosis, Roux-en-Y/*; Eating/PH; Fasting/PH; Female; Gastrectomy/*; Gastrointestinal Motility/*PH; Human; Jejunum/*SU; Male; Manometry; Middle Age; Postoperative Care; Stomach Neoplasms/PP/*SU.
.T
Manometric evaluation of jejunal limb after total gastrectomy and Roux-Orr anastomosis for gastric cancer.
.P
JOURNAL ARTICLE.
.W
Total gastrectomy with Roux-Orr anastomosis is frequently performed for gastric cancer. Since intestinal motility of the Roux limb has never been evaluated after this operation, pressure activity was investigated in the Roux limb of ten patients (aged 51-77 years) who had undergone total gastrectomy and Roux-Orr reconstruction. Investigations were carried out during a 6-h fast and 3 h after a 605 kcal mixed meal. During fasting only two patients had activity fronts and these were abnormal. All ten patients displayed non-propagating bursts of contractions and three had discrete clustered contractions and high amplitude jejunal contractions. The fed state was characterized by a severely reduced motor activity pattern and other abnormalities. Total gastrectomy with Roux-Orr anastomoses provokes a relatively severe disturbance in intestinal activity.
.A
Bassotti G; Gulla P; Betti C; Whitehead WE; Morelli A.
.I 274452
.U
91003251
.S
Br J Surg 9101; 77(9):1030-5
.M
Anastomosis, Surgical/*MT; Animal; Anus/SU; Colectomy/*MT; Defecation/PH; Dogs; Female; Gastrointestinal Transit/PH; Ileum/PH/*SU; Muscle, Smooth/SU; Postoperative Complications/PC; Pressure; Rectum/*SU.
.T
Single lumen ileum with myectomy: a possible alternative to the pelvic reservoir in restorative proctocolectomy.
.P
JOURNAL ARTICLE.
.W
An alternative procedure to construction of a pelvic ileal reservoir was assessed which avoids the need for a pouch, while providing an adequate rectal substitute and good continence. Thirty-six female adult beagles were allotted randomly to undergo total colectomy with (a) ileo-anal anastomosis alone, (b) ileo-anal anastomosis with two 15 cm myectomies, (c) ileo-anal anastomosis and myectomy with an ileo-ileal valve, or (d) ileo-anal anastomosis with a duplicated J pouch. The animals were studied before operation and at 4-weekly intervals for 20 weeks after operation. Mortality rates were similar. Ileal compliance was increased significantly by myectomy from 0.64 ml/mmHg (median, interquartile range 0.49-0.78) after ileo-anal anastomosis alone to 1.65 mmHg (1.16-1.93), P less than 0.01, an increase which was maintained. Ileal capacity was also increased both by myectomy and by the J pouch: ileo-anal anastomosis = 85 ml (75-100 ml), ileo-anal anastomosis and myectomy = 139 ml (116-156 ml), ileo-anal anastomosis and myectomy and ileo-ileal valve = 125 ml (range 85-145 ml), ileo-anal anastomosis and J pouch = 130 ml (range 75-165 ml) (P less than 0.01). Bowel function in the other three groups was markedly superior to ileo-anal anastomosis alone. Mean transit time was significantly less after ileo-anal anastomosis, 5.2 h (2.6-8.2 h) than after both ileo-anal anastomosis and myectomy, 10.5 h (9.6-13.9 h), P less than 0.05 and ileo-anal anastomosis and J pouch, 11.0 h (8.4-13.0 h), P less than 0.05, but addition of an ileo-ileal valve did not produce a further increase in transit time, 12.9 h (range 10.5-14.5 h), P = n.s.. Myectomy of single lumen ileum may be a useful alternative to a pelvic ileal reservoir in restorative proctocolectomy.
.A
Sagar PM; Holdsworth PJ; King RF; Salter G; Johnston D.
.I 274453
.U
91003252
.S
Br J Surg 9101; 77(9):1036-8
.M
Abscess/CO/SU; Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Bladder Fistula/CO/SU; Diverticulosis, Colonic/CO/*SU; Female; Human; Intestinal Fistula/CO/SU; Male; Middle Age; Postoperative Complications/ET; Sigmoid/SU; Sigmoid Diseases/*SU.
.T
Elective resection for diverticular disease of the sigmoid colon.
.P
JOURNAL ARTICLE.
.W
From 1966 to 1987, 177 consecutive patients were operated on electively for diverticular disease of the sigmoid colon. The indications for surgery were: colovesical fistula (n = 12), suspicion of residual abscess (n = 39), two or more previous attacks of acute inflammation (n = 52), chronic symptoms (n = 72) and suspicion of carcinoma (n = 2). An abscess was found at operation in 76 patients (43 per cent) and this was extracolic with local peritonitis in 52 patients (29 per cent). An unsuspected abscess was found in 25 of the 72 patients operated on for chronic symptoms. Colonic resection with primary anastomosis was performed in 95 per cent of the 177 patients and in 94 per cent of those 52 patients with an extracolic abscess. There were no postoperative deaths and no clinical anastomotic leakages. Long-term results were very good in 85 per cent of the 177 patients and in 82 per cent of the 72 patients operated on for chronic symptoms. The results of this series suggest that a one-stage procedure can be safely performed with some technical precautions in most patients operated on electively for diverticular disease, even if an extracolic abscess is found. The good long-term results in patients operated on for chronic symptoms suggest that such symptoms should be taken into account with respect to surgical indications.
.A
Moreaux J; Vons C.
.I 274454
.U
91003253
.S
Br J Surg 9101; 77(9):1039-40
.M
Adolescence; Adult; Anus/PP; Fecal Incontinence/PP/*SU; Female; Human; Male; Middle Age; Muscles/*TR; Physical Therapy; Postoperative Care; Pressure; Thigh.
.T
Gracilis muscle transposition for faecal incontinence.
.P
JOURNAL ARTICLE.
.W
Transposition of the gracilis muscle for faecal incontinence was performed in 13 patients. Six gained satisfactory continence, four were improved, two did not benefit from the operation and one patient died from intercurrent disease before closure of a pre-existing colostomy. Anal manometry compared with a control group showed no alteration in resting and pressure at a median of 35 mmHg (range 5-63 mmHg), whereas maximum squeeze pressure increased from a median of 38 mmHg (range 5-79 mmHg) to 59 mmHg (range 10-143 mmHg) (P = 0.041) which was, however, significantly lower than 130 mmHg (range 81-236 mmHg) in the control group. All patients who benefited from the operation had an increase in maximum squeeze pressure. The ability to retain a viscous fluid in the rectum was measured in seven patients, four of whom had gained satisfactory continence and three of whom had improved continence. They were able to retain a median volume of 200 ml (range 50-225 ml) without leakage compared with 325 ml (range 250-400 ml) in the control group. These patients could retain the maximum amount of viscous fluid for 5-8 min, whereas all control subjects could do so for more than 15 min. It is concluded that, although gracilis transposition never results in normal continence, acceptable continence may be achieved in selected patients provided careful attention is paid to the technical details of the procedure and provided that systematic postoperative exercises are performed.
.A
Christiansen J; Sorensen M; Rasmussen OO.
.I 274455
.U
91003254
.S
Br J Surg 9101; 77(9):1041-2
.M
Acute Disease; Arm/*BS; Attitude of Health Personnel; Great Britain; Hemorrhage/ET; Human; Ireland; Ischemia/*DT; Leg/*BS; Streptokinase/TU; Thromboembolism/DT; Thrombolytic Therapy/AE/*UT.
.T
Survey of the use of thrombolysis for acute limb ischaemia in the UK and Ireland.
.P
JOURNAL ARTICLE.
.W
A total of 156 vascular surgeons from the UK and Ireland responded to a postal questionnaire on the use of thrombolysis in acute limb ischaemia. Almost half had used thrombolysis in the previous 12 months. Low dose intra-arterial streptokinase (89 per cent) was the regimen most frequently used, but 33 per cent had used intravenous streptokinase. Detailed results for 103 patients (limb salvage rate 60 per cent, amputation rate 35 per cent, mortality rate 5 per cent) were similar to those of previously published reports. Complications in most series were infrequent, but in the entire survey there were six bleeding-related deaths and one death from anaphylaxis. A total of 67 per cent of surgeons with working experience indicated that selected patients with acute arterial thromboses were most suitable for thrombolysis, particularly if there was no neurological deficit and no run-off for surgical bypass. Distal or late emboli and graft occlusions were regarded as appropriate by some surgeons. This study demonstrated that many vascular surgeons currently use thrombolysis, although sparingly and in selected cases. Patients with acute limb ischaemia should be managed by experienced vascular surgeons who are aware of the new therapeutic alternatives, an ideal supported by almost three-quarters of respondents to this survey.
.A
Earnshaw JJ; Shaw JF.
.I 274456
.U
91003255
.S
Br J Surg 9101; 77(9):1043-5
.M
Adult; Blood Flow Velocity; Blood Vessels/IR; Female; Hand/*BS; Human; Intercostal Nerves/*SU; Ischemia/PP/*SU; Male; Middle Age; Raynaud's Disease/SU; Reoperation; Sympathectomy/*.
.T
Resympathectomy of the upper extremity.
.P
JOURNAL ARTICLE.
.W
Resympathectomy was performed in 27 patients (eight bilaterally) with ischaemic hand phenomena. An extended operative technique, resecting parts of the second and third intercostal nerves and their surrounding tissue, was used. In all 35 procedures the posterior extrapleural approach was used. Follow-up was from 3 to 12 years. Only the sympathetic ganglia had been removed during the previous surgery by the axillary approach (67 per cent of these patients had had a transient response for between 6 months and 2 years; 33 per cent had had no response at all). A direct subjective improvement was seen after 27 of the 35 reoperations (77 per cent). In 14 patients continuous wave Doppler ultrasound studies were available and showed a significant increase in peak forward frequency after operation (P less than 0.001). From these data it may be concluded that it is possible to obtain a resympathectomy effect, but reoperation should be reserved for special cases for whom survival of digits is essential.
.A
van Rhede van der Kloot EJ; Jorning PJ.
.I 274457
.U
91003258
.S
Br J Surg 9101; 77(9):1055-9
.M
Adult; Aged; Anesthesia, General/*; Human; Intraoperative Period; Leg/*BS; Middle Age; Postoperative Complications/ET; Sodium Chloride/PD; Support, Non-U.S. Gov't; Surgery, Operative/*; Thrombophlebitis/ET/US; Vasodilation/DE/*PH; Veins/AH/*PP/US.
.T
Venous stasis and vein lumen changes during surgery [see comments]
.P
JOURNAL ARTICLE.
.W
The mechanisms underlying the development of postoperative deep vein thrombosis remain to be fully elucidated. Previous studies have suggested that peroperative venous distension may be a factor associated with venous thromboembolism. In this study we have obtained high resolution ultrasound images of gastrocnemius and posterior tibial veins in 62 patients undergoing a range of general surgical procedures. From these we determined the changes in vein diameter occurring during the operative procedures, in response to induction of anaesthesia, and after completion of surgery. Veins showed no evidence of dilatation in response to the induction of anaesthesia, but by the end of the operative procedure showed distension of 22-28 per cent. Distension was most prominent in the gastrocnemius veins, and lesser distension was observed in the posterior tibial veins. In a series of patients who received an infusion of 1 litre of saline in addition to basal requirements, distension was 57 per cent compared with 22 per cent in the corresponding control group. Intraoperative venous distension is associated with factors that lead to deep vein thrombosis and may be involved in the mechanisms which result in the commencement of deep vein thrombosis.
.A
Coleridge-Smith PD; Hasty JH; Scurr JH.
.I 274458
.U
91003259
.S
Br J Surg 9101; 77(9):1060-1
.M
Anus Neoplasms/*SU; Case Report; Cicatrix/PC; Condylomata Acuminata/*SU; Human; Male; Methods; Middle Age; Postoperative Complications/PC; Skin Transplantation/IS; Surgical Instruments/*.
.T
Use of skin graft knife in the treatment of giant perianal condyloma acuminatum.
.P
JOURNAL ARTICLE.
.A
Notaras MJ; Murray WJ; Manek S.
.I 274459
.U
91003260
.S
Br J Surg 9101; 77(9):1062
.M
Deglutition Disorders/TH; Gastroscopy/MT; Gastrostomy/*MT; Human; Skin/SU.
.T
Percutaneous gastrostomy: an alternative endoscopic approach.
.P
JOURNAL ARTICLE.
.A
Iftikhar SY; McIntyre AS.
.I 274460
.U
91003261
.S
Br J Surg 9101; 77(9):1063-5
.M
Colonic Neoplasms/DI/PC/*TH; Colonoscopy; Diet; Human; Occult Blood; Rectal Neoplasms/DI/PC/*TH; Risk Factors.
.T
Cancer of the colon and rectum.
.P
CONSENSUS DEVELOPMENT CONFERENCE; JOURNAL ARTICLE; REVIEW.
.I 274461
.U
91003262
.S
Br J Surg 9101; 77(9):1071-2
.M
Diffusion; Fibrin; Human; Oxygen Consumption; Skin/ME; Varicose Ulcer/*ET.
.T
Aetiology of venous ulceration [letter; comment]
.P
COMMENT; LETTER.
.I 274462
.U
91003263
.S
Br J Surg 9101; 77(9):1073
.M
Aged; Aged, 80 and over; Cholecystectomy; Common Bile Duct Calculi/*SU; Human; Postoperative Complications/ET; Sphincterotomy, Transhepatic/*.
.T
Endoscopic sphincterotomy for bile duct stones in patients with intact gallbladders [letter; comment]
.P
COMMENT; LETTER.
.A
Templeton JL; Bornman PC.
.I 274463
.U
91003264
.S
Br J Surg 9101; 77(9):1073
.M
Biliary Fistula/SU; Echinococcosis, Hepatic/*SU; Human; Postoperative Complications/SU; Sphincterotomy, Transhepatic/*.
.T
Endoscopic sphincterotomy in hepatic hydatid disease open to the biliary tree [letter; comment]
.P
COMMENT; LETTER.
.A
Akoglu M; Hilmioglu F; Balay AR; Sahin B; Davidson BR.
.I 274464
.U
91003265
.S
Br J Surg 9101; 77(9):1074
.M
Cholangiography/*; Cholecystectomy/*; Common Bile Duct Calculi/RA; Human; Intraoperative Care.
.T
Operative cholangiography in elective cholecystectomy [letter; comment]
.P
COMMENT; LETTER.
.A
Coleman J; Paul A; Spangenberger W; Klein J; Troidl H.
.I 274465
.U
91003266
.S
Br J Surg 9101; 77(9):1074
.M
Burns, Chemical/*TH; Case Report; Child, Preschool; Esophageal Perforation/*TH; Human; Intubation, Gastrointestinal/*; Male; Mediastinitis/CO; Pneumothorax/CO.
.T
T tube intubation in the management of oesophageal fistula [letter; comment]
.P
COMMENT; LETTER.
.A
Zer M; Freud E.
.I 274466
.U
91003267
.S
Br J Surg 9101; 77(9):1074
.M
Animal; Education, Medical, Undergraduate/*; Intestine, Small/SU; Surgery/*ED; Swine.
.T
Use of fresh porcine bowel in surgical training [letter]
.P
LETTER.
.A
Hoffmann J; Munksdorf M; Fischer AB.
.I 274467
.U
91003268
.S
Br J Surg 9101; 77(9):1075
.M
Colorectal Neoplasms/*DT; Fluorouracil/*TU; Human; Time Factors.
.T
A randomized controlled trial of oral 5-FU versus placebo in colorectal cancer: results of 10 years observation time [letter]
.P
CLINICAL TRIAL; LETTER; RANDOMIZED CONTROLLED TRIAL.
.A
Hafstrom L.
.I 274468
.U
91003269
.S
Br J Surg 9101; 77(9):1075
.M
Cholecystectomy/*; Common Bile Duct/SU; Drainage; Human; Intubation/*AE; Postoperative Complications/*TH.
.T
Bile leakage after removal of T tubes from the common bile duct [letter]
.P
LETTER.
.A
Placer Galan C; Colina Alonso A.
.I 274469
.U
91003271
.S
Br J Surg 9101; 77(9):963
.M
Endoscopy, Digestive System; Esophageal and Gastric Varices/*TH; Fibrosis; Gastrointestinal Hemorrhage/*TH; Human; Portal Vein/PA; Sclerotherapy/*AE; Splenic Vein/PA.
.T
Endoscopic sclerotherapy: the far and near effects [editorial]
.P
EDITORIAL.
.A
Chaudhary A; Tatke M; Aranya RC.
.I 274470
.U
91003272
.S
Br J Surg 9101; 77(9):964-7
.M
Blood Transfusion/AE; Female; Human; Malaria/*CO/TM; Postoperative Complications/PC; Recurrence; Spleen/*SU; Splenectomy/AE; Splenic Rupture/SU; Splenomegaly/SU.
.T
Surgical aspects of malaria.
.P
JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL.
.W
The spread of drug-resistant organisms and increased international travel makes malaria a disorder of ever-increasing importance. This report reviews those aspects of malaria of surgical relevance. The importance of the spleen in host defence against malaria and other infections makes splenic preservation desirable whenever possible after rupture of the spleen. Tropical splenomegaly is caused by an abnormal immune response to malaria and is best managed medically. Careful selection of blood donors is essential to prevent transfusion malaria, and routine antimalarial prophylaxis is indicated for blood recipients in many endemic areas. The risk of postoperative malaria may justify chemoprophylaxis in certain patients.
.A
Gibney EJ.
.I 274471
.U
91003273
.S
Br J Surg 9101; 77(9):968-74
.M
Duodenum/*SU; Gastric Emptying/PH; Gastrointestinal Motility/PH; Human; Marginal Ulcer/PC; Pancreatectomy/*/MT; Pancreatitis/SU; Postoperative Complications/PC.
.T
Pylorus preserving pancreatoduodenectomy: an overview.
.P
JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL.
.W
Pylorus preserving pancreatoduodenectomy (PPPD) was reintroduced 12 years ago. Since that time, over 400 patients have undergone PPPD with approximately 41 per cent having chronic pancreatitis and 54 per cent having pancreatic and other periampullary malignancies. Reported 5-year survivals in this latter group have been comparable to those achieved by the classic Whipple procedure. The postoperative mortality rate in 339 reported patients has been 3.8 per cent. Postoperative morbidity, including delayed gastric emptying, has been similar to that of the classic Whipple operation. However, PPPD has been associated with fewer late problems with dumping, diarrhoea, delayed gastric emptying (8.6 per cent), and marginal ulceration (3.6 per cent). Moreover, most patients undergoing PPPD have been able to return to their preoperative and preillness weight. The additional advantage of decreased operative time makes PPPD an attractive alternative to the classic pancreatoduodenectomy.
.A
Grace PA; Pitt HA; Longmire WP.
.I 274472
.U
91003274
.S
Br J Surg 9101; 77(9):975-82
.M
Choledochostomy/IS/*MT; Common Bile Duct Calculi/*SU; Endoscopy; Human; Intraoperative Care; Postoperative Complications/ET.
.T
Operative choledochoscopy: common bile duct exploration is incomplete without it.
.P
JOURNAL ARTICLE; REVIEW; REVIEW, ACADEMIC.
.W
This paper reviews the reported experience of operative choledochoscopy. Development of choledochoscopes to the currently available rigid and flexible instruments is described. The collected results of both rigid and flexible choledochoscopy are reported. Retained stones occurred in 97 of 2712 stone-positive explorations with the rigid choledochoscope (3.6 per cent) and in 35 of 1726 stone-positive explorations with the flexible choledochoscope (2.0 per cent). Choledochoscopy should now be a mandatory part of common bile duct exploration.
.A
Motson RW; Wetter LA.
.I 274473
.U
91003275
.S
Br J Surg 9101; 77(9):983-7
.M
Adolescence; Adult; Aged; Child; Child, Preschool; Cholangioma/SU; Female; Hepatoma/PA/SU; Human; Liver Cirrhosis/CO; Liver Neoplasms/CO/PA/*SU; Liver Transplantation/*; Lymph Nodes/PA; Male; Middle Age; Neoplasm Staging; Prognosis; Retrospective Studies; Support, Non-U.S. Gov't.
.T
Primary hepatic malignancy: the role of liver transplantation.
.P
JOURNAL ARTICLE.
.W
Between January 1982 and April 1989, 134 patients with a suspected liver neoplasm were referred to the liver unit, Queen Elizabeth Hospital, Birmingham. In 105 (78 per cent), a primary hepatic neoplasm was histologically confirmed, and 47 patients (45 per cent) proved to have primary hepatocellular carcinoma. Twenty-nine orthotopic liver transplants were performed in 28 of these patients (27 per cent). Twenty patients (71 per cent) survived 30 days or longer (median 11.5 months; range 2-87 months), of whom nine are currently alive. We retrospectively analysed our data to determine the influence of preoperative evaluation, histological type and staging on outcome. Computed tomography proved to be superior to intraoperative assessment (86 versus 58 per cent) in diagnosing tumour positive nodes. Patients with tumour negative lymphadenopathy had a better prognosis. Postoperative stage I/II had a median survival of 16 months (range 3-87 months) compared with 7.5 months (range 2-20 months) for stage III. Non-cirrhotic patients with hepatocellular carcinoma had the best prognosis; cholangiocellular carcinoma and cirrhotic patients with hepatocelluar carcinoma had the worst outcome with no survivors beyond 1 year. Because of the advanced stage of disease at the time of presentation, the value of liver transplantation in primary liver cancer is limited. For those presenting with advanced disease confined to the liver (stage I/II) in whom conventional hepatic resection is not possible, significant benefit can be achieved in selected cases.
.A
Ismail T; Angrisani L; Gunson BK; Hubscher SG; Buckels JA; Neuberger JM; Elias E; McMaster P.
.I 274474
.U
91003276
.S
Br J Surg 9101; 77(9):987-8
.M
Adult; Bile Ducts, Intrahepatic/*/RA; Case Report; Cholelithiasis/RA/*TH; Female; Gallbladder Diseases/CO; Human; Lithotripsy/*.
.T
Management of intrahepatic calculi in Caroli's disease by extracorporeal shock wave lithotripsy.
.P
JOURNAL ARTICLE.
.A
Lointier PH; Kauffmann P; Francannet P; Pezet D; Chipponi J.
.I 274475
.U
91003277
.S
Br J Surg 9101; 77(9):989-91
.M
Aeromonas; Anastomosis, Roux-en-Y; Animal; Bacterial Infections/PC; Biliary Atresia/*SU; Cholangitis/*PC; Dogs; Intestinal Mucosa/SU; Portoenterostomy, Hepatic/*MT; Postoperative Complications/*PC; Random Allocation; Support, Non-U.S. Gov't.
.T
Mucosal intussusception to avoid ascending cholangitis.
.P
JOURNAL ARTICLE.
.W
Many methods have been devised to prevent ascending cholangitis following Kasai's hepatic portoenterostomy for biliary atresia. To investigate the effectiveness of mucosal intussusception in preventing ascending cholangitis, 20 mongrel dogs were randomized to undergo Roux-en-Y cholecystjejunostomy and common bile duct ligation with or without mucosal intussusception. Aeromonas hydrophila was instilled into the gastrointestinal tract. Bacterial cultures were grown from samples taken from the gallbladders and lower jejunum, and blood chemistry and barium studies were performed. The barium studies showed satisfactory lack of reflux in all ten dogs with mucosal intussusception. Only two of them had positive cultures for Aeromonas from the gallbladder 3 days after bacterial instillation into the jejunum. All ten dogs in the control group had positive cultures for Aeromonas from the gallbladder. Our results showed that the mucosal intussusception group had a significantly lower rate of recovery of organisms from the gallbladder compared with the control group when the organisms were instilled into distal intestine (P less than 0.05). The method is worthy of clinical trial as a means of preventing or treating ascending cholangitis.
.A
Yeh TJ; Chin TW; Tsai WC; Wei CF.
.I 274476
.U
91003278
.S
Br J Surg 9101; 77(9):992-5
.M
Adult; Aged; Atropine/PD; Dose-Response Relationship, Drug; Female; Human; Male; Manometry; Meperidine/AI/*PD; Middle Age; Morphine/*PD; Muscle Contraction/DE; Naloxone/PD; Oddi's Sphincter/*DE/PH; Support, Non-U.S. Gov't.
.T
Differing effects of pethidine and morphine on human sphincter of Oddi motility.
.P
JOURNAL ARTICLE.
.W
The aim of this study was to evaluate the effects of morphine and pethidine on human sphincter of Oddi motility. The action of these opioids on the sphincter of Oddi was evaluated by means of intraoperative manometry in 36 patients undergoing elective cholecystectomy. Both opioids were given in intravenous cumulative equipotent doses up to a maximum of 10 micrograms/kg morphine or 100 micrograms/kg pethidine. At these doses, morphine increased the mean(s.d.) frequency of contractions from 2.4(1.0) to 7.9(1.6) (P less than 0.001); this effect was reduced by naloxone (0.04 mg bolus, P less than 0.05). Pethidine inhibited the frequency of contractions from 1.5(0.8) to 0.8(0.5) (P less than 0.05); this response was blocked by atropine (0.6 mg bolus, P less than 0.01). Pretreatment with atropine or naloxone reduced the frequency of contractions significantly (P less than 0.05). The results illustrate different responses to pethidine and morphine of the sphincter of Oddi, and provide a pharmacological explanation for the suitability of pethidine over morphine as the analgesic of choice in patients experiencing biliary pain.
.A
Thune A; Baker RA; Saccone GT; Owen H; Toouli J.
.I 274477
.U
91003279
.S
Br J Surg 9101; 77(9):996-7
.M
Adult; Case Report; Esophageal Diseases/*PA/SU; Female; Granuloma, Plasma Cell/*PA/SU; Human.
.T
Plasma cell granuloma of the distal oesophagus.
.P
JOURNAL ARTICLE.
.A
Seco JL; Claver M; Bengoechea M; Moral G; Santamaria JL.
.I 274478
.U
91003280
.S
Br J Surg 9101; 77(9):998-9
.M
Colorectal Neoplasms/*SU; Female; Human; Intraoperative Care; Liver Neoplasms/DI/*SC/US; Male; Preoperative Care.
.T
Intraoperative ultrasonography and the detection of liver metastases in patients with colorectal cancer.
.P
JOURNAL ARTICLE.
.W
A total of 213 patients with carcinoma of the colon and rectum were examined to detect liver metastases. The study compared preoperative ultrasonography and inspection and palpation of the liver during surgery with intraoperative ultrasonography. Preoperative ultrasonography, inspection and palpation identified 238 metastases in 42 patients. Intraoperative ultrasonography detected 116 previously unrecognized metastatic tumours during 40 surgical procedures (P less than 0.01). High resolution intraoperative ultrasonography is safe and more accurate than preoperative imaging and surgical exploratory methods. The examination is simple to perform and success appears to be related to careful attention to detail.
.A
Olsen AK.
.I 274479
.U
91003674
.S
Can J Ophthalmol 9101; 25(5):229-33
.M
Acrylic Resins/*; Aged; Aged, 80 and over; Cataract Extraction/*; Chi-Square Distribution; Comparative Study; Female; Human; Hyaluronic Acid/*; Lenses, Intraocular/*; Male; Prospective Studies.
.T
A prospective comparison of 4% polyacrylamide (Orcolon) and 1% sodium hyaluronate (Healon) in cataract and intraocular lens implant surgery.
.P
CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL.
.W
We performed a prospective randomized clinical trial of 4% polyacrylamide (Orcolon) and 1% sodium hyaluronate (Healon) in routine extracapsular cataract extraction with posterior chamber lens implantation or in secondary anterior chamber lens implantation. Seventy consecutive patients were enrolled. The viscoelastic agents were compared in four areas intraoperatively: ease of injection, ease of removal, clarity of field and ability to hold back ocular tissues. Healon was significantly superior to Orcolon in all four areas. Further evaluations were performed on the first day and at 2 weeks postoperatively. Measurements of intraocular pressure (IOP) by Goldmann applanation and evaluations of corneal edema, epithelial keratitis and anterior chamber cellular reaction were recorded. Multivariable statistical analysis revealed only one difference between the two groups: significantly more patients in the Orcolon group (eight cases) than in the Healon group (two cases) had an IOP of 21 mm Hg or greater on the first postoperative day.
.A
Laflamme MY; Swieca R.
.I 274480
.U
91003675
.S
Can J Ophthalmol 9101; 25(5):234-8
.M
Adult; Aged; Aged, 80 and over; Cataract Extraction/*; Comparative Study; Double-Blind Method; Female; Human; Indomethacin/*PD; Male; Middle Age; Ophthalmic Solutions/PD; Prednisolone/*PD; Pupil/*DE; Support, Non-U.S. Gov't; Time Factors.
.T
Comparison of prednisolone acetate and indomethacin for maintaining mydriasis during cataract surgery.
.P
CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL.
.W
Preoperative topical nonsteroidal anti-inflammatory drugs such as flurbiprofen and indomethacin have been found to maintain mydriasis during cataract surgery. Steroidal anti-inflammatory drugs are commonly used to treat postoperative inflammation, but their effect on the maintenance of intraoperative mydriasis is unknown. Forty-six patients admitted for elective cataract surgery were randomly assigned to one of three treatment groups and received 1% prednisolone acetate, 1% indomethacin or artificial tears four times before surgery, in addition to standardized preoperative dilating drops and intraoperative epinephrine. Pupillary diameter was measured and the time interval noted five times during the surgery. During surgery the indomethacin group lost significantly less mydriasis than the control group. The mydriasis losses of the prednisolone acetate group were between those of the indomethacin and control groups, but these differences did not reach significance. We conclude that prednisolone acetate is less effective than indomethacin for maintaining mydriasis during cataract surgery.
.A
Dube P; Boisjoly HM; Bazin R; Chamberland G; Laughrea PA; Dube I.
.I 274481
.U
91003676
.S
Can J Ophthalmol 9101; 25(5):239-42
.M
Aged; Analysis of Variance; Cataract Extraction/*; Double-Blind Method; Eye Color; Female; Flurbiprofen/*PD; Human; Intraoperative Care; Male; Preoperative Care; Prostaglandin Antagonists/*PD; Pupil/*DE.
.T
Effect of flurbiprofen on the maintenance of pupillary dilation during cataract surgery.
.P
CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL.
.W
A randomized, double-blind clinical trial was performed to evaluate the effect of flurbiprofen sodium (0.03%), a potent prostaglandin inhibitor, on the maintenance of pupillary dilation during elective extracapsular cataract extraction. Intraoperative pupillary measurements were taken before incision, after lens extraction and following cortex aspiration. The treatment group demonstrated statistically significant maintenance of pupillary area at each stage and in total (p = 0.003). The results indicate that the inhibition of prostaglandin synthesis by flurbiprofen aids significantly in the maintenance of intraoperative pupillary dilation.
.A
Heinrichs DA; Leith AB.
.I 274482
.U
91003677
.S
Can J Ophthalmol 9101; 25(5):243-8
.M
Adolescence; Adult; Aged; Aged, 80 and over; Canada/EP; Child; Child, Preschool; Comparative Study; Corneal Diseases/EP/PA/*SU; Female; Graft Survival; Human; Keratoplasty, Penetrating/*/SN; Male; Middle Age; Reoperation.
.T
Changing indications for penetrating keratoplasty in Vancouver, 1978-87.
.P
JOURNAL ARTICLE.
.W
Indications for penetrating keratoplasty (PK) were assessed by clinicopathological review of 659 corneal buttons submitted from 1978 to 1987 to the Ophthalmic Pathology Service in Vancouver. Leading indications for PK were bullous keratopathy (22.2%), keratoconus (17.1%), scarring with or without chronic inflammation (13.5%), graft failure (12.1%), scarring or active keratitis secondary to virus (9.0%) and Fuchs' dystrophy (8.3%). The principal factors responsible for graft failure were also judged by clinicopathological correlation. The authors compare their findings with those in other series.
.A
Damji KF; Rootman J; White VA; Dubord PJ; Richards JS.
.I 274483
.U
91003678
.S
Can J Ophthalmol 9101; 25(5):249-51
.M
Adult; Aged; Case Report; Chloroquine/*AE/ME; Cornea/*ME; Female; Fluorescein Angiography; Fundus Oculi; Human; Hydroxychloroquine/*AE/ME; Male; Overdose/CO/DI; Pupil/DE; Retinal Diseases/*CI/DI.
.T
Is corneal deposition of antimalarial any indication of retinal toxicity?
.P
JOURNAL ARTICLE.
.W
Ninety-five percent of patients on chloroquine demonstrate corneal deposition of the drug with the pupil dilated; less than 10% of patients on hydroxychloroquine show any corneal changes when so examined. I describe one patient on chloroquine and two on hydroxychloroquine who demonstrated large amounts of corneal antimalarial drug, leading to the early diagnosis of definite retinopathy. Examination of the cornea with the pupil dilated may reveal the presence of retinal toxicity in some patients.
.A
Easterbrook M.
.I 274484
.U
91003679
.S
Can J Ophthalmol 9101; 25(5):252-5
.M
Eyelid Diseases/*TH; Human; Ontario; Ophthalmology; Questionnaires.
.T
The management of chalazion: a survey of Ontario ophthalmologists.
.P
JOURNAL ARTICLE.
.W
Owing to the variability and lack of standardization of chalazion management, a survey of Ontario ophthalmologists was undertaken. The results highlight what ophthalmologists consider to be problems in chalazion management and suggest that a chalazion operation should be treated with the same respect given any other operation.
