.I 54711
.U
88000001
.S
Alcohol Alcohol 8801; 22(2):103-12
.M
Acetaldehyde/*ME; Buffers; Catalysis; HEPES/PD; Nuclear Magnetic Resonance; Phosphates/*PD; Protein Binding; Ribonuclease, Pancreatic/AI/*ME; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
The binding of acetaldehyde to the active site of ribonuclease: alterations in catalytic activity and effects of phosphate.
.P
JOURNAL ARTICLE.
.W
Ribonuclease A was reacted with [1-13C,1,2-14C]acetaldehyde and sodium cyanoborohydride in the presence or absence of 0.2 M phosphate. After several hours of incubation at 4 degrees C (pH 7.4) stable acetaldehyde-RNase adducts were formed, and the extent of their formation was similar regardless of the presence of phosphate. Although the total amount of covalent binding was comparable in the absence or presence of phosphate, this active site ligand prevented the inhibition of enzymatic activity seen in its absence. This protective action of phosphate diminished with progressive ethylation of RNase, indicating that the reversible association of phosphate with the active site lysyl residue was overcome by the irreversible process of reductive ethylation. Modified RNase was analysed using 13C proton decoupled NMR spectroscopy. Peaks arising from the covalent binding of enriched acetaldehyde to free amino groups in the absence of phosphate were as follows: NH2-terminal alpha amino group, 47.3 ppm; bulk ethylation at epsilon amino groups of nonessential lysyl residues, 43.0 ppm; and the epsilon amino group of lysine-41 at the active site, 47.4 ppm. In the spectrum of RNase ethylated in the presence of phosphate, the peak at 47.4 ppm was absent. When RNase was selectively premethylated in the presence of phosphate, to block all but the active site lysyl residues and then ethylated in its absence, the signal at 43.0 ppm was greatly diminished, and that arising from the active site lysyl residue at 47.4 ppm was enhanced. These results indicate that phosphate specifically protected the active site lysine from reaction with acetaldehyde, and that modification of this lysine by acetaldehyde adduct formation resulted in inhibition of catalytic activity.
.A
Mauch TJ; Tuma DJ; Sorrell MF.
.I 54712
.U
88000002
.S
Alcohol Alcohol 8801; 22(2):113-6
.M
Adult; Alcohol, Ethyl/*AN; Breath Tests/*; Human; Irrigation; Male; Middle Age; Mouth/*; Temperature; Water.
.T
Reductions in breath ethanol readings in normal male volunteers following mouth rinsing with water at differing temperatures.
.P
JOURNAL ARTICLE.
.W
Blood ethanol concentrations were measured sequentially, over a period of hours, using a Lion AE-D2 alcolmeter, in 12 healthy male subjects given oral ethanol 0.5 g/kg body wt. Readings were taken before and after rinsing the mouth with water at varying temperatures. Mouth rinsing resulted in a reduction in the alcolmeter readings at all water temperatures tested. The magnitude of the reduction was greater after rinsing with water at lower temperatures. This effect occurs because rinsing cools the mouth and dilutes retained saliva. This finding should be taken into account whenever breath analysis is used to estimate blood ethanol concentrations in experimental situations.
.A
Gaylarde PM; Stambuk D; Morgan MY.
.I 54713
.U
88000003
.S
Alcohol Alcohol 8801; 22(2):117-9
.M
Alcoholism/*PP; Animal; Diprenorphine/PD; Female; Morphine/*PD; Naloxone/PD; Naltrexone/PD; Narcotic Antagonists/*PD; Rats; Rats, Inbred Strains; Receptors, Endorphin/*DE/PH; Seizures/PP; Substance Withdrawal Syndrome/PP.
.T
Does the blockade of opioid receptors influence the development of ethanol dependence?
.P
JOURNAL ARTICLE.
.W
We have tested whether the opioid antagonists naloxone (2 mg/kg), naltrexone (2 mg/kg) and diprenorphine (0.2 mg/kg), and the agonist morphine (4-8 mg/kg) given subcutaneously (10 min before ethanol for 7 days) modify the ethanol withdrawal syndrome (audiogenic seizures) following chronic ethanol intoxication in rats. We found that naloxone, naltrexone and diprenorphine modified the ethanol withdrawal syndrome. These findings do not rule out the possibility of a biochemical link between the action of ethanol and opiates at the level of opioid receptors.
.A
Kotlinska J; Langwinski R.
.I 54714
.U
88000006
.S
Alcohol Alcohol 8801; 22(2):147-54
.M
Adult; Alcohol Drinking/*PH; Alcoholism/*BL/CO; Erythrocyte Indices/*; Female; Follow-Up Studies; Gamma-Glutamyltransferase/*BL; Hepatomegaly/ET; Human; Male; Middle Age; Predictive Value of Tests; Sex Factors.
.T
Drinkwatchers--description of subjects and evaluation of laboratory markers of heavy drinking.
.P
JOURNAL ARTICLE.
.W
Clinical examination and measurement of MCV and GGT were carried out on 124 self-referred 'healthy' Drinkwatchers, all of whom had consumed at least 80 g alcohol/day for more than 2 years. The majority (66.1%) were in social classes II and III. Sixty-three subjects (54.1%) had a raised MCV, GGT or hepatomegaly. A raised MCV was significantly more likely to occur in men. Forty-five subjects (36.3%) had an enlarged liver of whom 17 had a normal MCV and GGT. This study shows that MCV and GGT are poor screening tests for excessive alcohol consumption in 'healthy' subjects but, if used at all, MCV appears to be more sensitive in women and GGT in men. Neither test is an adequate substitute for a careful history and full clinical examination.
.A
Barrison IG; Ruzek J; Murray-Lyon IM.
.I 54715
.U
88000007
.S
Alcohol Alcohol 8801; 22(2):155-9
.M
Adult; Alcoholism/*BL; Blood Platelets/*ME; Erythrocyte Indices; Gamma-Glutamyltransferase/BL; Human; In Vitro; Kinetics; Middle Age; Serotonin/*BL; Support, Non-U.S. Gov't.
.T
Platelet affinity for serotonin is increased in alcoholics and former alcoholics: a biological marker for dependence?
.P
JOURNAL ARTICLE.
.W
The kinetics of 3H serotonin platelet uptake were studied in alcoholics and former alcoholics to see whether differences found between alcohol-preferring and non-preferring rats could be reproduced in man. Three groups of patients were studied: 10 dependent alcoholics on admission for treatment; 10 dependent alcoholics after 20 days of treatment; 8 former dependent alcoholics, abstinent for 1-11 years. Controls were non-alcoholics, matched for age and sex. The Km for 3H serotonin uptake in platelets was lower in patients from all three groups compared to 15 controls. This phenomenon could be congenital or induced by the previous excessive intake of alcohol. We believe that this increased platelet affinity for serotonin, in the absence of cirrhosis of the liver and/or depression could be a marker for alcohol dependence, enabling the therapeutic effort to be focussed on these patients.
.A
Boismare F; Lhuintre JP; Daoust M; Moore N; Saligaut C; Hillemand B.
.I 54716
.U
88000008
.S
Alcohol Alcohol 8801; 22(2):161-6
.M
Adult; Affective Symptoms/DT; Alcoholism/*PP/PX; Clonidine/AD/*TU; Human; Infusions, Intravenous; Male; Substance Withdrawal Syndrome/*DT/PX; Support, Non-U.S. Gov't.
.T
Clonidine in alcohol withdrawal: a pilot study of differential symptom responses following i.v. clonidine.
.P
JOURNAL ARTICLE.
.W
The effects of an i.v. bolus of clonidine (1.5 mg/kg) on withdrawal symptoms were studied in 7 male alcoholics, and compared with 7 normal controls. Clonidine reduced both subjective and objective measures of withdrawal but this only reached significance for scores of depression and muscle tension. In comparison with controls alcoholics in withdrawal showed reduced sedative effects of clonidine.
.A
Glue P; Nutt D.
.I 54717
.U
88000009
.S
Alcohol Alcohol 8801; 22(2):167-79
.M
Adult; Alcohol Drinking/*; Female; Great Britain; Human; Interviews; Male; Population Surveillance/*; Recall; Support, Non-U.S. Gov't.
.T
Bias in a survey of drinking habits.
.P
JOURNAL ARTICLE.
.W
This paper presents data from a general population survey of three areas of Britain which manifest considerable differences in official rates of problem drinking, yet show similar patterns and levels of alcohol consumption. Consideration of various sources of bias (non-response, forgetting, selective under-reporting, and interviewer) suggest that they do not differentially influence self-reported alcohol consumption in the three areas.
.A
Crawford A.
.I 54718
.U
88000010
.S
Alcohol Alcohol 8801; 22(2):181-92
.M
Adult; Alcohol Drinking; Alcoholism/*PX; Family/*; Female; Gender Identity/*; Human; Identification (Psychology)/*; Male; Questionnaires; Regression Analysis; Sex Factors; Students/*PX; Support, U.S. Gov't, P.H.S.; Texas; Universities.
.T
Factors associated with young adult alcohol abuse.
.P
JOURNAL ARTICLE.
.W
The present study examined correlates of alcohol abuse among university students which have been conceptually linked to the developmental transitions faced by this population. Individual and family developmental theories led to the hypothesis that sex role identity conflict and stresses within the student's family of origin would be positively related to alcohol abuse scores. As expected, an accumulation of family stresses was related to alcohol abuse scores for both men and women. However, for each sex only one of the four sex role conflict variables which were considered was significantly related to alcohol abuse scores. For women, this variable was femininity conflict, while for men it was affiliation conflict.
.A
Koch-Hattem A; Denman D.
.I 54719
.U
88000011
.S
Alcohol Alcohol 8801; 22(2):193-8
.M
Age Factors; Aged; Aged, 80 and over; Alcohol Drinking; Alcoholism/CO/*EP/PX; Cognition/DE; Depression/EP; Health Status; Human; Life Style; Male; Mental Status Schedule; Smoking/*EP; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Alcohol and the elderly: relationships to illness and smoking.
.P
JOURNAL ARTICLE.
.W
A group of 33 semi-independent living nonagenarian men and a group of 32 65-75 year-old men of similar demographic characteristics, living at the California Veterans' Home, were compared in terms of alcohol use, past and present, and relationships to several somatic, mental and lifestyle aspects including smoking. The younger group had a higher prevalence of alcohol abuse and higher current alcohol intake (P less than 0.004). Higher alcohol intake related to greater smoking of cigarettes in the younger group. Alcohol tended to be related to an increased number of medical illnesses, and to increased use of major medications (P less than 0.005). There was an interactive effect between classes of alcohol use and scores on a mental status examination used to assess cognitive function (P less than 0.05).
.A
Jensen GD; Bellecci P.
.I 54720
.U
88000012
.S
Alcohol Alcohol 8801; 22(2):99-101
.M
Publishing; Research Design; Statistics/*.
.T
Concerning the probability of our confidence in statistics [editorial]
.P
EDITORIAL.
.A
Tittmar HG.
.I 54721
.U
88000305
.S
Br J Anaesth 8801; 59(8):1011-6
.M
Action Potentials/DE; Alcuronium/*PD; Dose-Response Relationship, Drug; Drug Synergism; Enflurane/*PD; Female; Halothane/*PD; Human; Isoflurane/*PD; Muscles/PH; Neuromuscular Junction/*DE; Support, Non-U.S. Gov't; Time Factors; Toxiferine/*AA.
.T
Potentiation of the neuromuscular blockade produced by alcuronium with halothane, enflurane and isoflurane.
.P
JOURNAL ARTICLE.
.W
The potentiation of alcuronium by halothane, enflurane and isoflurane was investigated using electromyography. In the first study, cumulative dose-response curves were constructed in four groups of 10 patients anaesthetized with one of the inhalation agents and nitrous oxide, or with fentanyl and droperidol (control). All three agents reduced the ED50 of alcuronium; the effect was marked with isoflurane (P less than 0.005) but less so with halothane (P less than 0.05) and enflurane (ns). In the second part of the investigation, designed primarily to test the duration of action of alcuronium with each agent, a single bolus dose of alcuronium 0.2 mg kg-1 was given to four similar groups (n = 5). The duration of action was significantly prolonged by enflurane (P less than 0.01) and isoflurane (P less than 0.05), but not by halothane. The possible reasons for this are discussed.
.A
Keens SJ; Hunter JM; Snowdon SL; Utting JE.
.I 54722
.U
88000306
.S
Br J Anaesth 8801; 59(8):1017-21
.M
Burns/*PP; Child; Depression, Chemical; Electromyography; Human; Muscles/DE; Succinylcholine/*PD; Time Factors.
.T
Electromyographic responses to small doses of suxamethonium in children after burns.
.P
JOURNAL ARTICLE.
.W
Integrated electromyographic studies in burned patients, and in normal controls, during the administration of small doses of suxamethonium (0.1 or 0.2 mg kg-1) have shown that the level of paralysis and the duration of paralysis are significantly increased in burn patients and that the effect is greater with larger burns. Repeated studies on patients using these small doses have shown that patients with burns pass through a phase of extreme sensitivity to the effects of suxamethonium, usually sometime between 4 and 12 days after the burn.
.A
Brown TC; Bell B.
.I 54723
.U
88000307
.S
Br J Anaesth 8801; 59(8):1022-6
.M
Anesthesia, Inhalation/*VE; Animal; Bronchi/*DE; Enflurane/*PD; Expiratory Reserve Volume; Female; Halothane/*PD; Horses/*PH; Isoflurane/*PD; Male; Support, Non-U.S. Gov't; Tidal Volume; Time Factors.
.T
Effect of halothane, enflurane and isoflurane on bronchomotor tone in anaesthetized ponies.
.P
JOURNAL ARTICLE.
.W
The effects of halothane, enflurane and isoflurane on bronchial calibre were investigated in five anaesthetized ponies using a computer-aided forced airflow oscillation technique to derive specific lower airways conductance (s.Glaw) and expiratory reserve volume (ERV). All the agents tended to increase s.Glaw (indicating bronchodilatation), but ERV was reduced by halothane and enflurane, and increased by isoflurane. It was concluded that the effects of these agents on bronchomotor tone were similar to those which occur in man. However, the reasons for the differences in their effects on ERV compared with those found in man remain to be determined.
.A
Watney GC; Jordan C; Hall LW.
.I 54724
.U
88000309
.S
Br J Anaesth 8801; 59(8):1035-9
.M
Adolescence; Adult; Aged; Blood Cell Count; Blood Transfusion, Autologous/*ST; Comparative Study; Erythrocytes/PH; Female; Heart Surgery; Heparin/BL; Human; Hydrogen-Ion Concentration; Leukocytes/PH; Male; Middle Age; Potassium/BL; Support, Non-U.S. Gov't.
.T
Autotransfusion: quality of blood prepared with a red cell processing device.
.P
JOURNAL ARTICLE.
.W
The quality of blood salvaged at operation and prepared with the Dideco Autotrans BT 795 autotransfusion device was compared with that of donor blood in 41 patients having cardiac surgery involving cardiopulmonary bypass. Saved blood had a higher haemoglobin concentration (17.3 v. 13.1 g dl-1; P less than 0.001), a higher 2,3-diphosphoglycerate concentration (5.3 v. 1.1 mmol litre-1; P less than 0.00001), higher white cell count (17.1 X 10(9) litre-1 v. 4.1; P less than 0.00001), higher pH (7.5 v. 6.6; P less than 0.00001) and a more physiological potassium concentration (5.4 v. 8.8 mmol litre-1; P less than 0.00001) than donor blood. Saved blood platelet count was 34.5 X 10(9) litre-1 compared with 146.24 X 10(9) litre-1 (P less than 0.00001) and its heparin concentration was 0.64 u. ml-1. We conclude that this autotransfusor is a useful aid to blood conservation, producing good quality red cells with relatively normal pH and potassium values. However, modification of the centrifugation and washing is required to lessen the high white cell count and heparin concentrations found in the saved blood.
.A
McShane AJ; Power C; Jackson JF; Murphy DF; MacDonald A; Moriarty DC; Otridge BW.
.I 54725
.U
88000310
.S
Br J Anaesth 8801; 59(8):1040-3
.M
Air; Animal; Female; Fetus; In Vitro; Liver/EM/*EN; Methyltransferases/*AI; Nitrous Oxide/*PD; Oxygen/PD; Pregnancy; Rats; Rats, Inbred Strains; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Tetrahydropteroylglutamate Methyltransferase/*AI; Time Factors.
.T
Inhibition of rat fetal methionine synthase by nitrous oxide. An in vitro study.
.P
JOURNAL ARTICLE.
.W
The effect of in vitro exposure to nitrous oxide on rat fetal and maternal methionine synthase activity was investigated. Enzyme solutions were prepared from livers of fetuses and mothers on day 19 of gestation and exposed to air, 50% oxygen or 50% nitrous oxide in oxygen for periods up to 24 h. Normal activity of methionine synthase in the fetus was about 65% of that in the mother. Activity decreased by about 25% over 24 h when the enzyme was incubated at 37 degrees C in the presence of either air or 50% oxygen. Nitrous oxide produced a time-dependent decrease in activity which generally was similar for both fetal and maternal enzyme. After 24 h exposure to nitrous oxide, activity has decreased to 14 and 17% of fetal and maternal control values, respectively.
.A
Baden JM; Serra M; Mazze RI.
.I 54726
.U
88000312
.S
Br J Anaesth 8801; 59(8):1052-5
.M
Cholinesterases/GE; Drug Hypersensitivity/EP/ET/*GE; England; Female; Gene Frequency; Genotype; Human; Male; Phenotype; Pregnancy; Succinylcholine/*AE; Support, Non-U.S. Gov't.
.T
Phenotyping of individuals sensitive to suxamethonium. The Cholinesterase Research Unit at the Royal Postgraduate Medical School.
.P
JOURNAL ARTICLE.
.W
Four hundred and thirty blood samples from suxamethonium-sensitive individuals have been phenotyped by the Cholinesterase Research Unit following its transfer from Exeter to the Hammersmith Hospital. The distribution of genotypes has been shown to be similar to that found in Exeter. Screening for the Elk and Elj genes has not yielded any major differences in the gene frequencies of sensitive individuals, even during pregnancy. The uneven sex distribution of the patients, as well as other unusual points that have arisen, are discussed. A new gene for the biosynthesis of cholinesterase has probably been identified.
.A
Whittaker M; Britten JJ.
.I 54727
.U
88000313
.S
Br J Anaesth 8801; 59(8):1056-8
.M
Axillary Artery/*PH; Blood Pressure/*; Case Report; Cerebral Aneurysm/*SU; Human; Intraoperative Complications; Male; Middle Age; Monitoring, Physiologic/*; Thromboangiitis Obliterans/*CO.
.T
Monitoring of axillary arterial pressure in a patient with Buerger's disease requiring clipping of an intracerebral aneurysm.
.P
JOURNAL ARTICLE.
.W
A 45-yr-old male with advanced Buerger's disease required surgical clipping of an intracerebral aneurysm. This case report emphasizes considerations of arterial pressure monitoring in a patient with advanced Buerger's Disease requiring a major surgical intervention.
.A
Yacoub OF; Bacaling JH; Kelly M.
.I 54728
.U
88000314
.S
Br J Anaesth 8801; 59(8):1059-62
.M
Bladder/*SU; Case Report; Child; Female; Human; Intraoperative Complications; Pulmonary Embolism/*ET.
.T
Massive intraoperative pulmonary embolism in a child.
.P
JOURNAL ARTICLE.
.W
An 11-yr-old girl suffered a massive pulmonary embolus during an operation to insert an artificial bladder sphincter. Forty minutes after the induction of anaesthesia, the heart rate increased and she became hypotensive and deeply cyanosed. A definitive diagnosis was not made during surgery, but she improved after 45 min of resuscitation with 100% oxygen, infusion of normal saline, ephedrine (total 45 mg) and intermittent external cardiac massage. The diagnosis was proved the next day by lung perfusion scan. There were no apparent risk factors.
.A
Goodman NW; Falkner MJ.
.I 54729
.U
88000315
.S
Br J Anaesth 8801; 59(8):949-53
.M
Abdomen/PH; Anesthesia/*AE; Atelectasis/*ET; Blood Volume; Diaphragm/PH; Functional Residual Capacity; Human; Pulmonary Gas Exchange; Thorax/PH.
.T
Anaesthesia, and atelectasis: the role of VTAB and the chest wall.
.P
JOURNAL ARTICLE.
.A
Jones JG.
.I 54730
.U
88000317
.S
Br J Anaesth 8801; 59(8):961-5
.M
Adult; Alcohol, Ethyl/BL/*PD; Human; Male; Psychomotor Performance/*DE; Time Factors.
.T
Effects of ethanol on psychomotor performance.
.P
JOURNAL ARTICLE.
.W
Three separate doses of alcohol (0.2, 0.4 and 0.8 g kg-1) were given to eight volunteers and compared with the effects of a placebo. The order of administration was randomized and the study performed double-blind. A battery of psychometric tests sensitive to central nervous system depression was repeatedly performed for 3.5 h. Alcohol, even in the highest dose, had little effect on psychomotor performance.
.A
Fagan D; Tiplady B; Scott DB.
.I 54731
.U
88000318
.S
Br J Anaesth 8801; 59(8):966-9
.M
Adult; Aged; Aged, 80 and over; Anesthesia, General/*; Atropine/*PD; Cognition/*DE; Comparative Study; Female; Glycopyrrolate/*PD; Human; Male; Middle Age; Postoperative Period; Pyrrolidines/*PD.
.T
Comparison of the effects of atropine and glycopyrrolate on cognitive function following general anaesthesia.
.P
JOURNAL ARTICLE.
.W
Tests of orientation, concentration and short-term visual memory were used to assess 72 patients 1 day before, and 2 days after, elective major surgery. Patients were premedicated with papaveretum and either atropine or glycopyrrolate, before receiving a standard general anaesthetic. Those who had received atropine showed significant postoperative short-term memory deficit (P less than 0.01), but no change in orientation or concentration. Those who had been given glycopyrrolate showed no significant cognitive changes after surgery. As glycopyrrolate does not cross the blood-brain barrier freely, these findings support the involvement of central cholinergic mechanisms in the deterioration of cognitive function in the postoperative period.
.A
Simpson KH; Smith RJ; Davies LF.
.I 54732
.U
88000320
.S
Br J Anaesth 8801; 59(8):978-82
.M
Adult; Anesthesia Recovery Period/*; Anesthesia, General/*; Anesthesia, Obstetrical/*; Buprenorphine/*; Cesarean Section/*; Female; Fentanyl/*; Human; Postoperative Period/*; Pregnancy.
.T
Use of simple tests to determine the residual effects of the analgesic component of balanced anaesthesia.
.P
JOURNAL ARTICLE.
.W
In order to evaluate simple means of determining the rate of recovery after general anaesthesia, the usefulness of the critical flicker fusion threshold test, the Maddox wing apparatus and the visual analogue scale were compared. The postanaesthetic recovery score was used as a reference. Two patient groups (n = 15 in each) received, in a randomized double-blind study, a similar balanced anaesthesia for Caesarean section, except that the analgesic component was either fentanyl 2.5 micrograms kg-1 i.v. or buprenorphine 7.5 micrograms kg-1 i.v. Maddox wing apparatus and visual analogue scale were sensitive enough to differentiate between the postanaesthetic residual effects of the two opioids, but critical flicker fusion threshold and, especially, postanaesthetic recovery score were insensitive in this respect. There was no difference between the two patient groups in mean arterial pressure and heart rate. Our results show that the residual effects of different kinds of opioids as an analgesic component of balanced anaesthesia can be differentiated using simple means like Maddox wing apparatus and visual analogue scales.
.A
Manner T; Kanto J; Salonen M.
.I 54733
.U
88000321
.S
Br J Anaesth 8801; 59(8):983-8
.M
Adult; Aged; Edrophonium/PD; Electromyography; Human; Middle Age; Muscle Contraction/DE; Neostigmine/PD; Neuromuscular Junction/*DE; Time Factors; Vecuronium/AI/*PD.
.T
Electrical and mechanical responses after neuromuscular blockade with vecuronium, and subsequent antagonism with neostigmine or edrophonium.
.P
JOURNAL ARTICLE.
.W
Six unpremedicated patients who had given their informed consent were given vecuronium 0.08 mg kg-1 before elective surgery. Recovery from neuromuscular blockade was measured electrically and mechanically. Neuromuscular blockade was antagonized 1 h after the administration of vecuronium with two doses of neostigmine 2.5 mg (three patients) or edrophonium 0.5 mg kg-1 (three patients). Although the onset of initial recovery was similar, subsequent recovery was faster when measured electrically (EMG) than when measured mechanically. Recovery appeared to be faster in younger patients. Reintroduction of neuromuscular blockade occurred after the second dose of neostigmine 2.5 mg, given to antagonize the block. This did not occur after either dose of edrophonium 0.5 mg kg-1.