.A
Smythe D; Hurwitz JJ; Tayfour F.
.I 274485
.U
91003680
.S
Can J Ophthalmol 9101; 25(5):256-9
.M
Biopsy; Case Report; Chloroquine/TU; Eyelid Diseases/DT/*PA; Female; Human; Middle Age; Sarcoidosis/DT/*PA.
.T
Sarcoidosis of the eyelid skin.
.P
JOURNAL ARTICLE.
.W
A 64-year-old white woman presented with nodular lesions on the arms and face, including both medial canthi and the left upper eyelid. Histopathological examination of the biopsied eyelid lesion and other facial lesions disclosed the presence of noncaseating granulomas strongly suggestive of sarcoidosis. No other evidence of ocular sarcoidosis was present. The patient had clinical, radiologic and laboratory findings consistent with a diagnosis of systemic sarcoidosis. Therapy with chloroquine phosphate led to regression of the cutaneous lesions.
.A
Brownstein S; Liszauer AD; Carey WD; Nicolle DA.
.I 274486
.U
91003681
.S
Can J Ophthalmol 9101; 25(5):260-2
.M
Acanthamoeba/DE/IP; Acanthamoeba Keratitis/DT/*ET/PA/PS; Adult; Animal; Benzamidines/TU; Biopsy; Case Report; Contact Lenses, Hydrophilic/*AE; Cornea/DE/PS; Human; Male; Neomycin/TU; Polymyxin B/TU.
.T
Acanthamoeba keratitis with two species of Acanthamoeba.
.P
JOURNAL ARTICLE.
.W
We describe a case of Acanthamoeba keratitis related to soft contact lens wear. The patient presented with a 3-week history of severe uniocular pain, radial stromal infiltrates and subepithelial infiltrates with no epithelial defect. Acanthamoeba was cultured from the corneal biopsy specimen, contact lens and lens case. The corneal biopsy culture grew both A. castellani and A. polyphaga as well as Escherichia coli. The patient was treated with topical dibromopropamidine isethionate (Brolene) drops, neomycin and polymyxin B drops and fortified gentamicin drops. Gradual clinical improvement ensued.
.A
Beattie AM; Slomovic AR; Rootman DS; Hunter WS.
.I 274487
.U
91003705
.S
Can Med Assoc J 9101; 143(6):459-60
.M
Asthma/PC/*TH; Chronic Disease; Emergencies; Human; Physicians, Family; Prognosis.
.T
Long-term management of asthma [letter; comment]
.P
COMMENT; LETTER.
.A
Dean MM.
.I 274488
.U
91003706
.S
Can Med Assoc J 9101; 143(6):460-1
.M
Antihypertensive Agents/*TU; Eating/*; Food Habits/*; Human; Hypertension/DH/*DT.
.T
Hypertension and eating habits [letter]
.P
LETTER.
.A
Watters WW.
.I 274489
.U
91003707
.S
Can Med Assoc J 9101; 143(6):461, 464-5
.M
Adolescence; Child; Head Injuries/MO/RA/*TH; Human; Injury Severity Score/*; Multiple Trauma/CO.
.T
Management of children with head trauma [letter; comment]
.P
COMMENT; LETTER.
.I 274490
.U
91003708
.S
Can Med Assoc J 9101; 143(6):466
.M
Great Britain; History of Medicine, 19th Cent.; History of Medicine, 20th Cent.; Human; Incisor/*/IN; Military Dentistry/HI; Military Personnel/*; Oral Health; Tooth Loss/*.
.T
Traumatic exodontia [letter; comment]
.P
COMMENT; HISTORICAL ARTICLE; LETTER.
.A
Sperber GH.
.I 274491
.U
91003709
.S
Can Med Assoc J 9101; 143(6):466-7
.M
Abortion, Induced/*; Abortion, Legal/*; Canada; Female; Human; Patient Advocacy; Pregnancy; Women's Rights.
.T
Abortion: a right or a treatment? [letter]
.P
LETTER.
.A
Ney PG.
.I 274492
.U
91003710
.S
Can Med Assoc J 9101; 143(6):467-8
.M
Drug Industry/*; Drugs/*; Human; Interprofessional Relations/*; Physicians/*.
.T
A sample argument [letter] [see comments]
.P
LETTER.
.A
Rapp MS.
.I 274493
.U
91003711
.S
Can Med Assoc J 9101; 143(6):468
.M
Health Behavior/*; Human; Preventive Medicine/*; Wit and Humor/*.
.T
Leave me alone [letter]
.P
LETTER.
.A
Esdaile DS.
.I 274494
.U
91003712
.S
Can Med Assoc J 9101; 143(6):473-4
.M
Canada; Human; Insurance, Health; Outcome and Process Assessment (Health Care); Practice Management, Medical/*; Quality Assurance, Health Care/*.
.T
Guidelines are essential for quality assurance in practice [editorial]
.P
EDITORIAL.
.A
Scott GW.
.I 274495
.U
91003716
.S
Can Med Assoc J 9101; 143(6):493-500
.M
Acquired Immunodeficiency Syndrome/*ET/PC; Adult; Chicago; Female; Human; HIV Infections/*ET/PC; Male; Middle Age; Occupational Diseases/*ET/PC; Occupational Exposure; Ohio; Ontario; Physicians/*; Professional Practice; Regression Analysis; Risk Factors; Social Environment; Support, Non-U.S. Gov't.
.T
Physicians' perception of personal risk of HIV infection and AIDS through occupational exposure.
.P
JOURNAL ARTICLE.
.W
Physicians' response to acquired immune deficiency syndrome (AIDS) is poorly understood and often attributed to fear of human immunodeficiency virus (HIV) infection through occupational exposure. We surveyed 268 physicians from three geographic regions in North American with different specialties and responsibilities for HIV-positive patients. An important difference was found between the published risk and the physicians' perceived risk of infection after a single occupational exposure. Almost half of the respondents stated that they feared contracting AIDS more than other diseases. The physicians who perceived themselves to be at high physical risk were more likely than the others to report that AIDS had changed the way they interact with their patients (r = 0.26, p less than 0.001). No relation was found between the perception of physical risk and the number of HIV-infected patients (r = -0.07, p = 0.15). However, the perception of social risk showed a small inverse correlation (r = -0.15, p less than 0.02), in which the physicians with more HIV-infected patients reported less concern about negative social consequences. The physicians who perceived themselves to be at high personal risk were more likely than the others to report that surgeons have the right to refuse patients who do not wish to undergo HIV antibody testing (r = -0.16, p less than 0.01 for physical risk; r = -0.29, p less than 0.001 for social risk). Multiple regression analyses indicated that physicians' perception of physical risk was not related to age or sex but was modestly related to income source. The perception of social risk was related to sex and income source. Physicians' perception of personal risk is a crucial, yet often unacknowledged, component of the fight against AIDS. Our findings suggest that lack of attention to this issue is seriously compromising initiatives designed to facilitate physician participation in AIDS care.
.A
Taylor KM; Eakin JM; Skinner HA; Kelner M; Shapiro M.
.I 274496
.U
91003718
.S
Can Med Assoc J 9101; 143(6):509-12
.M
Apnea/*ET; Calcium/BL; Female; Human; Hypercalcemia/BL/*CO/GE; Infant; Infant, Newborn; Male; Sleep Apnea Syndromes/ET.
.T
Hypercalcemia in infants presenting with apnea.
.P
JOURNAL ARTICLE.
.W
To our knowledge apnea in infants has not been associated with hypercalcemia. We describe seven hypercalcemic infants aged 2 days to 3 months who had presented with apnea; six of the seven were otherwise healthy. The apneic attacks were brief, and normal breathing was restored spontaneously or after tactile stimulation. The attacks stopped and the apnea monitoring was discontinued when the children were 1 month to 2 years of age. The only abnormal finding common to all of the patients was hypercalcemia. Idiopathic infantile hypercalcemia was diagnosed in six of the patients and familial benign hypercalcemia in one. Our findings suggest that determination of the plasma calcium level be included in the investigation of apnea in infancy.
.A
Kooh SW; Binet A.
.I 274497
.U
91003719
.S
Can Med Assoc J 9101; 143(6):513-6
.M
Adult; Case Report; Female; Human; Intelligence; Middle Age; Phenylalanine/BL; Phenylketonuria/BL/*DI/GE; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Undiagnosed phenylketonuria in adult women: a hidden public health problem.
.P
JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED CASES.
.A
Hanley WB; Clarke JT; Schoonheyt WE.
.I 274498
.U
91003720
.S
Can Med Assoc J 9101; 143(6):519-21
.M
Animal; Cattle; Colitis, Ulcerative/MI; Endotoxins/*/AN; Escherichia coli/CL/*IP; Escherichia coli Infections; Food Microbiology/*; Human; Manitoba; Meat/*; Pilot Projects; Serotyping.
.T
Verotoxin-producing Escherichia coli in ground beef in Manitoba.
.P
JOURNAL ARTICLE.
.I 274499
.U
91003721
.S
Can Med Assoc J 9101; 143(6):523
.M
Atherosclerosis/PA/*PP; Human; Remission, Spontaneous.
.T
Regression of atherosclerosis.
.P
JOURNAL ARTICLE.
.A
Moore S.
.I 274500
.U
91003722
.S
Can Med Assoc J 9101; 143(6):537-9
.M
Delivery of Health Care; Emergency Service, Hospital/*/OG; Ethnic Groups/*; Hospitals, Community/OG; Human; Indians, North American/*; Quebec; Transportation of Patients.
.T
Oka standoff a health care nightmare for native doctor.
.P
JOURNAL ARTICLE.
.A
Sutherland R.
.I 274501
.U
91003723
.S
Can Med Assoc J 9101; 143(6):545-6
.M
Cost Control; Health Care Rationing/*/EC/LJ; Human; Insurance, Health; Medicaid; Oregon; United States.
.T
Oregon tackles the health care rationing issue.
.P
JOURNAL ARTICLE.
.A
Silversides A.
.I 274502
.U
91003724
.S
Can Med Assoc J 9101; 143(6):546, 549
.M
Attitude of Health Personnel/*; Canada; Child; Down's Syndrome/PX/*TH; Human; Infant; Pediatrics; Physicians/*; Surgery; Technology, Medical.
.T
Medical advances, positive attitudes brighten future of Down's children.
.P
JOURNAL ARTICLE.
.A
Michaels E.
.I 274503
.U
91003725
.S
Can Med Assoc J 9101; 143(6):547
.M
Child; Down's Syndrome/*CO/TH; Human; Infant; Physicians, Family/*; Professional-Family Relations.
.T
Family physicians should be aware of Down's-related health problems.
.P
JOURNAL ARTICLE.
.I 274504
.U
91003726
.S
Can Med Assoc J 9101; 143(6):555-8
.M
Canada; Government/*; Human; Income; Military Medicine; Physicians/*; Private Practice; Public Health Administration/*/EC.
.T
Public service careers heaven for some MDs, hell for others.
.P
JOURNAL ARTICLE.
.A
Cohen L.
.I 274505
.U
91003727
.S
Can Med Assoc J 9101; 143(7):603-6
.M
Animal; Animal Testing Alternatives; Animal Welfare/*; Research.
.T
The animal rights war [letter] [see comments]
.P
LETTER.
.I 274506
.U
91003728
.S
Can Med Assoc J 9101; 143(7):607-9
.M
Adult; Female; Human; Hyperlipoproteinemia/BL/*DI/TH; Lipoproteins, HDL Cholesterol/BL; Lipoproteins, LDL Cholesterol/BL; Male; Triglycerides/BL.
.T
Detecting and treating dyslipoproteinemias [letter] [published erratum appears in Can Med Assoc J 1990 Nov 15;143(10):999]
.P
LETTER.
.I 274507
.U
91003729
.S
Can Med Assoc J 9101; 143(7):609-10
.M
Adolescence; Adult; Aged; Canada/EP; Human; Risk Factors; Suicide/*PC/SN.
.T
Preventing suicide [letter]
.P
LETTER.
.I 274508
.U
91003730
.S
Can Med Assoc J 9101; 143(7):611
.M
Acquired Immunodeficiency Syndrome/DT; Azathioprine/*/TU; Human; Male; Nomenclature/*; Prescriptions, Drug; Zidovudine/*/TU.
.T
Azathioprine or azidothymidine? [letter] [see comments]
.P
LETTER.
.A
Landis SJ.
.I 274509
.U
91003732
.S
Can Med Assoc J 9101; 143(7):613
.M
Computer Systems/*; Databases, Bibliographic; Software/*.
.T
ISI Sci-Mate Software System not available [letter; comment]
.P
COMMENT; LETTER.
.A
Roberts J.
.I 274510
.U
91003733
.S
Can Med Assoc J 9101; 143(7):613-4
.M
Abortion, Induced/*; Canada; Ethics, Medical/*; Female; Hippocratic Oath/*; Human; Pregnancy; Societies, Medical.
.T
CMA's code of ethics [letter]
.P
LETTER.
.A
Brown RH.
.I 274511
.U
91003734
.S
Can Med Assoc J 9101; 143(7):619-22
.M
Abstracting and Indexing/*; Publishing/*; Research; Review Literature/*; Writing.
.T
Structured abstracts of original research and review articles.
.P
JOURNAL ARTICLE.
.A
Squires BP.
.I 274512
.U
91003735
.S
Can Med Assoc J 9101; 143(7):625-7
.M
Acquired Immunodeficiency Syndrome/*EP; Canada/EP; Ethics, Medical/*; Human; HIV Seroprevalence/*; Jurisprudence/*; Population Surveillance.
.T
Guidelines on ethical and legal considerations in anonymous unlinked HIV seroprevalence research. Federal Centre for AIDS Working Group on anonymous unlinked HIV seroprevalence [see comments]
.P
GUIDELINE; JOURNAL ARTICLE.
.I 274513
.U
91003736
.S
Can Med Assoc J 9101; 143(7):629-32
.M
Canada; Communication; Feedback; Government; Health Policy; Human; Interprofessional Relations; Policy Making; Practice Management, Medical/*/ST; Professional Review Organizations/OG; Quality Assurance, Health Care/*.
.T
Guidelines for medical practice: 2. A possible strategy.
.P
JOURNAL ARTICLE.
.W
The recognition that much current medical practice is based on incomplete scientific evidence has led to calls for the generation of guidelines for optimal patterns of practice. These guidelines must be developed from a synthesis of existing scientific data ideally obtained from randomized clinical trials. However, at present we may have to rely on less satisfactory data and the views of experts in the field. The primary purpose of these initiatives must be to improve patient care. The Ontario Medical Association has made recommendations on how such guidelines should be produced, and in a recent survey a substantial majority of family physicians supported them. There is general agreement that the coordinating body should be independent of government and other interested parties. In addition, the medical profession must have the primary role, and a number of medical organizations should also be represented. We propose a possible structure for a group charged with developing guidelines for medical practice at a provincial level and on an experimental basis. Recommendations are made on its membership, function and relationship with other organizations. The identification and diffusion of justifiable, scientific practice patterns will help reduce waste of scarce resources, maintain the role of the profession as guardian of the quality of care and ultimately benefit the patient.
.A
Peachey DK; Linton AL.
.I 274514
.U
91003737
.S
Can Med Assoc J 9101; 143(7):633-9
.M
Aged; Depression/*TH; Human; Meta-Analysis; Prognosis.
.T
The prognosis of depression in the elderly.
.P
JOURNAL ARTICLE; REVIEW; REVIEW, MULTICASE.
.W
Controversy prompted a systematic and critical review of original research articles to determine the prognosis of depression in the elderly. A search of three computer databases for articles published from January 1980 to May 1989 and of the bibliographies of articles located revealed 10 reports, involving 990 subjects, that met the following inclusion criteria: original research, published in English or French since 1950, sample of at least 25 patients, inclusion of only patients over 60 years, mean follow-up period of 1 year or more and description of the patients' mental state during follow-up. The methods and study designs were then assessed with the use of the criteria for prognostic studies established by McMaster University Health Sciences Centre, Hamilton, Ont. All of the studies had serious, multiple flaws. Nevertheless, when the results were combined it appeared that at least 60% of the patients remained well or had relapses with recovery (mean follow-up 31.9 months); up to 25% remained continuously ill. Physical illness, cognitive impairment and severe depressive symptoms were frequently related to poor prognosis; most of the social factors studied were not related to prognosis. Future studies must pay attention to methods and design, particularly the composition of study populations, the assessment of outcomes and the control of extraneous prognostic factors.
.A
Cole MG.
.I 274515
.U
91003738
.S
Can Med Assoc J 9101; 143(7):641-6
.M
Bacterial Infections/*CO/PA; Deglutition Disorders/CO; Diarrhea/CO; Duodenal Diseases/CO/PA; Esophagitis/CO/PA; Female; Gastritis/CO/PA; Gastrointestinal Diseases/*CO/PA/PP; Human; HIV Infections/*CO/PA/PP; HIV Seropositivity/*; Intestinal Absorption/*PH; Male; Opportunistic Infections/CO; Proctitis/CO/PA; Xylose/PK.
.T
Gastrointestinal function and structure in HIV-positive patients.
.P
JOURNAL ARTICLE.
.W
We examined 19 patients (17 men) with human immunodeficiency virus (HIV) infection and gastrointestinal symptoms to determine whether those symptoms were due to either a gastrointestinal tract infection or a defect in mucosal absorption because of an enteropathy. The erythrocyte folate and serum vitamin B12 levels were within normal limits in all of the patients. The serum ferritin level was elevated in 12. The xylose absorption test results were abnormal in 8 of the 13 patients able to complete the study. None of the duodenal aspirates yielded a pathogen. Light microscopy revealed nonspecific lymphocytic inflammation without infection in the stomach (in seven patients), the esophagus (in five), the duodenum (in two) and the rectum (in two). However, biopsy specimens were positive for Candida albicans in the esophagus (four patients), cytomegalovirus in the esophagus (one) and the rectum (two), Helicobacter pylori in the antrum (two), Treponema infection in the rectum (two) and Mycobacterium avium-intracellulare in the small intestine (one). Only three patients had a normal series of biopsy specimens. All of the patients had similar ultrastructural changes at the epithelial-stromal junction of the antral glands and in the intestinal crypts. We conclude that abnormal biochemical and endoscopic findings are common in HIV-positive patients with gastrointestinal symptoms. Defects in carbohydrate absorption and ultrastructural changes may be responsible for some aspects of HIV enteropathy.
.A
Sutherland LR; Church DL; Gill MJ; Kelly JK; Hwang WS; Bryant HE.
.I 274516
.U
91003739
.S
Can Med Assoc J 9101; 143(7):647-8
.M
Air Pollutants/*AN; Carbon Monoxide/*AN; Carbon Monoxide Poisoning/ET; Environmental Exposure/*; Environmental Monitoring/IS; Human; Manitoba; Transportation/*; Ventilation.
.T
Carbon monoxide levels in indoor tractor-pull events--Manitoba.
.P
JOURNAL ARTICLE.
.I 274517
.U
91003741
.S
Can Med Assoc J 9101; 143(7):655-6
.M
Acquired Immunodeficiency Syndrome/*; Attitude to Health/*; Books/*; Child; Child, Preschool; Health Education/*; Human; HIV Infections/*; Interpersonal Relations.
.T
Tolerance for HIV patients goal of MD's book for children.
.P
JOURNAL ARTICLE.
.A
Johnston C.
.I 274518
.U
91003742
.S
Can Med Assoc J 9101; 143(7):660, 662
.M
Acquired Immunodeficiency Syndrome/*/PX; Attitude of Health Personnel/*; Communication; Female; Human; HIV Infections/*/PX; Male; Physician-Patient Relations/*.
.T
Use discretion in treating HIV patients, FPs told.
.P
JOURNAL ARTICLE.
.A
Trent B.
.I 274519
.U
91003743
.S
Can Med Assoc J 9101; 143(7):665-6
.M
Canada; Costs and Cost Analysis; Human; Malpractice/*EC/LJ.
.T
Damage awards to patients up 48% in 1989, CMPA reports.
.P
JOURNAL ARTICLE.
.A
Goldman B.
.I 274520
.U
91003744
.S
Can Med Assoc J 9101; 143(7):668
.M
Computer Systems/*; Emergencies; Equipment and Supplies, Hospital/*; Heart Arrest/*TH; Human.
.T
The Crashcart Companion.
.P
JOURNAL ARTICLE.
.A
Goldman B.
.I 274521
.U
91003745
.S
Can Med Assoc J 9101; 143(7):669-70
.M
Human; Medicine/*; Technology, Medical; Wit and Humor/*.
.T
Searching for the lemming gene.
.P
JOURNAL ARTICLE.
.A
Taylor PJ.
.I 274522
.U
91003746
.S
Can Med Assoc J 9101; 143(8):705-7
.M
Interprofessional Relations/*; Job Satisfaction/*; Nurses/*; Physicians/*.
.T
Here's why nurses are quitting [letter; comment]
.P
COMMENT; LETTER.
.I 274523
.U
91003747
.S
Can Med Assoc J 9101; 143(8):707-9
.M
Attitude to Health/*EH; Canada; Female; Home Childbirth/*; Human; Pregnancy; Questionnaires.
.T
Interest in alternative birthplaces among women in Ottawa-Carleton [letter; comment]
.P
COMMENT; LETTER.
.I 274524
.U
91003748
.S
Can Med Assoc J 9101; 143(8):709
.M
Embolism/*ET; Female; Human; Laser Surgery/*AE; Uterus/*SU.
.T
Embolism during intrauterine laser surgery [letter] [see comments]
.P
LETTER.
.A
Weber F; Wallace B.
.I 274525
.U
91003749
.S
Can Med Assoc J 9101; 143(8):709-10
.M
Ascorbic Acid/*UR; Human; Longevity/*.
.T
My quest for eternal youth [letter]
.P
LETTER.
.A
Vogel MJ.
.I 274526
.U
91003750
.S
Can Med Assoc J 9101; 143(8):711
.M
Hip Dislocation, Congenital/*EC; Human; Infant, Newborn; Mass Screening/*EC.
.T
Screening for congenital dislocation of the hip: an economic appraisal [letter]
.P
LETTER.
.A
Marzouk MS.
.I 274527
.U
91003751
.S
Can Med Assoc J 9101; 143(8):713-6
.M
Acquired Immunodeficiency Syndrome/*TM; Adolescence; Canada; Child; Female; Health Surveys; Human; Male; Sex Behavior/*; Sexually Transmitted Diseases/*TM.
.T
Implications of the Canada youth and AIDS study for health care providers [editorial]
.P
EDITORIAL.
.A
Bowie WR; Warren WK; Fisher WA; MacDonald NE; Doherty JA; Wells GA.
.I 274528
.U
91003752
.S
Can Med Assoc J 9101; 143(8):717-8
.M
Adolescence; Canada; Health Promotion/*MT; Human; Physician's Role; Sexually Transmitted Diseases/*PC.
.T
Prevention of sexually transmitted diseases: whose responsibility? What message? [editorial]
.P
EDITORIAL.
.A
Hankins CA.
.I 274529
.U
91003753
.S
Can Med Assoc J 9101; 143(8):721-3
.M
Canada; Chemistry, Clinical/IS; Cholesterol/*BL; Human; Quality Control/*.
.T
Out-of-laboratory measurement of the blood cholesterol level. Canadian Society of Clinical Chemists Task Force on Out-of-Laboratory Blood Cholesterol Measurement.
.P
JOURNAL ARTICLE.
.I 274530
.U
91003755
.S
Can Med Assoc J 9101; 143(8):733-7
.M
Aging/*ME; Female; Ferritin/BL; Follow-Up Studies; Gestational Age; Human; Infant Food/*; Infant, Low Birth Weight/*; Infant, Newborn; Iron/AD/*ME; Male; Nutritional Status; Support, Non-U.S. Gov't.
.T
Iron status of very-low-birth-weight infants during the first 15 months of infancy.
.P
JOURNAL ARTICLE.
.W
The adequacy of iron stores in infants of very low birth weight (defined as less than 1500 g) in Canada is unknown. We monitored the iron status of 81 such infants at 3, 6, 9, 12 and 15 months of age. All of the infants were fed formula fortified with iron (13 mg/L) for at least 6 months, starting at 2 months of age. The plasma ferritin level decreased after the formula was no longer used. Although 90% of the infants were given cereal fortified with iron (30 mg of iron per 100 g) by 9 months of age, the plasma ferritin level continued to decrease. The level was less than 10 micrograms/L in 54% of the infants at 12 months of age and in 74% at 15 months; this indicated depleted iron stores. Because of delayed development very-low-birth-weight infants eat small amounts of cereal and therefore require iron-fortified formula throughout infancy.
.A
Friel JK; Andrews WL; Matthew JD; Long DR; Cornel AM; Cox M; Skinner CT.
.I 274531
.U
91003756
.S
Can Med Assoc J 9101; 143(8):740-5
.M
Adult; Ambulatory Care Facilities/*UT; Attitude to Health/*; Consumer Satisfaction/*; Family Practice; Female; Human; Male; Ontario; Questionnaires; Support, Non-U.S. Gov't.
.T
Walk-in clinics: implications for family practice [see comments]
.P
JOURNAL ARTICLE.
.W
To understand better the reasons for the growth in popularity of walk-in clinics in Canada we surveyed 321 patients with a regular physician in Toronto who attended a walk-in clinic in the same city over a 16-day period in February 1988. They were asked their reason for attending the clinic, their perception of the urgency of their problem, their choices as alternatives to walk-in clinics and their satisfaction and concerns with the type of care received at the clinic. The three most common reasons for attending the clinic were convenient location (in 33% of the cases), inability to see their regular physician soon enough (in 16%) and no appointment needed (in 13%). Most (80%) of the patients felt that they needed medical attention within 24 hours after the onset of their problem. Most (83%) of the respondents would have sought medical attention at another walk-in clinic, from their regular physician or at an emergency department had the clinic been closed. Only 36% and 18% of the patients respectively responded that their regular physician worked evenings or weekends. Most of the visits to the clinic were outside regular weekday business hours. The level of satisfaction with the service received at the clinic was high. The extended hours and no-appointment philosophy of walk-in clinics, coupled with family physicians' reluctance to work evenings and weekends, have made such clinics an attractive option for patients with primary care problems that they believe require prompt attention.
.A
Rizos J; Anglin P; Grava-Gubins I; Lazar C.
.I 274532
.U
91003757
.S
Can Med Assoc J 9101; 143(8):747-9
.M
Aged; Case Report; Chloroquine/TU; Female; Ferrous Compounds/*AE; Human; Porphyria/*CI/DT; Porphyrins/UR.
.T
Porphyria cutanea tarda due to ferrous gluconate.
.P
JOURNAL ARTICLE.
.A
Ginsburg AD; Margesson LJ; Feleki K.
.I 274533
.U
91003758
.S
Can Med Assoc J 9101; 143(8):751-3
.M
Canada/EH; Disease Outbreaks/*PC; Erythromycin/TU; Human; Infant; Pertussis Vaccine/AD; Vaccination/*; Whooping Cough/DT/*EP/PC.
.T
Management of people exposed to pertussis and control of pertussis outbreaks [see comments]
.P
JOURNAL ARTICLE.
.I 274534
.U
91003759
.S
Can Med Assoc J 9101; 143(8):755
.M
Animal; Atherosclerosis/*ET; Cornea/BS; Human; Models, Cardiovascular; Neovascularization/*PP; Rabbits; Rats.
.T
Neovascularization and the atherosclerotic plaque.
.P
JOURNAL ARTICLE.
.A
Brem S.
.I 274535
.U
91003760
.S
Can Med Assoc J 9101; 143(8):762-5, 768-9
.M
Blood Banks/EC/*OG; Canada; Human; Red Cross.
.T
Canada's blood collection system should be reorganized, critics say [see comments]
.P
JOURNAL ARTICLE.
.A
Morgan PP; Cohen L.
.I 274536
.U
91003761
.S
Can Med Assoc J 9101; 143(8):770-3
.M
Canada; Human; Military Medicine/*OG; Physician's Role; War.
.T
Military MDs used to peace prepare for war [see comments]
.P
JOURNAL ARTICLE.
.A
Jones D.
.I 274537
.U
91003762
.S
Can Med Assoc J 9101; 143(8):781, 783
.M
Canada; Education, Medical/*TD; Physicians, Women/*.
.T
Women close in on 50% share of places in Canada's medical schools.
.P
JOURNAL ARTICLE.
.A
Sullivan P.
.I 274538
.U
91003763
.S
Can Med Assoc J 9101; 143(8):788-9
.M
Critical Care; Human; Intensive Care Units/*; Internship and Residency/*; Male.
.T
End of shift.
.P
JOURNAL ARTICLE.
.A
Patterson R.
.I 274539
.U
91003764
.S
Can Med Assoc J 9101; 143(8):790-1
.M
Cerebral Ischemia, Transient/*DI; Human; Male; Medical History Taking; Middle Age.
.T
With TIAs, MDs cannot rely on patients to provide a meaningful history.
.P
JOURNAL ARTICLE.
.A
Kalsner J; Kalsner S.
.I 274540
.U
91003839
.S
Cancer 9101; 66(7):1449-52
.M
Aged; Female; Human; Liver Neoplasms/SC; Lymphatic Metastasis; Male; Middle Age; Neoplasm Staging; Proglumide/*TU; Receptors, Cholecystokinin/*DE; Stomach Neoplasms/DT/*MO/PA; Survival Rate.
.T
The effect of the gastrin receptor antagonist proglumide on survival in gastric carcinoma.
.P
CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL.
.W
Gastric cancer remains a disease with a very poor prognosis, and there is no safe and effective form of therapy for advanced disease. Evidence is now abundant to show that gastrin stimulates the growth of both gastric and colorectal cancer cells in vitro and in vivo, and that blockade of gastrin receptors can prolong survival in xenografted nude mice. We have thus performed a randomized, controlled study of the gastrin/cholecystokinin receptor antagonist proglumide as therapy in 110 patients with gastric carcinoma. Proglumide had no overall effect on survival (Mantel-Cox statistic = 0.5, P = 0.48). The 95% confidence interval for the proglumide treated group was 260 to 474 days compared to 230 to 372 days for the control group. No significant difference was seen with proglumide, which has a relatively low affinity with the gastrin receptor and also has partial agonist activity. Drugs that are far more specific and potent gastrin receptor antagonists are becoming available, which may have a greater effect on survival, and further clinical trials of such compounds are clearly indicated to determine the efficacy of hormonal control of gastrointestinal malignancy.
.A
Harrison JD; Jones JA; Morris DL.
.I 274541
.U
91003840
.S
Cancer 9101; 66(7):1453-60
.M
Adult; Aged; Antineoplastic Agents, Combined/AE/*TU; Bleomycins/AD; Carcinoma, Squamous Cell/*DT; Cisplatin/AD; Combined Modality Therapy; Drug Administration Schedule; Female; Fluorouracil/AD; Follow-Up Studies; Head and Neck Neoplasms/*DT; Human; Hydroxyurea/AD; Male; Middle Age; Mitomycins/AD; Nasopharyngeal Neoplasms/*DT; Neoplasm Staging; Remission Induction; Survival Rate.
.T
Induction chemotherapy with a new regimen alternating cisplatin, fluorouracil with mitomycin, hydroxyurea and bleomycin in carcinomas of nasopharynx or other sites of the head and neck region.
.P
JOURNAL ARTICLE.
.W
Sixty-six patients with locally advanced (Stages III and IV) carcinoma of the head and neck were treated with three cycles of induction chemotherapy, consisting of cisplatin, fluorouracil (FU) infusion, bleomycin, mitomycin, and hydroxyurea, followed by radiotherapy and/or surgery. There were 48 men and 18 women with a median age of 55 years (range, 18 to 75 years) and Karnofsky performance status of 80 (range, 40 to 90). Primary site was nasopharynx (28 patients), followed by larynx (12) and others (26). Forty-one (62%) patients were presented with Stage IV disease. The response rate to induction chemotherapy was 27% complete response, 50% partial response, 20% stable disease, and 3% progressive disease. There was no significant difference in response rate between patients with cancer of nasopharynx or other sites (P greater than 0.1). Survival was 61% at 24 months. Patients with cancer of nasopharynx had a better survival than those with other primaries (P = 0.033). Toxicities from chemotherapy included alopecia (73%), nausea/vomiting (66%), leukopenia (54%), stomatitis (36%), anemia (32%), thrombocytopenia (16%), and diarrhea (9%). Grade IV toxicity was not observed. Induction chemotherapy with this new regimen resulted in a high response rate but may not be superior to cisplatin and FU alone. It can be safely combined with radiotherapy as a potentially curative therapy in squamous cell carcinoma of the head and neck. Chemotherapy followed by radiation therapy may yield survival similar to radical surgery in laryngeal and other head and neck cancers.
.A
Fountzilas G; Daniilidis J; Sridhar KS; Kalogera-Fountzila A; Zaramboukas T; Sombolos K; Destouni-Salem E; Vritsios A; Tourkantonis A.
.I 274542
.U
91003841
.S
Cancer 9101; 66(7):1461-7
.M
Adult; Aged; Antineoplastic Agents, Combined/TU; Breast Neoplasms/DI/MO/*TH; Combined Modality Therapy; Female; Follow-Up Studies; Human; Incidence; Lymphatic Metastasis/*DI; Mastectomy; Middle Age; Neoplasms, Unknown Primary/DI/*TH; Radiation Injuries/EP; Radiotherapy Dosage; Support, U.S. Gov't, P.H.S.; Survival Rate.
.T
Treatment of patients with isolated axillary nodal metastases from an occult primary carcinoma consistent with breast origin.
.P
JOURNAL ARTICLE.
.W
The records of 42 patients who had axillary metastases compatible with a clinically occult breast primary were reviewed. Forty patients had mammography performed as part of their evaluations. Mastectomy yielded the primary tumor in one of 13 patients; biopsy yielded positive results in one of five. Among the 29 patients who did not undergo mastectomy, 16 received breast irradiation, and 13 were simply observed for signs of the primary tumor. For the patients who did not undergo mastectomy, the 5-year actuarial risk for appearance of a primary was 17% in the irradiated group versus 57% in the nonirradiated group (P = 0.06). Patterns of failure are correlated with stage and local and systemic therapy. The results affirm our belief that patients with axillary metastases histologically consistent with breast tumor should be treated identically to patients with similar nodal stages and proven breast primaries.
.A
Ellerbroek N; Holmes F; Singletary E; Evans H; Oswald M; McNeese M.
.I 274543
.U
91003842
.S
Cancer 9101; 66(7):1468-71
.M
Adolescence; Antineoplastic Agents, Combined/AE/*TU; Child; Child, Preschool; Combined Modality Therapy; Female; Heart Neoplasms/TH; Heart Transplantation/*; Human; Infant; Liver Neoplasms/TH; Liver Transplantation/*; Lung Neoplasms/SC/TH; Male; Neoplasms/*DT/MO/SU; Peritoneal Neoplasms/SC/TH; Survival Rate.
.T
Cancer chemotherapy after solid organ transplantation.
.P
JOURNAL ARTICLE.
.W
To assess how well chemotherapy is tolerated after solid organ transplantation, we reviewed our experience at the Children's Hospital of Pittsburgh with five patients aged 1 to 12 years. Four patients had a liver transplant, indications for which were hepatoblastoma in two patients, hepatic failure secondary to Wilms' tumor chemoradiotherapy in one patient, and familial intrahepatic cholestasis in one patient. A fifth patient received a cardiac transplant for unresectable angiosarcoma of the right atrium. After transplant, chemotherapy was given for the treatment of the primary malignancy in four of the patients. The patient with familial intrahepatic cholestasis received chemotherapy for secondary lymphoproliferative disease that had not responded to the cessation of immunosuppression. All patients other than this patient were on immunosuppression with prednisone (0.5 to 2 mg/kg daily) and cyclosporine (to maintain serum levels at 800 to 1000 ng/ml radioimmunoassay) throughout the duration of chemotherapy. Courses of chemotherapy included one or more of the following agents: Adriamycin (Adr, 20 mg/m2 daily, three patients), Cyclophosphamide (Ctx, 1 gm/m2, one patient), cisplatin (CDDP, 90 mg/m2, one patient), Vincristine (Vcr, greater than 0.75 to 1.5 mg/m2, three patients), Actinomycin D (Act-D, 7.5 micrograms/kg, one patient), Ifosfamide (I, 1800 mg/m2, one patient) and Etoposide (VP-16, 100 mg/m2, one patient). All patients received greater than or equal to 3 courses (range, 3 to 9; mean, 5) of chemotherapy every 3 to 4 weeks. Dose reductions were made because of neutropenia in three patients but none were greater than 50%. Severe rejection was seen in one patient who had, however, manifested evidence of rejection prior to his first postoperative course of chemotherapy. No nephro or cardiac toxicity was seen. This preliminary experience suggests that chemotherapy is well tolerated after solid organ transplantation.
.A
Horn M; Phebus C; Blatt J.
.I 274544
.U
91003843
.S
Cancer 9101; 66(7):1472-4
.M
Aged; Antineoplastic Agents, Combined/*TU; Autopsy; Carmustine/AD; Case Report; Cyclophosphamide/AD; Female; Human; Melphalan/AD; Multiple Myeloma/*DT/PA; Prednisone/AD; Remission Induction; Vincristine/AD.
.T
Autopsy-documented cure of multiple myeloma 14 years after M2 chemotherapy.
.P
JOURNAL ARTICLE.
.W
Multiple myeloma was diagnosed in a 65-year-old woman in 1974 who thereafter received five-drug M2 chemotherapy. All protein abnormalities subsequently returned to normal and serial bone marrow studies documented complete bone marrow remission. Destructive bone lesions persisted radiographically, but did not progress. In 1987, a localized sigmoid adenocarcinoma was resected. In 1988, the patient presented with multiple brain metastases associated with a primary pulmonary adenocarcinoma that proved rapidly fatal. At autopsy, no evidence of multiple myeloma was found. This report describes the first tissue-documented cure of multiple myeloma 14 years after diagnosis and initiation of M2 chemotherapy. The possible association of multiple myeloma with other malignancies is also discussed.
.A
van Hoeven KH; Reed LJ; Factor SM.
.I 274545
.U
91003844
.S
Cancer 9101; 66(7):1475-9
.M
Adult; Ameloblastoma/*DT/SC; Antineoplastic Agents, Combined/*TU; Case Report; Cisplatin/AD; Cyclophosphamide/AD; Doxorubicin/AD; Female; Human; Lung Neoplasms/*DT/SC; Mandibular Neoplasms/PA.
.T
Pulmonary metastases from ameloblastoma of the mandible treated with cisplatin, adriamycin, and cyclophosphamide.
.P
JOURNAL ARTICLE.
.W
A case of delayed pulmonary metastases from an ameloblastoma of the mandible, which occurred 20 years after surgical resection of the primary tumor but with no recurrence at the primary site, is reported. Combination chemotherapy using cisplatin, adriamycin, and cyclophosphamide has produced a very good clinical and radiologically documented response in this case.
.A
Ramadas K; Jose CC; Subhashini J; Chandi SM; Viswanathan FR.
.I 274546
.U
91003845
.S
Cancer 9101; 66(7):1480-7
.M
Adult; Aged; Aged, 80 and over; Biopsy, Needle/EC/*MT; Breast Neoplasms/*DI; Carcinoma in Situ/PA; Carcinoma, Ductal/PA; Evaluation Studies; Female; Human; Mammography/*MT; Middle Age; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; Support, Non-U.S. Gov't.
.T
Prospective evaluation of radiologically directed fine-needle aspiration biopsy of nonpalpable breast lesions.
.P
JOURNAL ARTICLE.
.W
The application of fine-needle aspiration biopsy (FNAB) to the diagnosis of nonpalpable breast lesions was evaluated with a new method which uses standard needle localization under mammographic guidance to assure accurate sampling by FNAB. This method was prospectively applied to 100 mammographically detected breast lesions in 100 women (mean age, 53 years). All 100 patients underwent surgical excision of these nonpalpable lesions after cytologic aspiration. Sufficient aspirated material was obtained for cytologic diagnosis from 91 patients (91%). The histologic and cytologic interpretations were then compared. Twenty malignancies were ultimately diagnosed by histology (12 invasive ductal carcinoma, six ductal carcinoma in situ, and two lobular carcinoma in situ), of which 17 had been cytologically diagnosed. There were no false-positive diagnoses of malignancy by FNAB. False-negative readings (3.3%) included two cases of lobular carcinoma in situ and one case of ductal carcinoma in situ. This technique thus demonstrated a sensitivity of 85%, specificity of 100%, and overall diagnostic accuracy of 96.7% for the nonsurgical detection of malignancy in nonpalpable breast lesions. These results suggest that the established safety, reliability, and cost-effectiveness of FNAB can be maintained in this clinical setting. This procedure may obviate the need for open surgical biopsy in those patients with an unequivocal diagnosis of malignancy. It can also be done using standard techniques and equipment available in many community hospitals.
.A
Masood S; Frykberg ER; McLellan GL; Scalapino MC; Mitchum DG; Bullard JB.
.I 274547
.U
91003846
.S
Cancer 9101; 66(7):1488-92
.M
Adult; Case Report; Cervix Neoplasms/PA/*RT; Female; Follow-Up Studies; Human; Lumbosacral Plexus/*RE; Neoplasm Staging; Peripheral Nerve Diseases/ET; Radiation Injuries/*ET; Radiotherapy Dosage.
.T
Sacral plexus injury after radiotherapy for carcinoma of cervix.
.P
JOURNAL ARTICLE.
.W
A 42-year-old woman developed lower extremity weakness and sensory loss 1 year after external and intracavitary radiotherapy for Stage IB carcinoma of cervix. She has been followed for 5 years posttreatment, and the neurologic abnormalities have persisted, but no evidence of recurrent carcinoma has been found. We believe this to be a rare case of sacral plexus radiculopathy developing as a late complication after radiotherapy. Suggestions are made for improving the radiotherapy technique to prevent this complication in future cases.
.A
Stryker JA; Sommerville K; Perez R; Velkley DE.
.I 274548
.U
91003847
.S
Cancer 9101; 66(7):1493-8
.M
Antibodies, Monoclonal; Antigens, Neoplasm/*AN; Antigens, Surface/*AN; Carcinoma, Squamous Cell/*IM/SC; Human; Immunoenzyme Techniques; Laryngeal Neoplasms/*IM; Support, Non-U.S. Gov't.
.T
Relationship of 4F2 antigen with local growth and metastatic potential of squamous cell carcinoma of the larynx.
.P
JOURNAL ARTICLE.
.W
The 4F2 antigen is a cell-membrane glycoprotein which arises early in the G0-G1 phases of the cell cycle. This molecule is present in all established human cell lines and most malignant human cells. The authors used an indirect immunophosphatase method to study 50 squamous cell carcinomas of the larynx and ten lymph-node metastases, corresponding to six primary tumors, for 4F2 expression. The tumors showed several patterns of 4F2 staining which were correlated with different behaviors and prognoses of the neoplasms. Three different patterns (no staining, peripheral staining, and diffuse 4F2 expression) are described as are their relationships with metastatic behavior of the carcinomas. Tumors with metastases were found only in the third group (P = 0.0001). These results led to the following conclusions: (1) the 4F2 antigen is present in squamous cell carcinomas; (2) its distribution reflects the tumor-spreading pattern; and (3) it correlates with differentiation and metastatic behavior.
.A
Esteban F; Ruiz-Cabello F; Concha A; Perez Ayala M; Delgado M; Garrido F.
.I 274549
.U
91003848
.S
Cancer 9101; 66(7):1499-504
.M
Aged; Carcinoma, Bronchogenic/*IM; Cells, Cultured; Female; Human; Interferons/PD; Interleukin-2/PD; Killer Cells, Lymphokine-Activated/DE/*IM; Killer Cells, Natural/DE/*IM; Lung Neoplasms/*IM; Male; Middle Age; Support, Non-U.S. Gov't.
.T
In vitro natural killer and lymphokine-activated killer activity in patients with bronchogenic carcinoma.
.P
JOURNAL ARTICLE.
.W
The authors examined peripheral blood mononuclear cells from 45 patients with bronchogenic carcinoma to determine natural killer (NK) and lymphokine-activated killer (LAK) activity after in vitro incubation with media alone or media plus interferon gamma (IFN, 200 U/ml) and/or interleukin-2 (IL-2, 100 U/ml). Our results show that lymphocytes from patients with bronchogenic carcinoma can acquire LAK activity, but the level of activity acquired was significantly lower compared with lymphocytes from 25 control subjects when IL-2 cultures were supplemented with 10% autologous human serum (AHS) (15.6% +/- 2.1% specific release versus 26.0% +/- 2.9% specific release, P = 0.004). The LAK activity, defined as cytotoxicity of an NK-resistant cell line, of the patients' lymphocytes was augmented when cells were cultured with both IL-2 and IFN compared with IL-2 alone (P = 0.0001, paired t-test). Control subjects were unchanged (P = 0.09). There was no significant difference between groups of patients with different histologic types of tumor or different stages of disease. The NK activity, defined as killing of NK-sensitive K-562 target cells, of the patients' lymphocytes was not significantly different from that of the controls' lymphocytes (42.8% +/- 3.0% specific release versus 49.3% +/- 3.3% specific release, P = 0.16). These studies indicate the feasibility of IL-2 and IFN therapy in patients with bronchogenic carcinoma.
.A
Dunlap NE; Lane VG; Cloud GA; Tilden AB.
.I 274550
.U
91003849
.S
Cancer 9101; 66(7):1505-12
.M
Aged; Aged, 80 and over; Antigens, Neoplasm/*AN/BL; Carcinoma, Squamous Cell/*IM; Esophageal Neoplasms/*IM; Female; Human; Immunoenzyme Techniques; Lung Neoplasms/*IM; Male; Middle Age.
.T
Tumor-antigen 4. Its immunohistochemical distribution and tissue and serum concentrations in squamous cell carcinoma of the lung and esophagus.
.P
JOURNAL ARTICLE.
.W
The immunohistochemical distribution and concentrations of tumor-antigen 4 (TA-4) in tissues and serum were determined in patients with benign and malignant diseases, including 27 patients with squamous cell carcinoma (SCC; 15 in the lung and 12 in the esophagus). Tumor-antigen 4 immunoreactivity was present in the cytoplasm of many SCC tissues, especially in the hyperparakeratotic region, and in the cytoplasm of differentiated squamous cells of the intermediate layer of normal epithelia of various organs, but not in those of other types of lung cancers or benign pulmonary diseases. Consistent with the results of immunostaining, the TA-4 concentrations in SCC tissues of the lung, esophagus, and normal squamous epithelia were much higher than in those of lung cancer other than SCC, benign pulmonary diseases, normal lung, and submandibular gland tissues. The TA-4 concentration in SCC tissue tended to increase with increasing grades of differentiation. Serum TA-4 was elevated in 15 of 27 patients with SCC but in no patients with other types of lung cancer or benign diseases. These results indicate that TA-4 is an antigen related to the differentiation of squamous cells and that tumor cells of SCC can release a large amount of TA-4 into circulation whereas normal squamous epithelia cannot.
.A
Mino-Miyagawa N; Kimura Y; Hamamoto K.
.I 274551
.U
91003850
.S
Cancer 9101; 66(7):1513-6
.M
Adult; Aged; Carcinoma, Renal Cell/DT; Female; Human; Interleukin-2/*AE/TU; Kidney Neoplasms/DT; Male; Melanoma/DT; Middle Age; Myocardial Infarction/*CI/PA; Myocarditis/*CI/PA; Myocardium/PA; Necrosis/CI; Organ Weight.
.T
Myocarditis or acute myocardial infarction associated with interleukin-2 therapy for cancer.
.P
JOURNAL ARTICLE.
.W
The hearts of eight patients aged 22 to 67 years (mean, 41 years) who died during or within 4 days of interleukin-2 (IL-2) based immunotherapy for treatment of renal cell carcinoma or melanoma were studied at necropsy. Death resulted from combined cardiorespiratory failure in two patients, sepsis in four patients, acute myocardial infarction in one patient, and myocarditis in one patient. Transmural left ventricular necrosis was present in one of the two patients with significant atherosclerotic coronary artery narrowing. Noninfectious myocarditis was present in five patients: the inflammatory infiltrate was lymphocytic in four and composed of a mixture of eosinophils and lymphocytes in one. Although treatment-related deaths associated with high-dose IL-2 therapy are uncommon (1.5% in 652 consecutive patients), the potential for significant myocardial ischemia or myocarditis exists, and careful monitoring for arrhythmias or myocardial failure is warranted.
.A
Kragel AH; Travis WD; Steis RG; Rosenberg SA; Roberts WC.
.I 274552
.U
91003851
.S
Cancer 9101; 66(7):1517-23
.M
Adult; Aged; Antibodies, Viral/AN; Colorectal Neoplasms/IM/PA/*TH; Female; Human; Immunotherapy, Active/AE/*MT; Liver Neoplasms/SC; Lung Neoplasms/SC; Lymphatic Metastasis; Male; Middle Age; Neoplasm Staging; Newcastle Disease Virus/IM; Skin Tests; Support, Non-U.S. Gov't.
.T
Postoperative active specific immunization in colorectal cancer patients with virus-modified autologous tumor-cell vaccine. First clinical results with tumor-cell vaccines modified with live but avirulent Newcastle disease virus [published erratum appears in Cancer 1991 Apr 15;67(8):2124]
.P
JOURNAL ARTICLE.
.W
Sixteen patients with colorectal carcinoma Dukes' Stage B2, C, or D were treated with an autologous virus-modified tumor-cell vaccine after potential curative tumor resection (R0-Resection). An inoculum of 1 X 10(7) cells incubated with 32 hemagglutination units of nonirradiated Newcastle disease virus (NDV) was given intracutaneously up to four times at 10-day intervals. The delayed-type hypersensitivity (DTH) skin reaction was measured. The vaccination was well tolerated. In 11 of 16 patients an increasing reactivity against the vaccine was observed during the vaccination procedure. A challenge test using autologous tumor cells without NDV after the vaccination cycle revealed a specific antitumor sensibilization in 12 patients. The DTH response was not due to bacterial contamination or sensibility to the virus. Histologic examination of the vaccination site showed a dense infiltration of predominantly helper T-lymphocytes. We conclude that in most of the patients treated active, specific immunization led to a specific antitumor sensitivity.
.A
Bohle W; Schlag P; Liebrich W; Hohenberger P; Manasterski M; Moller P; Schirrmacher V.
.I 274553
.U
91003852
.S
Cancer 9101; 66(7):1524-8
.M
Adult; Antigens, CD/AN; Base Sequence; Case Report; Diagnosis, Differential; DNA, Viral/AN; Female; Hodgkin's Disease/*DI; Human; HTLV-I/IP; HTLV-I Antibodies/AN; Immunoenzyme Techniques; Leukemia-Lymphoma, T-Cell, Acute, HTLV-I-Associated/*DI/GE/IM; Molecular Sequence Data; Polymerase Chain Reaction.
.T
Acute T-cell leukemia/lymphoma mimicking Hodgkin's disease with secondary HTLV I seroconversion.
.P
JOURNAL ARTICLE.
.W
The authors observed a pleiomorphic lymphoma mimicking Hodgkin's lymphoma in a French Guyana black woman lacking antibodies for human T-cell lymphoma/leukemia virus type I (HTLV I). After two courses of chemotherapy with either mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) or doxorubicin, bleomycin, vincaleukoblastine, and dacarbazine (ABVD), a typical acute T-cell leukemia/lymphoma developed with HTLV I seroconversion. Specific HTLV I DNA sequences were detected using the polymerase chain reaction (PCR) on a lymph node biopsy obtained before chemotherapy. The mechanisms of the seroconversion are discussed.
.A
Picard F; Dreyfus F; Le Guern M; Tulliez M; d'Auriol L; Neron S; Galibert F; Saragosti S; Varet B.
.I 274554
.U
91003853
.S
Cancer 9101; 66(7):1529-33
.M
Adenocarcinoma/*IM/SC; Antigens, Tumor-Associated, Carbohydrate/*BL; Human; Immunohistochemistry; Lymphatic Metastasis; Neoplasm Invasiveness; Portal System/*IM; Radioimmunoassay; Stomach Neoplasms/*IM.
.T
Immunohistochemical studies on the main entrance-route of CA19-9 into the peripheral venous blood of gastric cancer patients. Correlation with CA19-9 levels in peripheral and portal blood.
.P
JOURNAL ARTICLE.
.W
The correlation between CA19-9 levels of portal and peripheral venous blood, and immunohistochemical variables of cancer lesions was examined in 53 gastric cancer patients and eight patients with benign diseases. Immunohistochemically, CA19-9 was found in 33 (62.5%) of 53 primary lesions. The antigen was found in the cancer cells of invasive lymphatics and node metastases of every CA19-9 localized cancer, although the cancer cells in veins showed little or no CA19-9. There was little or no antigen in the cancer cells in veins, lymphatics, or metastases of 20 CA19-9 nonlocalized primary lesions. Patients with CA19-9 nonlocalized cancer or with benign diseases showed no elevation of the antigen levels in peripheral or portal blood. CA19-9 levels of portal blood (mean, 76.4 U/ml; positive rate, 33.3%) were not different from those of peripheral blood (mean, 91.5 U/ml; positive rate, 33.3%). Additionally, the antigen levels of the blood in patients with lymphatic invasion or node metastases were significantly higher than those in patients without the invasion or the metastases, and every patient without the invasion showed no elevation of the antigen. These results suggest that production of the antigen in cancer cells may be a premise of CA19-9 elevation in peripheral blood and that CA19-9 may be drained by the thoracic duct of the lymphatic system via node metastases or invasive lymphatics, but not by the hematogenous portal system.
.A
Tabuchi Y; Deguchi H; Imanishi K; Saitoh Y.
.I 274555
.U
91003855
.S
Cancer 9101; 66(7):1539-43
.M
Aged; Biogenic Polyamines/*AN; Colonic Polyps/DI/*ME; Colorectal Neoplasms/DI/*ME; Female; Human; Intestinal Mucosa/ME; Male; Mass Screening/MT; Middle Age; Ornithine Decarboxylase/*ME; Precancerous Conditions/DI/*ME; Putrescine/AN; Spermidine/AN; Spermine/AN; Support, U.S. Gov't, P.H.S.; Tumor Markers, Biological/*AN.
.T
Colonic polyamine content and ornithine decarboxylase activity as markers for adenomas.
.P
JOURNAL ARTICLE.
.W
Polyamine content (putrescine, spermidine, and spermine) or ornithine decarboxylase (ODC) activity was measured in normal-appearing colonic mucosa from patients undergoing colonoscopy. Comparisons were made between those with and those without adenomatous polyps. Colonic mucosal polyamine content was measured in 44 persons. Mean putrescine content was 1.25 +/- 0.26 (SE) nmol/mg protein in 22 patients with adenomatous polyps compared with 0.53 +/- 0.12 nmol/mg protein in patients without polyps (P less than 0.02). Tissue content of spermidine and spermine did not differ between these two groups. Ornithine decarboxylase activity was measured in tissue from 45 patients. Mean ODC activity was 2.84 +/- 0.73 pmol/hr/mg protein in 23 persons with adenomatous polyps compared with 1.15 +/- 0.18 pmol/hr/mg protein in persons without polyps (P less than 0.05). Mucosal putrescine and ODC activity are elevated in patients with adenomatous polyps compared with patients without polyps. These biochemical markers may prove helpful in improving surveillance methods for colorectal cancer and premalignant adenomatous polyps.
.A
McGarrity TJ; Peiffer LP; Bartholomew MJ; Pegg AE.
.I 274556
.U
91003856
.S
Cancer 9101; 66(7):1544-51
.M
Antigens, Surface/AN; Case Report; Cell Differentiation; Cell Division; Erythroid Progenitor Cells/*CY/DE/ME; Erythropoietin/ME/PD; Growth Substances/PD; Human; Karyotyping; Leukemia, Myeloid, Philadelphia-Positive/BL; Male; Middle Age; Receptors, Endogenous Substances/AN; Tumor Cells, Cultured/*CY/DE.
.T
Establishment of an erythroid cell line (JK-1) that spontaneously differentiates to red cells.
.P
JOURNAL ARTICLE.
.W
The authors established a new hemopoietic cell line (JK-1) from a patient with chronic myelogenous leukemia in erythroid crisis. This JK-1 line predominantly consists of immature cells, but a small number of mature erythroblasts and red cells can be consistently seen without any specific differentiation inducer. The JK-1 cells grow in suspension culture supplemented with human plasma and carry double Philadelphia chromosomes. Hemoglobin staining with benzidine was positive for about 20% of cells and the type of the hemoglobin was for the most part HbF. Surface-marker analysis revealed JK-1 cells positive for glycophorin A, EP-1, and HAE9. The proportion of mature cells was elevated by the addition of delta-aminolevulinic acid. Erythropoietin (EPO) enhanced the growth of JK-1 cells either in the suspension or in methylcellulose semisolid culture. The total number of EPO receptors was 940 per cell, of which 220 sites had an affinity higher than the other 720 sites. This is the first report of an established human erythroid cell line which spontaneously undergoes terminal differentiation.
.A
Okuno Y; Suzuki A; Ichiba S; Takahashi T; Nakamura K; Hitomi K; Sasaki R; Tada K; Imura H.
.I 274557
.U
91003857
.S
Cancer 9101; 66(7):1552-4
.M
Adenocarcinoma/PA/SC; Axilla; Breast Neoplasms/PA; Colonic Neoplasms/PA; Human; Lymph Nodes/*PA; Lymphatic Metastasis/*PA; Mesentery; Necrosis; Rectal Neoplasms/PA.
.T
Regional differences in the intranodal distribution of tumor cells.
.P
JOURNAL ARTICLE.
.W
The intranodal distribution of tumor cells was examined in 103 mesenteric and 135 axillary nodes to determine the frequency of a circumferential type of distribution and its relationship, if any, to central necrosis. Eighteen percent of the mesenteric nodes removed at surgery from patients with colon cancer contained a circumferential rim of viable tumor cells in an area corresponding wholly or in part to the normal location of the marginal sinus. In each case this rim of tumor cells surrounded a large central area of necrosis. In contrast, only one of the 135 axillary nodes removed from patients with breast cancer demonstrated this pattern. These findings suggest that by interrupting blood and lymph vessels, the circumferential spread of tumor cells underlies development of central necrosis. Previously described structural dissimilarities between mesenteric and axillary nodes may explain the striking difference in incidence of this pattern in these nodes.
.A
Dumont AE; Harris MN; Vazquez M.
.I 274558
.U
91003858
.S
Cancer 9101; 66(7):1555-62
.M
Adenoma/GE/SC; Adult; Alkaline Phosphatase/ME; Aneuploidy; Calcium/BL; Carcinoma/GE/SC; DNA, Neoplasm/*AN; Female; Flow Cytometry; Human; Lung Neoplasms/SC; Lymphatic Metastasis; Male; Middle Age; Parathyroid Neoplasms/BL/CL/*GE; Support, Non-U.S. Gov't.
.T
Flow cytometric DNA analysis of parathyroid tumors. Implication of aneuploidy for pathologic and biologic classification.
.P
JOURNAL ARTICLE.
.W
The previous cytometric studies on parathyroid tumors have provided conflicting data regarding the relationship between DNA content and histopathology, resulting from differences in technical methods and data analysis. This study measured nuclear DNA of parathyroid tumors by flow cytometry in fresh material and determined whether DNA aneuploidy really assists in making a pathologic diagnosis of carcinoma or not. From May 1987 through April 1989, 65 consecutive patients operated on for primary hyperparathyroidism had DNA analysis of the freshly excised parathyroid tumors. Three of the patients had metastatic lesions of parathyroid carcinoma in the lung, cervical lymph nodes, and lung and mediastinal lymph nodes, respectively. Pathologic classifications of the lesions from the other 62 patients were 54 adenomas, four carcinomas, and four hyperplasias. In all the latter patients, hyperplasia was associated with a multiple endocrine neoplasia syndrome. Unequivocal evidence of aneuploidy was found in all of the metastatic lesions and 60% of the primary lesions of the carcinomas, in 9% of the adenomas and in 50% of the hyperplasias. Therefore, parathyroid carcinomas were more apt to be aneuploid than were adenomas (P = 0.0015, both-sided testing). In each of the cases of aneuploid hyperplasia, a small aneuploid peak was found. The high incidence of aneuploidy in patients with multiple endocrine neoplasia type 1 may indicate the presence of clonal heterogeneity of hyperplastic glands and the presence of an abnormal subset of cells that have malignant potential. Cell distribution analysis did not provide any significant information beyond ploidy level. In conclusion, DNA flow cytometric analysis of DNA ploidy patterns is a valuable adjunct to the histopathologic diagnosis of parathyroid neoplasms.
.A
Obara T; Fujimoto Y; Kanaji Y; Okamoto T; Hirayama A; Ito Y; Kodama T.
.I 274559
.U
91003859
.S
Cancer 9101; 66(7):1563-7
.M
Adenoma/DI; Biopsy/MT; Carcinoma in Situ/DI; Colonic Neoplasms/*DI/PA/SC; Colonic Polyps/DI; Cytodiagnosis/MT; Epithelium/PA; Human; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies.
.T
Brush cytology in the diagnosis of colonic neoplasms.
.P
JOURNAL ARTICLE.
.W
During a three-year period (1986-1988), 234 colonic brush specimens were received in the authors' laboratory. Nine samples (4%) were deemed unsatisfactory for evaluation because of inadequate cellularity and/or poor fixation. In 11 cases concomitant or follow-up histologic specimens were not available. The remaining 214 specimens included 82 malignant neoplasms, 88 neoplastic polyps (adenomas), and 44 nonneoplastic lesions. Sixty-seven (82%) of malignant neoplasms were correctly diagnosed by brush cytology. Three cases of adenoma with severe dysplasia or in situ carcinoma were diagnosed as adenocarcinoma by cytology. No false-positive diagnoses were made of nonneoplastic lesions. Brush cytology was found to be a more sensitive technique in the diagnosis of colon cancer than endoscopic biopsy (82% and 74% sensitivity, respectively). The combination of the two techniques increased the sensitivity to 90% and improved the overall accuracy of the test. Seventy-one (82%) of the colonic adenomas were correctly diagnosed by cytology. Brush cytology is a convenient, safe, and accurate technique which should be used concurrently with endoscopic biopsy or polypectomy.
.A
Ehya H; O'Hara BJ.
.I 274560
.U
91003860
.S
Cancer 9101; 66(7):1568-77
.M
Adolescence; Adult; Child; Child, Preschool; Combined Modality Therapy; Female; Follow-Up Studies; Human; Infant; Kidney Neoplasms/*PA/TH; Male; Neoplasm Staging; Nephrectomy; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Wilms' Tumor/*PA/TH.
.T
Pathologic delineation of the papillonodular type of cystic partially differentiated nephroblastoma. A review of 11 cases.
.P
JOURNAL ARTICLE.
.W
Eleven cases of a previously unrecognized papillonodular variant of cystic partially differentiated nephroblastoma (CPDN) are described. This type of CPDN has all the features of the conventional type of CPDN; however, in addition, there are grossly demonstrable papillonodular projections extending from the septa into the cyst lumina. The septa do not show any expansile tumor masses. Like most cases of the conventional type, this new type of CPDN was usually diagnosed in infants. Nephrectomy (total in 10 and partial in 1) was done in these cases. Additional chemotherapy with or without radiation therapy was given in seven cases. No recurrence was noted during the period extending from 21 months to 8 years in the eight cases in which follow-up data are available. Nephrectomy with regular follow-up visits for possible recurrence may be the management of choice. Pathologists should be aware of this variant of CPDN so that overtreatment can be avoided. The revised criteria for CPDN can be summarized as follows: (1) The discrete entirely cystic tumor contains luminal papillonodules in some cases. (2) Septa and the papillonodules, when present, are the only solid portion of the tumor and contain blastemal cells admixed with their normal and aberrant derivatives. (3) The tumor without and with papillonodules is classified as a conventional and papillonodular type of CPDN, respectively.
.A
Joshi VV; Beckwith JB.
.I 274561
.U
91003861
.S
Cancer 9101; 66(7):1578-89
.M
alpha 1-Antichymotrypsin/AN; alpha 1-Antitrypsin/AN; Adolescence; Adult; Aged; Aged, 80 and over; Castor Bean; Child; Child, Preschool; Combined Modality Therapy; Desmin/AN; Female; Human; Immunohistochemistry; Lectins/AN; Male; Middle Age; Recurrence; Sarcoma/MO/*PA/TH; Soft Tissue Neoplasms/MO/*PA/TH; Support, Non-U.S. Gov't; Survival Rate.
.T
Soft tissue sarcoma with additional anaplastic components. A clinicopathologic and immunohistochemical study of 27 cases.
.P
JOURNAL ARTICLE.
.W
This clinicopathologic study concerns 27 cases of "dedifferentiated" soft tissue sarcoma (DSTS), including 14 liposarcomas, six leiomyosarcomas, five chondrosarcomas, and two rhabdomyosarcomas. In addition, the authors conducted an immunohistochemical survey of 23 cases and an electron microscopic examination of three. The findings were compared with observations of 32 cases of de novo malignant fibrous histiocytoma (MFH). All tumors contained additional distinct anaplastic portions indistinguishable from MFH under conventional light microscopy, ultrastructurally, and in cases of immunoreactivity for alpha-1-antichymotrypsin and alpha-1-antitrypsin and on lectin histochemical findings for ricinus communis agglutinin and concanavalin agglutinin. The desmin reactivity present in anaplastic portions of 14 DSTS and in eight de novo MFH is taken to mean that myofibroblasts are present in these tumors. The anaplastic components of DSTS are presumed to represent the proliferation of another clone of undifferentiated mesenchymal cells that fail to differentiate along any specific lineage other than fibroblast-like cells, histiocyte-like cells, and myofibroblasts. Nineteen patients died of tumor and four are alive and well 1.6, 1.7, 2.1, and 5.2 years after the initial treatment, respectively.
.A
Hashimoto H; Daimaru Y; Tsuneyoshi M; Enjoji M.
.I 274562
.U
91003862
.S
Cancer 9101; 66(7):1590-5
.M
Administration, Oral; Cancer Care Facilities; Female; Follow-Up Studies; Human; India; Male; Morphine/*AD/AE; Neoplasms/*CO; Pain Measurement; Pain, Intractable/*DT/ET/PP; Palliative Treatment/*; Prospective Studies.