.A
Astley BA; Katz RL; Payne JP.
.I 54734
.U
88000322
.S
Br J Anaesth 8801; 59(8):989-94
.M
Adolescence; Adult; Aged; Arm; Atracurium/*PD; Electric Stimulation/MT; Human; Middle Age; Muscle Contraction/DE; Muscles/PH; Neuromuscular Junction/*DE; Succinylcholine/*PD; Time Factors.
.T
Onset and recovery of atracurium and suxamethonium-induced neuromuscular blockade with simultaneous train-of-four and single twitch stimulation.
.P
JOURNAL ARTICLE.
.W
Single twitch and train-of-four stimulation were applied at 0.08 Hz to each ulnar nerve and the force of contraction of the adductor pollicis was recorded during onset of and recovery from neuromuscular blockade by suxamethonium 1 mg kg-1 or atracurium 0.4 mg kg-1. Times to 90% first twitch blockade of train-of-four were (mean +/- SEM) 0.82 +/- 0.08 and 1.98 +/- 0.18 min for suxamethonium and atracurium, respectively, compared with times to 90% single twitch blockade of 1.00 +/- 0.07 and 3.35 +/- 0.37 min, respectively (P less than 0.05 in both cases). Apparent onset time also depended on how long train-of-four stimulation had been applied before injection of atracurium. The mode of stimulation had little effect on time to 10% recovery. The results are consistent with stimulation-induced augmentation in muscle blood flow, which increased delivery of the drug to the neuromuscular junction.
.A
Curran MJ; Donati F; Bevan DR.
.I 54735
.U
88000323
.S
Br J Anaesth 8801; 59(8):995-1003
.M
Adolescence; Adult; Atracurium/*PD; Azathioprine/PD; Dose-Response Relationship, Drug; Drug Interactions; Female; Human; Kidney Failure, Chronic/*PP; Male; Middle Age; Neuromuscular Junction/*DE; Pancuronium/*PD; Vecuronium/*PD.
.T
Atracurium, vecuronium and pancuronium in end-stage renal failure. Dose-response properties and interactions with azathioprine.
.P
JOURNAL ARTICLE.
.W
Dose-response relations for atracurium, vecuronium and pancuronium were determined in patients in end-stage renal failure for the initial neuromuscular blockade (using three cumulative doses) and for the maintenance of stable 90% response (during continuous infusion). All measurements were during renal transplant surgery, and the interaction of azathioprine on neuromuscular blockade was estimated. Mean ED95 doses were (microgram kg-1): atracurium 375.6, vecuronium 67.2, pancuronium 86.6; the initial blockade required significantly larger doses than in normal patients (37%, 20% and 45%, respectively, using ED50 values). Mean infusion rates for 90% sustained blockade in renal failure were (microgram kg-1 h-1): atracurium 409.4, vecuronium 78.3, pancuronium 14.2. The atracurium dose was not influenced by renal function, whereas vecuronium and pancuronium requirements were significantly reduced by 23.2% and 61.5%, respectively, compared with normal patients (previous study). Azathioprine was injected at the rate of 1 mg kg-1 min-1 for 3 min at stable 90% neuromuscular blockade with constant-rate infusion of the neuromuscular blocking drug. This produced a relatively small and transient antagonism of blockade--probably of negligible clinical significance.
.A
Gramstad L.
.I 54736
.U
88000425
.S
Br J Dermatol 8801; 117(1):1-9
.M
Animal; Antigen-Presenting Cells/*IM; Antigens/*IM; Dermatitis, Contact/*IM; Dinitrochlorobenzene/*IM/PK; Female; Langerhans Cells/AN; Mice; Mice, Inbred BALB C; Nitrobenzenes/IM/PK; Skin/AN/*IM; Skin Absorption.
.T
Control of the immune response to contact sensitizing chemicals by cutaneous antigen-presenting cells.
.P
JOURNAL ARTICLE.
.W
The fate of 2,4-dinitrochlorobenzene, a potent contact sensitizing chemical, and 2,4-dichloronitrobenzene, a non-sensitizer, was compared following their application to the skin of BALB/c mice. Although both chemicals were able to bind to protein in vitro and were capable of being absorbed across mouse skin in vivo, only 2,4-dinitrochlorobenzene was able to bind to cells in the skin and to induce the movement of these cells from the epidermis into the dermis and ultimately into the draining lymph nodes. The sensitization potential of a chemical may therefore be dependent on its ability to associate with and stimulate the efflux of cutaneous antigen-presenting cells.
.A
Botham PA; Rattray NJ; Walsh ST; Riley EJ.
.I 54737
.U
88000426
.S
Br J Dermatol 8801; 117(1):107-9
.M
Adult; Androgens/TU; Blood Platelet Disorders/DT/ET; Case Report; Human; Klinefelter's Syndrome/*BL/CO; Leg Ulcer/*BL/DT/ET; Male; Platelet Aggregation/*; Platelet Function Tests.
.T
Platelet hyperaggregability in a patient with Klinefelter's syndrome and leg ulcers.
.P
JOURNAL ARTICLE.
.W
We describe a patient with Klinefelter's syndrome complicated by recalcitrant leg ulcers, in whom marked platelet hyperaggregability was demonstrated and venous disease excluded. Androgen replacement therapy appeared to bring about healing of the patient's ulcers and was associated with reversal of the platelet abnormality. The possible role of androgen deficiency in the pathogenesis of leg ulceration is discussed.
.A
Norris PG; Rivers JK; Machin S; Dowd PM; Griffiths WA.
.I 54738
.U
88000428
.S
Br J Dermatol 8801; 117(1):111-5
.M
Adult; Case Report; Female; Human; Melanosis/*ET/PA; Skin/PA; Spectrum Analysis; Ultraviolet Rays/*AE.
.T
UVA-induced melanocytic lesions.
.P
JOURNAL ARTICLE.
.W
The occurrence of melanocytic lesions following PUVA therapy is well documented. We describe a patient who developed similar lesions after cosmetic use of a home sun-bed without psoralen administration. Histological examination showed increased numbers of large and sometimes atypical melanocytes, which may theoretically act as precursors for melanoma.
.A
Jones SK; Moseley H; Mackie RM.
.I 54739
.U
88000429
.S
Br J Dermatol 8801; 117(1):117-9
.M
Adult; Case Report; Facial Dermatoses/*ET; Human; Male; Occupational Dermatitis/*ET; Photosensitivity Disorders/*ET; Ultraviolet Rays/*AE; Welding/*.
.T
Photodermatitis due to spot welding.
.P
JOURNAL ARTICLE.
.W
The case of a patient with a 1-year history of recurrent, severe facial dermatitis is reported. The role of ultraviolet radiation from arc welding or other equipment at work in inducing dermatitis is discussed.
.A
Shehade SA; Roberts PJ; Diffey BL; Foulds IS.
.I 54740
.U
88000430
.S
Br J Dermatol 8801; 117(1):121-4
.M
Administration, Topical; Adult; Case Report; Clobetasol/AA/AD; Human; Male; Pigmentation Disorders/DT/*PA; Prurigo/DT/*PA; Skin/*PA.
.T
Prurigo pigmentosa.
.P
JOURNAL ARTICLE.
.W
Prurigo pigmentosa is a rare dermatosis which is most common in Japan. Although the histological features are non-specific, the clinical appearance is striking and is dominated by gross reticular pigmentation. A Chinese patient with prurigo pigmentosa is described.
.A
Cox NH.
.I 54741
.U
88000431
.S
Br J Dermatol 8801; 117(1):125-7
.M
Adult; Basement Membrane/IM; Case Report; Female; Goodpasture's Syndrome/*IM; Human; IgG/*IM; Skin/IM.
.T
Circulating anti-skin basement membrane zone antibodies in a patient with Goodpasture's syndrome.
.P
JOURNAL ARTICLE.
.W
We report the case of a patient with atypical bullous pemphigoid and haemoptysis in whom circulating IgG skin basement membrane zone antibodies were demonstrated. Six years later she developed acute renal failure due to Goodpasture's syndrome. This is the first case to raise the possibility of a link between epidermal and glomerular basement membrane antibodies.
.A
Davenport A; Verbov JL; Goldsmith HJ.
.I 54742
.U
88000432
.S
Br J Dermatol 8801; 117(1):131-2
.M
Acne/*ME; Human; Superoxide/*ME; Tetracyclines/*ME.
.T
Tetracyclines are potent scavengers of the superoxide radical [letter]
.P
LETTER.
.A
van Barr HM; van de Kerkhof PC; Mier PD; Happle R.
.I 54743
.U
88000433
.S
Br J Dermatol 8801; 117(1):132
.M
Aged; Comparative Study; Etretinate/*TU; Human; Keratosis Palmaris et Plantaris/*DT; Male; Paraneoplastic Syndromes/*DT.
.T
Usefulness of etretinate treatment in paraneoplastic plamoplantar hyperkeratosis [letter]
.P
LETTER.
.A
Berardesca E; Del Forno C; Vignini M.
.I 54744
.U
88000434
.S
Br J Dermatol 8801; 117(1):21-7
.M
Amyloid P Component/AN; Elastic Tissue/AN/*PA; Elastin/AN; Human; Muramidase/AN; Protease Inhibitors/AN; Skin/AN/*PA; Skin Diseases/*IM/PA; Sunlight/*AE; Support, Non-U.S. Gov't.
.T
Elastic fibres in normal and sun-damaged skin: an immunohistochemical study.
.P
JOURNAL ARTICLE.
.W
Sun-exposed and sun-protected skin obtained at post mortem from the nape of the neck in 14 subjects was immunostained using antisera to elastin, lysozyme, amyloid P component, and the plasma protease inhibitors alpha-I antitrypsin, alpha-I antichymotrypsin and alpha-2 macroglobulin. Both the normal elastic fibres in sun-protected skin, and elastosis in sun-exposed skin were positively immunostained for elastin, lysozyme and amyloid P component. Collagen fibres were unstained. No immunostaining of normal elastic fibres or elastosis in the skin was obtained with antisera to alpha-I antitrypsin, alpha-I antichymotrypsin or alpha-2 macroglobulin. It was concluded that the elastosis in sun-exposed skin does contain elastic fibres. The absence of immunostaining for plasma protease inhibitors probably indicates that the elastic material is mature, and not newly-formed.
.A
Mera SL; Lovell CR; Jones RR; Davies JD.
.I 54745
.U
88000435
.S
Br J Dermatol 8801; 117(1):29-36
.M
Adolescence; Adult; Aged; Female; Formaldehyde/DU; Human; Male; Mast Cells/*CL/PA; Middle Age; Skin/*CY/PA; Skin Diseases/PA; Stains and Staining; Support, Non-U.S. Gov't.
.T
Formalin sensitivity and differential staining of mast cells in human dermis.
.P
JOURNAL ARTICLE.
.W
The characteristics of the human dermal mast cell population with respect to formalin fixation sensitivity, toluidine blue staining and alcian blue/safranin staining were studied. Thirty-seven specimens of normal human skin were bisected. One half was fixed in 10% neutral buffered formalin and the other in Carnoy's fixative. Sections were cut and stained with either toluidine blue or alcian blue/safranin. Significantly more mast cells were visualized with alcian blue/safranin than with toluidine blue. With both stains, only approximately 50% of the mast cells observed in the Carnoy's fixed tissue could be visualized in the formalin-fixed tissue. Alcian blue/safranin staining revealed three patterns of mast cell granule staining: mast cells containing only alcian blue-positive granules, mast cells containing only safranin-positive granules, and mast cells containing a mixture of alcian blue-positive granules and safranin-positive granules. Mast cells containing only alcian blue-positive granules constituted the majority of the dermal mast cell population and 73% of these mast cells were formalin-sensitive. Mast cells containing only safranin-positive granules and those containing a mixture of alcian blue-positive granules and safranin-positive granules showed no evidence of formalin sensitivity. The human dermal mast cell population, therefore, displays heterogeneity with respect to formalin fixation sensitivity and alcian blue/safranin staining. Dermal mast cells were visualized in significantly greater numbers in skin from the head compared with that from the body or limbs.
.A
Marshall JS; Ford GP; Bell EB.
.I 54746
.U
88000436
.S
Br J Dermatol 8801; 117(1):37-41
.M
Adolescence; Adult; Cataract/*ET/ME; Child; Eczema/CO; Galactose/ME; Galactosemia/*CO/ME; Human; Lens, Crystalline/ME.
.T
Galactose tolerance in patients with atopic cataracts.
.P
JOURNAL ARTICLE.
.W
Galactosaemia has been suggested as a contributory factor in the pathogenesis of some presenile and senile cataracts. To assess whether galactosaemia plays any part in the development of atopic cataracts a galactose tolerance test was carried out in eight atopic dermatitis patients whose cataracts had appeared between the ages of 12 and 39 years. In seven patients a normal result was obtained and in one the result was just above normal. Impaired galactose tolerance appears to have no role in the pathogenesis of atopic cataract.
.A
Muhlemann MF; Mount JN; Cream JJ.
.I 54747
.U
88000437
.S
Br J Dermatol 8801; 117(1):43-7
.M
Acne/ME/*PP; Female; Human; Male; Sebaceous Glands/ME/*PP; Sebum/ME/*PH; Skin Appendage Diseases/PP; Support, Non-U.S. Gov't.
.T
Functional blockage of open comedones.
.P
JOURNAL ARTICLE.
.W
Sebum excretion rate was measured by a photometric technique. We demonstrated a high correlation between sebum excretion rates on the left and right sides of the upper back and between back and forehead skin. Sebum excretion rate measurements overlying an open comedone (blackhead) were significantly lower than those obtained from normal skin. This observation demonstrates a functional obstruction to the outflow of sebum and would suggest that the lack of involvement of open comedones in inflammatory acne is not because of the maintenance of a free flow of sebum.
.A
Simpson NB.
.I 54748
.U
88000439
.S
Br J Dermatol 8801; 117(1):57-66
.M
Adult; Blood Flow Velocity/RE; Dose-Response Relationship, Radiation; Erythema/*ET/PP; Female; Human; Male; Skin/BS/*RE; Time Factors; Ultraviolet Rays/*AE.
.T
Quantitative studies on UVA-induced erythema in human skin.
.P
JOURNAL ARTICLE.
.W
The erythemal response of normal human skin to UVA and UVB radiation was measured objectively using a reflectance instrument in seven subjects, and a laser Doppler velocimeter in two subjects. UVA radiation was produced using a newly-developed high-intensity UVA lamp. The slope of the log dose-erythemal response curve for UVA at 24 h after irradiation was found not to differ significantly from that for UVB. The time course of UVA erythema was biphasic; erythema was present immediately after irradiation, fell to a minimum at about 4 h and then rose to a broad plateau between 6 and 24 h. The intensity of the early phase was dose-rate dependent, whereas that in the later phase depended on dose only.
.A
Diffey BL; Farr PM; Oakley AM.
.I 54749
.U
88000440
.S
Br J Dermatol 8801; 117(1):67-72
.M
Anthraquinones/*TO; Cell Division/DE; Cell Line; Collagen/BI; Dose-Response Relationship, Drug; Fibroblasts/DE; Human; Proline Hydroxylase/*AI; Skin/CY/*DE/ME; Support, Non-U.S. Gov't.
.T
Toxicity of the anthraquinone glycoside P-1894B for human skin fibroblasts.
.P
JOURNAL ARTICLE.
.W
P-1894B inhibits prolyl hydroxylase in vitro and has been proposed as a topical treatment for dermal fibrosis. The drug had similar effects on two fibroblast lines from normal human skin and one line from a patient with lichen sclerosus et atrophicus. Exposure of logarithmically-growing cell monolayers for 72 h caused dose-dependent inhibition of proliferation at 0.05-0.5 microgram/ml but time-dependent cell death at 1-50 micrograms/ml. The epithelial cell line NCTC 2544 gave a similar result. Collagen lattices containing normal fibroblasts contracted more slowly in the presence of the drug at 0.1-0.5 microgram/ml, but this was clearly related to loss of viability. Collagen synthesis by monolayer cultures was unaffected at 0.05 and 0.1 microgram/ml P-1894B in one line of normal fibroblasts, but was reduced by 40% and 15%, respectively, in the other. The concentrations of P-1894B reported to be active against prolyl hydroxylase are therefore lethal to cultured skin cells. Although the effective use of dithranol as a topical anti-psoriatic agent, despite its cytotoxicity in vitro, is encouraging for P-1894B, further toxicological studies are imperative.
.A
Priestley GC.
.I 54750
.U
88000444
.S
Br J Dermatol 8801; 117(1):89-97
.M
Case Report; Chromatography, Thin Layer; Collagen/*DF; Ehlers-Danlos Syndrome/*GE/PA; Endoplasmic Reticulum/UL; Female; Fibroblasts/UL; Human; Male; Microscopy, Electron; Pedigree; Skin/PA/*UL.
.T
Ehlers-Danlos syndrome type I: a clinical and ultrastructural study of a family with reduced amounts of collagen type III.
.P
JOURNAL ARTICLE.
.W
Ehlers-Danlos syndrome (EDS) type I was diagnosed in an 18-year-old girl on the basis of marked skin hyperextensibility with generalized loose-jointedness, pigmented paper-tissue scars, and a pronounced tendency to bruising. Her father and one of her sisters showed a similar phenotype. Her mother was normal. Light microscopy of skin biopsies showed large, irregular collagen fibres in the father and daughter, with normal findings in the mother. Electron microscopy of the skin sections revealed a variation in diameter and shape of the collagen fibrils as well as slight dilatation of the rough endoplasmic reticulum of fibroblasts in father and daughter, but normal findings in the mother. Cultured fibroblasts did not show these changes. Measurements of collagen synthesis by fibroblast cultures showed that type III collagen levels were reduced to 50% of normal in the father and daughter, and were normal in the mother. The alpha I (III) proteins had a normal molecular weight, determined by SDS-PAGE electrophoresis. The phenotypes and biochemical results in the family members tested were compatible with autosomal dominant transmission. To our knowledge, this is the first report of a type III collagen deficiency in Ehlers-Danlos syndrome type I. The findings in this family, especially the pronounced bruising tendency, illustrate the heterogeneity within type I EDS.
.A
De Paepe A; Nicholls A; Narcisi P; De Keyser F; Quatacker J; Van Staey M; Matton M; Pope FM.
.I 54751
.U
88000445
.S
Br J Dermatol 8801; 117(1):99-105
.M
Dose-Response Relationship, Radiation; Human; Infrared Rays/*TU; Light Coagulation/*; Skin/PA/*SU; Tattooing/*.
.T
Tattoo removal using infra-red coagulation: a dose comparison.
.P
JOURNAL ARTICLE.
.W
Using an infra-red coagulator, 42 tattoos were treated using pulses of 1.125 s (27 tattoos) or 1.25 s (15 tattoos). Treatment failures occurred only in three professional tattoos. Amateur tattoos were satisfactorily treated in over 80% of cases regardless of dose. Deeper collagen necrosis occurred with 1.25 s, but scarring was clinically similar. Pre-treatment biopsy to assess pigment depth was of no value in selection of the optimum pulse duration and increased the complication rate. The possible mechanism of pigment removal is discussed.
.A
Venning VA; Colver GB; Millard PR; Ryan TJ.
.I 54752
.U
88000449
.S
Br J Dermatol 8801; 117(2):161-7
.M
Arthritis/BL; Cell Movement; Chemotaxis, Leukocyte; Female; Human; In Vitro; Male; Neutrophils/*PH; Psoriasis/*BL.
.T
Polymorphonuclear leukocyte function in psoriasis vulgaris.
.P
JOURNAL ARTICLE.
.W
Polymorphonuclear leukocyte (PMN) migration was assessed in vitro using the agarose plate method in patients with psoriasis vulgaris, and compared with an age- and sex-matched control group. No significant difference was found between the two groups in the PMN response to the chemotactic substances F-Met-Leu-Phe (FMLP) or zymosan activated serum (ZAS). Equally, the chemokinetic or chemotactic potential of psoriatic serum did not differ from control serum. Our results do not support a primary abnormality of PMN function in psoriasis.
.A
Pease CT; Fennell M; Staughton RC; Brewerton DA.
.I 54753
.U
88000450
.S
Br J Dermatol 8801; 117(2):169-74
.M
Aneuploidy/*; DNA/*AN; Flow Cytometry/*MT; Human; Skin Diseases/*GE/PA; Skin Neoplasms/AN/PA.
.T
A flow cytometric study of the significance of DNA aneuploidy in cutaneous lesions.
.P
JOURNAL ARTICLE.
.W
Aneuploidy has not to date been demonstrated in any entirely benign condition and thus is held to be implicit of neoplasia. DNA flow cytometry can be used to detect DNA aneuploidy rapidly. A technique has been developed to make possible flow cytometric analysis of formalin-fixed skin. The technique was validated by study of benign and pre-malignant dermatoses. Further studies were performed on skin conditions of questionable malignant potential. DNA aneuploidy was demonstrated in lichen sclerosus et atrophicus. Flow cytometry was unable to distinguish keratoacanthomas from squamous cell carcinomas.
.A
Newton JA; Camplejohn RS; McGibbon DH.
.I 54754
.U
88000451
.S
Br J Dermatol 8801; 117(2):175-83
.M
Acne/MI; Biological Assay; Chromatography, Thin Layer; Fatty Acids/ME/PD; Histamine/ME/PD; Human; Inflammation/*ME; Muscle, Smooth/DE; Propionibacterium acnes/*ME; Prostaglandins/ME; Staphylococcus epidermidis/*ME; Tryptamines/ME/PD.
.T
The production of inflammatory compounds by Propionibacterium acnes and other skin organisms.
.P
JOURNAL ARTICLE.
.W
Culture supernatants from four species of skin microorganisms (P. acnes, P. avidum, P. granulosum and S. epidermidis) were assayed for smooth muscle contracting substances which are indicative of inflammatory activity. At least three types of smooth muscle contracting substances were detected. These were: first, a substance active on a rat fundic strip preparation and antagonized by N,N-DMT. Activity was enhanced when cultures were grown in the presence of tryptophan. This substance was probably tryptamine. Second, a substance active on a guinea-pig ileum preparation and antagonized by mepyramine. Activity was enhanced when cultures were grown in the presence of histidine. This substance was probably histamine. Third, a substance active on a rat fundic strip preparation but not antagonized by N,N-DMT, mepyramine, atropine or indomethacin. Activity was enhanced when cultures were grown in the presence of glucose. This activity was probably due to acetate, propionate or other short-chain fatty-acid salts. Chromatographic analysis confirmed the presence of histamine, tryptamine and short-chain fatty acids in the culture supernatants. These substances if produced in vivo may cause or contribute to inflammation and pain directly without the prior mediation of the immune system. Cell extracts of Propionibacterium species were analysed by bioassay for the presence of prostaglandin-like compounds. These could not be detected in any of the eight strains of organisms tested.
.A
Allaker RP; Greenman J; Osborne RH.
.I 54755
.U
88000452
.S
Br J Dermatol 8801; 117(2):185-91
.M
Adolescence; Adult; Antibodies/*AN; Dermatitis Herpetiformis/DH/*IM/PA; Dietary Proteins/AD; Gliadin/IM; Gluten/AD; Human; IgA/*; Jejunum/PA; Middle Age.
.T
IgA anti-endomysial antibodies in dermatitis herpetiformis: correlation with jejunal morphology, gluten-free diet and anti-gliadin antibodies.
.P
JOURNAL ARTICLE.
.W
Circulating IgA-class anti-endomysium antibodies (EmA) can be detected by indirect immunofluorescence on monkey oesophagus sections. We found EmA in 22 (76%) of 29 patients with dermatitis herpetiformis (DH) on a normal, gluten-containing diet. The highest frequency (100%) of EmA was observed in patients with sub-total villous atrophy. IgA-class antigliadin antibodies (AGA) were found using an ELISA method in 59% of 29 DH patients and in 86% of those with sub-total villous atrophy. There was a significant correlation between EmA titres and AGA levels in individual patients. Gluten-free diet (GFD) treatment caused a rapid decrease in EmA titres; only three of the 12 patients still showed raised EmA after 6-12 months on a GFD and two of these three had failed to adhere to a strict diet. In contrast, no decrease in EmA titres occurred in four patients maintained on a normal diet, and two of the three patients with initially negative EmA developed positive titres when continuing on a normal diet. These results show that both IgA-class EmA and AGA are good indicators of jejunal damage in DH. The rapid fall of EmA titres after gluten withdrawal indicates that this test is also useful for monitoring a patient's adherence to a GFD.
.A
Reunala T; Chorzelski TP; Viander M; Sulej J; Vainio E; Kumar V; Beutner EH.
.I 54756
.U
88000453
.S
Br J Dermatol 8801; 117(2):193-201
.M
Adult; Aged; Female; Flowmeters; Human; Male; Middle Age; Psoriasis/PA/*PP/TH; Regional Blood Flow; Skin/*BS/PA; Support, Non-U.S. Gov't.
.T
Blood flow in psoriatic skin lesions: the effect of treatment.
.P
JOURNAL ARTICLE.
.W
Laser Doppler velocimetry (LDV) was used to assess the effect of treatment upon cutaneous blood flow in psoriatic skin lesions. The resolution of two separate plaques in each of seven subjects was followed. Six of the subjects received the Goeckerman regimen, the seventh was treated with psoralen-ultraviolet A (PUVA) therapy. Control LDV readings were taken from uninvolved skin sites during the treatment period. Cutaneous blood flow in the psoriatic lesions of the Goeckerman-treated patients decreased to levels comparable to those in uninvolved skin early in the course of treatment and significantly preceeded the observed clinical resolution from 4 to 8 days after initiation of therapy (P less than 0.05). Visible flare-ups sometimes appeared when patients were untreated (over a weekend, for example) and these eruptions were accompanied by a transient elevation of LDV readings. Perfusion of the lesions of the PUVA-treated patient remained consistently higher than perfusion of uninvolved skin despite clinical healing. In a separate series of experiments, blood flow at the extensor surface of the forearm was measured in the skin of normal subjects, the uninvolved skin of psoriatic patients and the untreated lesional skin of psoriatic patients. While the lesional skin had significantly higher perfusion levels than uninvolved psoriatic or normal control skin (P less than 0.01), there was no significant difference between blood flow to the uninvolved psoriatic skin of psoriatics and that to the skin of healthy controls.
.A
Khan A; Schall LM; Tur E; Maibach HI; Guy RH.
.I 54757
.U
88000455
.S
Br J Dermatol 8801; 117(2):207-15
.M
Binding Sites; Blister/ME; Blood Proteins/*ME; Diazepam/PD; Erythrocytes/*ME; Erythromycin/PD; Human; Indomethacin/PD; Methoxsalen/*ME; Protein Binding/DE; Salicylic Acids/PD; Support, Non-U.S. Gov't; Warfarin/PD.
.T
Binding of 8-methoxypsoralen to human serum proteins and red blood cells.
.P
JOURNAL ARTICLE.
.W
Serum binding of 8-methoxypsoralen (8-MOP) was studied by equilibrium dialysis. In therapeutic concentrations, 8-MOP binding in serum was high, 91.4%, and constant, indicating concentration-independent kinetics. This binding involved the two main proteins, human serum albumin and alpha 1-acid glycoprotein, in a saturable process with one class of binding sites (n) and affinity constants (Ka) of 1.295 X 10(4) mol/l and 2.115 X 10(4) mol/l, respectively. Binding to lipoproteins and gamma globulins was negligible and non-saturable in therapeutic concentrations, with nKa values of 0.35, 0.024, 0.013 and 0.0004 mumol/l for VLDL, LDL, HDL and gamma globulins, respectively. Inhibition of 8-MOP serum binding was observed with salicylic acid and indomethacin, but not with diazepam, warfarin or erythromycin. Over a range of therapeutic concentrations, the ration of 8-MOP concentration in red blood cells (RBCs) and in serum was constant at 20.3% and three times higher than would be expected if a simple diffusion of the 8-MOP plasma free fraction (fu) occurred. According to the measured and calculated parameters, simulations of 8-MOP blood binding in pathological states (hypoalbuminaemia with or without inflammation) showed variations of fu which were partially 'buffered' by RBCs. Simulation of 8-MOP protein binding at cutaneous interstitial fluid level showed that fu is approximately 30% and permitted prediction of a decrease of fu available to the epidermis in case of local or systemic inflammation. This may imply an increase in the minimum phototoxic dose relevant for PUVA and explain some cases of 'poor' responsiveness of psoriatic patients to PUVA therapy.
.A
Pibouin M; Zini R; Nguyen P; Renouard A; Tillement JP.
.I 54758
.U
88000457
.S
Br J Dermatol 8801; 117(2):225-30
.M
Adolescence; Adult; Dermatitis, Atopic/*PA; Dermatoglyphics; Female; Fingers/*PA; Human; Male; Middle Age; Sweat Glands/*PA.
.T
Sweat pore density on the fingertips of atopic patients.
.P
JOURNAL ARTICLE.
.W
Investigation of 18 patients with atopic eczema and 22 normal controls showed that women in both groups had significantly more sweat pore openings on their fingertips than men and that there were more glands per unit area on fingers 3 and 4 compared with the thumb and the first and second fingers. There was no significant difference in the number of sweat pores between normal and atopic individuals, although fingertip topography in the latter was disturbed.
.A
Andersen LB; Thestrup-Pedersen K.
.I 54759
.U
88000458
.S
Br J Dermatol 8801; 117(2):231-6
.M
Acne/*EP/ET/PA; Age Factors; Aged; Aged, 80 and over; Female; Great Britain; Human; Hyperplasia; Male; Sebaceous Glands/*PA; Sunburn/CO.
.T
Sebaceous gland hyperplasia and senile comedones: a prevalence study in elderly hospitalized patients.
.P
JOURNAL ARTICLE.
.W
Two hundred and eighty-six patients over the age of 65 (age range 65-102, mean age 82 years), who were hospitalized in geriatric wards, were examined clinically for the presence of sebaceous gland hyperplasia and senile comedones. The degree of solar elastotic change present was scored on a visual analogue scale. The prevalence rate of sebaceous gland hyperplasia and of senile comedones was found to be 26% in each case. Approximately one third of patients had both lesions. Neither of these lesions was related to either the degree of solar elastotic change or the skin type with regard to tanning ability. It was concluded that chronic solar exposure was not a likely cause of these common conditions.
.A
Kumar P; Marks R.
.I 54760
.U
88000460
.S
Br J Dermatol 8801; 117(2):243-5
.M
Biological Availability; Comparative Study; Human; Male; Ointments; Petrolatum; Salicylic Acids/ME/*PD; Skin/*DE; Urea.
.T
In vivo measurement of the keratolytic effect of salicylic acid in three ointment formulations.
.P
JOURNAL ARTICLE.
.W
The release and activity of salicylic acid from different ointment formulations was studied in vivo by staining the horny layer with silver nitrate and measuring the light reflectance profile over 56 h, after application of the ointment for 4 h. The peeling effect of an ointment containing 5% salicylic acid and 10% urea was tested and compared with 5% and 10% salicylic acid in petrolatum. It was shown that shedding from the stained sites was faster with the urea-containing preparation than with the classic petrolatum ointments. The method described can be used to assess the bioavailability of keratolytic agents incorporated in topical formulations.
.A
Nook TH.
.I 54761
.U
88000462
.S
Br J Dermatol 8801; 117(2):255-9
.M
Bone Neoplasms/CN/*GE; Case Report; Fibroma/CN/*GE; Human; Infant; Infant, Newborn; Leiomyoma/CN/*GE; Male; Prognosis; Skin Neoplasms/CN/*GE.
.T
Infantile myofibromatosis. Report of two cases in one family.
.P
JOURNAL ARTICLE.
.W
Two brothers with infantile myofibromatosis are reported. Both had cutaneous and skeletal myofibromas with spontaneous and complete healing of their cutaneous lesions. These cases suggest autosomal recessive inheritance of this rare disorder.
.A
Venencie PY; Bigel P; Desgruelles C; Lortat-Jacob S; Dufier JL; Saurat JH.
.I 54762
.U
88000463
.S
Br J Dermatol 8801; 117(2):261-2
.M
Carcinoma, Squamous Cell/*ET; Human; Keratosis/*CO; Remission, Spontaneous; Skin Neoplasms/*ET; Sunlight/*AE.
.T
Solar keratosis: fallacies in measuring remission rate and conversion rate to squamous cell carcinoma [letter]
.P
LETTER.
.A
Commens C.
.I 54763
.U
88000464
.S
Br J Dermatol 8801; 117(2):262-3
.M
Human; Mycosis Fungoides/GE/*IM; Phenotype; Skin Neoplasms/GE/*IM.
.T
Immunophenotypic analysis of early mycotic lesions [letter]
.P
LETTER.
.A
Slater DN.
.I 54764
.U
88000465
.S
Br J Dermatol 8801; 117(2):264
.M
Case Report; Child; Etretinate/*AE; Female; Human; Keratosis Palmaris et Plantaris/*DT; Nails, Malformed/CO; Syndrome.
.T
Failure of etretinate therapy in pachyonychia congenita [letter]
.P
LETTER.
.A
Soyuer U; Candan MF.
.I 54765
.U
88000481
.S
Br J Ophthalmol 8801; 71(7):485
.M
Aged; Female; Glaucoma, Open-Angle/*PP; Human; Intraocular Pressure/*; Male; Middle Age; Visual Fields/*.
.T
An enigma variation [editorial]
.P
EDITORIAL.
.A
Smith RJ.
.I 54766
.U
88000482
.S
Br J Ophthalmol 8801; 71(7):486-8
.M
Aged; Chronic Disease; Female; Glaucoma, Open-Angle/CO/*PP; Human; Intraocular Pressure/*; Male; Middle Age; Perimetry; Retrospective Studies; Scotoma/ET/*PP; Support, Non-U.S. Gov't; Visual Fields/*.
.T
Some observations on the relation between intraocular pressure reduction and the progression of glaucomatous visual loss.
.P
JOURNAL ARTICLE.
.W
A quantitative measure of visual field loss associated with kinetic perimetry in chronic open-angle glaucoma (COAG) is discussed. With this new technique an analysis of covariance is applied to a retrospective study of 41 COAG patients. It suggests that reduction of intraocular pressure may not be uniformly effective in controlling the progression of the disease.
.A
Schulzer M; Mikelberg FS; Drance SM.
.I 54767
.U
88000484
.S
Br J Ophthalmol 8801; 71(7):494-6
.M
Aged; Aged, 80 and over; Chronic Disease; Female; Glaucoma, Open-Angle/PP/*SU; Human; Intraocular Pressure/*; Male; Methods; Middle Age; Postoperative Period; Posture/*; Trabecular Meshwork/*SU.
.T
Postural response of intraocular pressure in chronic open-angle glaucoma following trabeculectomy.
.P
JOURNAL ARTICLE.
.W
Forty-six eyes with chronic open-angle glaucoma (COAG) and 24 eyes which had previously undergone trabeculectomy for COAG were studied and the postural response of the intraocular pressure compared with that of 70 normal eyes. In all three groups the greatest rise in intraocular pressure (IOP) occurred when the subject changed from the sitting to the lying position. In the control group this was never more than 2 mmHg in any subject. The rise was greater than 2 mmHg in 93% of the patients suffering from COAG who were treated medically and in 100% of the eyes of those on which trabeculectomy had been performed. The well recognised abnormal postural response of intraocular pressure in COAG appears both to be retained and to be unaffected in those eyes which have undergone trabeculectomy.
.A
Parsley J; Powell RG; Keightley SJ; Elkington AR.
.I 54768
.U
88000487
.S
Br J Ophthalmol 8801; 71(7):504-9
.M
Adolescence; Adult; Child; Child, Preschool; Cleft Palate/GE; Connective Tissue Diseases/*GE; Eye Diseases/*GE; Female; Human; Joint Diseases/GE; Lens Diseases/GE; Male; Middle Age; Myopia/GE; Physiognomy; Retinal Diseases/GE; Syndrome; Vitreous Body.
.T
Stickler's syndrome: a study of 12 families.
.P
JOURNAL ARTICLE.
.W
Stickler's syndrome is a congenital disease of connective tissue with considerable ocular and non-ocular lesions. This study reports 12 pedigrees (10 families and two isolated cases) and evaluates some peculiar ocular aspects not previously reported in the syndrome.
.A
Spallone A.
.I 54769
.U
88000488
.S
Br J Ophthalmol 8801; 71(7):510-5
.M
Adult; Aged; Anterior Chamber/PA; Aqueous Humor/*PH; Cornea/PA; Female; Fluorometry; Human; Intraocular Pressure; Male; Middle Age; Postoperative Period; Retina/*SU; Retinal Detachment/*SU; Scleral Buckling.
.T
Effects of the encircling procedure on the aqueous flow rate in retinal detachment eyes: a fluorometric study.
.P
JOURNAL ARTICLE.
.W
Fluorophotometry was carried out in nine cases of unilateral non-traumatic rhegmatogenous retinal detachment successfully treated by a combination of local buckling and an encircling procedure with a silicone band. After topical instillation of fluorescein the change in its concentration in the anterior chamber was followed, from which the loss rate of the dye from the anterior chamber (k0) and the cornea-aqueous transfer coefficient (kc.ca) were estimated. The thickness of the cornea and the anterior chamber volume were also measured, and the aqueous flow rate and the corneal endothelial permeability were calculated in individual eyes. The examinations performed 4-18 months after operation showed that the aqueous flow rate in the operated eye fell to 85 (SD 12)% of that in the fellow control eye (p less than 0.005). In the operated eye the anterior chamber volume also fell significantly, and the corneal endothelial permeability may have decreased. Ocular hypotension after the detachment surgery with encirclement was attributable to a decrease in the aqueous flow rate.
.A
Araie M; Sugiura Y; Minota K; Akazawa K.
.I 54770
.U
88000489
.S
Br J Ophthalmol 8801; 71(7):516-20
.M
Adenocarcinoma/*DI/PA; Adult; Case Report; Choroid Neoplasms/DI; Diagnosis, Differential; Eye Neoplasms/*DI/PA; Fluorescein Angiography; Fundus Oculi; Human; Male; Melanoma/DI; Pigment Epithelium of Eye/*/PA.
.T
Adenocarcinoma of retinal pigment epithelium [published erratum appears in Br J Ophthalmol 1988 Jan;72(1):80]
.P
JOURNAL ARTICLE.
.W
This report describes a 41-year-old man with an intraocular tumour misinterpreted clinically as choroidal melanoma. The fluorescein angiographic features were not fully characteristic of uveal malignancy, and indeed histopathology revealed the diagnosis of adenocarcinoma of the retinal pigment epithelium. It is suggested that, in cases with the fundus and angiographic findings described here, the rare possibility of adenocarcinoma of retinal pigment epithelium should be kept in mind. Of particular interest were the changing pathological findings in the various parts of the tumour, which paralleled the fluorescein angiographic pattern.
.A
Ramahefasolo S; Soubrane G; Dhermy P; Godel V; Regenbogen L; Coscas G.
.I 54771
.U
88000490
.S
Br J Ophthalmol 8801; 71(7):521-5
.M
Adult; Aged; Diplopia/*ET/SU; Eyeglasses; Human; Middle Age; Postoperative Complications/*; Retina/*SU; Retinal Detachment/*SU; Scleral Buckling/AE/MT.
.T
Diplopia after retinal detachment surgery.
.P
JOURNAL ARTICLE.
.W
Diplopia following retinal detachment usually responds to simple measures. Fifteen out of 311 cases developed diplopia lasting more than three months after conventional retinal detachment surgery. Binocular single vision was restored in 12 of the 15 cases (80%). The mean follow-up was four years. Diplopia was eliminated stepwise. If prisms were ineffective, our first surgical procedure was removal of the scleral buckle. If the retina was flat, we were prepared to remove the buckle early. When diplopia persisted after buckle removal, we proceeded to strabismus surgery. Our most consistent results followed strabismus surgery on the untreated eye. Prisms alone restored binocular single vision in six patients (40%), one of whom preferred to adopt a compensatory head posture. Removal of the scleral buckle restored binocular single vision in three patients (20%), with the help of a prism in one case and a compensatory head posture in another. Binocular single vision was restored after buckle removal and strabismus surgery in three further patients (20%), one requiring a prism in addition. Binocular single vision was not restored in three patients (20%).
.A
Fison PN; Chignell AH.
.I 54772
.U
88000492
.S
Br J Ophthalmol 8801; 71(7):531-6
.M
Adolescence; Adult; Biopsy; Case Report; Human; Male; Microscopy, Electron; Mitochondria, Muscle/EN/*UL; Muscles/ME/*UL; Optic Nerve Diseases/*GE/ME/PA.
.T
Leber's hereditary optic neuropathy: mitochondrial and biochemical studies on muscle biopsies.
.P
JOURNAL ARTICLE.
.W
Two patients with Leber's hereditary optic neuropathy underwent morphological and biochemical investigations of muscle biopsy samples from the biceps brachii. Although clinically there was no muscle weakness or atrophy, specific histochemical and electron microscopic examinations showed mild but distinct myopathic changes, including abnormal oxidative enzyme activities, aggregates of enlarged mitochondria in the subsarcolemmal regions, and disruptions of myofilaments. Biochemical analyses of mitochondria isolated from muscle samples did not show and deficiency in respiratory-chain enzyme complexes or defect in content of cytochromes. Leber's hereditary optic neuropathy is assumed to be a multisystem disorder involving skeletal muscle also.
.A
Uemura A; Osame M; Nakagawa M; Nakahara K; Sameshima M; Ohba N.
.I 54773
.U
88000493
.S
Br J Ophthalmol 8801; 71(7):537-9
.M
Case Report; Female; Human; Middle Age; Optic Disk/*; Optic Nerve Diseases/ET; Retinal Diseases/CO; Vision Disorders/*ET; Visual Fields.
.T
Optic disc drusen and episodic visual loss.
.P
JOURNAL ARTICLE.
.W
A case is reported in which recurrent episodes of visual loss occurred over a period of 26 years in a patient with bilateral optic disc drusen. Visual field loss was associated with episodes of ischaemic optic neuropathy. The possible mechanism is discussed.
.A
Sarkies NJ; Sanders MD.
.I 54774
.U
88000494
.S
Br J Ophthalmol 8801; 71(7):540-5
.M
Adolescence; Adult; Anemia, Sickle Cell/*CO; Female; Fluorescein Angiography; Fovea Centralis/PA; Human; Ischemia/*DI/ET; Macula Lutea/*BS; Male; Middle Age; Perimetry; Retinal Diseases/*CO; Sickle Cell Trait/*CO; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Visual Fields.
.T
Quantification of macular ischaemia in sickle cell retinopathy.
.P
JOURNAL ARTICLE.
.W
Macular ischaemia has a central role in the pathophysiology and prognosis of retinal macular disease. We attempted to quantitate two of its major components as follows: vascular nonperfusion, by measuring the foveal avascular zone (FAZ), using fluorescein angiography; and functional damage, using automated perimetry of the central 30 degrees. Sickle cell disease was chosen for study because it was considered a prototype for a purely ischaemic retinopathy without an exudative component. We found that the FAZ measurement was reproducible and that the patients with maculopathy had statistically larger FAZs than the normal controls (p = 0.016, Wilcoxon rank sum test). In addition, scotomas measured by visual field perimetry were significantly larger in the sickle cell patients with maculopathy than in those without maculopathy. Our results showed that angiography and perimetry of the central 30 degrees were more sensitive tests for the detection of ischaemic macular disease than visual acuity and that macular ischaemia could be quantified by their use.
.A
Lee CM; Charles HC; Smith RT; Peachey NS; Cunha-Vaz JG; Goldberg MF.
.I 54775
.U
88000496
.S
Br J Ophthalmol 8801; 71(7):549-52
.M
Aged; Animal; Carcinoma, Ehrlich Tumor; Cell Survival/DE/RE; Electron Spin Resonance; Eye/*AN; Eye Color/*; Female; Human; Hydrogen Peroxide; Male; Melanins/*AN/PD/RE; Middle Age; Superoxide; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Is there any difference in the photobiological properties of melanins isolated from human blue and brown eyes?
.P
JOURNAL ARTICLE.
.W
Investigations were carried out to determine whether the melanin present in the blue and brown eyes were eumelanin, the melanin present in black hair and dark skin, or pheomelanin, the melanin present in red hair and the skin of people with red hair. Our results showed that UV-visible irradiation of blue or brown eye melanin did not produce any superoxide. Irradiation of 51Cr-labelled Ehrlich ascites carcinoma cells in the presence of blue or brown eye melanin did not produce significant cell lysis. The electron spin resonance (ESR) signals of blue and brown eye melanins were very similar to those of eumelanin. Comparison of these findings with our previous results indicated that the blue and brown eye melanins are essentially eumelanin. The ESR signals further suggested that in the case of both blue and brown eye melanins the iris, ciliary body, choroid, and retinal pigment epithelium did not differ.
.A
Menon IA; Basu PK; Persad S; Avaria M; Felix CC; Kalyanaraman B.
.I 54776
.U
88000497
.S
Br J Ophthalmol 8801; 71(7):553-8
.M
Adolescence; Case Report; Dexamethasone/TU; Electroretinography; Female; Fluorescein Angiography; Human; Retinal Diseases/DI/DT; Retinal Vessels/*; Visual Fields.
.T
A case of frosted branch angiitis.
.P
JOURNAL ARTICLE.
.W
We report a case of frosted branch angiitis in a 16-year-old-girl. She noted a sudden and severe visual disturbance in both eyes, without other systemic symptoms. Diffuse retinal oedema and unusual sheathing of retinal veins were characteristic in both fundi. Fluorescein angiography showed no occlusion of the sheathed retinal veins, but some paravenous extravasation of dye was found in the late phase. With high doses of systemic corticosteroids her fundi and visual acuity improved greatly, though the vessels continued to show severe narrowing. At three months the pattern visually evoked cortical potentials were found to be normal, while flash electroretinograms were absent. No systemic abnormality has been found to explain the aetiology of this condition.
.A
Watanabe Y; Takeda N; Adachi-Usami E.
.I 54777
.U
88000498
.S
Br J Ophthalmol 8801; 71(7):559-62
.M
Age Factors; Case Report; Cryosurgery; Female; Fundus Oculi; Human; Infant, Newborn; Light Coagulation; Retina/SU; Retinopathy of Prematurity/*DI/SU.
.T
'Rush' type retinopathy of prematurity: report of three cases.
.P
JOURNAL ARTICLE.
.W
Three premature infants observed to develop severe stage III retinopathy of prematurity (ROP) at 3 to 5 weeks of age received immediate treatment by cryoablation and photocoagulation, with good results. The critical importance of the ophthalmic examination of premature babies from the age of 2 weeks, so as not to overlook such cases of 'rush' type ROP is stressed and the difficulty involved in treating such small neonates is discussed.
.A
Nissenkorn I; Kremer I; Gilad E; Cohen S; Ben-Sira I.
.I 54778
.U
88000499
.S
Br J Ophthalmol 8801; 71(7):563
.M
Caucasoid Race; Human; Macula Lutea/*; Retinitis/*ET; Sunlight/*AE.
.T
Foveomacular retinitis [letter]
.P
LETTER.
.A
Jacobs NA.
.I 54779
.U
88000500
.S
Br J Ophthalmol 8801; 71(8):565-9
.M
Acquired Immunodeficiency Syndrome/*CO; Adult; AIDS-Related Complex/CO; Cytomegalic Inclusion Disease/CO; Eye Diseases/*ET/PA; Fundus Oculi; Human; Male; Middle Age; Opportunistic Infections/CO; Prognosis; Prospective Studies; Retinal Diseases/ET/PA; Support, Non-U.S. Gov't.
.T
Ophthalmic findings in a group of ambulatory patients infected by human immunodeficiency virus (HIV): a prospective study.
.P
JOURNAL ARTICLE.
.W
Twenty-eight patients with either the acquired immune deficiency syndrome (AIDS) or persistent generalised lymphadenopathy (PGL) were studied prospectively as outpatients for up to one year. Six patients had fundal cotton wool spots at some stage of their follow-up and all six suffered opportunistic infections associated with AIDS. We suggest that ocular abnormalities may be prognostic for opportunistic infection in AIDS and discuss the wide range of ophthalmic complications consequent to HIV infection.
.A
Humphry RC; Weber JN; Marsh RJ.
.I 54780
.U
88000501
.S
Br J Ophthalmol 8801; 71(8):570-7
.M
Animal; Cornea/*AH/UL; Culture Media/*; Microscopy, Electron, Scanning; Organ Culture; Organ Preservation/*MT; Rabbits; Support, U.S. Gov't, P.H.S.; Time Factors.