.T
Continuing care for cancer pain relief with oral morphine solution. One-year experience in a regional cancer center.
.P
JOURNAL ARTICLE.
.W
This report is a prospective study of 223 patients with intractable cancer pain who were offered continuing care during the year 1988 at the Pain Relief Unit, Kidwai Memorial Institute of Oncology, Bangalore, India, with a minimum follow-up of 4 months and a maximum follow-up of 16 months. A high percentage of pain relief was attained within a mean duration of 4 days, which on follow-up was maintained at a steady level in most patients (91.1%). Oral morphine could not be continued in three patients because of vomiting. The main side effects noticed were nausea and vomiting, itching, and constipation. At any time during the first 140 days, only 30% of patients had side effects and appropriate medication successfully managed these side effects. During the rest of the study period, the side effects were minimal. Oral morphine used with proper adjuncts offers the best pain palliation in most patients, with minimal side effects.
.A
Vijayaram S; Ramamani PV; Chandrashekhar NS; Sudharshan R; Heranjal R; Lobo B; Obedullah D; Bhargava MK.
.I 274563
.U
91003863
.S
Cancer 9101; 66(7):1596-600
.M
Analysis of Variance; Female; Human; Male; Melanoma/*MO; Models, Statistical; Multivariate Analysis; Prognosis; Support, Non-U.S. Gov't; Survival Rate; Uveal Neoplasms/*MO.
.T
Clinical prognostic factors in patients with posterior uveal malignant melanoma.
.P
JOURNAL ARTICLE.
.W
The authors evaluated the prognostic value of clinically assessed variables for predicting length of survival until death from metastatic disease in 237 patient with a primary choroidal or ciliary body melanoma. Using multivariate Cox proportional hazards modeling, the authors identified the largest linear basal tumor diameter (mm), estimated by indirect ophthalmoscopy and fundus drawing, the location of the anterior margin of the tumor relative to the ocular equator and ora serrata, and the age of the patient at the time of treatment as the best combination of the clinically assessed variables for predicting survival. For each patient in this group, the authors computed a prognostic index based on the best multivariate Cox model. They showed that patients with low, intermediate, and high values of prognostic index had low, intermediate, and high melanoma-related mortality rates, respectively, during the first 5 to 8 posttreatment years. These results suggest that: (1) clinically assessed variables evaluated according to a standardized protocol are useful for predicting the survival of treated patients with posterior uveal melanoma and (2) ophthalmologists who assess potential clinical prognostic variables consistently may identify subgroups of patients with comparable mortality risk on the basis of noninvasive testing.
.A
Augsburger JJ; Gamel JW.
.I 274564
.U
91003865
.S
Cancer 9101; 66(7):1613-20
.M
Adult; Aged; Attitude to Health; Breast Neoplasms/*PC; Female; Health Behavior; Human; Mammography/EC/*MT; Mass Screening/*IS; Middle Age; Risk Factors; Support, Non-U.S. Gov't.
.T
Mammographic screening of women with increased risk of breast cancer.
.P
JOURNAL ARTICLE.
.W
Five hundred one women from Dallas County, Texas who participated in the American Cancer Society 1987 Texas Breast Screening Project were selected because of a self-reported family history of breast cancer (cases). They were matched with 501 randomly selected women from the same county with no family history (controls). Although there was a statistically significant trend with age for an increasing proportion of women to report having undergone mammography, there was no significant difference when comparing mammographic histories of cases with controls after controlling for age (31.5% versus 35.1%, P = 0.33). Significantly more cases (79%) perceived their risk for breast cancer to be moderate or greater compared with controls (54%, P less than 0.0001), but mammographic histories were not different when controlling for perceived risk. Both cases and controls cited lack of physician referral and cost as their reasons for not having undergone mammography. Women at increased risk for breast cancer (because of their family history) are not undergoing regular mammographic screening despite their self-awareness of the increase in their risk.
.A
Vogel VG; Graves DS; Vernon SW; Lord JA; Winn RJ; Peters GN.
.I 274565
.U
91003866
.S
Cancer 9101; 66(7):1621-9
.M
Adult; Age Factors; Antineoplastic Agents, Combined/TU; Breast Neoplasms/DT/*MO/SU; Clinical Protocols; Combined Modality Therapy; Cyclophosphamide/TU; Female; Follow-Up Studies; Human; Multivariate Analysis; Neoplasm Metastasis; Ovariectomy; Receptors, Estrogen/AN; Risk Factors; Support, U.S. Gov't, P.H.S.; Survival Rate.
.T
Survival of premenopausal women with metastatic breast cancer. Long-term follow-up of Eastern Cooperative Group and Cancer and Leukemia Group B studies.
.P
CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL.
.W
In premenopausal women with metastatic breast cancer, differences in survival curves early during follow-up can be misleading. The authors therefore analyzed long-term survival in 378 patients, entered in three randomized trials, started between 1973 and 1978. Combined data from the three trials were used to increase the power for identifying prognostic variables. Cancer and Leukemia Group B (CALGB) trial 7382 randomized patients to oophorectomy plus either cyclophosphamide or combination chemotherapy or observation. Eastern Cooperative Oncology Group (ECOG) 2174 randomized patients who had not progressed 3 months after oophorectomy to combination chemotherapy or combination chemotherapy or observation. Trial ECOG 2177 randomized estrogen receptor (ER) positive or ER-unknown patients to oophorectomy plus combination chemotherapy or immediate combination chemotherapy, and ER-negative patients were directly assigned to combination chemotherapy. Hence ER-negative patients need not have been healthy enough to be randomized to oophorectomy. With only 14% of the patients still alive, median survival on the three studies was 30, 24, and 28 months. The median survival of individual treatments changed noticeably in ECOG 2174 and ECOG 2177 with long-term follow-up. At this time there are no differences in survival between randomized regimens in any of the three trials. In a multivariate model, factors associated with significantly poorer survival were visceral-dominant disease, nodal metastases, breast metastases, age younger than 45 years, ER negativity, and not receiving chemotherapy immediately after oophorectomy. This treatment difference was thus not due to imbalances in the prognostic variables used in the model, but it may be due to imbalances of unknown prognostic factors or differences in patient selection.
.A
Falkson G; Gelman RS; Leone L; Falkson CI.
.I 274566
.U
91003867
.S
Cancer 9101; 66(7):1630-5
.M
Adenocarcinoma/MO/PA; Bladder/*PA; Bladder Neoplasms/MO/*PA; Carcinoma, Squamous Cell/MO/PA; Carcinoma, Transitional Cell/MO/PA; Cystoscopy; Female; Human; Male; Prognosis; Survival Rate.
.T
Analysis of bladder carcinoma by subsite. Cystoscopic location may have prognostic value.
.P
JOURNAL ARTICLE.
.W
Nine hundred fourteen cases of carcinoma of the urinary bladder registered from 1977 to 1988 with the Kansas state tumor registry were evaluated by subsite for differences in grade, histology, sex, age at diagnosis, and survival. Only initial occurrences of carcinoma were included. Carcinoma of the lateral walls accounted for 37.1%; the posterior wall, 17.9%; the trigone, 12.6%; the neck, 11.1%; the ureteric orifices, 9.8%; the dome, 7.7%; and the anterior wall, 3.8%. Malignant neoplasms occurring in the neck of the bladder had a significantly poorer prognosis by survival analysis (P less than 0.05). Malignancies of the dome were found to present as higher grade lesions (P = 0.00003), and carcinoma of the ureteric orifices and lateral walls tended to be of lower grade (P = 0.02 and P = 0.05, respectively). Carcinomas of the anterior wall and dome occurred in a more elderly population (mean ages, 75.6 and 73.9 years, respectively), and carcinomas of the trigone and ureteric orifices occurred in a younger group (mean ages, 68.3 and 67.5 years, respectively). On histologic evaluation the trigone gave rise to more squamous cell carcinoma than expected (P = 0.001, 325% of expected). No distribution difference was noted among subsites with respect to sex. These data show significant differences among subsites of the urinary bladder with regard to survival, grade, histology, and age at diagnosis.
.A
Stephenson WT; Holmes FF; Noble MJ; Gerald KB.
.I 274567
.U
91003868
.S
Cancer 9101; 66(7):1636-40
.M
Adult; Aged; Antineoplastic Agents, Combined/TU; Appendiceal Neoplasms/CO; Combined Modality Therapy; Female; Human; Middle Age; Ovarian Neoplasms/CO; Pseudomyxoma Peritonei/ET/PA/*TH; Reoperation.
.T
The management of pseudomyxoma peritonei.
.P
JOURNAL ARTICLE.
.W
The management of nine patients with pseudomyxoma peritonei was reviewed. Aggressive surgical resection of tumor is the standard of treatment, with many patients requiring multiple laparotomies. Chemotherapy, including the use of cisplatin is not effective. Long-term nutritional support provides a better quality of survival for select patients.
.A
Mann WJ Jr; Wagner J; Chumas J; Chalas E.
.I 274568
.U
91003869
.S
Cancer 9101; 66(7):1641-8
.M
Adolescence; Amputation; Bone Neoplasms/*DI/ET/SU; Child; Child, Preschool; Chondrosarcoma/*DI/ET/SU; Enchondromatosis/CO; Exostoses, Multiple Hereditary/CO; Female; Femoral Neoplasms/DI; Human; Humerus/PA/RA; Male; Neoplasm Recurrence, Local; Prognosis; Tibia/PA/RA.
.T
Chondrosarcoma of bone in children.
.P
JOURNAL ARTICLE.
.W
Chondrosarcoma of bone rarely occurs in children. This report analyzes the clinicopathologic features in a series of 47 patients with conventional chondrosarcoma who were less than 17 years of age. Of the 47 cases, 14 were from the Mayo Clinic files, and 33 were from our consultation files. Most of the lesions occurred in the trunk and upper ends of the long bones, with the humerus being the most frequent skeletal site. Twelve of the 47 tumors were secondary. The radiographic findings were the same as those seen in adult chondrosarcoma. Pathologically, the tumors were low grade. En bloc resection is the treatment of choice because of the high incidence of local recurrence with lesser surgical margins. Prognosis in childhood chondrosarcoma is no different from that in adult chondrosarcoma. None of the patients with follow-up data had metastasis.
.A
Young CL; Sim FH; Unni KK; McLeod RA.
.I 274569
.U
91003870
.S
Cancer 9101; 66(7):1649-53
.M
Adult; Aged; Antineoplastic Agents/*AE; Avoidance Learning/*; Female; Food Habits/*PX; Human; Longitudinal Studies; Male; Middle Age; Nausea/CI/*PX; Scapegoating/*; Support, Non-U.S. Gov't.
.T
The scapegoat effect on food aversions after chemotherapy.
.P
JOURNAL ARTICLE.
.W
The effects of consuming a novel food (halva) versus a familiar food (cookies) before gastrointestinal (GI) toxic chemotherapy on patients' preference for familiar foods consumed after chemotherapy treatment were compared. The development of aversions to the novel and familiar foods was also assessed. Patients with a history of posttreatment nausea consumed either a novel or a familiar food before chemotherapy and were asked to keep a food record through the next breakfast and to rate their preference for these foods. Patients who consumed halva before treatment were significantly more likely to increase their ratings for foods consumed after chemotherapy than patients who consumed familiar cookies. Aversions to the novel food were significantly more frequent than aversions to the familiar food. These findings provide evidence that a novel but not a familiar food consumed before chemotherapy can act as a scapegoat to prevent items in the regular diet consumed after chemotherapy from decreasing in preference. Providing patients with a novel food before chemotherapy is a useful clinical intervention to reduce the likelihood of forming aversions to familiar foods consumed after chemotherapy.
.A
Andresen GV; Birch LL; Johnson PA.
.I 274570
.U
91003871
.S
Cancer 9101; 66(7):1654-60
.M
Adult; Aged; Blacks/*; Comparative Study; Female; Human; Income; Male; Middle Age; Neoplasms/*EH/MO; New York/EP; Socioeconomic Factors; Survival Rate; United States/EP.
.T
Cancer mortality in a higher-income black population in New York State. Comparison with rates in the United States as a whole.
.P
JOURNAL ARTICLE.
.W
In the 1980 Census the median family income among blacks in Suffolk County, New York (i.e., $19,604) was much higher than that for American blacks as a whole (i.e., $12,618) and 94.1% of that for American whites (i.e., $20,840), but the proportion below the poverty level was still higher for Suffolk County blacks than for American whites. Observed numbers of deaths from 1979 to 1985 for total cancers and most cancer sites in Suffolk County black men and women were not lower than expected on the basis of age-specific and gender-specific death rates for blacks in the US. Although numbers of deaths from cervical cancer and prostate cancer were slightly lower than expected in Suffolk County blacks versus American blacks, these numbers were still significantly greater than expected on the basis of death rates among American whites. Age-specific death rates for age groups 25 to 44 years to 55 to 64 years tended to be lower in Suffolk County for lung cancers in black men but not for breast cancer in black women. Specific cancer sites, which differ in the direction of the association between incidence and socioeconomic status, age, and gender must be considered in comparisons of cancer mortality by race and socioeconomic level. Implications of the comparisons were discussed with regard to the goal of reducing racial differences in cancer death rates.
.A
Polednak AP.
.I 274571
.U
91003872
.S
Cancer 9101; 66(7):1661
.M
Aged; Breast Neoplasms/*TH; Combined Modality Therapy; Female; Human; Radiotherapy Dosage; Tamoxifen/*AE; Uterine Neoplasms/*CI/PA.
.T
Tamoxifen as a risk factor for endometrial cancer [letter; comment]
.P
COMMENT; LETTER.
.A
Hardell L.
.I 274572
.U
91003873
.S
Cancer 9101; 66(8):1663-70
.M
Adult; Aged; Antibodies, Monoclonal/*DU; Breast Neoplasms/*CH/MO/PA/TH; Female; Hormones/TU; Human; Immunohistochemistry; Menopause; Middle Age; Predictive Value of Tests; Prospective Studies; Receptors, Estrogen/*AN; Receptors, Progesterone/*AN; Support, U.S. Gov't, P.H.S.; Survival Analysis.
.T
Immunocytochemical estrogen and progestin receptor assays in breast cancer with monoclonal antibodies. Histopathologic, demographic, and biochemical correlations and relationship to endocrine response and survival.
.P
JOURNAL ARTICLE.
.W
Breast cancer specimens from 600 women were assayed for estrogen receptors (ER) using an immunocytochemical assay (ICA) employing the monoclonal antiestrophilin antibody H222 Sp gamma. Results showed significant correlation with biochemical ER determinations as well as with tumor grade and menopausal status. In 449 cases, results of progesterone receptor assay by ICA using the monoclonal anti-PgR antibody KD 68, also correlated significantly with biochemical PgR measurements. The ERICA/PgRICA positivity was significantly more frequent in postmenopausal white women. Colloid carcinomas were most likely to be ERICA positive and PgRICA positive whereas medullary carcinomas were most often negative. In 47 patients with advanced mammary carcinoma, results of ERICA and PgRICA were more closely related to endocrine response than those of ER and PgR by dextran-coated charcoal assay (DCC). In 339 women with Stage I or Stage II breast cancer, ERICA was significantly associated with disease-free survival. Analysis by Cox's proportional hazard model, however, showed PgRICA to be the best predictor of survival and disease-free survival in 197 women at the same stages of disease. These data indicate that ICA is more predictive of prognosis than biochemical ER and PgR. The ease of ICA performance coupled with these results indicate that the method is an acceptable substitute for DCC in analyzing breast cancers for ER/PgR.
.A
Pertschuk LP; Kim DS; Nayer K; Feldman JG; Eisenberg KB; Carter AC; Rong ZT; Thelmo WL; Fleisher J; Greene GL.
.I 274573
.U
91003874
.S
Cancer 9101; 66(8):1671-7
.M
Adolescence; Antineoplastic Agents, Combined/AE/*TU; Child; Child, Preschool; Cytarabine/AD/AE; Female; Human; Hydrocortisone/AD; Infant; Infusions, Intravenous; Leukemia, Lymphocytic, Acute, L1/*DT; Male; Methotrexate/AD; Pilot Projects; Remission Induction; Support, U.S. Gov't, P.H.S.; Teniposide/AD/AE; United States.
.T
Teniposide (VM-26) and continuous infusion cytosine arabinoside for initial induction failure in childhood acute lymphoblastic leukemia. A Pediatric Oncology Group pilot study.
.P
CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY.
.W
Twenty-six evaluable children with newly diagnosed acute lymphoblastic leukemia (ALL) who failed to achieve initial remission after receiving two to seven drugs for at least a 4-week period were given teniposide (VM-26) and continuous infusion cytosine arabinoside (Ara-C). Twenty-two received 150 mg/m2 of VM-26 on days 1 and 2 with 100 mg/2 of Ara-C as a continuous infusion on days 1 through 5; a second shortened course was given on day 14 to eight patients who had evidence of some antileukemic effect or were clinically judged able to tolerate a second course. The last four patients received three daily doses of VM-26 and a 7-day infusion of Ara-C at the same daily dosages. Twelve (48%) achieved complete remission (CR) of ALL. There was a trend toward decreasing response rates with an increasing number of drugs used in the initial induction regimen, i.e., five CR among seven patients with a prior two-drug induction attempt, six CR among 14 patients with a prior three- to four-drug induction attempt, and one CR among four patients with a prior five- to seven-drug induction attempt (P = 0.14). Ten of 17 non-T-cell patients and two of nine T-cell patients achieved remission (P = 0.10). The median time required to achieve a complete remission from the initiation of treatment was 26 days (range, 14-72 days). This period was shorter in those who required one course compared with those who required two induction courses, i.e., 25 days median vs. 44 days median. Toxicity was significant and due mainly to marrow aplasia and infection; one patient had severe prolonged VM-26-induced hypotension. Of the 12 patients entering remission, two were removed for marrow transplant and one was removed due to parental request. In the remaining nine patients, median remission duration was only 2 months (range, 1-18 months). All nine patients relapsed in the marrow. Among the entire group of 26 patients, only one patient is alive and a long-term event-free survivor (after allogeneic marrow transplant). Due to the current use of more aggressive initial induction regimens and the extremely poor prognosis in children who fail to achieve initial remission, more intensive regimens of continuation therapy or alternative therapies, such as bone marrow transplant, should be considered.
.A
Ochs J; Rivera GK; Pollock BH; Buchanan G; Crist W; Freeman AI.
.I 274574
.U
91003875
.S
Cancer 9101; 66(8):1678-84
.M
Antineoplastic Agents, Combined/*TU; Breast Neoplasms/*DT/MO/SU; Combined Modality Therapy; Cyclophosphamide/AD; Data Interpretation, Statistical; Dose-Response Relationship, Drug; Female; Fluorouracil/AD; Human; Levamisole/AD; Menopause; Methotrexate/AD; Retrospective Studies; Support, U.S. Gov't, P.H.S.; Survival Analysis.
.T
Association of disease-free survival and percent of ideal dose in adjuvant breast chemotherapy.
.P
CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL.
.W
The relationship between percent of ideal dose and disease-free survival was examined in 256 Stage II and III patients who participated in a 2-year breast adjuvant chemotherapy trial consisting of cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) given postoperatively. When analyzed analogously to previous work, the results confirmed a dose-response relationship: that is, there appeared to be an improved disease-free survival for patients receiving higher doses of adjuvant chemotherapy. The major criticism of such an analysis is its bias. This bias was addressed by considering only patients who were still receiving therapy at 6, 12, and 24 months; then, the dose-response relationship was no longer seen. Although causality cannot be inferred, the apparent differences in disease-free survival among the dose groups can be attributed to recurrences in the first 2 years among patients receiving lower doses of chemotherapy.
.A
Geller NL; Hakes TB; Petroni GR; Currie V; Kaufman R.
.I 274575
.U
91003876
.S
Cancer 9101; 66(8):1685-7
.M
Doxorubicin/AD/*TU; Drug Therapy, Combination; Female; Hepatoma/*DT; Human; Liver Neoplasms/*DT; Male; Middle Age; Prospective Studies; Support, Non-U.S. Gov't; Verapamil/AD/*TU.
.T
Doxorubicin for unresectable hepatocellular carcinoma. A prospective study on the addition of verapamil.
.P
CLINICAL TRIAL; JOURNAL ARTICLE.
.W
A prospective study was conducted to assess the safety and efficacy of the addition of oral verapamil to intravenous Adriamycin (doxorubicin) for the management of patients with unresectable hepatocellular carcinoma (HCC). All 28 patients studied had histologically verified disease, and cirrhosis was present in 20 of the 21 patients with adequate tissue sampling. The overall median survival was 57 days. Chemotherapy was terminated in seven patients after one course of treatment. Partial response and complete response were noted in four patients (19%) and one patient (4.8%), respectively, among the 21 patients evaluated. Side effects related to the chemotherapy were present in all patients studied. Death from fulminating sepsis occurred in three of the 13 patients with leukopenia. Symptomatic myocardial dysfunction developed in one patient. The addition of verapamil apparently did not potentiate the tumoricidal effect of systemic Adriamycin on HCC but probably did increase its complications.
.A
Lai EC; Choi TK; Cheng CH; Mok FP; Fan ST; Tan ES; Wong J.
.I 274576
.U
91003877
.S
Cancer 9101; 66(8):1688-91
.M
Adenocarcinoma/*DT; Adult; Aged; Antineoplastic Agents, Combined/AE/*TU; Carcinoma, Squamous Cell/*DT; Cisplatin/AD/AE; Dose-Response Relationship, Drug; Drug Evaluation; Female; Fluorouracil/AD/AE; Human; Male; Middle Age; Saline Solution, Hypertonic; Support, U.S. Gov't, P.H.S..
.T
A phase I trial of cisplatin in hypertonic saline and escalating doses of 5-fluorouracil by continuous intravenous infusion in patients with advanced malignancies.
.P
JOURNAL ARTICLE.
.W
Thirty-four patients with incurable solid tumors were treated in a Phase I trial with a fixed dose of high-dose cisplatin (CDDP) administered in hypertonic saline and escalating doses of infusional 5-fluorouracil (5-FU). Five treatment levels of 5-FU, ranging from 500 to 900 mg/m2/day for 5 days, were studied. Leukopenia, thrombocytopenia, and oral mucositis were the dose-limiting toxicities encountered. Nephrotoxicity was minimal. Ototoxicity and peripheral neuropathies were rare and mild in this patient group, but most patients received only a small number of treatment cycles. Diarrhea was not dose-limiting. Two complete responses (one non-small cell lung cancer and one sweat gland carcinoma) were observed. No other major responses were noted. With the dose of CDDP set at 35 mg/m2/day for 5 consecutive days, the maximum tolerated dose (MTD) of a concurrent 5-day 5-FU infusion was found to be 900 mg/m2/day. The recommended dosages for Phase II trials are 35 mg/m2/day CDDP and 800 mg/m2/day 5-FU for 5 consecutive days. Cancers of the lung, breast, gastrointestinal tract, and genitourinary tract would be reasonable targets for Phase II studies.
.A
Saltz L; Kelsen D.
.I 274577
.U
91003878
.S
Cancer 9101; 66(8):1692-6
.M
Adult; Aged; Aged, 80 and over; Antineoplastic Agents, Combined/AE/*TU; Bleomycins/AD/AE; Carcinoma, Squamous Cell/*DT/RT/SU; Child; Cisplatin/AD/AE; Combined Modality Therapy; Female; Fluorouracil/AD/AE; Human; Lip Neoplasms/*DT/RT/SU; Male; Middle Age; Skin Neoplasms/*DT/RT/SU.
.T
Treatment of advanced squamous cell carcinoma of the skin with cisplatin, 5-fluorouracil, and bleomycin.
.P
JOURNAL ARTICLE.
.W
The authors treated 14 patients with advanced squamous cell carcinoma (SCC) of the skin or lip with one to four cycles of combination chemotherapy consisting of cisplatin by bolus injection, and 5-fluorouracil (5-FU) and bleomycin by continuous 5-day infusion. Objective responses were seen in 11 of the 13 evaluable patients (84%). Four patients had a complete remission (30%) and seven patients, a partial remission (54%). Local control after definitive complementary radiation and/or surgical treatment was achieved in seven patients. Toxic side effects was acceptable; they consisted of nausea and vomiting in all patients, transient skin changes, hematologic (Grade 3/4) abnormalities in four patients, and pulmonary fibrosis in one elderly patient. These results show that this chemotherapy combination could play a role in reducing the tumor mass and in facilitating definitive treatment to obtain better functional and cosmetic results in advanced SCC of the skin.
.A
Sadek H; Azli N; Wendling JL; Cvitkovic E; Rahal M; Mamelle G; Guillaume JC; Armand JP; Avril MF.
.I 274578
.U
91003880
.S
Cancer 9101; 66(8):1703-10
.M
Adolescence; Antineoplastic Agents, Combined/*TU; Bone Neoplasms/*DT/PA/SU; Cisplatin/AD/AE; Combined Modality Therapy; Comparative Study; Doxorubicin/AD/AE; Female; Human; Ifosfamide/AD/AE; Infusions, Intra-Arterial; Infusions, Intravenous; Male; Methotrexate/AD/AE; Osteosarcoma/*DT/PA/SU; Support, Non-U.S. Gov't.
.T
Effect of intraarterial versus intravenous cisplatin in addition to systemic doxorubicin, high-dose methotrexate, and ifosfamide on histologic tumor response in osteosarcoma (study COSS-86).
.P
CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY.
.W
In osteosarcoma, intraarterial (IA) administration of systemic treatment has been advocated to improve local tumor response preparing for, or even obviating, definitive surgery. Because data from the literature did not unequivocally support the local superiority of IA infusion, a comparative study was started in 1986. Preoperative chemotherapy consisted of 45 mg/m2 of doxorubicin on days 1 and 2; 12 g/m2 of high-dose methotrexate on days 15 and 22; and 3 g/m2 of ifosfamide on days 29, 30, 50, and 51 followed on days 31 and 52 by intravenous (IV) versus IA tourniquet infusion of cisplatin (DDP). A strict randomization of patients was not feasible. A balanced distribution of risk factors was strived for by stratifying and allocating the appropriate patients centrally. The infusion time was prolonged from 1 to 5 hours in the IV group, and the DDP dose was reduced from 150 to 120 mg/m2 in both arms when intolerable ototoxicity became apparent. A multivariate analysis was performed to exclude a bias on the response rates from risk factor distribution and from modifications of DDP infusion time and dosage. The overall fraction of histologic good responders (greater than 90% necrosis) was not found to be different after IA versus IV treatment (34/50 [68%] vs. 41/59 [69%]). Intraarterial instead of IV use of DDP within an aggressive systemic treatment does not seem to improve the local tumor response.
.A
Winkler K; Bielack S; Delling G; Salzer-Kuntschik M; Kotz R; Greenshaw C; Jurgens H; Ritter J; Kusnierz-Glaz C; Erttmann R; et al.
.I 274579
.U
91003881
.S
Cancer 9101; 66(8):1711-6
.M
Carcinoma, Squamous Cell/*EP/PA; Case-Control Studies; Female; Human; Hypopharyngeal Neoplasms/*EP/PA; Italy/EP; Laryngeal Neoplasms/*EP/PA; Male; Middle Age; Support, Non-U.S. Gov't.
.T
Topographic classification, clinical characteristics, and diagnostic delay of cancer of the larynx/hypopharynx in Torino, Italy.
.P
JOURNAL ARTICLE.
.W
The case series of a population-based case-control study of laryngeal and hypopharyngeal cancers in Torino, Italy, included 281 men with clinical and anamnestic data. Two hundred fifteen, 28, and 38 cancers originated from the endolarynx, epilarynx, and hypopharynx, respectively. Regions invaded by the tumor were divided into 26 subsites. A classification based on the number of invaded subsites was proposed, which agreed well with the T classification of the TNM system. Cancers originating from the hypopharynx invaded more subsites than cancers from the endolarynx, and among the latter, supraglottic were more invasive than glottic lesions. The number of invaded subsites was strongly associated with nodal involvement. Among symptoms at onset of disease and at diagnosis, patients with endolaryngeal lesions reported dysphonia and dyspnea more frequently, and patients with lesions from other regions had a higher prevalence of dysphagia, odynophagia, otalgia, and adenopathia. Clinical and epidemiologic results of this study suggest considering the endolarynx, epilarynx, and hypopharynx as separate anatomic entities. Diagnostic delay was not associated with tumor size and showed a negative trend with involvement of cervical lymph nodes, suggesting that stage at diagnosis is due to intrinsic differences in tumor aggressiveness.
.A
Merletti F; Faggiano F; Boffetta P; Lehmann W; Rombola A; Amasio E; Tabaro G; Giordano C; Terracini B.
.I 274580
.U
91003882
.S
Cancer 9101; 66(8):1717-20
.M
Actuarial Analysis; Adenocarcinoma/MO/PA/*SU; Adult; Aged; Aged, 80 and over; Common Bile Duct Neoplasms/MO/PA/*SU; Comparative Study; Duodenum/SU; Female; Follow-Up Studies; Human; Male; Middle Age; Pancreatectomy; Pancreatic Neoplasms/MO/PA/SU; Survival Analysis; Vater's Ampulla/*.
.T
Long-term follow-up of 24 patients undergoing radical resection for ampullary carcinoma, 1953 to 1988.
.P
JOURNAL ARTICLE.
.W
Potentially curative radical pancreaticoduodenectomy for ampullary adenocarcinoma was performed in 24 patients over a 35-year period. The overall operative mortality was 12.5%. Actuarial survival rate at 5 years was 61% +/- 13.4 standard error of the mean (SEM) and subsequently remained unchanged. In the same time period, 21 patients underwent potentially curative radical pancreaticoduodenectomy for periampullary tumors of pancreatic origin. Similar analysis showed an overall operative mortality of 23.8% and a survival rate at 5 years of 27% +/- 12.5 SEM. The results of radical pancreaticoduodenectomy for ampullary carcinoma in the most recent years (1976 to 1988) were compared with those of former years (1953 to 1975). There were no statistically significant differences in the 5-year survival rate; however, the operative mortality decreased from 25% in the former period to 6.3% in the recent period. Survival was dependent on nodal status. The 5-year survival rate was 78% +/- 11.5 SEM in the absence of nodal metastasis versus 50% +/- 25 SEM in the presence of regional nodal metastasis. These findings support the concept that radical pancreaticoduodenectomy offers a realistic probability for cure in a selected group of patients with carcinomas of the ampulla of Vater.
.A
Shutze WP; Sack J; Aldrete JS.
.I 274581
.U
91003883
.S
Cancer 9101; 66(8):1721-5
.M
Adolescence; Adult; Age Factors; Aged; Aged, 80 and over; Breast Neoplasms/EH/EP/PA/*RA; Calcinosis/EH/EP/PA/*RA; Female; Fibrocystic Disease of Breast/EH/EP/PA/*RA; Human; Mammography; Middle Age; New Mexico/EP; Precancerous Conditions/EH/EP/PA/*RA; Predictive Value of Tests; Support, U.S. Gov't, P.H.S..
.T
Radiographic microcalcification and parenchymal patterns as indicators of histologic "high-risk" benign breast disease.
.P
JOURNAL ARTICLE.
.W
Breast tissue from a forensic autopsy series of 486 women (15 to 98 years of age) was studied radiographically and by histologic sampling. Prevalence of Wolfe P2/Dy parenchymal patterns decreased with age. Radiographic nonvascular microcalcification and histologic presence of marked ductal epithelial hyperplasia and lobular microcalcification increased with age. Both of these histologic parameters of increased risk for breast cancer correlated with the presence of radiographic microcalcification and Wolfe P2/Dy parenchymal pattern. The predictive value of the radiographic parameters for presence of "high-risk" proliferative fibrocystic change increased with age.
.A
Bartow SA; Pathak DR; Mettler FA.
.I 274582
.U
91003884
.S
Cancer 9101; 66(8):1726-31
.M
Adult; Blotting, Southern; Carcinoma, Squamous Cell/*MI/PA; Case Report; Cyclosporins/TU; DNA Probes, HPV/DU; DNA, Viral/AN; Heart Transplantation/*; Human; Male; Oropharyngeal Neoplasms/*MI/PA; Papillomaviruses/GE/*IP; Postoperative Complications/*MI/PA; Prednisone/TU.
.T
Human papillomavirus type 16 associated with oral squamous carcinoma in a cardiac transplant recipient.
.P
JOURNAL ARTICLE.
.W
Human papillomavirus type 16 (HPV 16) has been associated with a variety of squamous carcinomas, particularly those involving the anogenital tract. The authors report the development of an oropharyngeal carcinoma in a 43-year-old man approximately 20 months after cardiac transplantation while he was on a maintenance regimen of cyclosporine A and prednisone. The carcinoma was resistant to treatment, and he died of complications related to metastatic disease 3 years posttransplantation. Molecular biologic studies using nonisotopic-labeled viral DNA probes were done. In situ hybridization demonstrated the presence of HPV 16 DNA in the tumor cells. DNA dot blot analysis confirmed the presence of multiple copies of HPV 16 DNA within the tumor cells and their absence from adjacent normal-appearing tissue. Southern blot analysis suggested that the HPV 16 DNA was integrated into the tumor cell genome. With increasing recognition of the carcinogenicity of HPV type 16 infection, a role for this virus in the development of squamous cell malignancies in immunosuppressed organ transplant recipients is likely to be noted with increasing frequency.
.A
Demetrick DJ; Inoue M; Lester WM; Kingma I; Duggan MA; Paul LC.