.T
Histological study of corneas preserved in two new media.
.P
JOURNAL ARTICLE.
.W
A new corneal preserving medium (K-Sol), developed by Kaufman and others, contains purified chondroitin sulphate, TC 199, HEPES buffer, and gentamicin. Another new medium (JM) containing bicarbonate-free glucose-phosphate Ringer solution and dextran 70 has been developed in Japan. New Zealand white rabbit corneas with scleral rims were stored in each medium at 4 degrees C for one or two weeks. The condition of the endothelium was evaluated histologically. Corneas preserved in both media were in good condition at the end of one week. Corneas preserved in K-Sol for two weeks showed fewer endothelial changes than similar tissue stored in JM for two weeks. Corneal swelling was also less in corneas preserved in K-Sol, than in corneas preserved in JM.
.A
Tamaki K; Yamaguchi T; Varnell ED; Kaufman HE.
.I 54781
.U
88000502
.S
Br J Ophthalmol 8801; 71(8):575-84
.M
Adolescence; Birth Weight; Blindness/*ET/GE; Cataract/*CN; Child; Child, Preschool; Human; Infant, Newborn; Infant, Premature/*; Intelligence; Optic Atrophy/CO; Probability; Retinopathy of Prematurity/CO.
.T
Blindness in schoolchildren: importance of heredity, congenital cataract, and prematurity.
.P
JOURNAL ARTICLE.
.W
Of 99 children in the Royal Blind School, Edinburgh (which serves Scotland and part of N E England), 15 had optic atrophy (hydrocephalus 4, intracranial haemorrhage 2, prematurity 2, fetal distress 2, birth asphyxia 2, cerebral atrophy 1, cardiac arrest during hernia operation 1, and leukaemia 1). Fourteen had congenital cataract, 12 congenital retinal aplasia (Leber's congenital amaurosis) and 11 retinopathy of prematurity. There were small numbers in many other diagnostic categories, including three with non-accidental head injury. Mental retardation, spasticity, and nystagmus were frequent other correlates in all diagnostic categories. 'Very probably hereditary' was a conservative attribution in 36, while 'probable' seemed appropriate for 12-that is, almost 48% were hereditary. Only about 11 cases might have been prevented through genetic counselling, which testifies to the frequency of autosomal recessive hereditary disease, although no parents were consanguineous.
.A
Phillips CI; Levy AM; Newton M; Stokoe NL.
.I 54782
.U
88000503
.S
Br J Ophthalmol 8801; 71(8):585-92
.M
Animal; Antibodies/AN; Antigens; Disease Models, Animal; Eye Proteins; Fluorescein Angiography; Male; Rats; Support, Non-U.S. Gov't; Time Factors; Uveitis/IM/*PA.
.T
Experimental posterior uveitis. I: A clinical, angiographic, and pathological study.
.P
JOURNAL ARTICLE.
.W
The clinical, angiographic, and histopathological features of experimental posterior uveitis in the black hooded Lister rat are described. This mild form of experimental allergic uveoretinitis (EAU) is induced by sensitisation with retinal S antigen in Freund's complete adjuvant, and the inflammation produced is confined to the posterior segment of the eye. This allows for the first time precise photographic and angiographic documentation of the evolution of clinical signs, because there is minimal clouding of the vitreous by inflammatory cells. Clinically the disease is characterised by the appearance of disc oedema and periphlebitis, followed by focal infiltrates in the deep retinal layers, with eventual atrophy of the pigment epithelium. Histologically, retinal vasculitis is associated with focal mononuclear cell infiltration and necrosis of the photoreceptor layers. This model closely resembles the clinical features of idiopathic retinal vasculitis seen in man.
.A
Stanford MR; Brown EC; Kasp E; Graham EM; Sanders MD; Dumonde DC.
.I 54783
.U
88000505
.S
Br J Ophthalmol 8801; 71(8):598-601
.M
Absorption; Administration, Topical; Animal; Aqueous Humor/*ME; Cornea/*ME; Epithelium/ME; Fusidic Acid/AD/*PK; Injections; Male; Rabbits; Vitreous Body/*ME.
.T
Corneal and intraocular penetration of topical and subconjunctival fusidic acid.
.P
JOURNAL ARTICLE.
.W
Corneal tissue absorption and intraocular penetration of fusidic acid were assessed in the rabbit after topical or subconjunctival application. Corneal tissue levels of fusidic acid one hour after the last topical application of the drug were well above the minimum inhibitory concentrations (MICs) for most Gram-positive and many Gram-negative organisms. Adequate levels were achieved in the aqueous at one hour following the last topical application, but no significant levels were detected in the vitreous. The corneal tissue and aqueous levels declined at 12 and 24 hours following the last drug application, however, corneal tissue levels at 24 hours were considered to be above the MICs for most Gram-positive organisms. A single subconjunctival injection of 100 mg of fusidic acid produced levels above the MICs of most organisms in the cornea, aqueous, and vitreous which persisted over 24 hours, but subconjunctival injection of fusidic acid at this concentration resulted in conjunctival necrosis and corneal decompensation. Fusidic acid penetrates well into avascular tissue and fully penetrates corneas with both intact and debrided epithelium, as evidenced by the intracameral drug levels. Good corneal penetration and absence of known topical toxicity make fusidic acid suitable for the treatment of microbial keratitis caused by susceptible organisms.
.A
Taylor PB; Burd EM; Tabbara KF.
.I 54784
.U
88000506
.S
Br J Ophthalmol 8801; 71(8):602-8
.M
Adolescence; Adult; Color Perception; Evoked Potentials, Visual/*; Female; Human; Male; Middle Age; Optic Neuritis/*PP; Pattern Recognition, Visual; Space Perception; Vision/*PH; Visual Acuity; Visual Fields.
.T
Visual function and pattern visual evoked response in optic neuritis.
.P
JOURNAL ARTICLE.
.W
The disparity between clinical visual function and pattern visual evoked response (VER) was studied in 53 patients who had suffered an attack of optic neuritis (ON) more than six months before. The visual functions tested included Snellen visual acuity, colour vision, visual field, and contrast sensitivity. The effect of pattern presentation, check size, and luminance was tested by recording VERs with several stimulus configurations. VER amplitudes were found to be associated with the outcome of all four clinical tests, independently of check size, luminance, or the presentation method used. On the other hand VER latencies were hardly ever related to the results of any of the four clinical visual tests. These findings support the idea that VER amplitude provides information about visual spatial perception, while VER latency is more related to the extent of demyelination.
.A
Sanders EA; Volkers AC; van der Poel JC; van Lith GH.
.I 54785
.U
88000510
.S
Br J Ophthalmol 8801; 71(8):618-22
.M
Adult; Animal; Case Report; Female; Glaucoma/*ET/PA; Gnathostoma; Human; Middle Age; Nematode Infections/*/PA; Support, Non-U.S. Gov't; Uveitis, Anterior/*ET/PA.
.T
Intracameral gnathostomiasis: a cause of anterior uveitis and secondary glaucoma.
.P
JOURNAL ARTICLE.
.W
Recognition of parasitic diseases by Western physicians is becoming increasingly important because of increased international travel and the recent influx of refugees from South east Asia. We describe two patients who presented with acute anterior uveitis and secondary glaucoma caused by intracameral third stage larvae of Gnathostoma spinigerum. The parasites were successfully removed, with preservation of good visual acuity. The initial infection may occur through consumption of contaminated water and/or raw or undercooked foods, while the eyes may be involved even years later. Accurate diagnosis and surgical removal of the parasites may save life.
.A
Kittiponghansa S; Prabriputaloong A; Pariyanonda S; Ritch R.
.I 54786
.U
88000511
.S
Br J Ophthalmol 8801; 71(8):623-8
.M
Aged; Female; Human; Iris/PA/*SU/UL; Laser Surgery/*; Microscopy, Electron; Middle Age; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Histopathological characteristics of neodymium-YAG laser iridotomy in the human eye.
.P
JOURNAL ARTICLE.
.W
Light and electron microscopic studies of YAG laser iridotomies were performed in two human iridectomy specimens. Full-thickness defects were created and showed stromal and vascular necrosis. The light and electron microscopic configuration of the lesions was compatible with mechanical disruption from shockwaves. Thermal changes were absent in contrast to iridotomies created by argon laser photocoagulation.
.A
Goldberg MF; Tso MO; Mirolovich M.
.I 54787
.U
88000513
.S
Br J Ophthalmol 8801; 71(8):635-8
.M
Anophthalmos/*SU; Eye, Artificial; Female; Human; Male; Orbit/SU; Surgery, Plastic/*.
.T
Clinical anophthalmos.
.P
JOURNAL ARTICLE.
.W
We report on 15 patients (10 boys, 5 girls) with clinical anophthalmos. Two of them had bilateral anophthalmos, 10 had systemic anomalies, and six had abnormalities of their remaining eye. Only two appeared to have an associated underlying aetiology. Fourteen patients underwent orbital reconstruction or socket enlargement with varying degrees of success. Our own experience suggests that unnecessary lid procedures should be avoided, but we recommend early prosthetic fittings. We feel that a multidisciplinary approach is necessary to attain useful rehabilitation.
.A
O'Keefe M; Webb M; Pashby RC; Wagman RD.
.I 54788
.U
88000514
.S
Br J Ophthalmol 8801; 71(8):639-40
.M
Androgen Antagonists/*AE; Dark Adaptation/*DE; Human; Imidazoles/*AE; Male.
.T
Ocular toxicity of anandron [letter]
.P
LETTER.
.A
Brisset JM; Bertagna C; Proulx L.
.I 54789
.U
88000979
.S
Blood 8801; 70(4):1006-13
.M
Alleles; Antibodies, Monoclonal/DU; Christmas Disease/*GE; Factor IX/*GE; Female; Heterozygote Detection/*MT; Human; Male; Pedigree; Polymorphism (Genetics)/*; Radioimmunoassay; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Carrier testing in hemophilia B with an immunoassay that distinguishes a prevalent factor IX dimorphism.
.P
JOURNAL ARTICLE.
.W
Immunoassays with a monoclonal antibody (A-1) detect a prevalent dimorphism in plasma coagulation factor IX. The antibody was shown to react with a dimorphic segment of the normal factor IX sequence as follows. First, A-1 bound to isolated activation peptide (residues 146 through 180) prepared from activated factor IX from a normal plasma pool. Second, binding of recombinant factor IXs with A-1 or factor IX from normal individuals was strong only when they had Threonine (Thr) at position 148; factor IXs with the Alanine (Ala) allele at that position were far less reactive. Third, immunoblot reactivity of Escherichia coli fusion proteins containing known segments of the factor IX sequence restricted the epitope to residues 147 through 153. In 120 hemophilia B pedigrees, the Ala immunoassay allele frequency was 0.19 and did not differ from the Ala frequency in normal males. In 22 of 49 families, immunoassay testing was informative for classification of obligate or possible carriers. In one large family, 4 obligate carriers were heterozygous for the dimorphism and 3 of their 7 daughters were classified as carriers. In other families, when the affected member had less than 1 nmol/L factor IX antigen, heterozygosity for Thr/Ala alleles excluded the carrier state even when DNA studies were not informative. Strong linkage disequilibrium of Thr/Ala alleles with the common TaqI DNA polymorphism was found. Nineteen of 75 normal and hemophilic factor IX genes had the 1.3-kilobase (kb) fragment and coded for the Ala allele; the rest had the 1.8-kb fragment and coded for Thr. In selected families, the A-1 immunoassay is an inexpensive and rapid method to confirm and supplement restriction fragment length polymorphism analyses of DNA for carrier testing.
.A
Smith KJ; Thompson AR; McMullen BA; Frazier D; Lin SW; Stafford D; Kisiel W; Thibodeau SN; Chen SH; Smith LF.
.I 54790
.U
88000982
.S
Blood 8801; 70(4):1035-9
.M
Acid-Base Equilibrium; Adenosine Triphosphatase/ME/PH; Animal; Microscopy, Electron; Proteins/AN; Rabbits; Receptors, Transferrin/*ME; Reticulocytes/AN/EN/*ME/UL; Subcellular Fractions/AN/ME; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Transferrin/*ME.
.T
Rabbit reticulocyte coated vesicles carrying the transferrin-transferrin receptor complex: I. Purification and partial characterization.
.P
JOURNAL ARTICLE.
.W
Coated vesicles bearing the transferrin-transferrin receptor complex were isolated from rabbit reticulocytes by freeze-thaw cell lysis, followed by differential centrifugation with pelleting of vesicles at 100,000 g. Electronmicroscopy demonstrated the vesicles to have the characteristic morphology of coated vesicles, including the appearance of triskelions. The protein composition of the vesicles as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis included transferrin, transferrin receptor, and proteins of apparent mol wt of approximately 180,000, 140,000, 100,000, and 47,000 daltons. The 180,000 and 100,000 mol wt proteins were identified as clathrin and coated vesicle assembly factor proteins, respectively, by Western blot analyses. The vesicles had a Mg2+-dependent ATPase with a specific activity of approximately 8.5 nmoles ATP converted/min/mg vesicle protein. The vesicles could acidify the intravesicular space, as evidenced by the stimulation of the Mg2+-ATPase by the protonophore FCCP. Reticulocytes appear to be an excellent source of coated vesicles and as such should provide a model for studying the endocytosis of transferrin and the steps of iron uptake that proceed in these vesicles.
.A
Choe HR; Moseley ST; Glass J; Nunez MT.
.I 54791
.U
88000983
.S
Blood 8801; 70(4):1040-5
.M
Autoantibodies/*AN; Blood Platelets/*IM; Chronic Disease; Glycoproteins/*IM; Human; Immunologic Diseases/BL/*IM; Plasma/*IM; Purpura, Thrombocytopenic/BL/*IM; Splenectomy; Support, U.S. Gov't, P.H.S.; Thrombocytopenia/IM.
.T
Platelet-associated and plasma anti-glycoprotein autoantibodies in chronic ITP.
.P
JOURNAL ARTICLE.
.W
Chronic immune thrombocytopenic purpura (ITP) is due to platelet destruction by circulating antiplatelet antibody. Although autoantibodies against the platelet glycoprotein IIb/IIIa (GPIIb/IIIa) complex and GPIb have been demonstrated using various methods, practical assays for detection of platelet-associated or plasma autoantibodies have not been available. We studied 59 patients with chronic immune thrombocytopenic purpura in whom platelet-associated and plasma autoantibodies against the GPIIb/IIIa complex and GPIb were measured using a newly developed immunobead assay and a previously reported microtiter-well assay. Platelet-associated autoantibody was detected using the immunobead assay in 21 of 28 patients (75.0%; 13 with anti-GPIIb/IIIa, 8 with anti-GPIb). Plasma autoantibodies were noted in 34 of 59 patients (57.6%; 21 with anti-GPIIb/IIIa, 11 with anti-GPIb, and 2 with both). Positive results were noted in 30 of 59 patients using the immunobead assay and in only 14 of 59 using the microtiter-well assay, suggesting that solubilization of the platelets prior to antibody addition, as in the microtiter-well assay, alters epitope stability. Of the 31 thrombocytopenic control patients studied, all gave negative results using both assays. We conclude that these clinically adaptable assays allow detection of autoantibodies in most patients with chronic ITP, confirming the presence of an autoimmune process.
.A
McMillan R; Tani P; Millard F; Berchtold P; Renshaw L; Woods VL Jr.
.I 54792
.U
88000984
.S
Blood 8801; 70(4):1046-52
.M
Adolescence; Adult; Anemia, Aplastic/*DT/MO/PP; Antilymphocyte Serum/*TU; Child; Child, Preschool; Female; Forecasting; Human; Male; Middle Age; Severity of Illness Index.
.T
Survival after antilymphocyte globulin therapy for aplastic anemia depends on disease severity.
.P
JOURNAL ARTICLE.
.W
Sixty-four patients with aplastic anemia were treated with antilymphocyte globulin (ALG Merieux) between 1980 and 1985. The actuarial survival for all patients was 53% at 6 years, with 79% survival for nonsevere aplastic anemia (NSAA) and 36% for severe aplastic anemia (SAA). The neutrophil and platelet counts before treatment with ALG were highly predictive of survival, whereas sex, age, and etiology were not. Duration of disease prior to ALG treatment was inversely related to survival, although this was not statistically significant. Survival was closely associated with response to ALG, especially for patients with SAA. The response to one course of ALG was 33%. Eighteen patients who did not respond to an initial course of ALG received a second course; of these, four (22%) responded. The overall response to one or two courses of ALG was 40%. The mean RBC volume (MCV) measured after ALG treatment was a useful early indicator of response. Both the minimum lymphocyte count during ALG therapy and the mean lymphocyte count after therapy, however, were not significantly different between responders and nonresponders. The disappointing survival of patients with SAA in this study may reflect the poor clinical condition of severely affected patients referred to us and/or the presence of longstanding aplasia. The importance of studying a large series of patients with long-term follow-up to assess ALG in the treatment of aplastic anemia is shown by this investigation.
.A
Marsh JC; Hows JM; Bryett KA; Al-Hashimi S; Fairhead SM; Gordon-Smith EC.
.I 54793
.U
88000994
.S
Blood 8801; 70(4):1111-8
.M
Anemia, Sickle Cell/*BL; Chemistry; Erythrocyte Deformability/DE; Erythrocytes/*DE/PA; Human; Osmosis; Phosphatidylcholines/*PD; Reference Values; Sickle Cell Trait/*BL/PA; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
The molecular species composition of phosphatidylcholine affects cellular properties in normal and sickle erythrocytes.
.P
JOURNAL ARTICLE.
.W
The phosphatidylcholine specific transfer protein (PCTP) from bovine liver was used to retailor the molecular species composition of phosphatidylcholine (PC) in the membrane of normal (AA) and sickleable (SS) human erythrocytes. Changes in molecular species composition of PC altered morphology as well as cellular deformability and stability as measured with ektacytometry. In normal cells, replacement of native PC with 1-palmitoyl,2-arachidonoyl PC (PAPC) resulted in a decrease in osmotic fragility with no change in hydration, whereas replacement with 1,2-dipalmitoyl PC (DPPC) led to an increased osmotic fragility and cellular hydration. Replacement of native PC by 1-palmitoyl,2-oleoyl PC (POPC) in normal cells had no apparent effect on these parameters. In contrast, replacement of native PC in sickle cells with either PAPC, DPPC or POPC led to cellular hydration. Facilitation of PC exchange between subpopulations of SS cells separated on buoyant density also led to cellular hydration. These observations suggest that the state of hydration of sickle cells can be modified by the fatty acyl composition of PC and illustrate a a role for the lipid core in the observed permeability changes in sickle erythrocytes. They also raise the interesting possibility that the state of cellular hydration of sickle cells may be modulated by altering the molecular species composition of the membrane phospholipids.
.A
Kuypers FA; Chiu D; Mohandas N; Roelofsen B; Op den Kamp JA; Lubin B.
.I 54794
.U
88000997
.S
Blood 8801; 70(4):1131-5
.M
Aging/ME/*PH; Animal; Calcium/ME; Cells, Cultured; Cytosol/ME; Hematopoietic Stem Cells/*PH; Mice; Mice, Inbred C57BL; N-Formylmethionine Leucyl-Phenylalanine/PD; Neutrophils/ME/*PH; Osmolar Concentration; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Evidence that microenvironmental factors account for the age-related decline in neutrophil function.
.P
JOURNAL ARTICLE.
.W
We measured the function of neutrophils harvested from the supernatant of long-term marrow cultures in which stromal cell cultures derived from young mice were recharged with hematopoietic cells from old mice and vice versa. The functions measured were superoxide generation and enzyme secretion (lysozyme and glucuronidase), following cell activation by either phorbol myristate acetate (PMA) or Formyl-methionyl-leucyl-phenylalanine (FMLP). In addition we measured cytosolic calcium concentration and its increase following activation by FMLP. In all culture combinations recharge resulted in the recovery of greater than 2 X 10(6) cells/flask (95% neutrophils, 98% viable). Histologic studies of cytoplasmic markers indicated that recovered neutrophils were derived from the stem cell population employed for recharge. For each neutrophil parameter measured, function was markedly improved when old hematopoietic stem cells were recharged onto a young stroma and was significantly diminished when young stem cells were recharged onto an old stroma. This applied to superoxide generation, basal and stimulated enzyme levels, and to basal cytosolic calcium concentration and its increase following activation by FMLP. These results indicate that when old hematopoietic stem cells proliferate in a young microenvironment, neutrophil function returns virtually to normal. Conversely, function diminishes when young stem cells proliferate in an old stroma. These findings demonstrate, for the first time, that neutrophil function is modulated by microenvironmental factors, hormonal, cellular, or matrix, which are decreased in the elderly. That an age-related decline in function is extrinsic to the cell and is reversible has significance for the study of neutrophil function and of cellular aging and has potential therapeutic implications.
.A
Lipschitz DA; Udupa KB; Boxer LA.
.I 54795
.U
88001001
.S
Blood 8801; 70(4):1161-4
.M
Adenosine/*AA/PD; Cell Differentiation/*DE; Cell Division/DE; Cell Line; Cycloleucine/PD; Human; Hydrolases/AI; Nitrous Oxide/*PD; Osmolar Concentration; S-Adenosylhomocysteine/ME; S-Adenosylmethionine/ME; Support, Non-U.S. Gov't.
.T
Adenosine dialdehyde and nitrous oxide induce HL-60 differentiation.
.P
JOURNAL ARTICLE.
.W
Adenosine dialdehyde and nitrous oxide, specific S-adeno-sylhomocysteine hydrolase and methionine synthetase inhibitors, respectively, induced differentiation of the human promyelocytic cell line HL-60. Their effect did not appear to be mediated through changes in transmethylation or decreased S-adenosylmethionine synthesis because (1) there was little correlation between the concentrations of adenosine dialdehyde that induced differentiation and those that changed the ratio of the intracellular concentrations of S-adenosylmethionine to S-adenosylhomocysteine, and (2) inhibition of methionine adenosyltransferase by cycloleucine did not induce differentiation. The differentiation induced by adenosine dialdehyde was prevented by homocysteine and that by nitrous oxide was inversely related to the medium methionine concentration. This suggested that differentiation was secondary to decreased methionine synthesis.
.A
Pilz RB; Van den Berghe G; Boss GR.
.I 54796
.U
88001004
.S
Blood 8801; 70(4):1180-5
.M
Animal; Bacteria/*ME; Bone Marrow/*DE; Cell Division/DE; Cell Survival/DE; Chloramphenicol/AA/ME/*PO; Hematopoietic Stem Cells/CY/DE; Human; Mice; Mice, Inbred C57BL; Mitochondria/ME; Proteins/ME; Support, U.S. Gov't, P.H.S..
.T
Chloramphenicol-induced bone marrow injury: possible role of bacterial metabolites of chloramphenicol.
.P
JOURNAL ARTICLE.
.W
To explore the potential role of some bacterial metabolites of chloramphenicol (CAP) in CAP-induced hematotoxicity, we examined their cytotoxic effects on bone marrow cells in vitro using a number of cytotoxicity parameters. Among the metabolites tested, dehydro-CAP (DHCAP) and p-nitrophenyl-2-amino-3 hydroxypropanone-HCI (NPAP) were more toxic than CAP. DHCAP was at least as toxic as nitroso-CAP. At concentrations of less than or equal to 10(-4) mol/L, DHCAP caused total irreversible inhibition of myeloid colony (CFU-GM) growth and 80% inhibition of DNA synthesis in human bone marrow. Incubation of human bone marrow cells with 10(-4) mol/L nitroso-CAP or DHCAP for 24 hours resulted in 75% and 65% cell death respectively. Although DHCAP was 10- to 20-fold more cytotoxic than CAP, it was only one third as effective in inhibiting mitochondrial protein synthesis, indicating that DHCAP exerts its toxic effect by alternate mechanisms. The cytotoxicity of DHCAP and its relative stability, compared to the unstable nitroso CAP, suggest that this bacterial metabolite of CAP, and possibly others, may play a significant role in CAP-induced hematotoxicity.
.A
Jimenez JJ; Arimura GK; Abou-Khalil WH; Isildar M; Yunis AA.
.I 54797
.U
88001007
.S
Blood 8801; 70(4):1203-7
.M
Comparative Study; Electrophoresis; Histones/*BI; Human; Leukemia, Lymphocytic/*ME/PA; Reference Values; Support, Non-U.S. Gov't.
.T
Histone H1 degrees is synthesized by human lymphocytic leukemia cells but not by normal lymphocytes.