.I 274583
.U
91003885
.S
Cancer 9101; 66(8):1732-7
.M
Antibodies, Monoclonal/DU; Antigens, CD/*BI/IM; Antigens, Differentiation/*BI/IM; Antigens, Neoplasm/*BI/IM; Diagnosis, Differential; Human; Immunohistochemistry; Mesenchymoma/DI/*IM/ME; Sarcoma/DI/*IM/ME; Support, Non-U.S. Gov't.
.T
Expression of Ki-1 antigen (CD30) in mesenchymal tumors.
.P
JOURNAL ARTICLE.
.W
Expression of CD30(Ki-1) antigen has long been considered to be restricted to activated lymphocytes and related tumors. However, expression of this antigen has also been detected in embryonal carcinomas, in nonembryonal carcinomas, in malignant melanomas, and even in some myeloid cell lines and macrophages at late stages of differentiation. In this study, using monoclonal antibody Ki-1, expression of CD30 antigen was immunohistochemically examined in frozen sections of 28 benign and 63 malignant mesenchymal tumors. The authors found CD30 expressed in two of four leiomyomas, seven of 11 leiomysarcomas, one of six rhabdomyosarcomas, two of two aggressive fibromatoses, one of three fibrosarcomas, two of four synovial sarcomas, one giant cell tumors of tendon sheaths, all five malignant fibrous histiocytomas, all three osteosarcomas, one of three Ewing's sarcomas, in a tumor cell subpopulation of two of ten malignant schwannomas, and in the Schwann cell compartment of one of two ganglioneuromas tested. Furthermore, CD30 was consistently expressed in the myoepithelial compartment of 13 fibroadenomas. However, all five lipomas, all seven liposarcomas, all three neuroblastomas, both ganglioneuroblastomas, both chondrosarcomas, and tumors of disputed origin tested were consistently CD30 negative. These findings indicate that, outside the lymphatic system, CD30 antigen is not restricted to epithelial neoplasms but may also be present in tumors of mesenchymal origin. The authors conclude that CD30 antigen, although having limited utility in the differential diagnosis of tumors of questionable histogenesis, may eventually define relevant subgroups within the main tumor categories.
.A
Mechtersheimer G; Moller P.
.I 274584
.U
91003886
.S
Cancer 9101; 66(8):1738-42
.M
Adult; Aged; Antibodies, Monoclonal/DU; Antigens, Neoplasm/AN/*BI; B-Lymphocytes/*IM/ME; Female; Human; Immunophenotyping/*; Leukemia, B-Cell, Chronic/*IM/ME/PA; Male; Middle Age; Tumor Markers, Biological/AN.
.T
Immunophenotypes in "classical" B-cell chronic lymphocytic leukemia. Correlation with normal cellular counterpart and clinical findings.
.P
JOURNAL ARTICLE.
.W
This study evaluates the expression of a series of membrane antigens, normally expressed by B-lymphocytes of the lymphocytic mantle and marginal zone, in 90 selected cases of "classical" (mouse red blood cell-receptor+, CD20+, CD5+, surface immunoglobulin +/-) B-chronic lymphocytic leukemia (B-CLL) with the aim of contributing toward identifying the normal counterpart of B-CLL and any correlations between surface antigen pattern and certain clinical characteristics. Clustered (CD23, 25, 39, 40, 27, 1c, w75) and unclustered (NuB1, 7F7, KiB3) monoclonal antibodies (MoAb) were tested. Almost all cases showed high reactivity to CD23, 27, w75, 39, 40, and NuB1: expression of CD1c was very low and that of 7F7, KiB3, and CD25 was variable. The reactivity of 7F7 and KiB3 was strictly correlated, and they correlated individually with CD25. Results show that the most frequent B-CLL phenotype (CD19+, 5+, 23+, 27+, 39+, NuB1+, KiB3 +/-, 7F7 +/-, and CD25 +/-) corresponds to one or more cellular subsets in the mantle zone. No correlation was found between MoAb expression, surface immunoglobulin (SIg) class or type, clinical stage, disease activity, or age at diagnosis. The only difference (statistically borderline) was the expression of 7F7 and KiB3 (in young versus old patients). This suggests that modulations in the expression of surface antigens do not affect the clinical behavior of the disease.
.A
Baldini L; Cro L; Cortelezzi A; Calori R; Nobili L; Maiolo AT; Polli EE.
.I 274585
.U
91003887
.S
Cancer 9101; 66(8):1743-7
.M
Chromosomes, Human, Pair 18/*; Female; Gene Rearrangement/*; Gene Rearrangement, T-Lymphocyte/*; Genes, Immunoglobulin/*; Hong Kong/EP; Human; Immunoglobulin Joining Region/GE; Immunophenotyping; Lymphoma/EP/*GE/IM; Male; Middle Age.
.T
Rearrangement of immunoglobulin, T-cell receptor, and bcl-2 genes in malignant lymphomas in Hong Kong.
.P
JOURNAL ARTICLE.
.W
The pattern of malignant lymphomas in the Hong Kong Chinese population is characterized by a low incidence of Hodgkin's disease and follicular lymphomas. The authors studied the immunoglobulin (Ig), T-cell receptor (TCR), and bcl-2 gene rearrangement in 62 cases of malignant lymphoma in this population by Southern blot hybridization. Two cases of Hodgkin's disease showed no rearrangement of the Ig and TCR genes. All 42 cases of B-cell lymphoma had Ig heavy chain (JH) rearrangement with or without additional rearrangement of the light chains (C kappa and C lambda). One case of diffuse B-cell lymphoma had additional T-cell receptor beta-chain (C beta) rearrangement. Sixteen of 18 cases of T-cell lymphoma had C beta rearrangement, and one case of T-lymphoblastic lymphoma had additional JH rearrangement. Two of eight (25%) cases of follicular lymphoma but only one of the 34 (2.9%) cases of diffuse B-cell lymphoma had bcl-2 rearrangement that was detected by pFL-1 probe. None of the 62 cases showed bcl-2 rearrangement using the pFL-2 probe. In conclusion, the Ig and TCR gene rearrangement pattern of the lymphomas found in Hong Kong correlates well with the T-cell and B-cell lineage, which is similar to reports in the white population. However, the incidence of bcl-2 gene rearrangement in follicular B-cell lymphoma is lower than that reported in the US but comparable with that in Japan.
.A
Liang R; Chan V; Chan TK; Chiu E; Todd D.
.I 274586
.U
91003888
.S
Cancer 9101; 66(8):1748-54
.M
Adolescence; Cerebrospinal Fluid/*CY; Child; Child, Preschool; Female; Human; Infant; Leukemia, Lymphocytic, Acute, L1/DI/*PA; Leukocyte Count; Leukocytes/*PA; Male; Prognosis; Recurrence.
.T
Significance of blasts in low-cell-count cerebrospinal fluid specimens from children with acute lymphoblastic leukemia.
.P
JOURNAL ARTICLE.
.W
The purpose of this study was to determine whether the presence of more than 5% blasts in a differential count of cytocentrifuged cerebrospinal fluid (CSF) with less than 6 leukocytes/microliter was predictive of central nervous system (CNS) relapse in children with acute lymphoblastic leukemia (ALL). A double concentrate method of cytocentrifuge preparation was used to analyze 4543 consecutive CSF specimens from 349 children with ALL between January 1, 1982, and September 30, 1988. One hundred nine CSF specimens from 58 evaluable children had less than 6 leukocytes/microliter and more than 5% blasts on cytocentrifuge differential count (low-cell-count specimen with blasts [LCB]). During the study period, 25 of 332 evaluable children (7.5%) had CNS leukemic recurrence. In 22 of 25 (88%), the CNS relapse was preceded by at least one abnormal low-cell-count CSF specimen. One of 34 patients with a single LCB at diagnosis (3%) had subsequent CNS relapse compared with five of eight patients (62.5%) with a single LCB during remission (P = 0.0002). Of 16 children with two or more LCB during remission, nine (56%) had CNS relapse defined by standard criteria, whereas six additional patients in this group were declared to be in CNS relapse on the basis of their repetitive LCB. Whether diagnosing CNS recurrence earlier in its course based on a modification of the definition of CNS leukemia will change the frequency of subsequent adverse events or make possible decreased intensity of CNS retreatment remains to be determined.
.A
Odom LF; Wilson H; Cullen J; Bank J; Blake M; Jamieson B.
.I 274587
.U
91003889
.S
Cancer 9101; 66(8):1755-8
.M
Adult; Child; Enzyme Tests/*; Human; Immunophenotyping; Leukemia, Lymphocytic, Acute/BL/*DI/PA; Prognosis; Prospective Studies; Remission Induction; Support, Non-U.S. Gov't; Tumor Markers, Biological/BL; 5'-Nucleotidase/BL/*ME.
.T
Prognostic implication of ecto-5'-nucleotidase activity in acute lymphoblastic leukemia.
.P
CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY.
.W
Ecto-5'-nucleotidase (5'-N) activity was determined in 191 patients (71 children and 120 adults) with acute leukemia. Elevated values for 5'-N were registered in common acute lymphoblastic leukemia (ALL), but blast cells of T-cell ALL (T-ALL) and common ALL antigen-negative non-T-ALL had low enzyme activity comparable with the values of acute non-lymphocytic leukemia. Dependence of remission duration on 5'-N activity was analyzed in 74 adults with ALL, treated similarly in a prospective multicenter trial. The remission curves for ALL patients with 5'-N activity lower than 10 nmol/h x 10(6) cells were substantially and significantly better than those of patients with high activity (greater than 10 nmol/h x 10(6) cells). This difference was also evident in the immunologic subclass common ALL. Statistical evaluation showed that an interaction between immunologic subtype of the blast cells and their 5'-N activity had prognostic significance for remission duration. In addition to the independent factor, initial age, this interaction was also prognostic for survival.
.A
Gutensohn W; Thiel E.
.I 274588
.U
91003890
.S
Cancer 9101; 66(8):1759-62
.M
Age Factors; Aged; Human; Middle Age; Receptors, Androgen/*AN; Receptors, Estrogen/*AN; Receptors, Progesterone/*AN; Thyroid Diseases/PA; Thyroid Gland/*CH/PA; Thyroid Neoplasms/*CH/PA.
.T
Sex hormone receptors in human thyroid tissues.
.P
JOURNAL ARTICLE.
.W
The behavior of sex hormone receptors was studied in the cytosol of thyroid tissue samples in order to clarify the effects of sex hormones on diseases of the thyroid. Androgen receptor (AR), estrogen receptor (ER), and progesterone receptor (PgR) were assayed using the dextran-coated charcoal (DCC) method and analyzed by the method of Scatchard. Androgen receptor, ER, and PgR were negative in all of the cytosol prepared from normal thyroid tissues. However, the positive rates for the receptors in the neoplastic and nonneoplastic tissues were 22% for AR, 29% for ER, and 18% for PgR. Especially, the incidence of ER was significantly higher in neoplastic lesions than normal tissues. These data suggest that sex hormones, especially estrogen, may play a role in diseases of the thyroid.
.A
Miki H; Oshimo K; Inoue H; Morimoto T; Monden Y.
.I 274589
.U
91003891
.S
Cancer 9101; 66(8):1763-8
.M
Blotting, Southern; Carcinoma, Oat Cell/CH/*CO/PA; Case Report; DNA, Viral/AN; Human; HTLV-I/GE; HTLV-I Infections/*CO/PA; Lung Neoplasms/CH/*CO/PA; Male; Middle Age; Receptors, Interleukin-2/AN; Support, Non-U.S. Gov't; Tumor Markers, Biological/AN.
.T
Human T-cell leukemia virus type 1 associated with small cell lung cancer.
.P
JOURNAL ARTICLE.
.W
A patient with small cell lung cancer (SCLC) whose serum contained high levels of soluble interleukin-2 receptors is reported. Soluble interleukin-2 receptors in the supernatant of cultured SCLC cells obtained from the patient's pleural effusion while he had malignant pleuritis, increased almost linearly from the time of cell seeding. The expression of interleukin-2 receptors (Tac) on the SCLC cells were demonstrated by an immunofluorescence study. However, other lymphocytic markers, including OKT 11, OKT 4, OKT 8, B 1, and B 4, were not found on the cells with the exception of the natural killer cell marker, NKH-1. Southern blot analysis indicated the rearrangement of the T-cell receptor of the cancer cells. Moreover, monoclonal integration of human T-cell leukemia virus type 1 (HTLV-1) provirus in DNA from the cancer cells was also demonstrated. These observations suggest that some SCLC in HTLV 1 endemic areas are associated with HTLV-1.
.A
Matsuzaki H; Asou N; Kawaguchi Y; Hata H; Yoshinaga T; Kinuwaki E; Ishii T; Yamaguchi K; Takatsuki K.
.I 274590
.U
91003892
.S
Cancer 9101; 66(8):1769-74
.M
Human; Lewis Blood-Group System/*IM; Phenotype; Precancerous Conditions/*BL/PA; Stomach Neoplasms/*BL/PA; Support, Non-U.S. Gov't.
.T
Lewis system alterations in gastric carcinogenesis.
.P
JOURNAL ARTICLE.
.W
Alterations in the expression of type 1 blood group-related antigens (Lewis a and b) were examined immunohistochemically in 371 consecutives gastric biopsy and 80 surgical specimens from patients of gastric carcinoma. The ABH and Lewis phenotype and secretor status of the patients were correlated with histologic findings. An anomalous expression of Lewis a antigen was found in 88 of 249 gastric biopsy specimens of Lewis (a-b+) phenotype patients. The prevalence of this anomaly increased with the evolution of the premalignant process, in agreement with the commonly accepted model of gastric carcinogenesis. Thus, anomalous Lewis a antigen appeared in 66.6% of gastric dysplasia cases, in 64.6% of intestinal metaplasia, in 15.4% of atrophic gastritis, and in 7.4% of superficial gastritis. No alterations were found in subjects with normal gastric mucosa. Forty-seven of the 49 Lewis (a-b+) phenotype gastric carcinoma patients showed antigenic alterations in tumor cells (anomalous Lewis a antigen in 36 and loss of Lewis antigens in 11). In 26 of these gastric specimens an anomalous Lewis a antigen was present in areas of intestinal metaplasia and/or dysplasia away from the area of neoplastic transformation. The expression of Lewis a antigen in Lewis (a-b+) phenotype patients is a frequent phenomenon in gastric neoplastic cells and could result from the blocked synthesis of Lewis b antigen with accumulation of its precursors. These findings suggest that, during gastric carcinogenesis, antigenic alterations may precede neoplastic transformation. An anomalous Lewis a antigen could constitute a significant index of severity of the histologic lesion and contribute to identifying high-risk individuals.
.A
Torrado J; Blasco E; Gutierrez-Hoyos A; Cosme A; Lojendio M; Arenas JI.
.I 274591
.U
91003893
.S
Cancer 9101; 66(8):1775-80
.M
Adenocarcinoma/CH/*GE/PA; Comparative Study; DNA, Neoplasm/*AN; Female; Human; Lymphatic Metastasis; Male; Middle Age; Stomach Neoplasms/CH/*GE/PA; Support, Non-U.S. Gov't.
.T
Comparison of DNA content in gastric cancer cells between primary lesions and lymph node metastases.
.P
JOURNAL ARTICLE.
.W
Cytophotomtric DNA contents of tumor cells in primary lesions and the corresponding metastatic lymph nodes were compared in 61 cases of gastric cancer to determine whether the DNA content remains stable during lymph node metastasis. The DNA distribution patterns were grouped into three types, according to the proportion of aneuploid cell population. Changes in DNA patterns between primary and metastatic lesions were evident in 36 of 61 patients (59.0%); in the remaining 25 (41.0%), the same DNA distribution patterns were noted for both lesions. In 33 of these 36, DNA pattern in the primary carcinoma was transformed into a more narrowly scattered one in the metastatic lesion of the lymph node. Mean and modal values and the frequency of cells over tetraploid (4c) or hexaploid (6c) were significantly higher in the primary lesion compared with findings in the metastatic lesions. This reduction in DNA content in the metastatic lesions was a more frequent occurrence in differentiated (18 of 23) than in undifferentiated adenocarcinoma (15 of 35) (P less than 0.01). Therefore, in primary lesions with a widely scattered DNA ploidy, the tumor cells with a smaller DNA ploidy frequently metastasized to lymph nodes, particularly in cases of a differentiated carcinoma. Such observations may be pertinent in future designing of treatment protocols.
.A
Baba H; Korenaga D; Okamura T; Sugimachi K.
.I 274592
.U
91003894
.S
Cancer 9101; 66(8):1781-8
.M
Aged; Antineoplastic Agents, Combined/*TU; Bleomycins/AD; Case Report; Cyclophosphamide/AD; Doxorubicin/AD; Etoposide/AD; Female; Human; Immunohistochemistry; Leucovorin/AD; Lymphoma, Large-Cell/DI/DT/*PA; Male; Methotrexate/AD; Middle Age; Prednisone/AD; Procarbazine/AD; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Vincristine/AD.
.T
Angiotropic (intravascular) large cell lymphoma. A clinicopathologic study of seven cases with unique clinical presentations.
.P
JOURNAL ARTICLE.
.W
The authors recently reported the antigenic phenotypes of three cases of so-called "malignant angioendotheliomatosis" and suggested that angiotropic large cell lymphoma (ALCL) is a more appropriate designation for this disease. The authors now report an additional seven cases of ALCL with unique clinical presentations. One patient presented with prostate enlargement, the second with lytic bone lesions and thickened nasal sinus mucosa, the third had diffuse myalgia, the fourth had dyspnea and pulmonary infiltrates, the fifth had gangrene of the lower extremities, total-body skin involvement, and pancytopenia, the sixth had a lesion of the foreskin mimicking squamous cell carcinoma, and the seventh had a mediastinal mass. In all cases histologic features were characteristic of ALCL with, in two cases, extravascular spread into soft tissue. Immunohistologic studies showed a B-cell phenotype in five cases and a T-cell phenotype in one case. Two patients received combination chemotherapy using established treatment protocol for large cell lymphoma, and remain in complete clinical remission and two patients are responding clinically to combination chemotherapy. Two patients died shortly after receiving combination chemotherapy. One patient has only recently been diagnosed as having ALCL and no long-term follow-up is available. These data indicate that, although ALCL affects predominantly the central nervous system and skin, unusual clinical presentations may occur, and patients with ALCL may respond to combination chemotherapy for large cell lymphoma.
.A
Stroup RM; Sheibani K; Moncada A; Purdy LJ; Battifora H.
.I 274593
.U
91003895
.S
Cancer 9101; 66(8):1789-95
.M
Actuarial Analysis; Adult; Aged; Carcinoma/*GE/MO/PA/RT; Carcinoma, Squamous Cell/*GE/MO/PA/RT; DNA, Neoplasm/*AN; Female; Flow Cytometry; Human; Male; Middle Age; Nasopharyngeal Neoplasms/*GE/MO/PA/RT; Prognosis; Retrospective Studies; Support, Non-U.S. Gov't; Survival Analysis.
.T
A clinical and flow cytometric analysis of patients with nasopharyngeal cancer.
.P
JOURNAL ARTICLE.
.W
Abnormal cellular DNA content, a hallmark of malignancy, is known to be an important prognostic factor in many human solid tumors; however, no data have been published on whether cellular DNA content carries prognostic significance for patients with nasopharyngeal cancer (NPC). Archival, formalin-fixed, paraffin-embedded pathology specimens representing pretreatment tissue biopsies from 55 patients (41 men and 14 women) with NPC were analyzed for cellular DNA content in a retrospective fashion from 1968 to 1988. Individual tumors were classified as either lymphoepithelioma, squamous cell, or anaplastic carcinoma, and were staged according to International Union Against Cancer (UICC) criteria. All patients were treated with curative intent using a 4 to 6 MeV linear accelerator to total doses ranging from 50 to 60 Gy in 4 to 6 weeks. The overall 5-year actuarial survival for all 55 patients was 44.4% (men, 41%; women, 52%). Survival by T stage was as follows: T1, 65%; T2, 51%; T3, 36%; and T4, 27%. Similarly, the 5-year survival rate declined as the bulk of nodal metastases increased: N0, 62%; N2, 50%; N3, 37%; and N1, 25%. Patients who had anaplastic carcinoma had a 5-year survival of 73%, those with lymphoepithelioma had a 60% survival, and those with squamous cell cancer (SCC) had a 30% survival. There was a statistically significant difference in 5-year survival between patients with SCC and those with nonkeratinizing histologies (P less than 0.05). In addition, there was a significant association between patients older than 40 years of age with SCC and patients younger than 40 years of age with nonkeratinizing malignancies (P less than 0.01). Of the 55 tumors successfully analyzed, 22 (40%) were diploid and 33 (60%) were aneuploid. The mean coefficient of variation (CV) of all 55 samples was 6.17%. There was no significant difference in 5-year survival between patients with diploid and those with aneuploid tumors (48% versus 42%). Furthermore, there was no statistically significant survival difference between aneuploid and diploid tumors within any one histologic subgroup. There was also no significant survival difference related to the DNA index. The results indicate that the extent of local tumor spread is still the most important prognostic factor for patients treated with radiotherapy for NPC. The data support the conclusion that patients with lymphoepithelioma and anaplastic carcinomas have a superior survival to patients with squamous cell carcinoma.(ABSTRACT TRUNCATED AT 400 WORDS)
.A
Costello F; Mason BR; Collins RJ; Kearsley JH.
.I 274594
.U
91003896
.S
Cancer 9101; 66(8):1796-801
.M
Aged; Carcinoma, Mucinous/*PA/UL; Case Report; Female; Human; Microscopy, Electron; Submandibular Gland Neoplasms/*PA/UL.
.T
Mucinous adenocarcinoma of the submandibular gland.
.P
JOURNAL ARTICLE.
.W
A rare tumor not easily classifiable among published histologic categories for salivary gland tumors is reported. The neoplasm developed within the submandibular gland of a 78-year-old woman with invasion of the mandible and metastasis to regional lymph nodes. Histopathologically, cuboidal cells possessing clear cytoplasm and displaced round nuclei proliferated and exhibited an adenomatous pattern. Many cystic spaces surrounded by tumor cell strands were seen, mucus substance filled in the cystic spaces, and the tumor cells seemed mucus-secreting, but neither epidermoid cells nor papillary appearance could be observed. Electromicroscopically, numerous mucous droplets of low electron density were prominent in the cytoplasm, and the tumor cells had sparse irregular microvilli on the luminal surface. Mucin histochemistry, including paradoxical concanavalin A staining, revealed that the tumor cells contained neutral and acid mucins, and these were identified as class II and III mucosubstances. No other neoplastic lesion, except recurrent metastatic neck nodes, has been detected 6 years after the first examination, and it seems that the tumor is a rare primary mucinous adenocarcinoma of the submandibular gland.
.A
Osaki T; Hirota J; Ohno A; Tatemoto Y.
.I 274595
.U
91003898
.S
Cancer 9101; 66(8):1810-6
.M
Antineoplastic Agents, Combined/TU; Breast Neoplasms/CH/*GE/PA/TH; Combined Modality Therapy; Drug Therapy, Combination; DNA, Neoplasm/*AN; Female; Flow Cytometry; Human; Lymphatic Metastasis; Mastectomy, Modified Radical; Menopause; Ploidies/*; Prognosis; Receptors, Estrogen/*AN; Receptors, Progesterone/*AN; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Tamoxifen/TU.
.T
The use of flow cytometry for the prognosis of stage II adjuvant treated breast cancer patients.
.P
JOURNAL ARTICLE.
.W
Characterization of breast cancer cells by histology, flow cytometry, and steroid receptors was performed on 197 Stage II breast node positive cancer patients given adjuvant chemotherapy, plus tamoxifen for patients with positive hormone receptors. Histologic and steroid receptor assays were performed using standard techniques; flow cytometric analysis was performed from paraffin-embedded blocks obtained from the primary tumor. Quality control studies on reproducibility, tissue heterogeneity, and analysis procedures have been included. Of the 197 patients studied, aneuploidy was found in 102 (52%); the median %S value was 8% with a range of 0.4% to 38%. Our results demonstrated that number of positive nodes, receptor status, and grade were of prognostic value. Cell cycle kinetic data were not of independent prognostic value in this series. However, ploidy could differentiate in prognosis in the receptor-negative subgroup. Patients with receptor-negative tumors had a significantly better overall survival if the tumor was diploid in nature. Cell kinetics was not significantly prognostic for either receptor subgroup, although patients with higher %S tended to have better relapse-free and overall survival. This is in disagreement with other studies and may demonstrate that treatment has confounded our results and diminished the ability of flow cytometry data to help predict outcome.
.A
Kute TE; Muss HB; Cooper MR; Case LD; Buss D; Stanley V; Gregory B; Galleshaw J; Booher K.
.I 274596
.U
91003899
.S
Cancer 9101; 66(8):1817-27
.M
Adenocarcinoma/*DI/PA; Antibodies, Monoclonal/*DU/IM; Biopsy, Needle; Carcinoma/*DI/PA; Carcinoma, Squamous Cell/*DI/PA; Comparative Study; Diagnosis, Differential; Female; Fluorescent Antibody Technique; Human; Immunohistochemistry; Intermediate Filaments/IM; Lung Neoplasms/*DI/PA; Male; Smoking/PA; Support, Non-U.S. Gov't.
.T
Immunocytochemical characterization of lung tumors in fine-needle aspiration. The use of cytokeratin monoclonal antibodies for the differential diagnosis of squamous cell carcinoma and adenocarcinoma.
.P
JOURNAL ARTICLE.
.W
In the current study, immunocytochemical typing of intermediate filaments was used for a differential diagnosis of human lung tumors from transthoracic fine-needle aspiration biopsies (TFNAB). The authors have compared the cytologic diagnosis of 53 lung cancer cases with the immunofluorescence patterns obtained using a panel of monoclonal antibodies, five of which (KG 8.13, KM 4.62, Ks B.17, KS 8.12, KK 8.60) react with specific cytokeratin polypeptides and one with vimentin (VIM 13.2). Only in six of 23 samples cytologically diagnosed as squamous cell carcinoma did the immunocytochemical typing of cytokeratins (ICTC) confirm the cytologic diagnosis. In seven cases some of the tumor cells stained positively with antibody Ks B.17 specific for simple epithelial keratin (No: 18), suggesting the presence of some cells of glandular origin. In ten additional cases the ICTC was in conflict with the cytologic diagnosis of squamous cell carcinoma (i.e., antibodies Ks 8.12 and KK 8.60 were negative, and antibody Ks B.17, positive) supporting a diagnosis of adenocarcinoma. In 14 of 18 cases cytologically diagnosed as adenocarcinoma, the ICTC confirmed the diagnosis whereas in four cases additional presence of some squamous cells was noticed. The ICTC labeling of cases cytologically diagnosed as undifferentiated and large cell carcinomas was similar to that of the group of adenocarcinomas. Thus, the application of cytokeratin typing for TFNAB samples seems to provide a vital complementation to routine cytologic study, especially for cases cytologically diagnosed as squamous carcinoma.
.A
Bruderman I; Cohen R; Leitner O; Ronah R; Guber A; Griffel B; Geiger B.
.I 274597
.U
91003900
.S
Cancer 9101; 66(8):1828-32
.M
Adenocarcinoma/MO/*PA; Comparative Study; Human; Japan; Lymphatic Metastasis; Neoplasm Staging/*MT; Stomach Neoplasms/MO/*PA; Support, Non-U.S. Gov't; United States.
.T
Comparison of the conventional method of lymph node staging with a comprehensive fat-clearing method for gastric adenocarcinoma.
.P
JOURNAL ARTICLE.
.W
Discrepant results in long-term survival between United States and Japanese patients with resectable gastric adenocarcinoma may result from more accurate staging in the Japanese series. The authors compared a comprehensive fat-clearing method with the conventional pathology method of lymph node sampling in 11 patients undergoing curative gastrectomy and extended lymphadenectomy at their institution. Comprehensive fat-clearing doubled total lymph node counts (P less than 0.01), identified smaller lymph nodes (P less than 0.001), and identified more histologically involved nodes of significantly smaller size (P less than 0.001). Comprehensive fat-clearing pathologically upstaged 29% of the authors' eligible specimens. Accurate pathologic staging is necessary when comparing Japanese and United States survival data for resectable gastric adenocarcinomas.
.A
Candela FC; Urmacher C; Brennan MF.
.I 274598
.U
91003901
.S
Cancer 9101; 66(8):1833-5
.M
Adrenal Gland Neoplasms/*BL/DI; Adult; Aged; Diagnosis, Differential; Female; Human; Male; Middle Age; Neuropeptide Y/*BL; Pheochromocytoma/*BL/DI; Phosphopyruvate Hydratase/*BL; Tumor Markers, Biological/BL.
.T
Neuropeptide Y and neuron-specific enolase levels in benign and malignant pheochromocytomas.
.P
JOURNAL ARTICLE.
.W
Neuron-specific enolase (NSE) is the isoform of enolase, a glycolytic enzyme found in the neuroendocrine system. Neuropeptide Y (NPY) is a peptide recently discovered in the peripheral and central nervous systems. Serum NSE and plasma NPY levels have been reported to be increased in some patients with pheochromocytoma. The authors evaluated whether the measurement of these molecules could help to discriminate between benign and malignant forms of pheochromocytoma. The NSE levels were normal in all patients with benign pheochromocytoma (n = 13) and elevated in one half of those with malignant pheochromocytoma (n = 13). Plasma NPY levels were on the average significantly higher in the malignant (177.1 +/- 38.9 pmol/l, n = 16) than in the benign forms of the disease (15.7 +/- 389 pmol/l, n = 24). However, there was no difference in the percentage of patients with elevated NPY levels. These results show that determination of serum NSE may be useful for distinguishing between malignant and benign pheochromocytoma; the measurement of plasma NPY is not useful for differentiating the two kinds of tumors.
.A
Grouzmann E; Gicquel C; Plouin PF; Schlumberger M; Comoy E; Bohuon C.
.I 274599
.U
91003902
.S
Cancer 9101; 66(8):1836-42
.M
Aged; Bladder Neck Obstruction/ET; Bladder Neoplasms/CO/*PA/TH/UL; Case Report; Combined Modality Therapy; Histiocytoma/CO/*PA/TH/UL; Human; Male; Microscopy, Electron.
.T
Myxoid malignant fibrous histiocytoma of the bladder.
.P
JOURNAL ARTICLE.
.W
Although the most common soft tissue sarcoma of adulthood, malignant fibrous histiocytoma (MFH) is an extremely rare tumor of the urinary bladder. Only three well-documented cases have been reported in the world literature. The patient presented in this report represents the first case of the myxoid variant to develop in the urinary bladder. Whereas all previous patients with MFH of the bladder had intermittent hematuria, this patient's chief complaint was bladder outlet obstruction due to extension of the tumor into the prostate. He was managed with radical cystoprostatectomy, postoperative radiation therapy to the tumor bed, and adjuvant chemotherapy using doxorubicin. The patient tolerated the therapy well and was disease-free at the 3-year follow-up visit. The histogenesis, clinical features, pathologic characteristics, and treatment considerations of this rare bladder tumor are discussed in detail.
.A
Oesterling JE; Epstein JI; Brendler CB.
.I 274600
.U
91003903
.S
Cancer 9101; 66(8):1843-9
.M
Adenocarcinoma/GE/PA/SC; Carcinoma/GE/PA/SC; Diagnosis, Differential; DNA, Neoplasm/*AN; Female; Flow Cytometry; Human; Likelihood Functions; Neoplasms, Multiple Primary/DI/*GE/PA; Ovarian Neoplasms/*GE/PA/SC; Ploidies/*; Uterine Neoplasms/*GE/PA/SC.
.T
Flow cytometric DNA-ploidy analysis of synchronously occurring multiple malignant tumors of the female genital tract.
.P
JOURNAL ARTICLE.
.W
In this study the authors applied flow cytometric DNA-ploidy analysis to multiple female genital tract malignant tumors in 43 patients, most of whom (n = 37) had bilateral ovarian cancer. An algorithm was developed for calculation of the likelihood ratio of the probabilities that measured DNA index differences between multiple tumor localizations within the same patient could be attributed to measurement variation or to true biologic DNA content differences. The results of this statistical analysis show that in 72% of the cases (31 of 43) this probability ratio exceeded 1. Because the probability that two independent tumors will have a near-identical aneuploid DNA content is very low, this finding supports a metastatic process rather than the occurrence of multiple primary tumors in these patients. Thus, flow cytometric DNA-ploidy analysis can be helpful in the identification of metastatic disease in patients with multiple female genital tract malignant tumors.
.A
Smit VT; Fleuren GJ; van Houwelingen JC; Zegveld ST; Kuipers-Dijkshoorn NJ; Cornelisse CJ.
.I 274601
.U
91003904
.S
Cancer 9101; 66(8):1850-5
.M
Adolescence; Adult; Aged; Aged, 80 and over; Child; Female; Hong Kong; Human; Lymphoma, Non-Hodgkin's/*MO/PA; Male; Middle Age; Neoplasm Staging; Support, Non-U.S. Gov't; Survival Analysis.
.T
Histologic subtypes and survival of Chinese patients with non-Hodgkin's lymphomas.
.P
JOURNAL ARTICLE.