.P
JOURNAL ARTICLE.
.W
Using a two-dimensional gel electrophoresis system (sodium dodecyl sulphate/acetic acid-urea-hexadecyltrimethylammonium bromide) coupled with fluorography, we investigated the synthesis of H1 isoproteins in leukemic cells obtained from peripheral blood of eight children suffering from acute lymphoblastic leukemia (ALL) (four T-ALL, three common ALL, and one B-ALL) and in normal peripheral lymphocytes. H1 degrees was synthesized in leukemic cells but not in normal lymphocytes. Inhibition of DNA synthesis with hydroxyurea and 1-beta-D-arabinofuranosylcytosine induced an increase of relative synthesis of H1 degrees in leukemic cells but did not induce any detectable synthesis of H1 degrees in normal lymphocytes. H1 degrees synthesis was also undetectable in peripheral lymphocytes of leukemic children in complete remission after chemotherapy and in lymphocytes of a homozygotic twin of a leukemic patient. H1 degrees may be a marker of malignant transformation of lymphocytes and as such could be of use for early detection of relapse in patients with acute lymphocytic leukemia in apparent complete remission.
.A
Mannironi C; Rossi V; Biondi A; Ubezio P; Masera G; Barbui T; D'Incalci M.
.I 54798
.U
88001012
.S
Blood 8801; 70(4):1222-4
.M
Bone Marrow/CY/*ME; Cell Count; Cell Differentiation; Human; N-Formylmethionine Leucyl-Phenylalanine/PD; Receptors, Immunologic/*BI; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Acquisition of formyl peptide receptors during normal human myeloid differentiation.
.P
JOURNAL ARTICLE.
.W
By using a newly developed immune rosetting technique to isolate highly purified populations of myeloid precursor cells from normal human bone marrow and then inducing their differentiation with granulocyte and macrophage colony-stimulating factors (G/M-CSFs) in vitro, we studied the surface expression of chemotactic peptide receptors as the cells matured from the stage of the myeloblast to that of the mature, segmented neutrophil. We used ethylene glycol bis(succinimidyl succinate) to link N-formyl-Nle-Leu-Phe-Nle-[125I]iodo-Tyr-Lys to chemotactic peptide receptors on the surface of myeloid cells at sequential stages of maturation and then determined the density of receptor-radioligand complexes by autoradiography after sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Specific, saturable formyl peptide receptors were not detectable at the level of the myeloblast but gradually emerged through progressive stages of neutrophil maturation. The specific receptors for formyl peptide that appeared during cellular maturation had a mol wt of 55 to 70 kiloDalton (kD), corresponding to those present on the surface of peripheral blood neutrophils, and binding of the radioligand was highly specific in that it was completely inhibited by a 1,000-fold excess of F-Met Leu Phe. These data correlate with and provide insight into our recent observation that F-Met Leu Phe-induced membrane depolarization and transient increases in cytosolic free calcium are gradually acquired as neutrophils mature. This report represents to our knowledge the first description of the maturational development of chemotactic peptide receptor expression in normal human myeloid cells.
.A
Sullivan R; Griffin JD; Malech HL.
.I 54799
.U
88001013
.S
Blood 8801; 70(4):1225
.M
Animal; Bone Marrow/*PA; Etoposide/*PD; Mice.
.T
VP-16 in bone marrow purging [letter]
.P
LETTER.
.A
Stiff PJ.
.I 54800
.U
88001014
.S
Blood 8801; 70(4):1225-7
.M
Blood Platelets/*PH; Human; Models, Biological/*.
.T
Models of platelet formation [letter]
.P
LETTER.
.A
Trowbridge EA.
.I 54801
.U
88001015
.S
Blood 8801; 70(4):1227-8
.M
Antigens, Surface/*AN; Human; Megakaryocytes/*IM.
.T
Expression of immunologic markers in megakaryoblasts [letter]
.P
LETTER.
.A
San Miguel JF; Gonzalez M; Orfao A; Ojeda E; Canizo MC.
.I 54802
.U
88001018
.S
Blood 8801; 70(4):909-14
.M
Animal; Erythrocytes/*DE/EN; Female; Glutathione Peroxidase/ME; Hemoglobins/*PH; Hemolysis/*; Human; Hydrogen Peroxide/*PD; Male; Malondialdehyde/ME; Mice; Mice, Inbred Strains/*GE; Recombination, Genetic; Support, U.S. Gov't, P.H.S..
.T
Genetic differences in hemoglobin influence on erythrocyte oxidative stress hemolysis.
.P
JOURNAL ARTICLE.
.W
The RBC from mice of certain inbred strains hemolyzed under oxidative stress (2.0 mmol/L hydrogen peroxide), whereas red cells from mice of other strains did not. In the experimental system human erythrocytes did not hemolyze. The rate of formation of malonyldialdehyde (a fatty acid oxidative breakdown product) was fourfold higher in hemolytic v nonhemolytic red cells. There was insufficient variation in the levels of glutathione, peroxidase activity or its substrate, reduced glutathione, to explain these hemolysis differences. On the other hand, the antioxidants butylated hydroxyanisole and hydroxytoluene, and histidine protected the hemolysis-prone red cells from breaking open. The hemolysis trait demonstrated autosomal recessive Mendelian inheritance. When using inbred, recombinant inbred, and congenic inbred mice, this hemolysis/nonhemolysis trait correlated 1:1 with the type of hemoglobin beta chain in the RBC. This experimental system is a potential model for investigating the role of hemoglobin in prehemolytic events.
.A
Kruckeberg WC; Doorenbos DI; Brown PO.
.I 54803
.U
88001020
.S
Blood 8801; 70(4):921-5
.M
Abortion, Habitual/*CO/PC; Adult; Case Report; Chromosome Abnormalities/*CO/GE; Female; Fibrinogen/*BL/TU; Human; Karyotyping; Pedigree; Pregnancy; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Translocation (Genetics).
.T
A unique 7p/12q chromosomal abnormality associated with recurrent abortion and hypofibrinogenemia.
.P
JOURNAL ARTICLE.
.W
Recurrent first trimester abortions led to evaluation of a 25-year-old woman. Studies revealed she had hypofibrinogenemia (68 mg/dL) without evidence of dysfibrinogenemia or increased fibrinogen turnover. She was also found to have a unique 46,XX, t(7;12) (p 15.2;q24.31) karyotype. Hypofibrinogenemia and identical chromosomal abnormalities were found in other members of her kindred. Southern blots of genomic DNA from the patient, her mother, and her daughter hybridized to human fibrinogen probes showed alpha, beta, and gamma fibrinogen genes to be present and without structural alterations when compared to normal controls. We conclude that the chromosomal abnormality and the hypofibrinogenemia are related but in an unclear manner. Because fibrinogen infusion in the proposita was associated with successful gestation, we also concluded that the chromosomal abnormality itself was not responsible for the repeated abortions but that fibrinogen concentration may be critical in securing implantation.
.A
Kitchens CS; Cruz AC; Kant JA.
.I 54804
.U
88001270
.S
Br J Surg 8801; 74(8):668-70
.M
Adrenergic Fibers/*PH; Adult; Anus/DE/*IR/PH; Bupivacaine/PD; Electric Stimulation; Electromyography; Female; Human; Hypogastric Plexus/*PH; Labetalol/PD; Male; Middle Age; Muscle Relaxation; Rectum/IR/PH; Reflex/PH; Support, Non-U.S. Gov't; Sympathetic Nervous System/DE.
.T
Neural control of internal anal sphincter function.
.P
JOURNAL ARTICLE.
.W
The effect on anal tone of electrical stimulation of the presacral (hypogastric) sympathetic nerves has been studied in eight patients during abdominal rectopexy or restorative proctocolectomy. A sharp fall in anal pressure occurred in seven patients (mean fall 59 cmH2O; range 35-80 cmH2O). In one patient given a beta- and alpha-sympathetic blocking drug (labetalol 200 mg) intra-operatively, the anal pressure decreased by 15 cmH2O. These observations show that stimulation of the presacral sympathetic nerves causes relaxation of the internal anal sphincter and implies that these nerves may induce relaxation of the sphincter in vivo. The pathway of the recto-anal reflex has been studied intra-operatively in three patients undergoing rectal excision. The recto-anal reflex is present after presacral nerve blockade and after full mobilization of the rectum, but is abolished by circumferential rectal myotomy. The reflex has a local intramural pathway. This observation validates the assumption that absence of this reflex is a feature of aganglionosis, as in Hirschsprung's disease.
.A
Lubowski DZ; Nicholls RJ; Swash M; Jordan MJ.
.I 54805
.U
88001271
.S
Br J Surg 8801; 74(8):671-4
.M
Adolescence; Adult; Aged; Child; Colectomy; Crohn Disease/MO/*SU; Female; Human; Ileostomy; Male; Middle Age; Prognosis; Rectum/SU; Recurrence; Reoperation.
.T
Results of proctocolectomy for Crohn's disease.
.P
JOURNAL ARTICLE.
.W
Seventy-four patients have had a one-stage proctocolectomy for the management of Crohn's disease. Indications for operation were: acute colitis 28 per cent, chronic colitis 39 per cent, perianal disease 13 per cent, proctitis and perianal disease 8 per cent, bleeding 5 per cent, coexisting colonic malignancy 7 per cent. There were two hospital deaths (2.7 per cent), both associated with sepsis. Late deaths (n = 13) were most commonly associated with reoperations for recurrent disease (n = 3), cardiovascular disease (n = 4) and colorectal carcinoma (n = 1). Postoperative complications were principally associated with sepsis. Cumulative reoperation rates at 5 and 10 years were 19 and 24 per cent respectively. Recurrence was unrelated to the age of the patients, the duration of disease, or the presence of ileal disease at the time of colectomy.
.A
Scammell BE; Andrews H; Allan RN; Alexander-Williams J; Keighley MR.
.I 54806
.U
88001272
.S
Br J Surg 8801; 74(8):675-8
.M
Adult; Age Factors; Aged; Cholecystectomy/*AE; Colonic Neoplasms/*ET; Female; Human; Male; Middle Age; Rectal Neoplasms/*ET; Risk; Support, Non-U.S. Gov't.
.T
Unaltered risk of colorectal cancer within 14-17 years of cholecystectomy: updating of a population-based cohort study.
.P
JOURNAL ARTICLE.
.W
The incidence of colorectal cancer after cholecystectomy was analysed in a historical population-based cohort study comprising 16,439 patients who were completely followed up for 14-17 years after operation. The observed number of colorectal cancers (150) was lower than the expected number of 166.3 (relative risk (RR) = 0.90:95 per cent confidence limits 0.77-1.05) and the overall risk for colon cancer (RR = 0.95) did not differ significantly from that of rectal cancer (RR = 0.82). Separate analyses by sex, age at operation and duration of follow-up revealed relative risks close to or lower than unity. Some deviations indicating a substantially reduced risk might have been due to the play of chance alone. Our results contradict the idea both of a causal and of a non-causal association-through common aetiological factors-between surgically confirmed gallbladder disease and colorectal cancer.
.A
Adami HO; Krusemo UB; Meirik O.
.I 54807
.U
88001273
.S
Br J Surg 8801; 74(8):679-82
.M
Adult; Constipation/CO; Defecation; Female; Follow-Up Studies; Human; Male; Middle Age; Prognosis; Rectal Prolapse/*ET/PP/TH.
.T
Natural history of anterior mucosal prolapse.
.P
JOURNAL ARTICLE.
.W
Case notes of 250 patients (M:F, 1:2.7; age 48.7 +/- 16.5 years) in whom anterior mucosal prolapse had been diagnosed, at one hospital between 1974 and 1976, were reviewed. The commonest symptoms were bleeding (56 per cent), pain (32 per cent) and a sense of prolapse (32 per cent). The prevalence of constipation was significantly higher among women (47 per cent) than men (29 per cent). Perineal descent was present in 20 per cent of cases and was significantly more frequently associated with excessive straining at defaecation (28 per cent) compared with patients in whom there was no history of excessive straining (12 per cent). Sixty-six patients (26 per cent) experienced recurring symptoms over the 10 year period following presentation but did not deteriorate, while 28 patients (11 per cent) deteriorated. Deterioration was associated with a history of symptoms for longer than 1 year at the time of presentation, female sex, and the presence of perineal descent on clinical examination. The risk of developing perineal descent was less than 10 per cent over the 5 years after presentation while that of developing sphincter laxity among patients who had already developed perineal descent was 30 per cent over this period. Complete rectal prolapse occurred in 20 per cent (3/15) of patients with clinical perineal descent and sphincter laxity but was not seen in the absence of these signs. The results of treatment by submucosal phenol injection, mucosal rubber banding, or glycerine suppositories were the same.
.A
Allen-Mersh TG; Henry MM; Nicholls RJ.
.I 54808
.U
88001274
.S
Br J Surg 8801; 74(8):683-4
.M
Animal; Deglutition Disorders/ET; Esophagogastric Junction/*SU; Gastroesophageal Reflux/*SU; Implants, Artificial/*/AE; Pressure; Support, Non-U.S. Gov't; Swine.
.T
Implantation of a pressure cuff around the subphrenic oesophagus.
.P
JOURNAL ARTICLE.
.W
The possibility of implanting a pressure cuff around the subphrenic oesophagus as a barrier to reflux was tested in six pigs. The oesophagus tolerated cuff pressures from 48 to 95 cmH2O, corresponding to intra-oesophageal pressures from 27 to 75 cmH2O. The pigs with the perioesophageal cuff swallowed a solid diet without difficulty. However, dysphagia occurred in pigs kept alive for more than a month and the main reason was malfunction of the device because of surrounding fibrosis. This problem should be solved before implantation of the device in humans is attempted.
.A
Miskowiak J; Burcharth F; Olesen HP; Baden H; Hald T; Aggestrup S.
.I 54809
.U
88001275
.S
Br J Surg 8801; 74(8):685-7
.M
Adenocarcinoma/SU; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell/SU; Cardia; Esophageal Neoplasms/*SU; Esophagus/*SU; Female; Human; Male; Methods; Middle Age; Postoperative Complications; Sternum/*SU; Stomach Neoplasms/*SU.
.T
Partial and complete sternotomy for blunt oesophagectomy.
.P
JOURNAL ARTICLE.
.A
Kirk RM.
.I 54810
.U
88001276
.S
Br J Surg 8801; 74(8):688-9
.M
Adolescence; Adult; Aged; Edrophonium/*DU; Esophageal Diseases/*DI; Evaluation Studies; Human; Manometry; Middle Age; Spasm/DI.
.T
Edrophonium provocation test in the diagnosis of diffuse oesophageal spasm.
.P
JOURNAL ARTICLE.
.W
Criteria for diffuse oesophageal spasm(DOS) are dysphagia and chest pain with oesophageal manometry showing retention of peristalsis with the presence of synchronous contractions in response to wet swallows. Because of the intermittent nature of the symptoms, edrophonium was used as a provocative agent to increase diagnostic yield. Three hundred and ninety-six patients underwent transnasal manometry using a Gaeltec system of six internal transducers arranged at 5 cm intervals from the catheter tip; the majority of these patients received 10 mg edrophonium as an intravenous bolus. Reproduction of symptoms with typical manometry of DOS indicated a positive provocation test. There were no significant side effects. DOS was diagnosed in 34 patients who had either the typical manometry or a positive provocation test. Thirty of these patients received edrophonium. Twenty patients had baseline manometry which was diagnostic and ten of this group had a positive provocation test. The remaining 10 patients, who had normal baseline manometry, had positive provocation tests following the injection of edrophonium. Without edrophonium provocation testing, about a third of patients would not have been diagnosed as having DOS.
.A
Linsell J; Owen WJ; Mason RC; Anggiansah A.
.I 54811
.U
88001277
.S
Br J Surg 8801; 74(8):690-1
.M
Abdominal Neoplasms/TH; Adolescence; Biological Products/*AD; Child, Preschool; Female; Head and Neck Neoplasms/TH; Human; Infant; Lymphangioma/*TH; Male; Picibanil/*AD/TU; Retroperitoneal Neoplasms/TH; Sclerosing Solutions/*AD/TU.
.T
Intracystic injection of OK-432: a new sclerosing therapy for cystic hygroma in children.
.P
JOURNAL ARTICLE.
.W
Nine patients with cystic hygroma were treated with a new sclerosing therapy consisting of intracystic injection of OK-432 (group A Streptococcus pyogenes of human origin). Favourable results including complete regression in eight patients and marked regression in one were observed within 2-3 months without serious side-effects except for fever of 2-3 days' duration and local inflammatory reaction lasting for 3-4 days. Local inflammatory reaction did not cause any damage to the overlying skin and did not lead to scar formation.
.A
Ogita S; Tsuto T; Tokiwa K; Takahashi T.
.I 54812
.U
88001278
.S
Br J Surg 8801; 74(8):692-3
.M
Adolescence; Cecal Diseases/CO/*TH; Child; Child, Preschool; Follow-Up Studies; Human; Ileal Diseases/CO/*TH; Intussusception/CO/*TH; Recurrence.
.T
Intussusception in children 5-15 years of age.
.P
JOURNAL ARTICLE.
.W
Twenty cases of intussusception in children between the ages of 5 and 15 years were compared with intussusception in infancy and early childhood. They accounted for 18.5 per cent of all 108 children treated for intussusception in two large hospitals from 1964 to 1984. Diagnosis of intussusception was delayed, probably due to an unusual presentation. Fifty-five per cent had a definite predisposing factor precipitating the intussusception and 45 per cent had a small bowel intussusception, which warranted early surgical intervention. In the absence of contraindications no child should be disqualified from an attempt at hydrostatic reduction. After hydrostatic reduction careful follow-up is required to exclude an organic lesion, possibly by a small bowel follow-through meal. Surgery is indicated after hydrostatic reduction in case of chronically recurrent abdominal complaints.
.A
Reijnen JA; Joosten HJ; Festen C.
.I 54813
.U
88001280
.S
Br J Surg 8801; 74(8):696
.M
Bronchi/*; Bronchial Diseases/ET; Case Report; Foreign Bodies/*/CO; Hemorrhage/ET; Human; Plastics; Surgical Instruments.
.T
Serious hazard of plastic coding tape on surgical instruments.
.P
JOURNAL ARTICLE.
.A
Kraayenbrink M; Baer ST; Jenkins JG; Moore-Gillon V.
.I 54814
.U
88001282
.S
Br J Surg 8801; 74(8):700
.M
Breast/*BS; Breast Neoplasms/*CO; Case Report; Female; Human; Middle Age; Phlebitis/*CO; Skin/BS; Syndrome.
.T
Mondor's disease as a presenting symptom of breast cancer.
.P
JOURNAL ARTICLE.
.A
Levi I; Baum M.
.I 54815
.U
88001284
.S
Br J Surg 8801; 74(8):704
.M
Aged; Aged, 80 and over; Case Report; Cholelithiasis/CO/*PA; Female; Gallbladder/*PA; Gallbladder Neoplasms/CO/*PA; Human.
.T
Record number of gallstones.
.P
JOURNAL ARTICLE.
.A
Martin KW; Jackson BT.
.I 54816
.U
88001286
.S
Br J Surg 8801; 74(8):711-4
.M
Adult; Aged; Amputation/*; Bone Neoplasms/*RA/SU; Buttocks/SU; Histiocytoma/*RA/SU; Human; Middle Age; Sarcoma/*RA/SU; Soft Tissue Neoplasms/*RA/SU; Thigh/SU; Tomography, X-Ray Computed/*.
.T
Role of computed tomography in selecting patients for hindquarter amputation.
.P
JOURNAL ARTICLE.
.W
Nine patients with soft tissue sarcomas close to the pelvic girdle and one patient with a primary malignant bone tumour of the pelvis were referred for consideration of hindquarter amputation. Patients were considered unsuitable for hindquarter amputation on clinical grounds if malignant disease infiltrated into the perineum or across the sacro-iliac joint. If disease in the femoral triangle extended above the inguinal ligament the tumour's operability was seriously questioned. Buttock tumours which had passed through the greater sciatic notch to become palpable on pelvic examination were also considered likely to be inoperable. On computed tomographic (CT) examination, tumours were considered inoperable if the psoas muscle was involved above the inguinal ligament, or if malignant disease involved the sacro-iliac joint, sacrum or perineal structures. Soft tissue tumours of the buttock extending significantly through the greater sciatic notch were also considered likely to be inoperable. Five patients thought suitable for hindquarter amputation on clinical assessment had no excluding features on CT; four undergoing hindquarter amputation were proven on histological examination to have good clearance of their tumours. In another patient, considered suitable for hindquarter amputation on clinical grounds, CT suggested that en bloc wide excision of the tumour was feasible enabling the affected limb to be preserved. Four patients after clinical examination were considered unsuitable for hindquarter amputation and in all cases inoperability was confirmed by CT. CT complements clinical examination and provides an objective and reliable means of selecting patients for hindquarter amputation which should avoid unnecessary surgical exploration.
.A
Watkins RM; Thomas JM.
.I 54817
.U
88001287
.S
Br J Surg 8801; 74(8):715-20
.M
Adenocarcinoma/DT/*MO/SU; Antineoplastic Agents/*TU; Female; Human; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Prognosis; Retrospective Studies; Stomach/SU; Stomach Neoplasms/DT/*MO/SU; Support, Non-U.S. Gov't.
.T
Evaluation of the prognostic factors in gastric cancer: the effect of chemotherapy on survival.
.P
JOURNAL ARTICLE.
.W
This is a retrospective review of 328 consecutive patients with histologically confirmed gastric adenocarcinoma diagnosed in one centre between 1974 and 1984. Of these patients, 128 (39 per cent) had a curative resection, 32 (9.8 per cent) had a palliative resection, 33 (10.0 per cent) had a gastro-enterostomy, 26 (7.9 per cent) had a Celestin tube inserted, 58 (17.7 per cent) had a laparotomy alone, and 51 (15.5 per cent) had no surgical procedure. The 5 year survival was 11 per cent but all long term survivors were patients who had a curative resection. Using multivariate analysis the best predictor of survival after curative resection was the presence or absence of serosal involvement (P = 0.0004). Patients with a long history of presenting symptoms (greater than 6 months) survived longer than those with a short history (P = 0.001). The impact of chemotherapy on the survival of 202 patients with advanced gastric cancer was analysed by multivariate analysis. The median survival of the 50 patients receiving combination chemotherapy was better than that of the 152 who did not (median survivals 160 versus 71 days; P less than 0.001). When deaths occurring within 14 days of diagnosis were excluded, the significance value dropped to P = 0.02. Comparison of the groups treated between 1974 and 1979, when 8 per cent of 92 patients received chemotherapy, with 1980-1984, when 45 per cent of 110 patients received chemotherapy, showed no significant difference in survival.
.A
Cunningham D; Hole D; Taggart DJ; Soukop M; Carter DC; McArdle CS.
.I 54818
.U
88001288
.S
Br J Surg 8801; 74(8):721-5
.M
Adult; Aged; Bile Acids and Salts/*AN; Cholelithiasis/*CO/ME; Duodenogastric Reflux/*CO/ME; Female; Gastric Acidity Determination; Human; Male; Middle Age; Phospholipases/*ME; Phospholipases A/*ME; Stomach/ME; Stomach Ulcer/*ET/ME.
.T
Relative contribution of bile and pancreatic juice duodenogastric reflux in gastric ulcer disease and cholelithiasis.
.P
JOURNAL ARTICLE.
.W
Bile acid concentrations, phospholipase A2 activity and pH in the stomach were measured in the fasting state and for 2 h after a fat-containing test meal in patients with an active gastric ulcer (GU), in patients with gallstones before and after cholecystectomy and in normal subjects. Fasting and peak postprandial bile acid concentrations in the stomach were low in all normal controls. Although high concentrations were found in many patients with GU (P less than 0.01), similar concentrations were found in many patients with radiologically non-functioning gallbladders containing gallstones (NFG) (P less than 0.01) and also after cholecystectomy (AC) (P less than 0.01). Fasting intragastric phospholipase A2 activities were similar, and very high in GU and NFG patients compared with control subjects (P less than 0.01). High values were not found after cholecystectomy. There was no difference in pH profile or in postprandial phospholipase A2 between patient groups. Since patients with cholelithiasis or after cholecystectomy are not known to have an increased incidence of gastric ulceration, the significance of duodenogastric reflux in the aetiology of gastric ulcers must be questioned. If reflux does produce ulcers in GU patients then factors in addition to bile acid are probably involved. However, neither patterns of phospholipase A2 reflux nor pH profiles can explain the absence of gastric ulceration in those patients with gallstones who reflux large quantities of bile acid.
.A
Eyre-Brook IA; Smythe A; Bird NC; Mangnall Y; Johnson AG.
.I 54819
.U
88001290
.S
Br J Surg 8801; 74(8):728-30
.M
Adult; Aged; Aged, 80 and over; Bile Duct Diseases/DI/TH; Bile Duct Neoplasms/DI; Cholelithiasis/*DI/TH; Cholestasis/*DI/TH; Drainage/MT; Endoscopy/*MT; Female; Human; Male; Middle Age.
.T
Percutaneous transhepatic cholangioscopy.
.P
JOURNAL ARTICLE.
.W
Since 1983, percutaneous transhepatic cholangioscopy has been performed in 50 patients for both therapeutic and diagnostic purposes. Percutaneous transhepatic cholangioscopy was used to evaluate the nature of obstructive jaundice in 15 patients and bile duct stones were removed in 35 patients, 27 of whom also had intrahepatic duct stones. The overall success rate for stone removal was 80 per cent. Complications were few with no mortality. Emergency surgery was necessary in two patients, one for subphrenic haematoma, the other for a bile leak. Percutaneous transhepatic cholangioscopy is an effective and safe method for management of biliary stones and is a useful procedure for establishing the diagnosis of obstructive jaundice.
.A
Chen MF; Jan YY; Lee TY.
.I 54820
.U
88001291
.S
Br J Surg 8801; 74(8):731-3
.M
Aged; Bile Duct Neoplasms/PA/RA/*SU; Bile Ducts/PA/*SU; Case Report; Cholangiography; Female; Human; Male; Middle Age; Prosthesis/*.
.T
Loss of substance in bile ducts treated by a new surgical endoprosthesis.
.P
JOURNAL ARTICLE.
.W
Three cases of loss of substance of the common bile duct in patients with neoplastic disease treated by a new surgical endoprosthesis are reported. In all patients a good biliary drainage was obtained without a biliary fistula. There were no complications related to this method. Long-term follow-up showed persistence of the good immediate results. Surgical endoprostheses might be an alternative in cases with peroperative loss of substance of the common bile duct in patients with neoplastic disease to hepato-enteric anastomoses.
.A
Sezeur A; Kracht M; Rey P; Leandri J; Malafosse M.
.I 54821
.U
88001292
.S
Br J Surg 8801; 74(8):734-5
.M
Animal; Disease Models, Animal; Guinea Pigs; Polyglactin 910/AE; Polyglycolic Acid/AE; Polymers/*AE; Polypropylenes/AE; Polytetrafluoroethylene/AE; Support, Non-U.S. Gov't; Surgical Wound Infection/*ET; Sutures/*.
.T
Suture materials in contaminated wounds: a detailed comparison of a new suture with those currently in use.
.P
JOURNAL ARTICLE.
.W
The relationship between five different suture materials (expanded polytetrafluoroethylene (PTFE), polypropylene, polyglycolic acid, polydioxanone and polyglactin 910) and infection has been studied in 540 guinea-pig wounds contaminated with synergistic enteric organisms. The recently introduced expanded PTFE suture has been studied because, unlike the others, it has not previously been studied under these contaminated conditions. The incidence of wound infection in the control series was 26 per cent and all suture materials increased this figure significantly. The infection rate using expanded PTFE of 51 per cent was similar to all other sutures except polyglycolic acid, which produced an infection rate of 41 per cent. This difference was not statistically significant at the 5 per cent level. This confirms other studies including our own which show that the presence of most suture materials in contaminated wounds increases the incidence of infection. It further demonstrates that expanded PTFE is no different from other materials in this regard.
.A
Paterson-Brown S; Cheslyn-Curtis S; Biglin J; Dye J; Easmon CS; Dudley HA.
.I 54822
.U
88001295
.S
Br J Surg 8801; 74(8):741
.M
Dumping Syndrome/PC; Enterostomy/*; Filtration; Human; Ileostomy; Infusion Pumps; Infusions, Parenteral/*IS; Jejunostomy/*; Methods.
.T
Pumping device for re-infusion excretions derived from a proximal jejunostomy or high output fistula.
.P
JOURNAL ARTICLE.
.A
Gouma DJ; de Bruyn H; Rinsema W; Soeters PB.
.I 54823
.U
88001297
.S
Br J Surg 8801; 74(8):748-9
.M
Animal; Appendicitis/*ET/PS; Cecum/PS; Enterobius/IP; Female; Human; Male; Oxyuriasis/*CO/PS.
.T
Role of Enterobius vermicularis in the aetiology of appendicitis.
.P
JOURNAL ARTICLE.
.W
An evaluation was made of the histological material obtained from all 1529 appendices removed during the last 5 years at Southmead Hospital, Bristol, in order to elucidate possible relationships between the incidence of Enterobius vermicularis and the origin of inflammation in the appendix. In total, 1419 appendices were removed as cases of clinical appendicitis and 110 in the course of another surgical procedure. E. vermicularis was identified in 2.7 per cent of patients with clinical appendicitis and was most commonly seen in appendices with either chronic inflammation or where the appendix was histologically normal. E. vermicularis was rarely associated with histological changes of acute appendicitis. No cases of E. vermicularis infestation occurred in appendices removed during the course of other surgical procedures. The results suggest that, although E. vermicularis may have a causal role in appendicular pain and chronic inflammation, it is rarely related to acute appendicitis.
.A
Budd JS; Armstrong C.
.I 54824
.U
88001298
.S
Br J Surg 8801; 74(8):750-2
.M
Abdomen; Human; Mortality/*; Severity of Illness Index; Suppuration/*.
.T
Comparison of the local and systemic effects of sepsis in predicting survival.
.P
JOURNAL ARTICLE.
.W
Progress in the study of sepsis has been hampered by the lack of a suitable system for grading its severity. Systems suggested for scoring sepsis have been based either on its systemic effects (APACHE II) or on a mixture of local and systemic variables (sepsis score). The APACHE II and sepsis scores were applied to patients with intra-abdominal sepsis of more than 3 days' duration, to determine if local or systemic factors were more important in predicting survival. Of 45 patients studied, 14 died. The sepsis score for non-survivors (median 21.5, range 11-32) was significantly higher than for survivors (median 14, range 10-26, P less than 0.05). There was overlap between the two groups, such that an individual score had no predictive value. The local component of the sepsis score was not significantly increased in non-survivors (P less than 0.05), but the systemic component was (P less than 0.05). The APACHE II score for non-survivors (median 24, range 15-38) was significantly higher than for survivors (median 12, range 3-21), and correctly identified 13 of the 14 fatalities. Both the systemic and non-systemic components (age and chronic disease) were significantly higher among the latter. The APACHE II was more effective than the sepsis score in predicting survival. We conclude that any system used for scoring sepsis should be based on systemic rather than local effects. At present the APACHE II score is preferred.
.A
Ponting GA; Sim AJ; Dudley HA.
.I 54825
.U
88001299
.S
Br J Surg 8801; 74(8):753-4
.M
Bile Duct Diseases/RA; Cholangiography/AE/*MT; Cholelithiasis/RA; Fluoroscopy/*; Human; Intraoperative Care/*MT; Radiation Dosage; Radiographic Image Enhancement.
.T
Fluoroscopic peroperative cholangiography: technique and associated radiation hazards.
.P
JOURNAL ARTICLE.
.W
The techniques specific to peroperative fluorocholangiography are discussed based on an experience of 632 cholangiograms and an estimation has been made of the associated radiation doses to staff and patients. Rapid and accurate information can be obtained during fluorocholangiography using appropriate techniques with acceptably low radiation hazards.
.A
Faulkner K; Gunn A; Harrison RM; Perry EP.
.I 54826
.U
88001300
.S
Br J Surg 8801; 74(8):755-7
.M
Aorta/*SU; Blood Coagulation; Blood Transfusion, Autologous/*; Disposable Equipment/*; Hemolysis; Hemorrhage; Human; Support, Non-U.S. Gov't.
.T
Salvage autotransfusion in aortic surgery: initial studies using a disposable reservoir.
.P
JOURNAL ARTICLE.
.W
Transmission of disease by allogeneic transfusion can be avoided using several techniques by which a patient receives his own blood. Sixty patients undergoing aortic surgery consented to salvage interoperative autotransfusion. A mean of 895 ml shed blood was reinfused under full heparinization, representing 12-74 per cent of total blood loss. Bank blood requirements fell from 4.9 units to 3.4. No important haematological or clinical complications were noted (including coagulation studies) but haemolysis was detected 4 h postoperatively by plasma haemoglobin levels of 0.05 +/- 0.03 g/dl. This preliminary study confirms the applicability of salvage autotransfusion during elective vascular surgery by demonstrating an appreciable saving in bank blood transfusion (70 per cent).
.A
Clifford PC; Kruger AR; Smith A; Chant AD; Webster JH.
.I 54827
.U
88001301
.S
Br J Surg 8801; 74(8):758
.M
Esophagus/*PH; Human; Hydrogen-Ion Concentration; Monitoring, Physiologic/*.
.T
Twenty-four-hour ambulatory oesophageal pH monitoring [letter]
.P
LETTER.
.A
McLauchlan G; Lucas ML; McColl KE.
.I 54828
.U
88001302
.S
Br J Surg 8801; 74(8):758-9
.M
Abdomen/*; Child; Child, Preschool; Human; Pain/*ET.
.T
Non-specific acute abdominal pain [letter]
.P
LETTER.
.A
Jones PF.
.I 54829
.U
88001303
.S
Br J Surg 8801; 74(8):759
.M
Anti-Inflammatory Agents, Non-Steroidal/*AE; Duodenal Ulcer/*CI; Human; Peptic Ulcer Perforation/*CI.
.T
Perforated duodenal ulcers [letter]
.P
LETTER.
.A
Blower AL; Armstrong CP.
.I 54830
.U
88001304
.S
Br J Surg 8801; 74(8):759-60
.M
Colitis/*PA; Colon/*BS; Human; Ischemia/PA.
.T
Colon "cast" in a patient with ischaemic colitis [letter]
.P
LETTER.
.A
Phillips RK; Armitage NC.
.I 54831
.U
88001305
.S
Br J Surg 8801; 74(8):760
.M
Adrenergic Beta Receptor Blockaders/AE; Gangrene/*CI; Human.
.T
Peripheral gangrene associated with beta-blockade [letter]
.P
LETTER.
.A
Kynaston HG; Roberts DH; Davies WT.
.I 54832
.U
88001306
.S
Br J Surg 8801; 74(8):760
.M
Aged; Aortic Aneurysm/*SU; Aortic Diseases/*ET; Blood Vessel Prosthesis/*; Case Report; Human; Intestinal Fistula/*ET; Male; Postoperative Complications/*.
.T
Secondary aorto-enteric fistulae [letter]
.P
LETTER.
.A
Galland RB.
.I 54833
.U
88001475
.S
Brain 8801; 110 ( Pt 4):1015-31
.M
Adult; Electric Stimulation; Female; Fingers/IR; Human; Male; Median Nerve/PH; Muscle Contraction; Neural Conduction/*; Neurons, Afferent/*PH; Paresthesia/*PP; Refractory Period, Neurologic/*; Skin/*IR; Support, Non-U.S. Gov't; Temperature.
.T
Hyperexcitability of cutaneous afferents during the supernormal period. Relevance to paraesthesiae.
.P
JOURNAL ARTICLE.
.W
The excitability of cutaneous afferents in the median nerve of 20 normal human subjects was investigated using a supramaximal conditioning stimulus and a submaximal test stimulus that produced an afferent volley of 20 to 40% of maximum. The intensity of the test stimuli was 1.1 to 1.25 times threshold for the first recruited axons (defined as a compound action potential of approximately 0.5 microV). The amplitude of the test volley did not reach the control amplitude until conditioning-test intervals of 3.4 ms. This was followed by a period of increased axonal excitability which reached a peak at intervals of 5 to 8 ms and declined gradually into a late phase of subnormality at 15 to 20 ms. The amplitude of the submaximal test potential was potentiated by, on average, 47% (range 9-146%) during the supernormal period. There were no significant changes in latency. The time course and the degree of potentiation were reproducible in the same subject on separate occasions. When the limb was cooled, the latency of the onset of supernormality was increased and the degree of supernormality was decreased and ultimately abolished. There was an inverse relationship between the degree of potentiation and the size of the test volley. High-frequency repetitive stimulation of the digital nerves for 10 min modified axonal excitability and produced spontaneous paraesthesiae that lasted for 20 min after the stimulation. Following this prolonged stimulus train, single submaximal stimuli evoked larger cutaneous afferent potentials than before the train, and the extent of the potentiation during the supernormal period was increased. It is concluded that prolonged repetitive stimulation of cutaneous afferents has two effects, one on axonal threshold, the second on the supernormal period. It is suggested that, in this experimental model, paraesthesiae result from ectopic impulses generated when axonal excitability is highest, namely at the peak of the supernormal period.
.A
Ng A; Burke D; Al-Shehab A.
.I 54834
.U
88001476
.S
Brain 8801; 110 ( Pt 4):1033-44
.M
Aged; Human; Lip/*PP; Male; Middle Age; Movement/*; Muscle Rigidity/*ET/PP; Parkinson Disease/*CO; Speech/PH; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Labial kinematics during speech in patients with parkinsonian rigidity.
.P
JOURNAL ARTICLE.
.W
Studies of orofacial motor control in Parkinson's disease (PD) have demonstrated that these subjects may exhibit hypokinesia and bradykinesia, as well as increased muscle tone. Yet the relationship between aberrations of orofacial movement and muscle rigidity remains unclear. Measures of labial muscle rigidity and movement were made for 12 parkinsonian and 9 age-matched control subjects. Displacement amplitude, peak instantaneous velocity, and movement time were evaluated during repetitive syllable productions. The results showed that while mean parkinsonian displacement amplitudes and velocities were lower than the normal control subjects, there was no statistical relationship between labial rigidity and the degree of movement abnormality. It is concluded that while rigidity may play a part in the overall disability, it does not sufficiently explain the labial articulatory difficulties associated with parkinsonism. This is in agreement with the literature on limb rigidity and movement aberrations in PD, suggesting that rigidity and bradykinesia may represent independent pathophysiological phenomena.
.A
Caligiuri MP.
.I 54835
.U
88001477
.S
Brain 8801; 110 ( Pt 4):1045-59
.M
Affective Disorders/*ET; Aphasia/ET; Brain/RA; Cerebral Cortex/*RA; Cerebrovascular Disorders/*CO/RA; Cognition Disorders/ET/PX; Comparative Study; Depression/ET/PX; Human; Male; Middle Age; Severity of Illness Index; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Tomography, X-Ray Computed.
.T
Comparison of cortical and subcortical lesions in the production of poststroke mood disorders.
.P
JOURNAL ARTICLE.
.W
Patients with single stroke lesions, verified by computerized tomography, involving either cortical tissue or restricted entirely to subcortical structures were examined for mood disorders. Those with left anterior lesions, either cortical or subcortical, had significantly greater frequency and severity of depression than patients with any other lesion location. A strong correlation between the severity of depression and proximity of the lesion to the frontal pole was observed for both left cortical and subcortical groups. Right hemisphere lesions did not show the same correlation with depression but were associated with a significantly higher incidence of undue cheerfulness. These findings demonstrate the importance of the location of subcortical lesions in poststroke mood disorders and suggest that anterior subcortical structures may play an important but lateralized role in the production or regulation of mood.
.A
Starkstein SE; Robinson RG; Price TR.
.I 54836
.U
88001478
.S
Brain 8801; 110 ( Pt 4):1061-79
.M
Acetylcholinesterase/ME; Adult; Bungarotoxins/ME; Case Report; Electromyography; Electrophysiology; Female; Human; Intercostal Muscles/PA/UL; Motor Endplate/EN/ME; Muscles/EN; Neuromuscular Diseases/GE/PA/PP; Neuromuscular Junction/*; Pedigree; Support, Non-U.S. Gov't; Syndrome.
.T
The slow channel syndrome. Two new cases.
.P
JOURNAL ARTICLE.
.W
Two patients are described with a myasthenic syndrome that presented in early adult life. One patient had 2 asymptomatic first degree relatives with similar electrophysiological findings. Both patients had abnormal fatiguability, arm weakness being prominent; neither of them responded to anticholinesterase medication. An abnormal decrement at 3 Hz stimulation was present, and a single stimulus evoked a repetitive response. Electrophysiological studies on biopsied intercostal muscle showed miniature endplate potentials of normal amplitudes but with prolonged rise and decay times. Anticholinesterase staining (Case 1) was not reduced, and showed elongation of some endplates. Ultrastructural studies (Case 2) showed degeneration of junctional folds and diffusely thickened endplate basal lamina. Calcium deposits were not observed and myopathic changes were slight. The findings are consistent with a prolonged open time of the ACh-induced ion channel.
.A
Oosterhuis HJ; Newsom-Davis J; Wokke JH; Molenaar PC; Weerden TV; Oen BS; Jennekens FG; Veldman H; Vincent A; Wray DW; et al.
.I 54837
.U
88001479
.S
Brain 8801; 110 ( Pt 4):819-41
.M
Adult; Aged; Aged, 80 and over; Case Report; Electrophysiology; Female; Human; Infection/*CO; Male; Middle Age; Multiple Organ Failure/*CO; Nervous System Diseases/CO/*ET/PA/PP; Retrospective Studies; Support, Non-U.S. Gov't.
.T
Critical illness polyneuropathy. A complication of sepsis and multiple organ failure.
.P
JOURNAL ARTICLE.
.W
Nineteen patients developed polyneuropathy complicating critical illness. They had been admitted to a critical care unit following intubation for cardiac or pulmonary disease and had developed sepsis and multiple organ failure. Approximately one month following intubation, failure to wean from the ventilator and limb weakness prompted neurological referral. Examination disclosed weakness and wasting of muscles and impaired tendon reflexes in most, but not all, patients. Electrophysiological studies in 17 patients revealed attenuated compound muscle and sensory nerve action potential amplitudes and widespread denervation on needle electromyography. Autopsy in 9 patients who died of their critical illness revealed widespread primary axonal degeneration of motor and sensory fibres, with extensive denervation atrophy of limb and respiratory muscles. Survivors recovered from the polyneuropathy three to six months following discharge. Seventeen of the patients were segregated by electrophysiological criteria into mild (8) and severe (9) polyneuropathy categories. An analysis of these two groups failed to reveal putative metabolic, drug, nutritional or toxic factors that might be responsible for the polyneuropathy. Our studies suggest that the mechanism may be a fundamental defect, still unknown, which causes dysfunction of all organ systems in this syndrome.
.A
Zochodne DW; Bolton CF; Wells GA; Gilbert JJ; Hahn AF; Brown JD; Sibbald WA.
.I 54838
.U
88001480
.S
Brain 8801; 110 ( Pt 4):843-53
.M
Adult; Aged; Biopsy; Female; Human; Male; Middle Age; Nervous System Diseases/*ET/PA/PP; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Sural Nerve/PA; Vasculitis/*CO.
.T
Nonsystemic vasculitic neuropathy.
.P
JOURNAL ARTICLE.
.W
Among 65 patients with necrotizing vasculitis, 45 had systemic and 20 had nonsystemic vasculitic neuropathy. In nonsystemic vasculitic neuropathy, clinically only nerves are affected; there are no, or few, constitutional symptoms or serological abnormalities. The clinical and pathological features are those of an ischaemic neuropathy caused by a necrotizing vasculitis of small arterioles. These 20 patients had neuropathic symptoms for a median time of 11.5 yrs (range 1-35 yrs). The clinical pattern of neuropathy was that of multiple mononeuropathy in 13, asymmetric neuropathy in 4, distal polyneuropathy in 3, and sensory polyneuropathy in 1. As compared with their initial evaluation, 8 are now worse, 5 are better, 4 are approximately the same, and 3 are dead from unrelated causes. Prednisone was thought to prevent the development of new lesions in some cases. By contrast, of the 41 patients with systemic necrotizing vasculitis whose outcome is known, 12 are dead (median time, 1.5 yrs, range 3 months-8 yrs) and 29 are alive (median time, 6 yrs, range 6 months-22 yrs).
.A
Dyck PJ; Benstead TJ; Conn DL; Stevens JC; Windebank AJ; Low PA.
.I 54839
.U
88001481
.S
Brain 8801; 110 ( Pt 4):855-67
.M
Animal; Brain Diseases/*ET/PA; Hyponatremia/BL/CO/*DT/PA; Myelin Sheath/*PA; Rabbits; Saline Solution, Hypertonic/TU; Sodium/BL; Support, Non-U.S. Gov't; Time Factors.
.T
Encephalopathy and myelinolysis after rapid correction of hyponatraemia.
.P
JOURNAL ARTICLE.
.W
Considerable controversy has followed the recent publication of studies indicating that central pontine myelinolysis is caused by rapid correction of hyponatraemia. Alternative suggestions have been that myelinolysis is due to uncorrected hyponatraemia, that it occurs only with over-correction of hyponatraemia or that it is due to coincidental hypoxia. The following experiments were undertaken to clarify the relationship between myelinolysis and derangements of serum sodium and their treatment. Severe hyponatraemia ([Na+] less than or equal to 122 mmol/l) was produced in three groups of rabbits by injection of vasopressin and 5% dextrose in water. Rabbits with severe uncorrected hyponatraemia sustained for seven days or more did not show myelinolysis at autopsy. Myelinolytic lesions did develop in 3 of 7 rabbits in a second group in which corrective infusion of hypertonic saline was administered after only three days of severe hyponatraemia. Neurological deterioration also occurred in rabbits in the third group which received hypertonic saline within 24h of developing severe hyponatraemia. In this group no lesions were apparent at autopsy. No animal became hypernatraemic with correction. These results indicate that even prolonged severe hyponatraemia does not lead to myelinolysis if it remains uncorrected, but that rapid correction of hyponatraemia, without over-correction, can cause neurological disease. Accordingly, a rapid rise in serum sodium should be avoided.
.A
Illowsky BP; Laureno R.
.I 54840
.U
88001482
.S
Brain 8801; 110 ( Pt 4):869-86
.M
Color Perception/*PH; Human; Support, Non-U.S. Gov't; Vision Disorders/*PP; Visual Fields/*.
.T
Chromaticity and achromaticity. Evidence for a functional differentiation in visual field defects.
.P
JOURNAL ARTICLE.
.W
In the visual field defects of 10 patients who had suffered lesions in the postgeniculate part of the primary visual projection, red-green discrimination and achromatic target detection was tested. In addition, 8 of these patients were tested for detection of red and green targets. Targets were presented on a low photopic achromatic background, so that the red and green targets differed from the background both in intensity and in wavelength, whereas the achromatic target differed in intensity only. Six patients showed evidence of discriminating between red and green targets, 5 patients could also detect the colour targets, but none could detect the achromatic one that was presented at the same retinal position. These results imply that wavelength and intensity information are treated differentially, and suggest that these patients possess residual colour-opponent channels that subserve the defective part of the visual field.
.A
Stoerig P.
.I 54841
.U
88001483
.S
Brain 8801; 110 ( Pt 4):887-905
.M
Adult; Aged; Brain Diseases/CO/RA; Color Perception; Female; Flicker Fusion; Geniculate Bodies/*; Human; Male; Middle Age; Motion Perception; Physical Education and Training; Saccades; Scotoma/*ET/PP; Support, Non-U.S. Gov't; Tomography, X-Ray Computed; Vision/*.
.T
Residual vision in patients with retrogeniculate lesions of the visual pathways.
.P
JOURNAL ARTICLE.
.W
Twenty-five subjects have been studied who, as a result of damage to the striate cortex, were 'blind' in extensive areas (scotomata) of the visual fields. Of these 25 subjects, 5 exhibited residual vision in response to transient lights presented within the scotoma, which enabled them to locate the stimuli by hand-reaching or by eye movements; the latter have been measured by electro-oculography. The residual vision underlying their responses was characterized by low flicker-fusion and by sensitivity in detection of movement which increased as target speed was raised. Discrimination for the direction of target movement was poor, but spatial resolution in the discrimination of target displacement was essentially normal. The subjects were unable to recognize or discriminate the spatial structure of targets located within the 'blind' field, and the observed dissociation between spatial discrimination of displacement and pattern is examined in relation to the 'two systems' hypothesis of visual function. There is no obvious correlation between the extent of neuronal damage as revealed by CT scans and the existence of residual vision.
.A
Blythe IM; Kennard C; Ruddock KH.