.W
The histologic subtypes and survival of 840 Chinese patients with non-Hodgkin's lymphoma (NHL) were reviewed. All cases were classified according to the Rappaport and Kiel systems and the Working Formulation (WF). A low incidence of nodular/follicular lymphomas (12%) was observed. The most common histologic subtypes were diffuse histiocytic, diffuse centroblastic, and diffuse large cell lymphomas, according to Rappaport, Kiel, and the WF, respectively. A high proportion (24%) of the cases were unclassifiable, according to Kiel, because of the precise terms of the classification. The "favorable"-prognosis NHL, according to Rappaport, or the low-grade NHL, according to Kiel and the WF, had a more indolent clinical course. However, except for the nodular mixed (Rappaport) or follicular mixed (WF) lymphomas which appeared to behave like the more aggressive NHL, a plateau was not seen in the survival curves of our patients with other kinds of favorable-prognosis or low-grade NHL, indicating the lack of curative potential of these tumors. The lymphoplasmacytoid lymphoma, according to Kiel, also appeared to have a more aggressive clinical course. A plateau was seen in most of the other survival curves of patients with the more aggressive tumors, indicating the prospect of cure. However, the prognosis of the very aggressive tumors such as the diffuse lymphoblastic and diffuse small noncleaved cell lymphomas, according to the WF, remains very poor with a median survival of less than 10 months.
.A
Liang R; Loke SL; Ho FC; Chiu E; Chan TK; Todd D.
.I 274602
.U
91003905
.S
Cancer 9101; 66(8):1856-60
.M
Agammaglobulinemia/ET; Antineoplastic Agents, Combined/*TU; Case Report; Child; Cyclophosphamide/AD; Dexamethasone/TU; Doxorubicin/AD; Drug Therapy, Combination; DNA, Viral/AN; Epstein-Barr Virus/GE; Human; Lymphoma, B-Cell/CO/*DI/DT/MI; Male; Meningeal Neoplasms/CO/*DI/DT/MI; Methotrexate/AD; Vincristine/AD.
.T
Primary leptomeningeal B-cell lymphoma in a 8-year-old child.
.P
JOURNAL ARTICLE.
.W
A case of primary leptomeningeal B-cell lymphoma in an 8-year-old, previously healthy child is described. The child was found to have hypogammaglobulinemia, and the Epstein-Barr virus genome was identified in cultured tumor cells despite blood serology being negative for the virus. The patient was treated with cyclophosphamide, doxorubicin, vincristine, and dexamethasone, plus intrathecal methotrexate, and initially improved. Before the initiation of craniospinal radiation, the patient developed progressive disease, deteriorated, and died 9 months after the onset of symptoms.
.A
Hayani A; Venger BH; Rouah E; Laurent JP; Mahoney DH; McClain KL.
.I 274603
.U
91004180
.S
Cathet Cardiovasc Diagn 9101; 20(4):227-37
.M
Adult; Aged; Aged, 80 and over; Angioplasty, Transluminal, Percutaneous Coronary/*MT; Combined Modality Therapy; Comparative Study; Coronary Disease/*TH; Coronary Vessels/RA; Double-Blind Method; Female; Follow-Up Studies; Human; Male; Methylprednisolone/AD; Middle Age; Myocardial Infarction/*TH; Recurrence; Support, Non-U.S. Gov't.
.T
Multi-Hospital Eastern Atlantic Restenosis Trial: design, recruitment, and feasibility. M-HEART Investigators.
.P
CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL.
.W
A randomized control trial was set up to examine factors that influence restenosis and determine the effects of corticosteroids on restenosis following successful PTCA. The rationale for the study agent chosen, design, recruitment, and feasibility, as well as initial patient demographic data and initial results are presented.
.A
Hill JA; Macdonald RG; Jugo R; Hirshfeld JW Jr; Goldberg S; Savage MP; Vetrovec G; Cowley M; Bass TA; Margolis JR; et al.
.I 274604
.U
91004181
.S
Cathet Cardiovasc Diagn 9101; 20(4):238-40
.M
Adult; Angioplasty, Transluminal, Percutaneous Coronary/*IS; Case Report; Combined Modality Therapy; Coronary Artery Bypass; Coronary Disease/*TH; Coronary Vessels/*RA; Equipment Failure; Follow-Up Studies; Foreign Bodies/*RA; Human; Male; Postoperative Complications/TH; Recurrence; Reoperation.
.T
Fractured and retained guide-wire fragment during coronary angioplasty--unforeseen late sequelae.
.P
JOURNAL ARTICLE.
.W
During a difficult coronary angioplasty, the tip of the guide wire became inadvertently wedged in a distal vessel, fractured, and retained in situ. Because of the otherwise successful nature of the angioplasty and the patient's great risk for cardiac surgery, it was elected to leave the wire fragment in place. Recurrence of symptoms led to recatheterization, which in addition to restenosis of the original angioplasty site showed diffuse narrowing of the arterial segment that contained the retained wire fragment. This occurred despite systemic anticoagulation with Coumadin in the interval between procedures. Thus retained guide wire fragments in patent coronary arteries may cause arterial narrowing despite systemic anticoagulation.
.A
Doorey AJ; Stillabower M.
.I 274605
.U
91004182
.S
Cathet Cardiovasc Diagn 9101; 20(4):241-3
.M
Adult; Angina, Unstable/RA; Case Report; Chest Pain/RA; Coronary Vessel Anomalies/GE/*RA; Coronary Vessels/*RA; Diagnosis, Differential; Human; Karyotyping; Klinefelter's Syndrome/GE/*RA; Male; Periostitis/RA.
.T
Klinefelter's syndrome with anomalous origin of left main coronary artery [see comments]
.P
JOURNAL ARTICLE.
.W
Klinefelter's syndrome is a rare entity. Even rarer is an anomalous origin of the Left Main Coronary Artery. For both conditions to occur in the same patient is hence exceedingly rare. Reported here is a never previously reported case of a coronary congenital anomaly in a patient with Klinefelter's syndrome together with the proper angiographic approach.
.A
Albazzaz SJ.
.I 274606
.U
91004183
.S
Cathet Cardiovasc Diagn 9101; 20(4):244-6
.M
Adult; Angioplasty, Transluminal, Percutaneous Coronary/*IS; Aortography; Case Report; Coronary Disease/*TH; Equipment Failure; Femoral Artery/*RA; Heart Catheterization/*IS; Human; Iliac Artery/*RA; Male; Recurrence.
.T
Entrapment of a folded-over introducer sheath in the iliofemoral artery: an unusual complication of PTCA guiding catheter exchange [see comments]
.P
JOURNAL ARTICLE.
.W
An arterial introducer sheath became folded over in the iliac artery during PTCA. This probably resulted from withdrawal of a doubled over Judkins left coronary guiding catheter through the introducer sheath. Nonsurgical, atraumatic removal was accomplished after the acute bend of the introducer sheath had been withdrawn to the site of arterial entrance.
.A
Marsa RJ; Smith DC; Park JS; Jang GD.
.I 274607
.U
91004184
.S
Cathet Cardiovasc Diagn 9101; 20(4):247-50
.M
Angioplasty, Transluminal, Percutaneous Coronary/*IS; Case Report; Coronary Vessels/*/RA; Emergencies/*; Equipment Failure; Foreign Bodies/*TH; Human; Male; Middle Age; Myocardial Infarction/RA/*TH.
.T
An alternative method for transcatheter retrieval of intracoronary angioplasty equipment fragments.
.P
JOURNAL ARTICLE.
.A
Mintz GS; Bemis CE; Unwala AA; Hadjimiltiades S; Kimbiris D.
.I 274608
.U
91004185
.S
Cathet Cardiovasc Diagn 9101; 20(4):251-3
.M
Angiography; Angioplasty, Transluminal/*MT; Arterial Occlusive Diseases/RA/*TH; Case Report; Human; Intermittent Claudication/TH; Ischemia/RA/*TH; Leg/*BS; Male; Middle Age; Support, Non-U.S. Gov't.
.T
Retrograde recanalization of an occluded posterior tibial artery by using a posterior tibial cutdown: two case reports.
.P
JOURNAL ARTICLE.
.W
Recanalization of two occluded posterior tibial arteries was successfully achieved by utilizing a retrograde approach via a posterior tibial artery cutdown at the level of the ankle. Both cases were previously unsuccessfully attempted by using an antegrade approach. Thus, the choice of access vessel (arterial entry site) becomes a crucial determinant of angioplasty success.
.A
Iyer SS; Dorros G; Zaitoun R; Lewin RF.
.I 274609
.U
91004186
.S
Cathet Cardiovasc Diagn 9101; 20(4):254-6
.M
Angioplasty, Transluminal/*IS; Atherosclerosis/RA/*TH; Case Report; Combined Modality Therapy; Endarterectomy/*IS; Human; Hypertension, Renovascular/TH; Male; Middle Age; Recurrence; Renal Artery/RA; Renal Artery Obstruction/RA/*TH.
.T
Percutaneous high-speed rotational atherectomy (Rotablator) of a restenosed ostial renal artery: a case report.
.P
JOURNAL ARTICLE.
.A
Zaitoun R; Dorros G; Iyer SS; Lewin RF.
.I 274610
.U
91004187
.S
Cathet Cardiovasc Diagn 9101; 20(4):257-60
.M
Angina Pectoris/TH; Angioplasty, Transluminal, Percutaneous Coronary/*IS; Case Report; Coronary Disease/RA/*TH; Coronary Vessels/RA; Heart Catheterization/*IS; Human; Male; Middle Age.
.T
Use of the Arani Guiding Catheter with a twist.
.P
JOURNAL ARTICLE.
.A
Rizzo TF; Silverstein DK.
.I 274611
.U
91004188
.S
Cathet Cardiovasc Diagn 9101; 20(4):261-6
.M
Angiography/*IS; Angioplasty, Transluminal, Percutaneous Coronary/*IS; Coronary Disease/RA/*TH; Coronary Vessels/RA; Heart Catheterization/*IS; Human.
.T
Angioplasty of small-diameter coronary arteries using an angiographic catheter and probe.
.P
JOURNAL ARTICLE.
.A
Webb JG; Myler RK; Stertzer SH; Guermonprez JL; Jais JM; Maouad J.
.I 274612
.U
91004189
.S
Cathet Cardiovasc Diagn 9101; 20(4):267-70
.M
Animal; Blood Coagulation/*DE; Embolization, Therapeutic/*IS; Heparin/*AD; Polyethylene Terephthalate/*; Steel/*; Vascular Patency/DE; Whole Blood Coagulation Time.
.T
Systemic heparinization does not prevent clot formation in coil embolization.
.P
JOURNAL ARTICLE.
.W
Therapeutic transcatheter closure with Gianturco-type steel coils has been applied to a variety of vascular communications in children with congenital heart disease. Vessel closure depends upon successful thrombus formation around the coil. Since systemic anticoagulation with heparin is commonly used during catheterization and cardiac surgery, we studied the effect of systemic heparinization on the efficiency of vessel occlusion by coil embolization in lambs. Catheters inserted in femoral arteries were used to arteriographically locate and size 36 systemic arteries in 9 lambs weighing 4.2 to 7.4 kg. Twenty-four vessels were embolized prior to heparinization with 400 u/kg heparin, IV. Effective anticoagulation was demonstrated by post-heparin activated clotting time (ACT) values greater than 300 sec. Seven vessels (29%) were not successfully coil-embolized because of inadequate coil position or distant embolization of the coil; 17 (71%) of these vessels were shown to be successfully occluded by arteriography 6 to 77 min later. After a period of systemic heparinization ranging from 71 to 159 min, 9/17 arteries remained occluded, 7/17 could not be examined arteriographically due to early demise of the animal, and only 1/17 showed recanalization. A second group of 12 vessels were embolized after heparinization. Eight (75%) were successfully occluded, and 4 (25%) were not successfully coil-embolized because of inadequate coil position or coil embolization to distant arteries. We conclude that systemic heparinization had no measurable effect on occlusion rates in coil-embolized systemic arteries in the lamb. These data support the use of systemic heparinization, when indicated, during or following therapeutic coil embolization in children.
.A
Johnson WH Jr; Peterson RK; Howland DF; Lock JE.
.I 274613
.U
91004190
.S
Cathet Cardiovasc Diagn 9101; 20(4):271-5
.M
Aortic Valve/*PP; Aortic Valve Stenosis/DI/*PP; Blood Pressure/*PH; Heart Catheterization/*; Human; Support, U.S. Gov't, Non-P.H.S..
.T
Simplified method for estimating true aortic valve mean gradient from simultaneous left ventricular and peripheral arterial pressure recordings.
.P
JOURNAL ARTICLE.
.W
Estimation of the aortic valve gradient by simultaneous recording of left ventricular and peripheral arterial pressures is subject to error due to delay and modulation of the arterial pressure contour as it propagates from the ascending aorta. This error can be corrected by averaging the mean gradients derived from unaltered and temporally aligned simultaneous left ventricular-peripheral arterial pressure tracings. In 26 patients with aortic stenosis and simultaneous recordings of ascending aortic and femoral arterial pressure we compared this method with a simplified approach in which the peripheral arterial pressure is partially aligned by advancing it against the left ventricular pressure by 50% of the time delay of the simultaneously recorded upstrokes. Gradients measured this way predicted the true aortic valve gradients (left ventricular-ascending aortic) with a mean difference of +1.1 mm Hg (range = +10 to -5 mm Hg). We recommend use of this simplified method of correction because it predicts true aortic valve gradient equally well as the averaging technique (r = 0.977 vs. 0.979) and requires half the time and effort.
.A
Folland ED; Parisi AF; Comei C.
.I 274614
.U
91004191
.S
Cathet Cardiovasc Diagn 9101; 20(4):276-8
.M
Adult; Aged; Aged, 80 and over; Angioplasty, Transluminal, Percutaneous Coronary/*IS; Coronary Disease/*TH; Heart Catheterization/*IS; Human; Middle Age; Myocardial Reperfusion/*IS.
.T
Experience with the use of coronary autoperfusion catheter during complicated angioplasty.
.P
JOURNAL ARTICLE.
.W
Between February and July of 1989, 22 patients underwent the use of the Stack autoperfusion catheter following acute occlusion or obstructive dissection during coronary angioplasty; in 20 cases conventional balloon was used in an attempt to correct the angiographic appearance followed by the use of Stack catheter when results were sub-optimal. Only 1 patient (4.5%) required surgical revascularization. Although our study is not prospective or randomized, our observations suggest a significant impact in decreasing the need for emergency surgical revascularization after complicated coronary angioplasty with the use of this approach.
.A
Saenz CB; Schwartz KM; Slysh SJ; Palanca K; Curry RC Jr.
.I 274615
.U
91004192
.S
Cathet Cardiovasc Diagn 9101; 20(4):287
.M
Comparative Study; Contrast Media/*; Coronary Vessels/*RA; Diatrizoate/*AE; Diatrizoate Meglumine/*AE; Drug Combinations; Human; Iopamidol/*AE; Risk Factors; Ventricular Fibrillation/*CI.
.T
Ventricular fibrillation during coronary arteriography [letter; comment]
.P
COMMENT; LETTER.
.A
Hirshfeld JW Jr.
.I 274616
.U
91004193
.S
Cathet Cardiovasc Diagn 9101; 21(1):1-6
.M
Angioplasty, Transluminal, Percutaneous Coronary/*AE; Comparative Study; Coronary Arteriosclerosis/*ET/RA; Coronary Vessels/IN/RA; Female; Follow-Up Studies; Human; Male; Middle Age; Prospective Studies; Recurrence; Time Factors.
.T
Does percutaneous transluminal coronary angioplasty accelerate atherosclerotic lesions?
.P
JOURNAL ARTICLE.
.W
Recent reports have suggested that angioplasty may cause or accelerate coronary arterial stenoses secondary to traumatic injury. Ninety-four coronary angiograms performed in a 1 yr period were reviewed in patients who had successful coronary angioplasty 6 to 30 mo (mean 10.7) prior to restudy. Restenosis was found in 43 of 140 dilated lesions (31%) and in 41 of 94 patients (44%). Thirty-three (35%) patients had new or progressive lesions outside the angioplasty site. New or progressive lesions occurred with similar frequency in the arteries that did not have angioplasty (23/155 = 15%) as in the arteries that did (13/127 = 10%; chi-square n.s.). In the arteries which underwent angioplasty, new or progressive lesions occurred as commonly proximal to the PTCA site (7/14, 50%) as distal (6/13, 46%). New or progressive lesions occurred in 29% of patients with concomitant restenosis, and 40% of those without restenosis (chi-square n.s.). No clinical, angiographic, or procedural factors distinguished patients with new and progressive lesions in target vessels from those without these lesions in target vessels. Patients with progressive lesions anywhere in the coronary tree were more likely to have had a shorter duration of anginal symptoms before angioplasty and a family history of coronary disease when compared with patients without progressive atherosclerosis. In conclusion, new and progressive lesions outside the angioplasty site occur after the procedure but appear unrelated to the restenosis process or traumatic injury by angioplasty instrumentation.
.A
Nguyen KP; Shaw RE; Myler RK; Webb JG; Stertzer SH.
.I 274617
.U
91004194
.S
Cathet Cardiovasc Diagn 9101; 21(1):10-2
.M
Acute Disease; Case Report; Diagnosis, Differential; Electrocardiography; Female; Heart Catheterization; Human; Middle Age; Myocardial Infarction/*DI; Myocarditis/*DI/PA; Myocardium/PA.
.T
Myocarditis simulating acute transmural myocardial infarction.
.P
JOURNAL ARTICLE.
.W
A patient with cardiogenic shock had typical electrocardiographic findings of acute anterior transmural myocardial infarction. Cardiac catheterization revealed normal coronary arteries and severe biventricular failure. Postmortem examination confirmed normal coronary arteries; acute myocarditis, but no evidence for infarction, was found. Electrocardiographic changes of myocarditis may be indistinguishable from acute transmural infarction. In suspected cases, cardiac catheterization should be considered prior to thrombolytic therapy.
.A
Chakko S; Woska D; de Marchena E; Morales AR; Castellanos A.
.I 274618
.U
91004195
.S
Cathet Cardiovasc Diagn 9101; 21(1):13-4
.M
Aged; Aorta, Thoracic; Brachiocephalic Veins/*IN; Case Report; Catheterization, Swan-Ganz/*AE; Cineangiography; Human; Jugular Veins/*; Male.
.T
Misplacement of a Swan-Ganz catheter after insertion through the left internal jugular vein.
.P
JOURNAL ARTICLE.
.W
We report a case of perforation of the left brachiocephalic vein after insertion through the left internal jugular vein. Entrapment of air in the balloon occurred, possibly due to high surrounding tissue pressure at its base, preventing deflation. We emphasize the potential hazards of catheterization via the left internal jugular vein.
.A
Unger P; Stoupel E; Berkenboom G.
.I 274619
.U
91004196
.S
Cathet Cardiovasc Diagn 9101; 21(1):15-7
.M
Aged; Angioplasty, Transluminal/IS/*MT; Case Report; Catheterization/IS; Female; Femoral Artery/*; Human; Intermittent Claudication/*TH; Male; Middle Age.
.T
Use of a guiding catheter for contralateral femoral artery angioplasty.
.P
JOURNAL ARTICLE.
.W
We describe a unique method employing a transseptal sheath as a "guiding catheter" that allows contralateral retrograde femoral artery access to perform balloon angioplasty of proximal superficial femoral artery lesions. This technique simplifies arterial access, provides support for crossing lesions, and allows angiographic visualization of target lesions during the procedure.
.A
White CJ; Nguyen M; Ramee SR.
.I 274620
.U
91004197
.S
Cathet Cardiovasc Diagn 9101; 21(1):18-22
.M
Adult; Balloon Dilatation/*; Case Report; Echocardiography; Female; Human; Implants, Artificial; Mitral Valve/SU; Mitral Valve Insufficiency/*SU; Mitral Valve Stenosis/*TH/US.
.T
Percutaneous valvuloplasty in a patient with mitral stenosis following surgical annuloplasty.
.P
JOURNAL ARTICLE.
.W
A case is described in which a patient with a Carpentier-Edwards annuloplasty ring developed mitral stenosis and was treated with percutaneous mitral valvuloplasty. Possible mechanisms for the development of mitral stenosis are briefly discussed.
.A
Saenz CB; Nocero MA; Weaver CJ.
.I 274621
.U
91004198
.S
Cathet Cardiovasc Diagn 9101; 21(1):23-5
.M
Aged; Angiography; Angioplasty, Transluminal, Percutaneous Coronary/*; Case Report; Coronary Arteriosclerosis/*SU/TH; Coronary Vessels/RA/*SU; Emergencies; Human; Male; Myocardial Infarction/TH; Recurrence; Shock, Cardiogenic/*SU/TH; Vascular Patency.
.T
Salvage from cardiogenic shock by atherectomy after failed emergency coronary artery angioplasty.
.P
JOURNAL ARTICLE.
.W
In this case report of a patient undergoing angioplasty for cardiogenic shock during acute myocardial infarction, recurrent occlusion resulted in recurrence of shock. Atherectomy reestablished lasting patency and reversed the patient's hemodynamic collapse. Atherectomy deserves further investigation as a means to salvage vessel patency during unsuccessful coronary angioplasty.
.A
Smucker ML; Sarnat WS; Kil D; Scherb DE; Howard PF.
.I 274622
.U
91004199
.S
Cathet Cardiovasc Diagn 9101; 21(1):26-7
.M
Aged; Balloon Dilatation/*AE; Cardiopulmonary Bypass/*MT; Case Report; Heart Injuries/*ET/TH; Heart Ventricle/IN; Human; Male; Mitral Valve Stenosis/*TH.
.T
Left ventricular rupture complicating percutaneous mitral commissurotomy: salvage using percutaneous cardiopulmonary bypass support.
.P
JOURNAL ARTICLE.
.W
Left ventricular rupture resulting in death has been reported to be a complication of percutaneous mitral commissurotomy. We report a 71-year-old man in whom a left ventricular rupture occurred during percutaneous mitral commissurotomy and resulted in hemodynamic collapse due to acute cardiac tamponade. The patient was stabilized using percutaneously instituted cardiopulmonary bypass support with subsequent repair of the left ventricle and successful mitral valve replacement. Three months later this patient remains in New York Heart Class I.
.A
Shawl FA; Domanski MJ; Yackee JM; Wish MH; Dullum M; Neimat S.
.I 274623
.U
91004200
.S
Cathet Cardiovasc Diagn 9101; 21(1):28-40
.M
Arteriovenous Fistula/EP/RA; Coronary Vessel Anomalies/*EP/RA; Coronary Vessels/*RA; Female; Human; Incidence; Male; Middle Age; Ohio/EP; Pulmonary Artery/AB.
.T
Coronary artery anomalies in 126,595 patients undergoing coronary arteriography.
.P
JOURNAL ARTICLE.
.W
Coronary artery anomalies were found in 1,686 patients (1.3% incidence) undergoing coronary arteriography at the Cleveland Clinic Foundation from 1960 to 1988. Of the 1,686 patients, 1,461 (87%) had anomalies of origin and distribution, and 225 (13%) had coronary artery fistulae. Most coronary anomalies did not result in signs, symptoms, or complications, and usually were discovered as incidental findings at the time of catheterization. Eighty-one percent were "benign" anomalies: 1) separate origin of the left anterior descending and circumflex from the left sinus of Valsalva; 2) ectopic origin of the circumflex from the right sinus of Valsalva; 3) ectopic coronary origin from the posterior sinus of Valsalva; 4) anomalous coronary origin from the ascending aorta; 5) absent circumflex; 6) intercoronary communications; and 7) small coronary artery fistulae. Other anomalies may be associated with potentially serious sequelae such as angina pectoris, myocardial infarction, syncope, cardiac arrhythmias, congestive heart failure, or sudden death. Potentially serious anomalies include: 1) ectopic coronary origin from the pulmonary artery; 2) ectopic coronary origin from the opposite aortic sinus; 3) single coronary artery; and 4) large coronary fistulae. Coronary artery anomalies require accurate recognition, and at times, surgical correction.
.A
Yamanaka O; Hobbs RE.
.I 274624
.U
91004201
.S
Cathet Cardiovasc Diagn 9101; 21(1):41-4
.M
Case Report; Coronary Vessels/*RA; Electrocardiography/*; Female; Heart Catheterization; Human; Middle Age; Myocardial Infarction/*DI/RA.
.T
Reciprocal ECG changes in acute myocardial infarction and angiographic correlation [clinical conference]
.P
CLINICAL CONFERENCE; JOURNAL ARTICLE.
.A
Porter TR; Vetrovec GW.
.I 274625
.U
91004202
.S
Cathet Cardiovasc Diagn 9101; 21(1):45-50
.M
Angioplasty, Transluminal, Percutaneous Coronary/*IS/MO; Animal; Comparative Study; Coronary Circulation/*PH; Coronary Disease/PC; Coronary Vessels/*; Dogs; Electrocardiography; Female; Male; Support, Non-U.S. Gov't.
.T
Left main percutaneous transluminal coronary angioplasty with the autoperfusion catheter in an animal model.
.P
JOURNAL ARTICLE.
.W
Left main coronary angioplasty is associated with high risk because of interruption of blood flow to much of the left ventricle during balloon inflation. An "autoperfusion" balloon angioplasty catheter that allows blood to flow passively distal to an inflated balloon was tested in dogs and compared with inflations with standard balloon catheters. During 3 min occlusions of the left main coronary artery with the autoperfusion catheter, regional myocardial blood flow was preserved at 0.60 +/- 0.14 ml/min/g, compared with 0.07 +/- 0.03 ml/min/g during inflation with standard balloon catheters (P less than 0.01). Similarly, at the end of 3 min of inflation, left ventricular systolic pressure and dP/dt were maintained with autoperfusion catheter inflation, but they were severely depressed after standard angioplasty balloon inflation. All seven dogs survived autoperfusion balloon inflation, whereas five of seven developed sustained ventricular tachycardia and/or ventricular fibrillation during or after standard balloon inflation. Thus, distal blood flow, hemodynamics, and survival were preserved during autoperfusion balloon inflation in the left main coronary artery.
.A
Turi ZG; Rezkella S; Campbell CA; Kloner RA.
.I 274626
.U
91004203
.S
Cathet Cardiovasc Diagn 9101; 21(1):51-4
.M
Aged; Angiography/MT; Aortic Valve Stenosis/*DI; Coronary Vessels; Fluoroscopy; Heart Catheterization/IS/*MT; Human; Support, U.S. Gov't, P.H.S..
.T
A rapid, effective technique for retrograde crossing of valvular aortic stenosis using standard coronary catheters [see comments]
.P
JOURNAL ARTICLE.
.W
Retrograde crossing of valvular aortic stenosis can be challenging even to experienced angiographers. In 446 of 447 consecutive patients with aortic stenosis catheterized during the past 3 years, a technique using a standard Judkins right coronary catheter and a floppy straight tipped guide wire was successful in rapidly and efficiently crossing these pathologically distorted valves in retrograde fashion. Once the valve was crossed, the coronary catheter was replaced with a pigtail catheter for pressure and ventriculography. The majority of these valves required less than 2 min to cross using this technique. This method is valuable in limiting the time required for catheterization, thus helping to reduce procedure related morbidity in these oftimes critically ill patients.
.A
Harrison JK; Davidson CJ; Phillips HR; Harding MB; Kisslo KB; Bashore TM.
.I 274627
.U
91004204
.S
Cathet Cardiovasc Diagn 9101; 21(1):55-7
.M
Angiography/*AE; Case Report; Catheterization/*AE/IS; Coronary Vessels/*RA; Human; Iliac Artery/*IN; Male; Middle Age.
.T
A new complication of coronary arteriography.
.P
JOURNAL ARTICLE.
.W
The introduction of a sharply angulated catheter through an arterial sheath for percutaneous coronary arteriography was associated in 7 cases with dissection of the iliac arteries; this extended to the lumbar aorta at the level of the coeliac axis. The catheter tip should be introduced gently and preferably straightened out with a good length of guide wire to avoid this complication.
.A
Raphael MJ; Donaldson RM.
.I 274628
.U
91004205
.S
Cathet Cardiovasc Diagn 9101; 21(1):58-60
.M
Cineradiography/*ST; Heart/*RA; Human; Videotape Recording/*ST.
.T
Interim standard: videotape recorders for transferring cardiac cinefluorographic studies. Laboratory Performance Standards Committee, the Society for Cardiac Angiography and Interventions.
.P
GUIDELINE; JOURNAL ARTICLE.
.I 274629
.U
91004206
.S
Cathet Cardiovasc Diagn 9101; 21(1):63
.M
Aged; Case Report; Female; Heart Atrium; Heart Catheterization/*; Heart Neoplasms/*; Human; Myxoma/*.
.T
Transseptal left atrial catheterization [letter]
.P
LETTER.
.A
Henderson MA.
.I 274630
.U
91004207
.S
Cathet Cardiovasc Diagn 9101; 21(1):7-9
.M
Aged; Balloon Dilatation/*AE; Case Report; Echocardiography, Doppler; Electrocardiography; Female; Heart Catheterization; Human; Lutembacher's Syndrome/*ET/US; Mitral Valve Stenosis/*TH; Rheumatic Heart Disease/*TH; Time Factors.
.T
Acquired Lutembacher syndrome or mitral stenosis and acquired atrial septal defect after transseptal mitral valvuloplasty.
.P
JOURNAL ARTICLE.
.W
Critical mitral stenosis in selected patients may be treated successfully with percutaneous mitral valvuloplasty. Complications of this procedure, particularly an atrial septal defect following transseptal approach, are generally of minor clinical significance. We describe a woman who initially underwent a successful percutaneous double-balloon mitral valvuloplasty via the transseptal approach. Three months later she presented with right-sided heart failure. Color Doppler echocardiography and cardiac catheterization demonstrated an atrial septal defect (ASD) as well as restenosis of the mitral valve. We conclude that significant ASDs may occur following transseptal mitral valvuloplasty with appearance of right ventricular failure and that color Doppler imaging aids in the diagnosis of this new variant of the classical Lutembacher syndrome.
.A
Sadaniantz A; Luttmann C; Shulman RS; Block PC; Schachne J; Thompson PD.
.I 274631
.U
91004536
.S
Can J Anaesth 9101; 37(6):603-7
.M
Anesthesia, Inhalation/*HI/IS; Animal; Heart/DE; Heart Diseases/PP; History of Medicine, 19th Cent.; History of Medicine, 20th Cent.; Human; Nitrous Oxide/*HI/PD.
.T
Nitrous oxide 1844-1990 [editorial; comment]
.P
COMMENT; EDITORIAL; HISTORICAL ARTICLE.
.A
O'Connor JP.
.I 274632
.U
91004537
.S
Can J Anaesth 9101; 37(6):608-12
.M
Analgesia, Epidural/*/AE; Cesarean Section/*AE; Female; Human; Morphine/*AD/AE; Pain, Postoperative/*PC; Pregnancy.
.T
Epidural morphine for post-caesarean analgesia [editorial; comment]
.P
COMMENT; EDITORIAL.
.A
Writer WD.
.I 274633
.U
91004538
.S
Can J Anaesth 9101; 37(6):613-7
.M
Adult; Aged; Anesthesia, Inhalation/*; Blood Pressure/DE; Cardiac Output/DE; Heart Rate/DE; Heart Valve Diseases/PP/SU; Human; Hypertension, Pulmonary/*PP; Middle Age; Mitral Valve/*/SU; Nitrous Oxide/AD/*PD; Pulmonary Artery; Pulmonary Circulation/*DE; Pulmonary Wedge Pressure/DE; Stroke Volume/DE; Vascular Resistance/DE; Ventricular Function/*DE.
.T
Nitrous oxide does not exacerbate pulmonary hypertension or ventricular dysfunction in patients with mitral valvular disease [see comments]
.P
JOURNAL ARTICLE.
.W
Using the rapid-response thermistor pulmonary artery catheter and transoesophageal echocardiography, this study examined the effects of 100 per cent oxygen, 70 per cent nitrous oxide/30 per cent oxygen, and 70 per cent nitrogen/30 per cent oxygen on the pulmonary circulation and ventricular function in ten patients with pulmonary hypertension. In comparison with baseline measurements, nitrous oxide administration resulted in small but statistically significant (P less than 0.05) changes in mean arterial pressure (76 +/- 14 to 67 +/- 12), mean pulmonary arterial pressure (37 +/- 14 to 33 +/- 13 mmHg), and cardiac output (3.7 +/- 1.4 to 3.2 +/- 1.1 L.min-1). Seventy per cent nitrogen resulted in no significant changes from baseline. The repeat 100 per cent oxygen measurements were nearly identical to the nitrous oxide measurements. It is concluded that nitrous oxide does not exacerbate pulmonary hypertension or ventricular dysfunction during high-dose fentanyl anaesthesia in patients with mitral valvular disease.
.A
Konstadt SN; Reich DL; Thys DM.
.I 274634
.U
91004541
.S
Can J Anaesth 9101; 37(6):629-35
.M
Adolescence; Adult; Aged; Anesthesia Recovery Period; Anesthesia, Intravenous/*; Anesthetics; Blood Pressure/DE; Cholecystectomy/*; Female; Fentanyl/*AA/AD/AE/BL/PD; Heart/DE; Heart Rate/DE; Human; Isoflurane/AD; Male; Middle Age; Pain, Postoperative/PC; Respiratory Insufficiency/ET; Support, Non-U.S. Gov't; Time Factors.
.T
Low-dose sufentanil in major surgery.
.P
JOURNAL ARTICLE.