.I 54842
.U
88001484
.S
Brain 8801; 110 ( Pt 4):907-15
.M
Alzheimer's Disease/*GE/IM; Antigens, Viral/*AN; Base Sequence; Brain/IM/*ME; DNA/ME; Genes, Viral/*; Human; Nucleic Acid Hybridization; RNA; Support, Non-U.S. Gov't.
.T
A study of viral genomes and antigens in brains of patients with Alzheimer's disease.
.P
JOURNAL ARTICLE.
.W
The presence of viral nucleic acid sequences and antigens from a variety of conventional viruses in selected brain regions of cases of Alzheimer's disease (AD), diagnosed pathologically, was investigated using molecular hybridization and immunocytochemical techniques. Seven DNA and 4 RNA viruses were used as probes in 18 AD and 5 control brains. With Southern blot hybridization, no viral DNA sequences could be detected in the cerebral cortex. With dot blot hybridization, results were also negative, except for 2 cases, 1 a control brain, the other an AD brain, which gave a positive signal in the RNA extracted from the substantia innominata when c-DNA from measles virus was used as a probe. Four specific brain areas from each of 8 AD brains and 5 controls tested with viral probes (3 DNA and 5 RNA viruses), using immunocytochemical techniques for viral antigens, showed no positive reproducible specific reactions. These results, although negative, do not totally exclude the possibility that conventional viruses may play a role in the aetiology and pathogenesis of AD.
.A
Pogo BG; Casals J; Elizan TS.
.I 54843
.U
88001485
.S
Brain 8801; 110 ( Pt 4):917-34
.M
Aged; Blood Vessels/PP; Cerebral Ischemia/*ET; Cerebrovascular Circulation/*; Hemiplegia/*CO/PP; Human; Male; Middle Age; Migraine/*CO/PP; Muscle Tonus/*; Support, Non-U.S. Gov't; Xenon Radioisotopes/ME.
.T
Focal ischaemia caused by instability of cerebrovascular tone during attacks of hemiplegic migraine. A regional cerebral blood flow study.
.P
JOURNAL ARTICLE.
.W
During the course of hemiplegic migraine in 3 patients, changes in regional cerebral blood flow (rCBF) were recorded by the intracarotid 133Xe method and a 254 multidetector camera covering one hemisphere. The rCBF measurements were performed in conjunction with cerebral angiography. During repeated rCBF measurements all 3 patients developed focal hypoperfusion originating in the frontal lobe, subsequently spreading posteriorly to involve the precentral and postcentral regions. In 2 cases focal hyperperfusion appeared to precede the hypoperfusion. In association with the rCBF changes the patients developed transient motor and/or sensory deficits and subsequently severe headache. No signs of arterial occlusion were found. In the over and underperfused regions blood flow fluctuated rapidly because of instability of cerebrovascular tone, defined as transient constriction of the smallest cerebral vessels (arterioles) alternating with a normal calibre for these vessels and/or short periods of vasodilatation. It is considered to be a primary pathological condition of the vessels. When vasoconstriction was present the blood flow decreased to values consistent with ischaemia, which was probably the cause of the neurological deficits. On the basis of these observations and previous work from our laboratory we conclude that instability of cerebrovascular tone may cause focal ischaemia during the course of attacks of classical and hemiplegic migraine.
.A
Friberg L; Olsen TS; Roland PE; Lassen NA.
.I 54844
.U
88001486
.S
Brain 8801; 110 ( Pt 4):935-59
.M
Adult; Evoked Potentials; Female; Human; Male; Memory Disorders/*PP/PX; Memory, Short-Term/*; Middle Age; Neuropsychological Tests; Reaction Time; Sound/*; Support, U.S. Gov't, P.H.S.; Task Performance and Analysis.
.T
Disordered auditory short-term memory in man and event-related potentials.
.P
JOURNAL ARTICLE.
.W
Four patients with conduction aphasia and impaired auditory but relatively preserved visual digit spans were tested in a task of short-term memory, a digit probe identification task, in both the visual and auditory modalities. Five age-matched normal subjects served as controls. Behavioural measures of response accuracy and reaction time and scalp derived event-related potentials were determined as a function of the number of items to be remembered. These measures were also recorded in a task requiring the detection of infrequent stimuli ('oddball' paradigm). The patients' performance and event-related potential wave forms for the 'oddball' task were no different from those of the controls. In the digit probe identification tasks the patients showed a reduction in amplitude of a positive component at a latency of approximately 450 ms (P450) of the event-related potential to correctly identified probes in the auditory modality. This component was within normal limits with visual testing. There was an inordinate increase in the patients' reaction time to auditory but not visual stimuli when the number of items to be remembered increased from one to three. Event-related potentials were also analysed as a function of speed of reaction time, position of the matching item in the stimulus presentation set and whether the probe was correctly identified as being in-set or out-of-set. Event-related potentials associated with fast reaction times in the auditory task when a single item was presented were no different between patients and controls, indicating that patients were capable of both performing normally and generating normal potentials on some trials. The data suggest that the deficit in auditory short-term memory in these patients occurs during stimulus classification.
.A
Starr A; Barrett G.
.I 54845
.U
88001487
.S
Brain 8801; 110 ( Pt 4):961-91
.M
Aphasia/ET/*RA; Cerebral Cortex/PP/*RA; Cerebral Hemorrhage/CO/RA; Cerebral Infarction/CO/RA; Corpus Striatum/PP/RA; Human; Models, Neurological; Models, Psychological; Putamen/PP/RA; Tomography, X-Ray Computed/*.
.T
Correlations of subcortical CT lesion sites and aphasia profiles.
.P
JOURNAL ARTICLE.
.W
We have analysed the aphasia profiles of 19 cases with subcortical infarction or haemorrhage. Several components of the aphasic syndromes, especially sentence length and grammatical form (together compromising fluency), ease of speech initiation, articulation, voice volume, and auditory comprehension, were individually isolated for correlation with CT lesion site. Each component had a specific lesion site correlation, and lesions in various deep periventricular white matter regions were the critical ones for all components of aphasia. Simple tabulation of lesions as cortical or subcortical, and restricting analysis to lesions of basal ganglia would both have proved inadequate to account for clinical findings. A review of 61 subcortical cases in the neurological literature for which CT and aphasia data were available supports these conclusions.
.A
Alexander MP; Naeser MA; Palumbo CL.
.I 54846
.U
88001488
.S
Brain 8801; 110 ( Pt 4):993-1013
.M
Adult; Basal Ganglia Diseases/*PA; Case Report; Choline Acetyltransferase/ME; Female; Hallervorden-Spatz Syndrome/IM/*PA/PP; Human; Immunochemistry; Middle Age; Nervous System/EN/IM/PA; Neurofibrils/*PA; Somatostatin/IM.
.T
Adult onset Hallervorden-Spatz disease with neurofibrillary pathology. A discrete clinicopathological entity.
.P
JOURNAL ARTICLE.
.W
Three adults with progressive cognitive decline and extrapyramidal dysfunction were studied. They were all mentally retarded women without known chromosomal abnormalities, ranging in age at the time of onset from 31 to 42 yrs with an average duration of illness of 6 yrs. Neurological signs were stereotyped and consisted of a unilateral equinovarus foot posture followed by progressive dementia, rigidity and quadriparesis. Identical pathological findings were noted in all cases. There was marked deposition of iron-containing pigments in the globus pallidus and reticulate zone of the substantia nigra. Numerous axonal spheroids were noted in these areas and in the gracile and cuneate nuclei. In addition to these typical changes of Hallervorden-Spatz disease (HSD), abundant neurofibrillary tangles (NFTs) were found within the hippocampus, neocortex, nuclei of basal forebrain, subthalamic nucleus and brainstem reticular formation. Rare Hirano bodies and granulovacuolar degeneration were noted within the hippocampus; neuritic plaques and amyloid deposits were absent. Ultrastructurally the NFTs were mostly paired helical filaments (PHFs) with a diameter of 20 to 25 nm and a half-periodicity of 80 nm. Straight filaments and incompletely twisted forms were also seen. Immunocytochemistry with polyclonal antibodies to PHFs was positive in a distribution identical to that of Bodian-positive NFTs. Biochemical analysis of frozen frontal cortex from 1 case revealed a 94% depletion of the cholinergic marker enzyme choline acetyltransferase. Somatostatin-like immunoreactivity was within normal range. Study of 1 case with laser microprobe mass analysis revealed evidence of aluminium accumulation in tangle-bearing hippocampal neurons. Adjacent tangle-free neurons failed to show comparable accumulations. These findings indicate that adult onset HSD occurring in mentally retarded individuals may represent a distinct clinicopathological entity associated with neurofibrillary pathology without amyloid deposition.
.A
Eidelberg D; Sotrel A; Joachim C; Selkoe D; Forman A; Pendlebury WW; Perl DP.
.I 54847
.U
88001770
.S
Can Med Assoc J 8801; 137(6):473
.M
Bed Occupancy; Canada; Emergency Service, Hospital/*OG; Hospital Design and Construction/*; Hospitalization; Human.
.T
Emergency department space [letter]
.P
LETTER.
.A
Dickinson G.
.I 54848
.U
88001771
.S
Can Med Assoc J 8801; 137(6):473-4
.M
Anencephaly/*; Human; Infant, Newborn; Tissue Donors/*.
.T
Transplanting organs from anencephalic infants [letter]
.P
LETTER.
.A
Laberge JM.
.I 54849
.U
88001772
.S
Can Med Assoc J 8801; 137(6):474
.M
Human; Ontario; Prescriptions, Drug/*ST; Societies, Medical/*.
.T
Doctors should write "no substitution" on some prescriptions, OMA decides [letter]
.P
LETTER.
.A
Ham Pong AJ.
.I 54850
.U
88001773
.S
Can Med Assoc J 8801; 137(6):474-6, 480
.M
Antibodies, Viral/*AN; Homosexuality/*; HIV/*IM; Male; Sex Behavior/*; Statistics/*.
.T
HIV seroconversion and sexual behaviour in a cohort of homosexual men [letter]
.P
LETTER.
.A
Soskolne CL; Newman SC; Bulanski EM; Fung GW; Kwong PC; Waida E.
.I 54851
.U
88001774
.S
Can Med Assoc J 8801; 137(6):481-2
.M
Child; Child Welfare/*; Health/*; Health Status/*; Human; Ontario; Poverty/*; Public Policy/*.
.T
Public policies and the health of children. Committee on Child Welfare, Ontario Medical Association [editorial]
.P
EDITORIAL.
.I 54852
.U
88001775
.S
Can Med Assoc J 8801; 137(6):482-3
.M
Human; Resuscitation/*ED; Teaching/MT.
.T
Cardiopulmonary resuscitation revisited [editorial]
.P
EDITORIAL.
.A
Couves CM.
.I 54853
.U
88001777
.S
Can Med Assoc J 8801; 137(6):491-6
.M
Canada; Clinical Competence/*; Cognition; Education, Professional, Retraining; Heart Arrest/MO; Human; Medical Staff, Hospital/PX/*ST; Nursing Staff, Hospital/PX/*ST; Perception; Resuscitation/*ED/ST; Retention (Psychology); Support, Non-U.S. Gov't; Time Factors.
.T
Effects of training in cardiopulmonary resuscitation on competence and patient outcome.
.P
JOURNAL ARTICLE.
.W
Between 1981 and 1985 we carried out a study in two medium-sized nonteaching community hospitals to determine the rate of deterioration of knowledge and skills in cardiopulmonary resuscitation (CPR) among physicians and nurses, the accuracy of their perceptions of their knowledge and skills, the effects of practice on retention and the effect of CPR training on mortality. The participants' knowledge and skills were measured before training and immediately after, 6 months after and 12 months after training. Information on all attempts at CPR involving hospital staff was collected from medical records and from interviews with the participants. A total of 31 physicians and 54 nurses were followed during the study. Six months after training there was no difference in CPR knowledge or skills between the physicians and the nurses. In both groups CPR skills had deteriorated to near pretraining levels. By 6 months the physicians' knowledge had deteriorated to a level not significantly different from that before training. The nurses maintained a significant improvement in knowledge test scores at 12 months over those before training (p = 0.037). The physicians had an accurate perception of their knowledge but not their skills 6 months and 12 months after training, whereas the nurses did not accurately perceive either their knowledge or their skills after training. Experience with CPR did not contribute to post-training knowledge or skills in either group. There was no evidence that death rates were lower when basic life support (BLS) was begun by trained staff than when it was begun by untrained staff. The probability of survival was greater when BLS was begun within 4 minutes of arrest than when it was begun after 4 minutes, regardless of whether advanced cardiac life support was begun within 10 minutes.
.A
Curry L; Gass D.
.I 54854
.U
88001778
.S
Can Med Assoc J 8801; 137(6):497-500
.M
Aged; Aged, 80 and over/*; Arthritis/SU; Consumer Satisfaction; Female; Hip Prosthesis/*/PX; Human; Length of Stay; Male; Postoperative Complications/EP; Reoperation; Risk Factors; Support, Non-U.S. Gov't.
.T
Risks and benefits of elective hip replacement in the octogenarian.
.P
JOURNAL ARTICLE.
.W
We reviewed the records for 100 consecutive cases of elective hip replacement in 91 patients in their 80s (average age 82.8 years), all of whom lived in their own homes before surgery. In 92 cases the patients returned home, 59 within 3 weeks. The average duration of hospital stay was 20.1 days. In eight cases there were major complications, including three cases of myocardial infarction (one of them fatal) and two cases of pulmonary embolism (one of them fatal). In 15 cases there were moderate complications, including deep venous thrombosis (in 5) and urinary tract complications necessitating transurethral prostatectomy (in 2). In 44 cases there were minor complications, including the need for urinary catheterization (in 27) and brief periods of postoperative confusion (in 14). In 33 cases there were no complications; in 31 of these cases the patients returned directly home within 3 weeks. The preoperative risk rating of the American Society of Anesthesiologists (ASA) correlated well with the complication rates: the rates of major complications in cases with a rating of ASA class I, II or III were 0%, 6% and 15% respectively. In 49 of 52 cases in which the procedure had been performed more than 2 years previously, the patients were happy they had had the operation.
.A
Phillips TW; Grainger RW; Cameron HS; Bruce L.
.I 54855
.U
88001779
.S
Can Med Assoc J 8801; 137(6):503-6
.M
Allied Health Personnel/ED; Education, Continuing/*; Education, Medical, Continuing; Education, Nursing, Continuing; Health Occupations/*ED; Human; Ontario; Telecommunications/*; Telephone.
.T
Continuing education through Telemedicine for Ontario.
.P
JOURNAL ARTICLE.
.W
Telemedicine for Ontario (TFO) is a continuing education program for health professionals. It is an interactive audio system, organized and operated by the five provincial medical schools, that is designed to offer otherwise unavailable educational programs to health professionals in northern or other isolated areas of Ontario. TFO has provided programs in three categories--medicine, nursing and allied health--and has covered a wide range of topics; the programs have been tailored to the stated needs and interests of the participants. By 1986 there were 199 sites throughout Ontario that participated regularly, and there were approximately 25,000 individual registrations in the 1985-86 seasons. Our results from this 3-year pilot study have indicated the feasibility of the medium and its acceptance by health professionals. The next stage of the program's evaluation will include analyses of its impact on clinical practice and on the health status of patients.
.A
Lindsay EA; Davis DA; Fallis F; Willison DB; Biggar J.
.I 54856
.U
88001780
.S
Can Med Assoc J 8801; 137(6):511-2
.M
Aged; Carrier State/MI; Case Report; Disease Outbreaks/*; Female; Hepatitis B/*EP/TM; Human; Middle Age; Nursing Homes/*; Ontario.
.T
An outbreak of hepatitis B in a nursing home.
.P
JOURNAL ARTICLE.
.I 54857
.U
88001781
.S
Can Med Assoc J 8801; 137(6):513-5
.M
Adult; Case Report; Female; Hepatitis Antibodies/AN; Hepatitis B/IM/PC/*TM; Hepatitis B e Antigens/IM; Hepatitis B Core Antigens/IM; Hepatitis B Surface Antigens/AN; Human; Immunoglobulins/AD; Infant, Newborn; Pregnancy; Pregnancy Complications, Infectious/*TM.
.T
Symptomatic hepatitis B in an infant.
.P
JOURNAL ARTICLE.
.I 54858
.U
88001782
.S
Can Med Assoc J 8801; 137(6):532, 536
.M
Ambulatory Care Facilities/*/OG; Canada; Human.
.T
Walk-in clinics: "as far as we're concerned, the patient is king".
.P
JOURNAL ARTICLE.
.A
Milne M.
.I 54859
.U
88001783
.S
Can Med Assoc J 8801; 137(6):537-9
.M
Human; Organ Procurement/*; Professional-Family Relations/*.
.T
Requesting organ donations: the hardest question to ask.
.P
JOURNAL ARTICLE.
.A
Houlihan P.
.I 54860
.U
88001784
.S
Can Med Assoc J 8801; 137(6):548
.M
Emergency Service, Hospital/*; Human; Patient Discharge; Patient Education/*MT; Software/*.
.T
This software provides personalized instructions for emergency patients.
.P
JOURNAL ARTICLE.
.A
Goldman B.
.I 54861
.U
88001785
.S
Can Med Assoc J 8801; 137(7):585
.M
Canada; Human; Language/*; Societies, Medical.
.T
The quest for a sexless language.
.P
JOURNAL ARTICLE.
.A
Woods D.
.I 54862
.U
88001786
.S
Can Med Assoc J 8801; 137(7):586-7
.M
Commitment of Mentally Ill/*LJ; Human; Ontario; Psychiatry/*.
.T
Is psychiatry being harmed by involuntary hospitalization and treatment? [letter]
.P
LETTER.
.I 54863
.U
88001787
.S
Can Med Assoc J 8801; 137(7):587-8, 590-1
.M
Adrenergic Beta Receptor Blockaders/*AE/PD; Anaphylaxis/*CI; Human; Risk Factors.
.T
Beta-blocker therapy and the risk of anaphylaxis [letter]
.P
LETTER.
.A
Toogood JH.
.I 54864
.U
88001788
.S
Can Med Assoc J 8801; 137(7):591
.M
Alcoholism/*MO; Canada; Human.
.T
Years of life lost because of alcohol [letter]
.P
LETTER.
.A
Tuttle MJ.
.I 54865
.U
88001789
.S
Can Med Assoc J 8801; 137(7):591-2
.M
Boxing/*; British Columbia; Human.
.T
Boxing [letter]
.P
LETTER.
.A
Schinbein JE.
.I 54866
.U
88001790
.S
Can Med Assoc J 8801; 137(7):592
.M
Administrative Personnel; Adult; Aged; Child; Child Abuse, Sexual/*; Female; Great Britain; Human; Male; Middle Age; Physicians, Family.
.T
Sexual abuse of children: an update [letter]
.P
LETTER.
.A
Wilson MS.
.I 54867
.U
88001792
.S
Can Med Assoc J 8801; 137(7):602
.M
Canada; Curriculum; Education, Medical, Undergraduate/*; Human; Occupational Medicine/*ED.
.T
Teaching occupational health to medical undergraduates [editorial]
.P
EDITORIAL.
.A
Markham J; Fisher LA.
.I 54868
.U
88001793
.S
Can Med Assoc J 8801; 137(7):605-7
.M
Costs and Cost Analysis; Family Practice/*/EC; Human; Office Visits/*; Ontario; Research Design; Smoking/*TH; Statistics; Support, Non-U.S. Gov't.
.T
A second look at the effects of supportive follow-up on smoking cessation.
.P
JOURNAL ARTICLE.
.W
In 1982 a report in CMAJ (1982; 126: 127-129) indicated that the addition of supportive follow-up appointments in a family practice increased the 6-month cigarette abstinence rate from 12% to 23%. We reanalysed the data by means of recognized standards for treatment success and found little evidence that the treatment had any reliable effect on attempts to quit that lasted at least 3 months: 8.5% and 4.8% of the groups with and without supportive follow-up respectively abstained for more than 3 months. We discuss a problem of the experimental design (longer evaluative follow-up for the control group than for the treatment group) and cost-benefit issues.
.A
Kozlowski LT; Page A.
.I 54869
.U
88001794
.S
Can Med Assoc J 8801; 137(7):609-12
.M
Evaluation Studies; Family Practice/*; Follow-Up Studies; Human; Office Visits/*; Ontario; Research Design; Smoking/*TH; Statistics.
.T
Supportive follow-up for cigarette smokers in a family practice: issues of method, analysis and state of the art.
.P
JOURNAL ARTICLE.
.W
Kozlowski and Page have criticized a study published in 1982 in CMAJ on the effects of supportive follow-up on the rate at which patients quit smoking cigarettes. We agree with some of their general sentiments about the need for establishing a consensus on the evaluation of smoking cessation programs. More specifically, we defend the particular analysis originally used, given the state of knowledge and constraints on the study. We examine their main objections: the definition of successful cessation, the design of the study, the exclusion of patients lost to follow-up, the methods of statistical analysis used and the strength of more recent evidence on the usefulness of follow-up visits. We believe that the role of supportive follow-up deserves further evaluation.
.A
Wilson DM; Singer J; Best JA.
.I 54870
.U
88001795
.S
Can Med Assoc J 8801; 137(7):613-9
.M
Chewing Gum; Family Practice/*; Human; Methods; Nicotine; Office Visits; Ontario; Patient Education; Physician's Role; Smoking/*TH.
.T
A smoking cessation intervention program for family physicians.
.P
JOURNAL ARTICLE.
.W
Family physicians are able to approach many patients who smoke but are often hesitant to help them quit. Lack of knowledge about effective interventions is a major reason for this hesitancy. The important components that have been tested in physician-initiated smoking cessation interventions are advice to quit, information about the risks of smoking and techniques for quitting, nicotine gum, setting a date for quitting and offers of supportive follow-up visits. We describe a cessation program developed for family physicians that incorporates these factors into three types of visits over a 2-month period: the challenge visit, which occurs during a regular office visit and focuses on advice and setting a date to quit; the quit-date visit, which involves instructing patients on the proper use of nicotine gum, if applicable, and confirming their desire to quit; and four supportive follow-up visits, which provide continuing encouragement for 2 months and allow physicians to monitor withdrawal symptoms, relapses and other problems. Such a program can be effectively incorporated into a general practice.
.A
Wilson DM; Lindsay EA; Best JA; Gilbert JR; Willms DG; Singer J.
.I 54871
.U
88001796
.S
Can Med Assoc J 8801; 137(7):620-4
.M
Adolescence; Adult; Age Factors; Aged; Asthma/EP/*MO; Canada; Child; Child, Preschool; Female; Hospitalization; Human; Infant; Male; Middle Age.
.T
Increased rates of illness and death from asthma in Canada.
.P
JOURNAL ARTICLE.
.W
Recent rates of illness and death from asthma in Canada and rates of hospital admission/separation for asthma were examined by age group and region. The death rates were higher in 1982-84 than in 1970-72, especially among those aged 15 to 34 years. Increases were also noted in hospital admission/separation rates, especially among those less than 15 years of age. Hospital admission/separation rates were highest in the Maritime provinces and Saskatchewan, whereas death rates were highest in Alberta and Saskatchewan. Examination of death certificates for coding errors and recoding of certificates to a single (8th) revision of the International Classification of Diseases indicated that changes in disease coding and errors in coding did not account for the significant increase in rates of death from asthma for those aged 15 to 34 years. These increases in rates of illness and death from asthma are unexplained and warrant further investigation.
.A
Mao Y; Semenciw R; Morrison H; MacWilliam L; Davies J; Wigle D.
.I 54872
.U
88001797
.S
Can Med Assoc J 8801; 137(7):625-9
.M
Aged; Cognition Disorders/ET; Costs and Cost Analysis; Dementia/*DI; Diagnosis, Laboratory/EC; Human; Tomography, X-Ray Computed/EC.
.T
The diagnosis of dementia.
.P
JOURNAL ARTICLE.
.W
The diagnosis of dementia in the elderly has important personal and social consequences, and a small proportion of cases initially diagnosed may be reversible. An understanding of the operating characteristics and cost-effectiveness of clinical signs and symptoms and of laboratory investigations in the diagnosis of dementia is needed to diagnose accurately yet contain costs. Using published criteria, we critically appraised the current scientific literature on the diagnosis of dementia. The articles that essentially satisfied our criteria suggested that duration and severity of dementia best predicted reversibility and the need for computed tomography of the head. A decision rule may be used to select among a number of investigations now advocated as routine in diagnosing dementia, with little or no risk of missing clinically significant diagnoses and with appreciable cost savings. The reversibility of dementia may not be as major an issue as previously believed, since most instances may be early, atypical presentations of Alzheimer-type dementia.