.W
The purpose of this study was to assess the efficacy of sufentanil 1 micrograms.kg-1 during N2O-O2 and intermittent isoflurane anaesthesia in major non-cardiac surgery. Thirty-one patients (18 females, 13 males; mean age 47 yr), undergoing cholecystectomy received a 1 microgram.kg-1 bolus of sufentanil before the induction of anaesthesia with thiopentone. On average, three sufentanil increments were administered, to a total (bolus + maintenance) dose of 1.5 micrograms.kg-1. Cardiovascular stability was not achieved in eleven patients who then were given isoflurane. The arterial pressure decreased after sufentanil (P less than 0.05), reaching a nadir (mean 108/65 mmHg, heart rate 63 bpm) at one minute post-incision. Clinically important hypertension or hypotension did not occur in any patient. One patient, receiving beta-blocker therapy, required atropine to control bradycardia. Postoperative respiratory depression did not occur in patients who received less than one micrograms.kg-1.hr-1 with the last increment being given more than 20 minutes before the end of anaesthesia. Slight respiratory depression in the recovery room was reported in one patient, who had received a total of 1.3 micrograms.kg-1.hr-1 of sufentanil, and the last sufentanil increment 24 min before the end of surgery. The most frequently reported side-effects were nausea (35 per cent) and vomiting (23 per cent). Induction, maintenance and recovery from anaesthesia were rated as "good" in 87, 87, and 74 per cent of the cases, respectively, and "satisfactory" in the remainder. We conclude that this technique is valuable to assure good protection of the cardiovascular system without undue respiratory depression during recovery.
.A
Perreault L; Vezina D; Roberts K; Baillargeon R.
.I 274635
.U
91004542
.S
Can J Anaesth 9101; 37(6):636-40
.M
Acetaminophen/TU; Adult; Analgesia, Epidural/*; Anesthesia, Epidural; Anesthesia, Obstetrical; Cesarean Section/*AE; Dizziness/CI; Female; Human; Morphine/AD/AE/*TU; Nausea/CI; Pain, Postoperative/*PC; Pregnancy; Respiratory Insufficiency/CI; Retrospective Studies; Time Factors; Vomiting/CI.
.T
Epidural morphine for analgesia after caesarean section: a report of 4880 patients [see comments]
.P
JOURNAL ARTICLE.
.W
This retrospective study was undertaken to assess the efficacy and safety of epidural morphine in providing analgesia following Caesarean section under epidural anaesthesia. The morphine was administered as a single bolus, following delivery, in doses ranging from 2 to 5 mg. The charts of 4880 Caesarean sections, performed on 4500 patients, were reviewed. The duration of analgesia and the occurrence of any symptoms which might be side-effects of the epidural morphine were recorded. The duration of analgesia was 22.9 +/- 10.1 hr and was not correlated with the dose of epidural morphine. Eleven per cent of the patients required no supplemental analgesia during the first 48 hr. Twelve patients (0.25 per cent) had respiratory rates less than 10 breaths per minute, on at least one occasion. No serious sequelae resulted from these periods of bradypnoea. Pruritus occurred in 58 per cent of patients, nausea and vomiting in 39.9 per cent and dizziness in ten per cent. Herpes simplex labialis was recorded in 3.5 per cent of patients. Epidural morphine is thus confirmed as an effective analgesic technique post-Caesarean section with 3 mg being the optimal dose. Even in this young healthy patient population, clinically detectable respiratory depression occurs so clinical respiratory monitoring is indicated.
.A
Fuller JG; McMorland GH; Douglas MJ; Palmer L.
.I 274636
.U
91004543
.S
Can J Anaesth 9101; 37(6):641-4
.M
Adult; Anesthesia, General/*; Anesthesia, Obstetrical/*; Apgar Score; Awareness/*DE; Blood Gas Analysis; Blood Pressure/DE; Cesarean Section/*/MT; Delivery; Female; Fetal Blood/CH; Heart Rate/DE; Human; Infant, Newborn; Ketamine/*PD; Pregnancy; Pregnancy Outcome/*; Respiration/DE; Time Factors; Umbilical Veins.
.T
Maternal awareness and neonatal outcome after ketamine induction of anaesthesia for Caesarean section.
.P
JOURNAL ARTICLE.
.W
Ketamine was used as the sole anaesthetic during the induction-to-delivery interval in 20 full-term patients undergoing elective Caesarean section. The intravenous administration of ketamine 1.5 mg.kg-1 was followed by succinylcholine 1.5 mg.kg-1 and tracheal intubation. The mother's lungs were then ventilated using 100 per cent oxygen until the baby was delivered. Intraoperative maternal awareness was assessed by the isolated forearm technique. The Apgar scores of the newborn at one and five minutes, as well as their umbilical vein blood gases were also evaluated and correlated with the induction-to-delivery (I-D) and the uterine incision-to-delivery (U-D) intervals. In 13 patients (Group A) the I-D interval was less than 10 min and U-D interval less than 90 sec, while in seven (Group B) the I-D interval was greater than or equal to 10 min and the U-D interval greater than or equal to 90 sec. The isolated arm test was negative in all patients having an I-D interval less than 10 min, and was positive in three patients when the I-D interval exceeded ten minutes. The newborns of group A showed higher Apgar scores at one minute, as well as higher umbilical vein PO2 than was achieved in Group B. It was concluded that the technique used was not associated with maternal awareness or neonatal depression, provided that the I-D interval was less than 10 min and the U-D interval was less than 90 sec.
.A
Baraka A; Louis F; Dalleh R.
.I 274637
.U
91004544
.S
Can J Anaesth 9101; 37(6):645-9
.M
Adult; Anesthesia, General/*; Blood Glucose/*ME; Blood Pressure/PH; Catecholamines/BL; Central Venous Pressure/PH; Fatty Acids, Nonesterified/BL; Female; Glucagon/BL; Glucose/*ME; Glucose Clamp Technique; Human; Insulin/BL; Male; Surgery, Minor; Surgery, Operative/*; Time Factors.
.T
Decreased glucose utilization during prolonged anaesthesia and surgery.
.P
JOURNAL ARTICLE.
.W
We studied the influence of prolonged anaesthesia and surgery on glucose metabolism by means of the euglycaemic insulin clamp method in eight patients who underwent prolonged surgery. Eleven patients who underwent surgery of short duration served as a control group. Plasma concentrations of catabolic hormones were measured simultaneously. Glucose utilization during prolonged anaesthesia, (PA) group, was lower than that in the control group (P less than 0.01) (glucose utilization 7.59 +/- 0.73 mg.kg-1.hr-1 in the control group vs 4.03 +/- 0.71 mg.kg-1.hr-1 in PA group respectively). There were no significant differences in plasma catecholamine and glucagon concentrations between the PA and control groups. Plasma-free fatty acid levels increased significantly in the PA group before the euglycaemic insulin clamp (free fatty acid level: 0.496 +/- 0.053 mmol.L-1 in the control group, vs 0.834 +/- 0.103 mmol.L-1 in the PA group at the pre-clamp period, P less than 0.01). Tissue resistance to exogenous insulin increased during prolonged anaesthesia and surgery although there were no significant changes in plasma catabolic hormone levels.
.A
Tsubo T; Kudo T; Matsuki A; Oyama T.
.I 274638
.U
91004545
.S
Can J Anaesth 9101; 37(6):650-5
.M
Administration, Oral; Adolescence; Adult; Aged; Antacids/AD/AN/*TU; Citrates/AD/AN/*TU; Drug Combinations; Fasting; Gastric Acid/PH; Gastric Juice/*PH/SE; Gastrointestinal Contents; Human; Hydrogen-Ion Concentration; Metoclopramide/AD/*TU; Middle Age; Ranitidine/AD/*TU; Spectrophotometry; Support, Non-U.S. Gov't; Surgery, Operative/*; Time Factors.
.T
Gastric fluid volume and pH in elective surgical patients: triple prophylaxis is not superior to ranitidine alone.
.P
JOURNAL ARTICLE.
.W
The effect of oral ranitidine alone was compared with sequentially administered ranitidine, metoclopramide, and sodium citrate on gastric fluid volume and pH in 196 healthy, elective surgical inpatients, each of whom was randomly assigned to one of four groups. Patients in all groups received oral ranitidine 150 mg 2-3 hr before the scheduled time of surgery. Those in Group 1 also received oral metoclopramide 10 mg one hour before surgery, and sodium citrate 0.3 M 30 ml on call to the operating room; Group 2 received sodium citrate but no metoclopramide; Group 3 received metoclopramide but no sodium citrate; Group 4 received ranitidine alone. Following induction of anaesthesia a #18 Salem sump tube was passed into the stomach and all available gastric fluid was aspirated. Volumes were recorded and pH measured. In all groups mean pH was greater than 5.8, although at least one patient in each group had pH less than 2.5. Mean volumes were significantly greater in patients who received citrate (Groups 1 and 2: 22 and 19 ml) than in those in those who did not (Groups 3 and 4: 10 and 8 ml). One patient in Group 2 and one in Group 3 had pH less than 2.5 with volume greater than 25 ml. Our results do not demonstrate any advantage of double or triple prophylaxis over ranitidine alone. The practical difficulty of correctly administering two or even three medications, each at different but exact preoperative intervals, is emphasized.
.A
Maltby JR; Elliott RH; Warnell I; Fairbrass M; Sutherland LR; Shaffer EA.
.I 274639
.U
91004546
.S
Can J Anaesth 9101; 37(6):656-8
.M
Administration, Cutaneous; Aerosols; Ambulatory Surgery; Analysis of Variance; Anesthesia, Local/*; Bloodletting/*AE/IS; Catheterization, Peripheral/IS; Comparative Study; Ethyl Chloride/*/AD; Female; Human; Injections, Intradermal; Lidocaine/*/AD; Pain/*PC; Support, Non-U.S. Gov't.
.T
Ethyl chloride and venepuncture pain: a comparison with intradermal lidocaine.
.P
JOURNAL ARTICLE.
.W
One hundred and twenty unpremedicated patients undergoing gynaecological surgery were randomly allocated to one of three equal treatment groups to assess the effectiveness of ethyl chloride in producing instant skin anaesthesia to prevent the pain of venepuncture from a 20 G cannula. They received either no anaesthetic, 0.2 ml one per cent lidocaine plain intradermally or a ten-second spray of ethyl chloride at the cannulation site. Ethyl chloride produced skin anaesthesia that significantly reduced the pain of venepuncture. However, it was not as effective as intradermal lidocaine. It had no effect on vein visualisation or ease of cannulation. Ethyl chloride can be recommended as a method of producing instant skin anaesthesia.
.A
Armstrong P; Young C; McKeown D.
.I 274640
.U
91004547
.S
Can J Anaesth 9101; 37(6):659-62
.M
Analysis of Variance; Anesthesia, General/*; Axilla; Body Temperature/*/PH; Cardiopulmonary Bypass/*; Equipment Design; Esophagus; Forehead/*; Human; Hypothermia, Induced; Middle Age; Monitoring, Physiologic; Rectum; Regression Analysis; Skin Temperature/*/PH; Support, Non-U.S. Gov't; Thermometers/*; Time Factors.
.T
Does forehead liquid crystal temperature accurately reflect "core" temperature?
.P
JOURNAL ARTICLE.
.W
Liquid crystal thermometry (LCT) is a non-invasive alternative to temperature monitoring. We evaluated the ability of forehead LCT, rectal temperature, and axillary skin temperature to trend distal oesophageal temperature during rapid warming on cardiopulmonary bypass. In 24 patients undergoing open heart surgery, temperatures were measured during the rapid warming phase on bypass (12-35 min). Scattergrams of temperature vs time for the four temperature sites each contained 150 data points. Polynomial regression analysis revealed that LCT, but not axillary or rectal temperatures, correlated with oesophageal temperature. We conclude that forehead LCT may be useful to monitor temperature trends and to detect rapid elevations in body temperature when more invasive temperature monitoring is inappropriate or unavailable.
.A
Allen GC; Horrow JC; Rosenberg H.
.I 274641
.U
91004548
.S
Can J Anaesth 9101; 37(6):663-71
.M
Anesthesia; Brain/DE/ME/*PP; Brain Injuries/ME/*PP; Cerebral Ischemia/ME/*PP; Cerebrovascular Circulation/PH; Heart Surgery; Human.
.T
Brain protection: physiological and pharmacological considerations. Part I: The physiology of brain injury.
.P
JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL.
.W
Ischaemia, whether focal or global in nature, produces a sequence of intracellular events leading to increased cell permeability to water and ions including Ca++. There is a loss of cellular integrity and function, with increased production of prostaglandins, free radicals, and acidosis with lactate accumulation. These events may be exacerbated by glucose administration. Pharmacological agents aimed at alleviating ischaemic injury could be directed at decreasing cerebral metabolic requirements for oxygen, improving flow to ischaemic areas, preventing Ca+(+)-induced injury, inhibition of free radical formation, lactate removal, inhibition of prostaglandin synthesis, and prevention of complement-mediated leukocyte aggregation. Part I of this paper describes some of the pathophysiological events leading to ischaemic brain injury. Part 2 of this paper will consider the current agents available for brain protection.
.A
Murdoch J; Hall R.
.I 274642
.U
91004549
.S
Can J Anaesth 9101; 37(6):672-4
.M
Cardiac Pacing, Artificial/*MT; Case Report; Esophagus; Fistula/SU; Human; Infant, Newborn; Intraoperative Complications/*TH; Recurrence; Spinal Cord Diseases/SU; Tachycardia, Paroxysmal/*TH; Tachycardia, Supraventricular/*TH.
.T
Transoesophageal pacing for perioperative control of neonatal paroxysmal supraventricular tachycardia.
.P
JOURNAL ARTICLE.
.W
The perioperative management of a 16-day-old infant with recurrent supraventricular tachycardia (SVT) is discussed. Vagal manoeuvres and medication were not adequate in controlling the SVT. Since the patient was scheduled for extensive surgery in the prone position, it was decided to use transoesophageal pacing as the method of choice for conversion of SVT. Transoesophageal pacing succeeded several times in overriding the SVT and restoring normal heart rate and haemodynamic variables. The advantages and disadvantages of various methods of treating SVT in the newborn are discussed.
.A
Stevenson GW; Schuster J; Kross J; Hall SC.
.I 274643
.U
91004551
.S
Can J Anaesth 9101; 37(6):678-9
.M
Adult; Analgesia, Epidural; Anesthesia, Epidural/*; Anesthesia, Obstetrical/*; Case Report; Female; Herpes Gestationis/*CO; Human; Pregnancy; Pregnancy Complications/*.
.T
Epidural analgesia for a parturient with herpes gestationis.
.P
JOURNAL ARTICLE.
.W
A 23-yr-old parturient with herpes gestationis spontaneously delivered a normal healthy infant under epidural analgesia. She received five injections of bupivacaine 0.5 per cent over a ten-hour period. There was no infection at the lumbar region, even though her body was covered with vesicles and bullae including the face and neck. Eight months after delivery the patient still has a vesicular eruption which occurs mainly during her menses.
.A
Eldor J; Zlotogorski A; Meirow D; Cohen M.
.I 274644
.U
91004552
.S
Can J Anaesth 9101; 37(6):680-4
.M
Adult; Analgesia, Epidural; Anesthesia, Epidural/*; Anesthesia, Obstetrical/*; Case Report; Cesarean Section/*; Female; Heart Defects, Congenital/*CO; Heart Ventricle/AB; Human; Labor, Induced/*; Pain, Postoperative/PC; Pregnancy; Pregnancy Complications, Cardiovascular/*; Transposition of Great Vessels/*CO.
.T
Epidural anaesthesia for labour and caesarean section in a parturient with a single ventricle and transposition of the great arteries.
.P
JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED CASES.
.W
We describe a case of a 29-year-old parturient with a single ventricle and transposition of the great arteries who had lumbar epidural analgesia/anaesthesia with a local anaesthetic for labour, emergency Caesarean section and postoperative pain. Her outcome and that of her baby was successful. The anaesthetic techniques used in other parturients with similar congenital cardiac anomalies are reviewed.
.A
Fong J; Druzin M; Gimbel AA; Fisher J.
.I 274645
.U
91004554
.S
Can J Anaesth 9101; 37(6):689
.M
Anesthesiology/HI; Canada; History of Medicine, 20th Cent.; Manitoba; Portraits.
.T
Beverly Charles Leech (1898-1960).
.P
HISTORICAL ARTICLE; HISTORICAL BIOGRAPHY; JOURNAL ARTICLE.
.A
Shephard DA.
.I 274646
.U
91004555
.S
Can J Anaesth 9101; 37(6):690-4
.M
Carbon Radioisotopes/DU; Choline Acetyltransferase/AI/*ME; Dose-Response Relationship, Drug; Ion Exchange Resins; Pancuronium/AD/*PD; Regression Analysis; Succinylcholine/AD/*PD; Support, Non-U.S. Gov't; Tubocurarine/AD/*PD; Vecuronium/AD/*PD.
.T
Pancuronium, vecuronium, and d-tubocurarine inhibit and succinylcholine stimulates choline acetyltransferase activity.
.P
JOURNAL ARTICLE.
.W
The effects of the nondepolarizing muscle relaxants (NDMR), pancuronium, vecuronium, and d-tubocurarine and a depolarizing muscle relaxant, succinylcholine, were studied on choline acetyltransferase (ChAT) activity. A radiochemical assay was used in the determination of ChAT activity using purified placental enzyme. Pancuronium at concentrations of 10(-7) M, 10(-6) M, 10(-5) M, 10(-4) M, and 10(-3) M inhibited ChAT activity by 3, 10, 15, 40 and 85 per cent, respectively; vecuronium at concentrations of 10(-6) M, 10(-5) M, 10(-4) M, and 10(-3) M inhibited ChAT activity by 5, 10, 26 and 57 per cent, respectively; d-tubocurarine at concentrations of 10(-6) M, 10(-5) M, 10(-4) M, and 10(-3) M inhibited ChAT activity by 0, 4, 12.5 and 29 per cent, respectively; whereas succinylcholine at concentrations of 10(-7) M, 10(-6) M, 10(-5) M, and 10(-4) M activated ChAT activity by 8, 10, 1, and 2 per cent, respectively. Even though our present data demonstrated a significant dose-dependent inhibitory effect on ChAT activity by pancuronium, vecuronium and d-tubocurarine, it is unlikely that this inhibitory effect will contribute to the mechanism of action of NDMR. Our data, however, may suggest an additional mechanism for the phenomena of tetanic and train-of-four fades that are seen following the administration of nondepolarizing muscle relaxants.
.A
Kambam JR; Janson VE; Day P; Sastry BV.
.I 274647
.U
91004556
.S
Can J Anaesth 9101; 37(6):695-8
.M
Caffeine/AE; Calcium/*PD; Contracture/*PP; Drug Interactions; Halothane/AE; Human; In Vitro; Malignant Hyperthermia/*PP; Muscle Contraction/*DE/PH; Muscles/DE/PP; Nifedipine/PD; Quinacrine/PD; Strontium/PD; Succinylcholine/AE; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Verapamil/PD.
.T
The importance of calcium ions for in vitro malignant hyperthermia testing.
.P
JOURNAL ARTICLE.
.W
Intracellular Ca++ levels in skeletal muscle are elevated during the in vitro contracture response of muscle from subjects with malignant hyperthermia. The role of Ca++ in the bathing medium and the consequences of substitution of Sr++ for Ca++ in the response to agents associated with malignant hyperthermia were examined. When Ca++ was omitted from the bathing medium the contractures induced in human vastus lateralis by halothane (three per cent) or succinylcholine (50 mM) were reduced by 80 and 100 per cent, respectively, while contractures induced by caffeine (8 mM) were only reduced by 50 per cent. Substitution of Ca++ by another divalent cation, Sr++, completely restored contractures induced by caffeine, but only partially restored contractures induced by halothane or succinylcholine (to 50 and 30 per cent of Ca(++)-containing medium, respectively). Mepacrine (10 microM) was effective in antagonizing contractures by caffeine, whereas verapamil and nifedipine (10 microM) were not. These results support an essential role for extracellular Ca++ not fulfilled by Sr++ in contracture induction by halothane and succinylcholine, but not by caffeine.
.A
Fletcher JE; Huggins FJ; Rosenberg H.
.I 274648
.U
91004557
.S
Can J Anaesth 9101; 37(6):699-704
.M
Ambulatory Surgery/*SN; Anesthesia/SN; Canada/EP; Diagnosis; Hemorrhage/EP; Hospitals, General/*SN; Human; Outpatient Clinics, Hospital/*; Patient Admission/*SN; Patient Discharge/SN; Postoperative Complications/EP; Syncope/EP.
.T
Hospital admissions from the Surgical Day Care Centre of Vancouver General Hospital 1977-1987.
.P
JOURNAL ARTICLE.
.W
The admissions to Vancouver General Hospital from its Surgical Day Care Centre were reviewed for the period 1977 to 1987. The overall mean rate of admission for the period was 0.28 per cent, for surgically-related admissions 0.22 per cent and for anaesthesia-related admissions 0.07 per cent. The principal reasons for surgery-related admissions were postoperative bleeding, complications, the need for further surgery, the requirement for prolonged postoperative care, and pain. Urology had a particularly high percentage of admissions compared with its workload, because of the diagnostic nature of much of the work. Anaesthesia-related admissions included "syncope," lack of an accompanying adult, aspiration pneumonitis and coincident acute disease. Twelve of the 14 patients admitted with syncope had surgery in the afternoon and had received less than ideal amounts of intravenous fluid. Seven of the 12 ASA physical status II patients admitted had an admission diagnosis related to the coincident disease.
.A
Fancourt-Smith PF; Hornstein J; Jenkins LC.
.I 274649
.U
91004558
.S
Can J Anaesth 9101; 37(6):705
.M
Analgesia/*MT; Bupivacaine/AD/*TU; Case Report; Catheterization; Chest Pain/DT; Human; Male; Middle Age; Pleura; Rib Fractures/*TH.
.T
Continuous infusion interpleural analgesia for multiple fractured ribs [letter]
.P
LETTER.
.A
Hudes ET.
.I 274650
.U
91004559
.S
Can J Anaesth 9101; 37(6):705-6
.M
Cricoid Cartilage; Human; Intubation, Intratracheal/*; Thyroid Cartilage; Tracheotomy.
.T
Failed intubation [letter]
.P
LETTER.
.I 274651
.U
91004561
.S
Can J Anaesth 9101; 37(6):707
.M
Anesthesia, Closed-Circuit/*IS; Anesthesia, Inhalation/*IS; Equipment Design; Equipment Failure; Human.
.T
Breathing circuit occlusion due to defect in swivel port connector [letter]
.P
LETTER.
.A
Ananthanarayan C; Urbach G; Tincombe C; Smith R; Marshall-Hanasyk S.
.I 274652
.U
91004562
.S
Can J Anaesth 9101; 37(6):707-9
.M
Cervical Vertebrae/*IN; Fiber Optics; Human; Intubation, Intratracheal/*MT; Respiration/*; Respiration, Artificial/MT.
.T
Airway management in C-spine injuries [letter; comment]
.P
COMMENT; LETTER.
.A
Yealy DM; Cantees KK; McGuinness JP.
.I 274653
.U
91004563
.S
Can J Anaesth 9101; 37(6):709
.M
Anesthesia/*AE; Canada; Coroners and Medical Examiners; Embolism, Air/*MO; Human; Registries/*.
.T
Fatal embolism [letter; comment]
.P
COMMENT; LETTER.
.A
Davies JM; Armstrong JN.
.I 274654
.U
91004564
.S
Can J Anaesth 9101; 37(6):709-10
.M
Anesthesia, Epidural/*IS; Catheterization/IS; Equipment Failure; Human; Sodium Chloride/AD; Thrombosis/*PC.
.T
Prevention of obstruction of epidural catheter by blood clot [letter; comment]
.P
COMMENT; LETTER.
.A
Kumar CM.
.I 274655
.U
91004565
.S
Can J Anaesth 9101; 37(6):710-1
.M
Adult; Aged; Analgesia, Epidural/*; Anesthesia, Epidural/AE; Anesthesia, Spinal/AE; Headache/*DT/ET; Human; Middle Age; Morphine/*AD/AE; Spinal Puncture/AE.
.T
Epidural morphine injections for the treatment of postspinal headache [letter]
.P
LETTER.
.A
Eldor J; Guedj P; Cotev S.
.I 274656
.U
91004566
.S
Can J Anaesth 9101; 37(6):711
.M
Electromyography/DE; Hand; Human; Muscle Contraction/DE; Muscles/*DE/PH; Vecuronium/*PD.
.T
Clinical, electrical and mechanical correlations during recovery from neuromuscular blockade with vecuronium [letter; comment]
.P
COMMENT; LETTER.
.A
Kopman AF.
.I 274657
.U
91004567
.S
Can J Anaesth 9101; 37(6):712
.M
Adult; Anesthesia, Epidural/*/MT; Anesthesia, Obstetrical/*; Bupivacaine/AD; Case Report; Female; Fentanyl/AD; Human; Lumbar Vertebrae/*SU; Orthopedic Fixation Devices/*; Pregnancy; Pregnancy Complications/*; Scoliosis/*SU.
.T
Subdural catheterization and opiate administration in a patient with Harrington rods [letter; comment]
.P
COMMENT; LETTER.
.A
Howard R; Anderson W.
.I 274658
.U
91004662
.S
Circ Res 9101; 67(4):1007-16
.M
Adenine/PD; Adenosine Cyclic Monophosphate/PD; Adenosine Triphosphate/*PD; Animal; Calcium Channels/DE/PH; Electric Conductivity; Female; Isoproterenol/PD; Male; Membrane Potentials/PH; Myocardial Contraction/*DE; Papillary Muscles/PH; Pertussis Toxins/PD; Rats; Rats, Inbred Strains; Stimulation, Chemical; 1-Methyl-3-Isobutylxanthine/PD.
.T
The mechanism of positive inotropy induced by adenosine triphosphate in rat heart.
.P
JOURNAL ARTICLE.
.W
When applied extracellularly in the micromolar range, ATP and related compounds induced a positive inotropy in the rat papillary muscle. This was also true in the rat auricle after pertussis toxin treatment. Then, in both tissues, ATP further increased the contraction after a maximal beta-adrenergic stimulation. The increase in contractile force could be related to the increase in the calcium current. The L-type calcium current was measured by whole-cell patch-clamp recording in single cells isolated from the rat ventricle after the sodium and potassium currents were inhibited by tetrodotoxin and cesium, respectively. When added alone, 10 microM ATP increased the calcium current by 60%. Adenosine 5'-O-(3-thiotriphosphate) was also able to increase calcium current. Adenosine was much less effective, and GTP, UTP, CTP, and ITP were without effect. A similar increase in calcium current was observed when ATP was added in addition to a maximal stimulation by a beta-adrenergic agonist or after internal perfusion with cyclic AMP. However, this increase was preceded by a transient decrease whose origin could not be attributed to a P1-purinergic agonistic effect of ATP. The transient decrease was not elicited by adenosine or in a magnesium-free HEPES solution and was not suppressed after pertussis toxin treatment. This effect appeared related to the variations in the holding current also observed upon ATP application. Together with vasodilation, ATP and adenine compounds induced positive inotropy. The latter effect could be attributed in part to the increase in calcium current and was independent of cyclic AMP. Both effects are complementary with the beta-adrenergic stimulation and can help healthy cells to compensate the failing zone from which ATP could be released.
.A
Scamps F; Legssyer A; Mayoux E; Vassort G.
.I 274659
.U
91004663
.S
Circ Res 9101; 67(4):1017-26
.M
Animal; Argipressin/AA/PD; Arterioles/DE/*PH; Colon/BS; Guinea Pigs; Human; Ileum/BS; Intestinal Mucosa/*BS; Norepinephrine/PD; Phenylephrine/PD; Rabbits; Receptors, Angiotensin/DE/PH; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Vascular Resistance; Vasoconstriction/DE; Vasopressins/AI/*PD.
.T
Characterization of vasopressin actions in isolated submucosal arterioles of the intestinal microcirculation.
.P
JOURNAL ARTICLE.
.W
Submucosal arterioles are the final resistance vessels of the mesenteric circulation; they supply intestinal mucosa and smooth muscle and contribute significantly to total mesenteric resistance. Characterization of receptors present on submucosal arterioles has not been carried out, because these vessels have not been accessible to study by previous methods. We have used a novel optical method for on-line tracking of outside diameter from in vitro preparations of submucosal arterioles in the ileum and colon of guinea pigs, rabbits, and humans to characterize the vasoconstrictor responses to vasopressin as well as other vasopressor agents along the gastrointestinal tract. All ileal submucosal arterioles showed smoothly graded constrictor responses, whereas colonic arterioles from each species exhibited rhythmic vasoconstrictions. Vasopressin constricted guinea pig and human submucosal arterioles (EC50, 1 nM) by activating classical V1 receptors; dissociation equilibrium constants (Kd) for the V1 antagonist d(CH2)5 Tyr (Me) arginine vasopressin were 1-3 nM. This antagonist was 10-50-fold more potent in inhibiting vasopressin constrictions in rabbit submucosal arterioles (Kd = 0.05-0.1 nM). No evidence for the presence of V2 receptors was obtained in any arteriole, and no significant differences in the alpha 1-adrenoceptor-mediated constrictions were observed in these vessels. Results from this study suggest the presence of heterogeneity of V1 receptors in submucosal arterioles; these differences appear to be species dependent. Our results also suggest that intrinsic vasoconstrictor properties of submucosal arterioles differ along the length of the gastrointestinal tract; these differences appear to be species independent.
.A
Vanner S; Jiang MM; Brooks VL; Surprenant A.
.I 274660
.U
91004664
.S
Circ Res 9101; 67(4):1027-34
.M
Anesthesia; Animal; Aorta, Thoracic/*PA; Atherosclerosis/*PA/PP; Blood Pressure/DE; Cell Survival; Chloralose/PD; Endothelium, Vascular/IM/*PA; Heart Rate/DE; IgG/AN; Male; Metoprolol/PD; Norepinephrine/BL; Rabbits; Receptors, Adrenergic, Beta/*PH; Sympathetic Nervous System/*PP.
.T
Experimental sympathetic activation causes endothelial injury in the rabbit thoracic aorta via beta 1-adrenoceptor activation.
.P
JOURNAL ARTICLE.
.W
Sympathetic activation appears to accelerate the development of atherosclerosis, an effect that may be inhibited by beta-receptor blockade. It is unclear, however, which mechanisms mediate this effect. In view of the significance attached to endothelial injury in the initial phases of atherogenesis, we decided to test whether sympathetic activation might lead to an increase in endothelial injury. Chloralose anesthesia was used to induce sympathetic activation and the presence of intracellular IgG as a criterion of endothelial cell injury. The beta 1-selective beta-blocker metoprolol was used to evaluate if the effect(s) of sympathetic activation might be mediated by beta 1-adrenoceptors. In normal rabbits, the frequency of injured endothelial cells in unbranched areas of the thoracic aorta was 0.23%, compared with 1.93% in circumostial areas. Chloralose anesthesia caused significant increases in blood pressure, heart rate, and plasma norepinephrine, that is, caused sympathetic activation, and led to an approximately fivefold increase in the number of injured cells both in unbranched and in circumostial areas. This increase was totally inhibited by metoprolol pretreatment, indicating that it was mediated by beta 1-receptors. These observations suggest one possible mechanism that may connect sympathetic activation with atherogenesis and explain why beta-blockade protects against atherosclerosis.
.A
Pettersson K; Bejne B; Bjork H; Strawn WB; Bondjers G.
.I 274661
.U
91004667
.S
Circ Res 9101; 67(4):787-94
.M
Actins/GE; Animal; Aorta, Abdominal; Basement Membrane/*ME; Collagen/*GE; Constriction; DNA Probes; Fibroblasts/ME; Fluorescent Antibody Technique; Gene Expression/*; Heart Enlargement/ET/*ME; Hypertension/CO; Male; Myocardium/*ME; Myofibrils/*ME; Nucleic Acid Hybridization; Rats; Rats, Inbred Strains; RNA, Messenger/ME; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Regulation of fibrillar collagen types I and III and basement membrane type IV collagen gene expression in pressure overloaded rat myocardium.
.P
JOURNAL ARTICLE.
.W
Left ventricular hypertrophy is based on cardiac myocyte growth. The hypertrophic process can be considered heterogeneous based on whether it also includes a remodeling and accumulation of fibrillar types I and III collagens that are responsible for impaired myocardial stiffness. In the heart, the messenger RNA (mRNA) for fibrillar collagen types I and III has been detected only in cardiac fibroblasts, whereas mRNA for basement membrane collagen type IV is present in both fibroblasts and myocytes. We studied the early and long-term expression of these collagenous proteins in rat myocardium after abdominal aortic banding with renal ischemia. Complementary DNA probes for rat pro-alpha 2 (I), mouse type III and mouse type IV collagens, and chicken beta-actin were used. Northern and dot blot analysis on total RNA extracted from left ventricular tissue indicated a sixfold increase in steady-state levels of mRNA for collagen type I on day 3 of abdominal aortic banding, which had declined to control levels by day 7 where it remained rather constant at 4 and 8 weeks. Type III collagen showed a similar pattern of gene expression after banding. mRNA levels for type IV collagen, on the other hand, were elevated on day 1 after banding, returning to control at day 7 and remaining constant. Actin mRNA levels also increased on day 1 of banding, followed by a rapid return to control levels. Monospecific antibody to types I and III collagens and immunofluorescent light microscopy on frozen sections of the myocardium revealed that at 1 week after banding, the distribution and density of these collagens were similar to those of control animals.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Chapman D; Weber KT; Eghbali M.
.I 274662
.U
91004668
.S
Circ Res 9101; 67(4):795-802
.M
Animal; Antibodies, Monoclonal/*PD; Antigens, CD/IM; Capillaries/PP; Capillary Permeability; Endothelium, Vascular/PP; Female; Guinea Pigs; Human; Integrins/*IM; Lung/BS/PA; Male; Neutrophils/*PH; Opsonins/PD; Organ Weight; Phagocytosis/*; Pulmonary Edema/*ET/PA/PP; Receptors, Leukocyte-Adhesion/*IM; Support, U.S. Gov't, P.H.S.; Vasoconstriction; Zymosan/PD.
.T
Pulmonary edema induced by phagocytosing neutrophils. Protective effect of monoclonal antibody against phagocyte CD18 integrin.
.P
JOURNAL ARTICLE.
.W
We studied the changes in pulmonary hemodynamics and lung wet weight induced with opsonized zymosan (OZ) in isolated guinea pig lungs perfused with Ringer-albumin solution containing neutrophils (PMNs). Addition of OZ to the PMN-perfused lungs caused pulmonary vasoconstriction and weight gain; neither OZ nor PMNs added individually to the perfusate altered pulmonary vasomotor tone or wet weight. The steady gain in lung weight by 1,588 +/- 464 mg over the 45-minute study period was associated with pulmonary capillary hypertension and an increase in the capillary filtration coefficient, indicative of increased lung vascular permeability. These responses may not be due to generation of oxygen radicals, because the alterations in pulmonary hemodynamics and lung weight were not reduced by addition of superoxide dismutase, catalase, or superoxide dismutase plus catalase. We examined the basis of the PMN-mediated effects by layering PMNs on bovine pulmonary artery endothelial monolayers. Challenge with OZ resulted in increased endothelial permeability to 125I-albumin. The monoclonal antibody IB4 (directed against CD18, the common beta-subunit of structurally related adhesion receptors on phagocytes, LFA-1, Mac-1, and P150,95) prevented the OZ-mediated increase in PMN adherence to endothelial cells and the increase in endothelial permeability to 125I-albumin. IB4 also inhibited the lung weight gain mediated by the OZ-stimulated PMNs in intact lungs. The protective effect of IB4 could be ascribed neither to inhibition of uptake of OZ by PMNs nor to inhibition of release of oxygen radicals, myeloperoxidase, and elastase.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Kaslovsky RA; Horgan MJ; Lum H; McCandless BK; Gilboa N; Wright SD; Malik AB.
.I 274663
.U
91004670
.S
Circ Res 9101; 67(4):814-25
.M
Acid-Base Equilibrium/*; Adenosine Triphosphate/ME; Aged; Amiloride/*AA/PD; Ammonium Chloride/PD; Bicarbonates/*PD; Buffers; Cells, Cultured; Energy Metabolism; Fluoresceins; Fluorescent Dyes; Human; Hydrogen-Ion Concentration; Mammary Arteries; Middle Age; Muscle, Smooth, Vascular/DE/*ME; Protons/*; Sodium/*ME/PD; Sodium Radioisotopes; Support, Non-U.S. Gov't; SITS/PD.
.T
Intracellular pH in human arterial smooth muscle. Regulation by Na+/H+ exchange and a novel 5-(N-ethyl-N-isopropyl)amiloride-sensitive Na(+)- and HCO3(-)-dependent mechanism.
.P
JOURNAL ARTICLE.
.W
We investigated in a physiological salt solution (PSS) containing HCO3- the intracellular pH (pHi) regulating mechanisms in smooth muscle cells cultured from human internal mammary arteries, using the pH-sensitive dye 2',7'-bis(2-carboxyethyl)-5(6)-carboxyfluorescein (BCECF) and 22Na+ influx rates. The recovery of pHi from an equivalent intracellular acidosis was more rapid when the cells were incubated in CO2/HCO3(-)-buffered PSS than in HEPES-buffered PSS. Recovery of pHi was dependent on extracellular Na+ (Km, 13.1 mM); however, it was not attenuated by 4-acetamido-4'-isothiocyanatostilbene-2,2'-disulfonic acid (SITS), indicating the absence of SITS-sensitive HCO3(-)-dependent mechanisms. Recovery instead appeared mostly dependent on processes sensitive to 5-(N-ethyl-N-isopropyl)amiloride (EIPA), indicating the involvement of Na+/H+ exchange and a previously undescribed EIPA-sensitive Na(+)- and HCO3(-)-dependent mechanism. Differentiation between this HCO3(-)-dependent mechanism and Na+/H+ exchange was achieved after depletion of cellular ATP. Under these conditions, the NH4Cl-induced 22Na+ influx rate stimulated by intracellular acidosis was markedly attenuated in HEPES-buffered PSS but not in CO2/HCO3(-)-buffered PSS. EIPA also appeared to inhibit the two mechanisms differentially. In HEPES-buffered PSS containing 20 mM Na+, the EIPA inhibition curve for the intracellular acidosis-induced 22Na+ influx was monophasic (IC50, 39 nM), whereas in an identical CO2/HCO3(-)-buffered PSS, the inhibition curve exhibited biphasic characteristics (IC50, 37.3 nM and 312 microM). Taken together, the results indicate that Na+/H+ exchange and a previously undescribed EIPA-sensitive Na(+)- and HCO3(-)-dependent mechanism play an important role in regulating the pHi of human vascular smooth muscle. The involvement of the latter mechanism depends on the severity of the intracellular acidosis, varying from approximately 25% in severe intracellular acidosis up to 50% at lesser, more physiological, levels of induced acidosis.
.A
Neylon CB; Little PJ; Cragoe EJ Jr; Bobik A.
.I 274664
.U
91004671
.S
Circ Res 9101; 67(4):826-34
.M
Animal; Arterioles/AH/PH; Blood Flow Velocity; Blood Viscosity; Hematocrit; Male; Microcirculation/AH/*PH; Models, Biological/*; Rats; Rats, Inbred Strains; Splanchnic Circulation/*PH; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Blood flow in microvascular networks. Experiments and simulation.
.P
JOURNAL ARTICLE.
.W
A theoretical model has been developed to simulate blood flow through large microcirculatory networks. The model takes into account the dependence of apparent viscosity of blood on vessel diameter and hematocrit (the Fahraeus-Lindqvist effect), the reduction of intravascular hematocrit relative to the inflow hematocrit of a vessel (the Fahraeus effect), and the disproportionate distribution of red blood cells and plasma at arteriolar bifurcations (phase separation). The model was used to simulate flow in three microvascular networks in the rat mesentery with 436,583, and 913 vessel segments, respectively, using experimental data (length, diameter, and topological organization) obtained from the same networks. Measurements of hematocrit and flow direction in all vessel segments of these networks tested the validity of model results. These tests demonstrate that the prediction of parameters for individual vessel segments in large networks exhibits a high degree of uncertainty; for example, the squared coefficient of correlation between predicted and measured hematocrit of single vessel segments ranges only between 0.15 and 0.33. In contrast, the simulation of integrated characteristics of the network hemodynamics, such as the mean segment hematocrit or the distribution of blood flow velocities, is very precise. In addition, the following conclusions were derived from the comparison of predicted and measured values: 1) The low capillary hematocrits found in mesenteric microcirculatory networks as well as their heterogeneity can be explained on the basis of the Fahraeus effect and phase-separation phenomena. 2) The apparent viscosity of blood in vessels of the investigated tissue with diameters less than 15 microns is substantially higher than expected compared with measurements in glass tubes with the same diameter.
.A
Pries AR; Secomb TW; Gaehtgens P; Gross JF.
.I 274665
.U
91004673
.S
Circ Res 9101; 67(4):844-51
.M
Acetylcholine/*SE; Animal; Dogs; Electric Stimulation; Electrophysiology; Female; Heart Rate/*PH; Male; Sinoatrial Node/PH; Support, U.S. Gov't, P.H.S.; Time Factors; Vagus Nerve/*PH.
.T
Effects of the spatial dispersion of acetylcholine release on the chronotropic responses to vagal stimulation in dogs.
.P
JOURNAL ARTICLE.
.W
We determined the effects of changing the spatial dispersion of acetylcholine release on the phase-dependent chronotropic responses to vagal stimulation in anesthetized dogs. We stimulated the vagus nerves with one brief burst of electrical pulses each cardiac cycle, and we changed the timing of the stimulus by a small, constant amount each cardiac cycle to scan the entire cycle. To vary the heterogeneity of acetylcholine release, we changed the voltage of the stimulus pulses over a range of submaximal values. To achieve the maximum homogeneity of acetylcholine release, we used supramaximal voltages, and we varied the level of acetylcholine release from each excited fiber by changing the number of pulses per burst. We used the average cardiac cycle length of the phase-response curve to assess the overall vagal effect, independent of its timing within the cardiac cycle. We found that the amplitude of the phase-response curve varied directly and the minimum-to-maximum phase difference varied inversely with the overall efficacy of vagal activity. However, for any given alteration in the overall efficacy, the specific changes in the characteristics of the phase-response curve did not depend on whether the alteration was achieved by varying the number of pulses per burst or by varying the stimulus voltage. Therefore, we conclude that although the cardiac chronotropic response is very sensitive to changes in the timing of vagal stimulation, it is not influenced appreciably by the spatial dispersion of acetylcholine release from the vagal nerve endings over a wide range of stimulation strengths.
.A
Yang TE; Cheng J; Levy MN.
.I 274666
.U
91004674
.S
Circ Res 9101; 67(4):852-61
.M
Animal; Blood Pressure/DE; Body Fluids/*PH; Capillary Permeability/DE; Dextrans/*PD; Hemodynamics/*DE; Kinetics; Lung/BS/*PH; Lymph/PH; Osmotic Pressure; Plasma Volume/DE; Proteins/*ME; Serum Albumin/ME; Sheep; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Effects of dextran 70 on hemodynamics and lung liquid and protein exchange in awake sheep.
.P
JOURNAL ARTICLE.
.W
We studied the effect of intravenous dextran 70 infusion on lung liquid and protein exchange to determine whether its effects were due to altered hemodynamics or to altered microvascular permeability. In each of six instrumented awake sheep with chronic lung lymph fistulas, we performed three experiments: 1) control, 2) a 30-minute infusion of 1 l of 6% dextran 70, and 3) an infusion of 1 l of 0.9% NaCl. In addition to pulmonary hemodynamics and lymph dynamics, we measured the plasma-to-lung lymph equilibration rate of [125I] albumin. We followed all the sheep for 10 hours, including a 2-hour baseline period. Dextran was more effective in expanding plasma volume (63 +/- 15% [mean +/- SD]) than saline (11 +/- 6%) at the end of the 30-minute infusion. Pulmonary vascular pressures increased after dextran and remained elevated for 8 hours, whereas after saline the pressures returned to baseline within 1 hour. After dextran, lung lymph flow increased and remained elevated. It was only transiently increased after saline. We confirmed that dextran equilibrated rapidly with lung lymph (half-time, less than 0.6 hour), even though it maintained plasma volume expansion for the whole body (half-time, 11.1 +/- 2.7 hours). The dextran increased both plasma and lymph total macromolecular osmotic pressure but did not increase the plasma-interstitial (lymph) osmotic pressure difference in the lung, except transiently during the infusion. The lymph/plasma protein concentration ratio increased after dextran due mainly to plasma protein dilution. There were no differences in the half-time of tracer albumin equilibration between plasma and lung lymph (control, 2.2 +/- 0.6 hours; saline, 2.0 +/- 0.6 hours; dextran, 2.3 +/- 0.6 hours). Dextran 70 increased liquid filtration mainly by increasing microvascular pressure and possibly filtration surface area. There was no evidence for a change in the leakiness of the lung microvascular barrier to albumin.
.A
Arakawa M; Jerome EH; Enzan K; Grady M; Staub NC.
.I 274667
.U
91004675
.S
Circ Res 9101; 67(4):862-70
.M
Adrenergic Beta Receptor Blockaders/PD; Animal; Blood Pressure/DE; Cats; Electric Stimulation; Female; Lung/*BS/IR; Male; Norepinephrine/*PH; Prazosin/PD; Propanolamines/PD; Propranolol/PD; Receptors, Adrenergic, Alpha/*PH; Receptors, Adrenergic, Beta/*PH; Support, U.S. Gov't, P.H.S.; Sympathetic Nervous System/*PH; Yohimbine/PD.
.T
Analysis of pulmonary vascular responses in cats to sympathetic nerve stimulation under elevated tone conditions. Evidence that neuronally released norepinephrine acts on alpha 1-, alpha 2-, and beta 2-adrenoceptors.
.P
JOURNAL ARTICLE.
.W
The influence of an increase in vascular tone on responses to sympathetic nerve stimulation and the receptors mediating these responses were investigated in the pulmonary vascular bed of the cat. Under conditions of controlled blood flow and constant left atrial pressure, stimulation of the sympathetic nerves to the lung elicited a biphasic response characterized by an initial increase in lobar arterial pressure followed closely by a decrease. The response to nerve stimulation was reproducible with respect to time and was not altered when a delay coil was added to the perfusion circuit, indicating that the response was directly mediated. The increase in pressure was reduced by prazosin and by yohimbine, whereas the decrease in pressure was blocked by propranolol or ICI 118551. These data suggest that the pressor component of the response is mediated by alpha 1- and postjunctional alpha 2-adrenoceptors, whereas the depressor response is mediated by beta 2-receptors. The pressor response was enhanced by propranolol or ICI 118551, whereas the depressor response was enhanced by prazosin or yohimbine, suggesting that the response to nerve stimulation represents the net effect of the actions of neuronally released norepinephrine on alpha- and beta-receptors. The pressor response to nerve stimulation was enhanced when tone was elevated with a prostaglandin endoperoxide analogue and when beta-receptors were blocked. The effects of an increase in tone and a passive increase in pressure on responses to sympathetic nerve stimulation were different.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Hyman AL; Lippton HL; Kadowitz PJ.
.I 274668
.U
91004676
.S
Circ Res 9101; 67(4):871-85
.M
Aging/*PH; Animal; Blood Pressure; Cell Count; Heart/PP; Heart Enlargement/*PA/PP; Heart Rate; Heart Ventricle/PP; Hyperplasia; Male; Myocardium/*PA; Organ Weight; Rats; Rats, Inbred F344; Support, U.S. Gov't, P.H.S..
.T
Myocyte cell loss and myocyte cellular hyperplasia in the hypertrophied aging rat heart.
.P
JOURNAL ARTICLE.
.W
To determine the effects of age on the myocardium, the functional and structural characteristics of the heart were studied in rats at 4, 12, 20, and 29 months of age. Mean arterial pressure, left ventricular pressure and its first derivative (dP/dt), and heart rate were comparable in rat groups up to 20 months. During the interval from 20 to 29 months, elevated left ventricular end-diastolic pressure and decreased dP/dt indicated that a significant impairment of ventricular function occurred with senescence. In the period between 4 and 12 months, a reduction of nearly 19% in the total number of myocytes was measured in both ventricles. In the subsequent ages, similar decreases in myocyte cell number were found in the left ventricle, whereas in the right ventricle, the initial loss was fully reversed by 20 months. Moreover, from 20 to 29 months, a 59% increase in the aggregate number of myocytes occurred in the right ventricular myocardium. In the left ventricle, a 3% increment was also seen, but this small change was not statistically significant. These estimations of myocyte cellular hyperplasia, however, were complicated by the fact that cell loss continued to take place with age. The volume fraction of collagen in the tissue, in fact, progressively increased from 8% and 7% at 4 months to 16% and 22% at 29 months in the left and right ventricles, respectively. In conclusion, myocyte cellular hyperplasia tends to regenerate the ventricular mass being lost with age in the adult mammalian rat heart.
.A
Anversa P; Palackal T; Sonnenblick EH; Olivetti G; Meggs LG; Capasso JM.
.I 274669
.U
91004677
.S
Circ Res 9101; 67(4):886-92
.M
Animal; Dogs; Electrocardiography; Mathematics/*; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Ventricular Fibrillation/PP.
.T
Is fibrillation chaos?
.P
JOURNAL ARTICLE.
.W
Ventricular fibrillation is examined to determine whether it is an instance of deterministic chaos. Surface ECGs from dogs in fibrillation were used to generate a state space representation of fibrillation. Our analysis failed to identify a low-dimensional attractor that could be associated with fibrillation. The results suggest that fibrillation is similar to a nonchaotic random signal. We note, however, that such random-looking but nonchaotic behavior can also be generated by a nonlinear deterministic system.
.A
Kaplan DT; Cohen RJ.
.I 274670
.U
91004678
.S
Circ Res 9101; 67(4):893-901
.M
Animal; Biomechanics; Calcium/PD; Elasticity; Energy Metabolism/*; Mathematics; Myocardial Contraction/DE/*PH; Papillary Muscles/AH/DE/*PH; Pressure; Rabbits.
.T
Heat released during relaxation equals force-length area in isometric contractions of rabbit papillary muscle.
.P
JOURNAL ARTICLE.
.W
It has been claimed that the mechanical performance and the related energy turnover of the left ventricle can be reliably predicted on the basis of its time-varying elastance behavior. In its most elementary form, this behavior can be mathematically described by E(t) = P(t)/[V(t)-Vd], where E is ventricular elastance, t is time, P is ventricular pressure, V is ventricular volume, and Vd is the intercept of the end-systolic pressure-volume line on the volume axis. To find out how this behavior of the ventricle as a whole is related to the properties of the myocardium, we tested the energetic prediction for the ventricle that the pressure-volume area of an isovolumic contraction equals the energy released in relaxation in experiments on isolated rabbit papillary muscle at 20 degrees C. To that end, the energy (joules) contained by the force-length area of the muscles, contracting isometrically, was compared with the heat (joules) liberated in relaxation as measured with thermopiles. Mechanical performance of the muscles was varied by altering initial muscle length and external calcium. The slope of the resulting relation between force-length area and heat liberated in relaxation (n = 26) was not significantly different from unity. Thus, the energetic prediction of the time-varying elastance model developed for the whole left ventricle was confirmed by experiments on rabbit papillary muscle at 20 degrees C.
.A
Mast F; Elzinga G.
.I 274671
.U
91004679
.S
Circ Res 9101; 67(4):902-12
.M
Animal; Carbon Radioisotopes; Chromatography, High Pressure Liquid; Comparative Study; Dogs; Female; Indicator Dilution Techniques/*; Kinetics; Leucine/ME; Male; Muscles/ME; Myocardium/*ME; Phenylalanine/ME; Proteins/BI/*ME; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Tritium.
.T
In vivo measurement of myocardial protein turnover using an indicator dilution technique.
.P
JOURNAL ARTICLE.
.W
We applied a nondestructive tracer technique, previously developed for measuring skeletal muscle protein turnover, to the measurement of myocardial protein turnover in vivo. During a continuous infusion of L-[ring-2,6-3H]phenylalanine to anesthetized, overnight-fasted dogs, we measured the uptake of radiolabeled phenylalanine from plasma and the release of unlabeled phenylalanine from myocardial proteolysis using arterial and coronary sinus catheterization and analytic methods previously applied to skeletal muscle. Using these measurements, together with a model of myocardial protein synthesis that assumes rapid equilibration of tracer specific activity between myocardial phenylalanyl-tRNA and circulating phenylalanine, we estimated the rates of heart protein synthesis and degradation. The rate of heart protein synthesis was also estimated directly from the incorporation of labeled phenylalanine into tissue protein. The use of [3H]phenylalanine was compared with L-[1-14C]leucine in the measurement of heart protein turnover in dogs given simultaneous infusion of both tracers. Leucine uptake and release by the myocardium exceeded that of phenylalanine by 3.1 +/- 0.4- and 1.7 +/- 0.3-fold, respectively, consistent with leucine's 2.4-fold greater abundance in heart protein and its metabolism via other pathways. Phenylalanine is the preferred tracer for use with this method because of its limited metabolic fate in muscle. One theoretical limitation to the method, slow equilibration of circulating labeled phenylalanine with myocardial phenylalanyl-tRNA, was resolved by comparison of these specific activities after a 30-minute infusion of labeled phenylalanine in the rat. A second, empirical limitation involves precision in the measurement of the small decrements in phenylalanine specific activity that occur with each pass of blood through the coronary circulation. This was addressed by improving the precision of both the measurements of phenylalanine concentration and phenylalanine specific activity using high-performance liquid chromatography. We conclude that the in vivo measurement of phenylalanine tracer exchange across the myocardium permits the nondestructive estimation of heart protein turnover in the intact animal.
.A
Revkin JH; Young LH; Stirewalt WS; Dahl DM; Gelfand RA; Zaret BL; Barrett EJ.
.I 274672
.U
91004680
.S
Circ Res 9101; 67(4):913-22
.M
Action Potentials; Animal; Caffeine/PD; Calcium/AD/PD; Electric Stimulation; Isoproterenol/PD; Myocardial Contraction/DE/*PH; Potassium/AD/PD; Rats; Ryanodine/PD; Sarcolemma/*PH; Sarcomeres/*PH/UL; Sarcoplasmic Reticulum/*PH; Sodium/AD/PD; Strontium/PD; Support, Non-U.S. Gov't; Tetraethylammonium Compounds/PD.
.T
Sarcolemma, sarcoplasmic reticulum, and sarcomeres as limiting factors in force production in rat heart.
.P
JOURNAL ARTICLE.
.W
Inotropic interventions were compared with respect to their maximum effect on force of contraction in rat myocardium to identify limiting steps in calcium handling. Peak force, sarcomere length, and action potentials were measured in thin ventricular trabeculae. Relevant control conditions were stimulation frequency, 0.2 Hz; [Ca2+]o, 1 mM; [K+]o, 5 mM; [Na+]o, 150 mM. The inotropic interventions and results were as follows. 1) The interventions of high [Ca2+]o, low [Na+]o, high [K+]o, addition of tetraethylammonium chloride, or postextrasystolic potentiation resulted in approximately the same (within 5%) maximum force (Fmax). Above the respective optimum doses, force declined and aftercontractions were often observed. Combinations of the different interventions never enhanced force to above Fmax. This suggests that Fmax is determined by a maximum level of Ca2+ in the sarcoplasmic reticulum, above which spontaneous release occurs. 2) Sr2+ (10 mM) caused an increase of force to 1.3 X Fmax and lengthening of contraction and action potentials. The force-sarcomere length relation was, then, similar to that in skinned fibers at maximum activation. Hence, 1.3 X Fmax reflects saturation of the sarcomeres. We postulate that a large influx of Sr2+ during the long action potential can circumvent the reticulum and activate the sarcomeres directly. When the reticulum was blocked with ryanodine, maximum force of tetanic contractions was about 1.1 X Fmax. This result supports the above conclusions. 3) Isoproterenol increased force to a maximum that was 20% below Fmax and shortened the contraction. This may be due to a decreased sensitivity of the sarcomeres to Ca2+ or to stimulation of the Ca2+ pump in the reticulum, that is, an increasing fraction of the released Ca2+ is sequestered before it can activate the sarcomeres. Thus, three factors that limit force production were identified, depending on the inotropic stimulus.
.A
Schouten VJ; Bucx JJ; de Tombe PP; ter Keurs HE.
.I 274673
.U
91004681
.S
Circ Res 9101; 67(4):923-32
.M
Animal; Blood Pressure; Coronary Vessels/*PH; Diastole/*PH; Dogs; Heart/*PH; Heart Atrium/PH; Heart Rate; Heart Ventricle/AH/PH; Pressure; Support, U.S. Gov't, P.H.S.; Venous Pressure/*PH.
.T
Effects of coronary venous pressure on left ventricular diastolic distensibility.
.P
JOURNAL ARTICLE.
.W
Coronary arterial pressure and flow are known to influence left ventricular (LV) diastolic distensibility, but the influence of coronary venous pressure is unknown. To test the hypothesis that increased coronary venous pressure leads to an increase in LV wall volume and a decrease in LV diastolic distensibility, we studied excised, blood-perfused LV isovolumic dog hearts without the pericardium. In protocol I (n = 8), to raise coronary venous pressure the pressure of right atrium (RA) and right ventricle (RV) was increased by the height of a blood reservoir connected with a cannula that opened in both the RA and RV. In protocol II (n = 7), to isolate the effect of RV enlargement on LV diastolic distensibility (direct ventricular interaction), an isovolumic RV balloon was used with coronary venous pressure held constant at 0 mm Hg. Changes in LV diastolic distensibility were assessed by shifts of the LV end-diastolic pressure-volume relation. Changes in LV wall volume were detected by subepicardial segment length at end-diastole. The mean pressures of RA and RV (protocol I) and RV balloon only (protocol II) were increased from 0 to 15 and 30 mm Hg over a range of LV volume. In protocol I, when RA.RV pressure was increased from 0 to 30 mm Hg at three levels of LV volume (22 +/- 2, 31 +/- 3, and 40 +/- 3 ml), LV end-diastolic pressures increased significantly from 5.2 +/- 0.3 to 11.2 +/- 1.5, from 10.4 +/- 0.3 to 18.2 +/- 1.2, and from 20.2 +/- 1.0 to 28.8 +/- 1.2 mm Hg, respectively. In protocol II, when RV balloon pressure was increased from 0 to 30 mm Hg at the three LV volumes (21 +/- 3, 31 +/- 3, and 41 +/- 4 ml), LV end-diastolic pressures showed smaller increases from 5.2 +/- 0.2 to 6.6 +/- 0.2, from 9.8 +/- 0.3 to 11.6 +/- 0.6, and from 19.0 +/- 0.5 to 21.4 +/- 0.8 mm Hg, respectively. In both protocols, the LV end-diastolic pressure-volume relation shifted upward in a nearly parallel fashion, but the shift was much greater in protocol I than in protocol II. Despite constant LV volume, an increase in LV wall dimension in protocol I was significant and much greater than that in protocol II. From these results, we conclude that increased coronary venous pressure decreases LV diastolic distensibility with increasing LV wall volume, and this mechanism appears to act independently of diastolic ventricular interaction caused by RV enlargement.
.A
Watanabe J; Levine MJ; Bellotto F; Johnson RG; Grossman W.
.I 274674
.U
91004682
.S
Circ Res 9101; 67(4):933-40
.M
Amino Acid Sequence; Animal; Base Sequence; Chickens; Cloning, Molecular/*; Comparative Study; Dihydropyridines/*PD; DNA/*GE; Gene Expression; Gizzard/CH; Molecular Sequence Data; Myosin-Light-Chain Kinase/*GE; Nucleic Acid Hybridization; Phosphorylation; Restriction Mapping; RNA, Messenger/AN; Sequence Homology, Nucleic Acid; Species Specificity; Tissue Distribution.
.T
Cloning and characterization of a vertebrate cellular myosin regulatory light chain complementary DNA.
.P
JOURNAL ARTICLE.
.W
We have isolated two series of complementary DNAs (cDNAs) from a chicken gizzard cDNA library encoding two isoforms of phosphorylatable myosin regulatory light chain (RLC). One of the cDNAs encodes a previously isolated smooth muscle myosin RLC (also referred to as LC20-A); the other encodes a protein that shares 92% homology with the LC20-A isoform. The phosphorylatable threonine and serine residues at positions 18 and 19 of the two myosin RLC sequences are conserved. The two cDNAs are 81% homologous at the nucleotide level over the coding region; the 5' and 3' untranslated regions are divergent. Most of the DNA nonhomology in the coding region does not affect the protein sequence, indicating strong evolutionary conservation pressure to maintain the myosin RLC structure. Northern blot analysis using 3' untranslated region probes reveals restrictive tissue specific expression of one myosin RLC isoform (LC20-A) in smooth muscle tissue and not in other tissues examined. In contrast, the novel myosin RLC isoform messenger RNA (mRNA) is uniformly expressed in all smooth and nonmuscle tissues examined and is designated as cellular myosin RLC for this reason. Our results indicate that cellular and smooth muscle myosin RLC isoforms are distinct and are encoded by separate genes. This report describes the cloning of a novel vertebrate cellular myosin RLC mRNA that differs from previously characterized smooth muscle RLC isoform mRNAs in both primary sequence and expression pattern.
.A
Zavodny PJ; Petro ME; Lonial HK; Dailey SH; Narula SK; Leibowitz PJ; Kumar CC.
.I 274675
.U
91004683
.S
Circ Res 9101; 67(4):941-7
.M
Adenosine Diphosphate/PD; Amino Acid Sequence; Drug Synergism; Fibrinogen/*PD; Human; Molecular Sequence Data; Oligopeptides/CS/PD; Peptide Fragments/PD; Peptides/*PD; Platelet Aggregation/DE; Platelet Aggregation Inhibitors/*PD; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S..
.T
Synergistic inhibition of platelet aggregation by fibrinogen-related peptides.
.P
JOURNAL ARTICLE.
.W
We have evaluated the ability of the fibrinogen-related peptides Gly-Arg-Gly-Asp-Ser (GRGDS), Gly-Gln-Gln-His-His-Leu-Gly-Gly-Ala-Lys-Gln-Ala-Gly-Asp-Val (gamma-chain peptide), and Gly-Pro-Arg-Pro (GPRP) to inhibit platelet aggregation in platelet-rich plasma individually and in combination. When used alone, GRGDS totally inhibited ADP-induced aggregation of human platelets in platelet-rich plasma; however, the maximum inhibitory effect of the other peptides was less than 80%. The concentrations necessary to inhibit platelet aggregation in plasma by 50% were 100 mumols/l and 1 and 3.2 mmol/l for GRGDS, gamma-chain peptide, and GPRP, respectively. When evaluating the effect of peptide mixtures, we discovered that the combination GPRP + GRGDS worked together synergistically (p less than 0.001, analysis by surface response methodology), whereas GPRP + gamma-chain peptide did not. For example, our analysis indicated that a mixture of 50 mumols/l GRGDS plus 180 mumols/l GPRP would produce 50% inhibition of platelet aggregation. This is an effect twofold greater than that produced by 50 mumols/l GRGDS alone, and one that would require an 18-fold greater concentration of GPRP if used alone. These data indicate that the combination GPRP + GRGDS inhibited platelet aggregation in plasma in a synergistic fashion and suggest the potential value of their combined use in antithrombotic therapy.
.A
Adelman B; Gennings C; Strony J; Hanners E.
.I 274676
.U
91004684
.S
Circ Res 9101; 67(4):948-59
.M
Adenosine Triphosphate/ME; Animal; Anoxia/*PA/PP; Aorta/SU; Constriction; Coronary Disease/*PA/PP; Glycogen/ME; Heart Enlargement/*PA/PP; Heart Ventricle/PP; Lactates/ME; Male; Microscopy, Electron; Myocardial Contraction; Myocardium/ME/PA; Phosphocreatine/ME; Pressure; Rats; Rats, Inbred Strains; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Increased ischemic injury but decreased hypoxic injury in hypertrophied rat hearts.
.P
JOURNAL ARTICLE.
.W
The purpose of this study was to compare the degree of ischemic and hypoxic injury in normal versus hypertrophied rat hearts to investigate basic mechanisms responsible for irreversible myocardial ischemic injury. Hearts from rats with bands placed on the aortic arch at 23 days of age (BAND) and sham-operated rats (SHAM, 8 weeks postoperative) were isolated, perfused with Krebs buffer, and had a left ventricular balloon to measure developed pressure. Hearts were made globally ischemic until they developed peak ischemic contracture and were reperfused for 30 minutes. Additional hearts were perfused for 15 minutes with glucose-free hypoxic buffer followed by 20 minutes of oxygenated perfusion. There was an 87% increase in heart weight of BAND compared with SHAM (p less than 0.01). During ischemia, lactate levels increased faster in BAND compared with SHAM, ischemic contracture occurred earlier in BAND than in SHAM despite no difference in ATP levels, and postischemic recovery of left ventricular pressure was less in BAND (26.8 +/- 5.6% of control left ventricular pressure, mean +/- SEM) compared with SHAM (40 +/- 4.6%, p less than 0.05). During hypoxic perfusion, lactate release was greater in BAND than in SHAM (48.8 +/- 1.2 versus 26.6 +/- 0.97 mumols/g, p less than 0.01), and with reoxygenation, lactate dehydrogenase release was less in BAND than in SHAM (13.2 +/- 0.7 versus 19.5 +/- 0.2 IU/g, p less than 0.01). After hypoxia and reoxygenation, left ventricular pressure recovery was greater in BAND than in SHAM (93 +/- 8.4% versus 66 +/- 5.3%, p less than 0.01). Thus, this study suggests that hypertrophied hearts have a greater potential for glycolytic metabolism, resulting in an increased rate of by-product accumulation during ischemia, which may be responsible for the increased susceptibility of hypertrophied hearts to ischemic injury.
.A
Anderson PG; Allard MF; Thomas GD; Bishop SP; Digerness SB.
.I 274677
.U
91004685
.S
Circ Res 9101; 67(4):960-78
.M
Adenine/AA/PD; Adenosine/AD/*PD; Adenosine Deaminase/AI; Animal; Anoxia/PP; Atrioventricular Node/DE/*PP; Bundle of His/PP; Comparative Study; Depression, Chemical; Dipyridamole/PD; Female; Guinea Pigs; Heart Atrium/PP; Heart Block/PP; Heart