.A
Wilson DB; Guyatt GH; Streiner DL.
.I 54873
.U
88001798
.S
Can Med Assoc J 8801; 137(7):630-2
.M
Accidents/*; Accidents, Traffic/*; Adolescence; Adult; Child; Child, Preschool; Human; Motorcycles; Prospective Studies; Recreation/*; Rural Population; Safety; Saskatchewan; Support, Non-U.S. Gov't; Wounds and Injuries/EP.
.T
Accidents involving off-road motor vehicles in a northern community.
.P
JOURNAL ARTICLE.
.W
The increasing number of accidents associated with off-road motor vehicles used for recreational purposes prompted this prospective study. During 1985 the records of victims of all motor vehicle accidents who were seen at the Hudson Bay Union Hospital, Hudson Bay, Sask., were studied; patients involved in on-road vehicle accidents were included for comparison. Emphasis was placed on age, vehicle type, mechanism of accident, injury severity and the use of safety features. Almost half of the victims of off-road vehicle accidents were under 16 years of age. The poor adherence to government legislation and manufacturer recommendations was evident in the number of people who did not wear helmets or use headlights.
.A
Hasselback P; Wilding HR.
.I 54874
.U
88001799
.S
Can Med Assoc J 8801; 137(7):635-6
.M
Adult; Amodiaquine/*AE; Case Report; Female; Human; Malaria/PC; Neuromuscular Diseases/*CI.
.T
Neuromyopathy associated with amodiaquine hydrochloride.
.P
JOURNAL ARTICLE.
.A
Wittes R.
.I 54875
.U
88001800
.S
Can Med Assoc J 8801; 137(7):637-8
.M
Acquired Immunodeficiency Syndrome/*ET/IM/PA; Adult; Antibodies, Viral/AN; Blood Transfusion/AE; Canada; Case Report; Human; HIV/IM; Male; Time Factors; Zaire.
.T
A case of acquired immune deficiency syndrome before 1980.
.P
JOURNAL ARTICLE.
.A
Rogan E Jr; Jewell LD; Mielke BW; Kunimoto D; Voth A; Tyrrell DL.
.I 54876
.U
88001801
.S
Can Med Assoc J 8801; 137(7):639-40
.M
Acquired Immunodeficiency Syndrome/*CO/PC; Health Manpower; Hemodialysis/*; Human; Occupational Diseases/PC.
.T
Recommendations for providing dialysis treatment to patients infected with human immunodeficiency virus.
.P
JOURNAL ARTICLE.
.I 54877
.U
88001802
.S
Can Med Assoc J 8801; 137(7):656
.M
Education, Medical/*; Human; Physicians, Women/*; Prejudice/*.
.T
The taxicab theory.
.P
JOURNAL ARTICLE.
.A
Waugh D.
.I 54878
.U
88001803
.S
Can Med Assoc J 8801; 137(7):658-60
.M
Administrative Personnel/*ED; Education, Medical, Continuing/*; Human; Ontario.
.T
PMI courses helping meet need for physician-managers.
.P
JOURNAL ARTICLE.
.A
Sullivan P.
.I 54879
.U
88001805
.S
Can Med Assoc J 8801; 137(8):699-700
.M
Ethics, Medical/*; Female; Human; Male; Physician-Patient Relations/*; Psychiatry/*; Sex Behavior/*.
.T
Sexual misconduct [letter]
.P
LETTER.
.A
Seeman MV.
.I 54880
.U
88001806
.S
Can Med Assoc J 8801; 137(8):700
.M
Canada; Female; Human; Influenza Vaccine/*AE; Middle Age; Polyradiculoneuritis/EP/*ET.
.T
Statement on influenza vaccination for the 1987-88 season [letter]
.P
LETTER.
.A
Martin S.
.I 54881
.U
88001807
.S
Can Med Assoc J 8801; 137(8):701
.M
Canada; Legislation, Drug/*; United States.
.T
Drug legislation in the silly season [letter]
.P
LETTER.
.A
Kirshen AJ.
.I 54882
.U
88001808
.S
Can Med Assoc J 8801; 137(8):701-2
.M
Breast Feeding/*; Female; Human; Milk, Human/AN; Propylthiouracil/*AE/PK.
.T
Propylthiouracil and breast-feeding [letter]
.P
LETTER.
.A
Goldman JM.
.I 54883
.U
88001809
.S
Can Med Assoc J 8801; 137(8):702
.M
Canada; Drug Labeling/*; Societies, Pharmaceutical.
.T
Improving drug labels [letter]
.P
LETTER.
.A
Fowler R.
.I 54884
.U
88001810
.S
Can Med Assoc J 8801; 137(8):702
.M
Canada; Feces/*PS; Health Services Misuse/EC; Human; Parasitic Diseases/DI/*EC.
.T
Searching for parasites in stool: once is usually enough [letter]
.P
LETTER.
.A
Montessori GA; Bischoff L.
.I 54885
.U
88001811
.S
Can Med Assoc J 8801; 137(8):705-8
.M
Canada; Fluoridation/*/AE/TD; Human; Mass Media; Politics; Public Opinion.
.T
Fluoridation: why is it not more widely adopted? [editorial]
.P
EDITORIAL.
.A
Musto RJ.
.I 54886
.U
88001812
.S
Can Med Assoc J 8801; 137(8):715-20
.M
Adult; Canada; Ethics, Medical/*; Female; Human; Infant; Jurisprudence; Male; Mental Retardation/*; Patient Advocacy/*LJ.
.T
After "Eve": whither proxy decision-making?
.P
JOURNAL ARTICLE.
.W
One of the most difficult problems facing physicians is how to approach proxy decisions made on behalf of congenitally incompetent patients. The author considers two recent court cases that attempt to provide guidelines: Re Stephen Dawson, which opts for a substituted-judgement approach, and Eve v. Mrs E.) which injoins best-interests considerations. The author explores the impact of Eve v. Mrs. E. as superseding Re Stephen Dawson, considers its ethical implications and attempts to clarify the best-interests criterion by sketching some guidelines for its interpretation. In so doing, he tries to reconcile the two decisions by laying bare their common underlying ethical rationale. The author concludes by pointing out some ethically questionable implications of Eve v. Mrs. E. in the area of allocation of health care resources.
.A
Kluge EH.
.I 54887
.U
88001813
.S
Can Med Assoc J 8801; 137(8):722-6
.M
Adult; Aged; Aged, 80 and over; Antibodies, Viral/AN; Comparative Study; Hemagglutination Inhibition Tests; Hemagglutinins, Viral/IM; Human; Immunization Schedule/*; Influenza Vaccine/*AD/IM; Male; Middle Age; Orthomyxovirus Type A, Human/IM; Orthomyxoviruses Type B/IM; Support, Non-U.S. Gov't.
.T
Comparison of one- and two-dose regimens of influenza vaccine for elderly men.
.P
JOURNAL ARTICLE.
.W
In November and December 1984, 102 male residents of a long-term care facility (mean age 74.6 [extremes 59 and 97] years) received 0.5 ml of trivalent inactivated whole-virion influenza vaccine, containing 15 micrograms of the hemagglutinin of each of A/Philippines/2/82 (H3N2), A/Chile/83 (H1N1) and B/USSR/83. A second dose of the vaccine was administered to a subgroup of 55 randomly chosen subjects 8 weeks later. Serum samples were collected from all the subjects before and 4, 8, 12 and 16 weeks after administration of the first dose and were assayed for hemagglutinin-inhibiting (HAI) antibody to each of the three antigens. At 8 weeks there were significant increases (p less than 0.05) in the geometric mean titre of antibody and in the proportion of subjects with HAI antibody titres of 1:40 or more (except to the B/USSR antigen) in both groups. There were no differences between the groups at 8 weeks or at 16 weeks (8 weeks after administration of the second dose of vaccine) in the frequency of seroconversion, the geometric mean titre or the proportion of subjects with HAI antibody titres of 1:40 or more. Overall, 60%, 32% and 13% of the 102 subjects had titres of 1:40 or more to the A/Philippines, A/Chile and B/USSR antigens respectively at 16 weeks. The results suggest that a second dose of influenza vaccine given 8 weeks after the first does not enhance the immune response in elderly men and that a substantial proportion of this population remains unprotected against infection (having HAI antibody titres of less than 1:40) during the influenza season.
.A
Levine M; Beattie BL; McLean DM.
.I 54888
.U
88001814
.S
Can Med Assoc J 8801; 137(8):728-32
.M
Abnormalities/EP; Adult; Female; Human; Hypertension/DI/EP; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases/EP; Labor, Premature/EP; Pre-Eclampsia/DI/EP; Pregnancy; Pregnancy Complications/DI/*EP; Pregnancy Complications, Cardiovascular/DI/EP; Pregnancy Outcome/*; Prospective Studies; Retrospective Studies; Risk Factors; Support, Non-U.S. Gov't.
.T
Maternal and neonatal outcome in pregnancies with no risk factors.
.P
JOURNAL ARTICLE.
.W
Between November 1979 and April 1984, 790 consecutive pregnant women who considered themselves as having a "normal" pregnancy were followed in private practice from 9 weeks' gestation until 6 weeks post partum. The women had no pre-existing disease or problem classified as a risk to the pregnancy at the time of their first visit, had a singleton pregnancy and gave birth at Notre-Dame Hospital, Montreal. Maternal complications occurred during the course of pregnancy in 181 women (23%). Complications were mostly related to obstetric conditions (10%), such as preterm labour, intrauterine growth retardation (IUGR) and antepartum hemorrhage, or to medical conditions (12%), the most prevalent of which was hypertension (77% of medical conditions). Neonatal complications occurred in 183 infants (23%). The corrected perinatal death rate was 2.5 per 1000. Prematurity, IUGR and dysmaturity/postmaturity accounted for nearly half of the complications. Hyperbilirubinemia occurred in 7% of the cases. Among women without any maternal complications during pregnancy, the frequency rate of neonatal complications was 19%, compared with 23% among the entire group of 790 women. Our results suggest that the absence of maternal complications does not protect the infant from a neonatal complication. Further refinement is needed to identify markers of obstetric, medical and neonatal complications in pregnancies with no risk factors.
.A
Moutquin JM; Gagnon R; Rainville C; Giroux L; Amyot G; Bilodeau R; Raynauld P.
.I 54889
.U
88001815
.S
Can Med Assoc J 8801; 137(8):733-4
.M
Canada; Child, Preschool; Chlamydia trachomatis; Chlamydia Infections/EP; Gastrointestinal Diseases/EP/MI; Human; Infant; Measles/EP; Middle Age; Pneumonia, Mycoplasma/EP; Virus Diseases/*EP.
.T
Laboratory evidence of human viral and selected nonviral infections in Canada in 1986.
.P
JOURNAL ARTICLE.
.A
Neumann PW.
.I 54890
.U
88001816
.S
Can Med Assoc J 8801; 137(8):734-5
.M
Canada; Child; Child, Preschool; Human; Immunization Schedule; Infant; Middle Age; Tetanus/PC; Tetanus Toxoid/*/AD/AE; Wound Infection/PC.
.T
Statement on tetanus toxoid.
.P
JOURNAL ARTICLE.
.A
Acres SE.
.I 54891
.U
88001818
.S
Can Med Assoc J 8801; 137(8):746-7
.M
Canada; Hospices/*; Human; Terminal Care.
.T
La Maison Sarrazin: serenity before science.
.P
JOURNAL ARTICLE.
.A
Woods D.
.I 54892
.U
88001820
.S
Can Med Assoc J 8801; 137(8):754
.M
Canada; Health Services/*OG/TD; Physician's Role/*; Role/*.
.T
Why should doctors get involved in medical administration?
.P
JOURNAL ARTICLE.
.A
Roberts P.
.I 54893
.U
88001821
.S
Can Med Assoc J 8801; 137(8):756-8
.M
Abortion, Legal/*; Canada; Female; Human; Organizations; Physicians/*; Pregnancy.
.T
Canadian Physicians for Life: "what we have here is a silent minority".
.P
JOURNAL ARTICLE.
.A
Trent B.
.I 54894
.U
88001902
.S
Cancer 8801; 60(7 Suppl):1669-70
.M
Breast Neoplasms/*PC; Costs and Cost Analysis; Female; Human; Mammography/*EC; Mass Screening/*EC; United States.
.T
Addressing the needs and solutions to increase the use of low-cost screening mammography.
.P
JOURNAL ARTICLE.
.A
Dodd GD; Fink DJ; Bertram DA.
.I 54895
.U
88001903
.S
Cancer 8801; 60(7 Suppl):1669-701
.M
Breast Neoplasms/*PC; Costs and Cost Analysis; Female; Human; Mammography/*EC; Mass Screening/*EC.
.T
American Cancer Society Workshop on Strategies to Lower the Cost of Screening Mammography. July 16-18, 1986, Annapolis, Maryland.
.P
JOURNAL ARTICLE.
.I 54896
.U
88001904
.S
Cancer 8801; 60(7 Suppl):1671-4
.M
Breast Neoplasms/*PC; Costs and Cost Analysis; Female; Human; Mammography/*EC; Mass Screening/*EC; United States.
.T
The history and present status of radiographic screening for breast carcinoma.
.P
JOURNAL ARTICLE.
.W
Many of the perceived and actual difficulties in the creation of screening centers have been solved or are amenable to solution. The amount of radiation delivered to the breast during mammography no longer poses a significant risk and there is ample evidence that screening mammography can detect occult disease. While substantial evidence is lacking with respect to a decrease in mortality in patients under 50 years of age, there is an unequivocal gain in those over 50 years of age. Other concerns center around the number of trained radiologists available to interpret large numbers of screening mammograms, the use of lay screeners to minimize the physician shortage and the availability of instruction centers to educate those radiologists not formally trained in mammography. The question of quality control is closely tied to the training of the radiologist and must be addressed if screening centers are to function efficiently. All of the above are correctable to a greater or lesser degree, but the problem of cost remains. To survey all women over 40 years of age at a cost of $50.00 per examination would require an expenditure in excess of two billion dollars a year, a staggering sum even in the context of the economy of the 1980s. It is necessary that these costs be lowered if the full potential of a major cancer detection procedure is to be realized. This conference has both the responsibility and opportunity to perform a significant service for the women of the US. We ask all of you to devote your greatest ingenuity to achieving its major purpose, the development of a practical strategy for cost reduction in mammography. While it may not be possible to achieve all that we wish, the formulation of any reasonable plan to increase public access will be a major accomplishment. I remind you of a French aphorism: "The greatest crime is to do nothing because we fear we can only do a little."
.A
Dodd GD.
.I 54897
.U
88001905
.S
Cancer 8801; 60(7 Suppl):1675-7
.M
Breast Neoplasms/*PC; Costs and Cost Analysis; Female; Human; Mammography/*EC; Mass Screening/*EC; Physician's Role/*; Role/*; United States.
.T
The role of the radiologist in mammography screening.
.P
JOURNAL ARTICLE.
.A
Strax P.
.I 54898
.U
88001906
.S
Cancer 8801; 60(7 Suppl):1678-9
.M
Breast Neoplasms/*PC; Costs and Cost Analysis; Female; Human; Mammography/*EC; Mass Screening/*EC; United States.
.T
The essentials of screening mammography.
.P
JOURNAL ARTICLE.
.A
McLelland R.
.I 54899
.U
88001908
.S
Cancer 8801; 60(7 Suppl):1684-7
.M
Breast Neoplasms/*PC; Cost Control; Costs and Cost Analysis; Female; Human; Mammography/*EC; Mass Screening/*EC; North Carolina.
.T
A successful effort to lower costs in screening mammography.
.P
JOURNAL ARTICLE.
.A
Bird RE.
.I 54900
.U
88001909
.S
Cancer 8801; 60(7 Suppl):1688-91
.M
Breast Neoplasms/*PC; Cost Control; Costs and Cost Analysis; Female; Human; Mammography/*EC; Mass Screening/*EC; Mobile Health Units/*EC; United States.
.T
Low cost mammography screening. Practical considerations with emphasis on mobile operation.
.P
JOURNAL ARTICLE.
.A
Sickles EA; Weber WN; Galvin HB; Ominsky SH; Sollitto RA.
.I 54901
.U
88001910
.S
Cancer 8801; 60(7 Suppl):1692-3
.M
Breast Neoplasms/*PC; False Negative Reactions; Female; Human; Malpractice/*; Mammography/*; Mass Screening/*LJ; United States.
.T
Legal aspects of mammography screening.
.P
JOURNAL ARTICLE.
.A
Gebhard PG; Feingold SG.
.I 54902
.U
88001911
.S
Cancer 8801; 60(7 Suppl):1694-9
.M
American Cancer Society/*; Breast Neoplasms/*PC; Costs and Cost Analysis; Female; Human; Insurance, Health, Reimbursement; Mammography/*EC; Mass Screening/*EC; Occupational Health Services/EC; United States; Voluntary Health Agencies/*.
.T
American Cancer Society: Cost of screening mammography. Issues, recommendations, and solutions.
.P
JOURNAL ARTICLE.
.I 54903
.U
88001912
.S
Cancer 8801; 60(8):1703-7
.M
Adult; Case Report; Dactinomycin/*AD/TU; Extremities/*; Female; Fibrosarcoma/*DT; Follow-Up Studies; Histiocytoma/*DT; Human; Male; Melphalan/*AD/TU; Middle Age; Perfusion, Regional; Sarcoma/*DT; Soft Tissue Neoplasms/*DT.
.T
Results of isolated regional perfusion in the treatment of malignant soft tissue tumors of the extremities.
.P
JOURNAL ARTICLE.
.W
High-grade soft tissue sarcomas of the extremities continue to pose problems of local disease control and deaths from distant metastases. Between 1969 and 1976, eight patients with primary and six with recurrent high-grade soft tissue sarcomas of the extremities were treated by isolated regional perfusion with cytostatics and local excision. None received systemic adjuvant chemotherapy or external-beam radiotherapy. During the follow-up (median, 13 years) five patients (36%) developed distant metastases. One was cured after resection of a pulmonary metastasis. In one other patient (7%) recurrent local disease was diagnosed after 48 months; he was cured after resection of the local lesion followed by postoperative external beam radiotherapy. The actuarial 5-year and 10-year survival was 69%. Treatment caused no cardiovascular complications and there was no postoperative mortality.
.A
Hoekstra HJ; Schraffordt Koops H; Molenaar WM; Oldhoff J.
.I 54904
.U
88001914
.S
Cancer 8801; 60(8):1713-9
.M
Adult; Antineoplastic Agents, Combined/*TU; Combined Modality Therapy; Comparative Study; Female; Hodgkin's Disease/*DT/MO/RT; Human; Male; Mechlorethamine/AD; Neoplasm Staging; Prednisone/AD; Procarbazine/AD; Prognosis; Remission Induction; Support, Non-U.S. Gov't; Time Factors; Vincristine/AD.
.T
Predictive value of the early response to chemotherapy in high-risk stages II and III Hodgkin's disease.
.P
JOURNAL ARTICLE.
.W
A series of 60 patients with "high risk" Stage II and III Hodgkin's disease (B symptoms, or large mediastinal mass, or E lung disease) were staged without laparotomy and treated with combined modality treatment: mechlorethamine, vincristine, procarbazine, and prednisone (6 MOPP) plus radiotherapy. Patients were restaged after the first three courses of MOPP and the status of response to therapy at that time was called early response to chemotherapy (ERC). The rate of nitrogen mustard and procarbazine delivery (MRD) during the first three cycles of chemotherapy also was assessed. At the completion of the therapy patients were restaged and the final response was assessed. Fifty-two (86.7%) patients entered complete remission (CR). Forty-eight percent of the complete responders achieved CR in the first three courses of MOPP. Eight-year survival and disease-free survival (DFS) rates of the patients achieving CR were 71% and 73%, respectively. Survival and DFS were significantly better for the patients who achieved CR in the first three cycles of chemotherapy than for patients who entered CR at a later stage of therapy: 8-year survival 90% versus 55% (P = 0.00); 8-year DFS 87% versus 59% (P = 0.01). The attainment of a complete ERC was adversely affected by lymphocyte depletion (LD) histologic type (P = 0.01) and MRD less than 65% (P = 0.04). However, when a multivariate regression analysis was used, ERC was the only significant prognostic variable for survival and DFS and its predictive value was confirmed even after correction by MRD. These data suggest that the rapidity of response to chemotherapy could be an important prognostic factor in high-risk Stage II and III Hodgkin's disease.
.A
Levis A; Vitolo U; Ciocca Vasino MA; Cametti G; Urgesi A; Bertini M; Canta M; Monetti U; Bosio C; Jayme A; et al.
.I 54905
.U
88001915
.S
Cancer 8801; 60(8):1720-3
.M
Case Report; Child; Combined Modality Therapy; Dacarbazine/*TU; Female; Follow-Up Studies; Human; Infant; Male; Melanoma/*DT/MO/SU; Retrospective Studies; Skin Neoplasms/*DT/MO/SU.
.T
Adjuvant and neoadjuvant chemotherapy with dacarbazine in high-risk childhood melanoma.
.P
JOURNAL ARTICLE.
.W
Four of four children with clinical Stage II-IIIB childhood melanoma treated at The University of Texas System Cancer Center M.D. Anderson Hospital with surgical excision of gross disease and adjuvant or neoadjuvant chemotherapy with dimethyl triazeno-imidazole carboxamide (dacarbazine) were alive without evidence of disease at 2, 6, 9.5, and 10.5 years after treatment. In one of the four patients suspected pulmonary nodules developed shortly after the start of chemotherapy, but regressed completely with continued treatment. In another patient with a primary left wrist melanoma and palpable epitrochlear and axillary nodes, there was dramatic shrinkage of nodal disease during chemotherapy and subsequent biopsies were cytologically negative. The expected survival of children with this rare condition when diagnosed at a comparably advanced stage and treated primarily by surgery is 32% compared with the 100% survival in these four cases. Although dacarbazine has not been notably successful as adjuvant therapy in high-risk adult melanoma, data from this small series is suggestive of an adjuvant effect in high-risk childhood melanoma and merits further study although the rarity of this condition may make a controlled trial difficult.
.A
Boddie AW Jr; Cangir A.
.I 54906
.U
88001916
.S
Cancer 8801; 60(8):1724-8
.M
Antineoplastic Agents, Combined/*TU; Breast Neoplasms/*DT; Comparative Study; Female; Human; Infusions, Intravenous; Middle Age; Mitoxantrone/AD/TO; Random Allocation; Time Factors; Vinblastine/AD/TO.
.T
Chemotherapy with mitoxantrone in combination with continuous infusion vinblastine for metastatic breast cancer.
.P
JOURNAL ARTICLE.
.W
The efficacy of mitoxantrone in combination with vinblastine was assessed in 156 patients with metastatic breast cancer who had been treated previously with one or multiple chemotherapeutic regimens. Mitoxantrone was given by random assignment, either as a 10 mg/m2 single intravenous dose or in five consecutive daily fractions of 2 mg2. Vinblastine was given as a continuous intravenous infusion of 1.2 mg/m2 daily for 5 days. In 115 evaluable patients previously treated with doxorubicin, 21 objective responses (18%) and 11 minor responses (10%) were observed with similar distribution in the two treatment groups. Median time to progression was 27 weeks and 23 weeks, respectively. Eight (32%) of 25 patients who had not received doxorubicin achieved objective remissions and two (8%) had minor responses. Toxic effects were similar for the two treatment schedules. Major toxicities were myelosuppression and neutropenic fever. Other toxicities were mild. Cardiotoxicity, presumably caused by mitoxantrone, occurred in four patients. The combination of mitoxantrone and vinblastine appeared to offer no advantage over single-agent therapy, probably because of the dosage reduction required by the overlapping myelosuppressive toxicity.
.A
Fraschini G; Yap HY; Mann G; Buzdar AU; Blumenschein GR; Hortobagyi GN.
.I 54907
.U
88001917
.S
Cancer 8801; 60(8):1729-30
.M
Adult; Antineoplastic Agents, Combined/*TU; Bleomycins/AD; Case Report; Cisplatin/AD; Combined Modality Therapy; Etoposide/AD; Human; Lymph Node Excision; Male; Orchiectomy; Retroperitoneal Space; Teratoma/*DT/SU; Testicular Neoplasms/*DT/SU; Vinblastine/AD.
.T
Failure of adjuvant chemotherapy in testicular cancer.
.P
JOURNAL ARTICLE.
.W
Two cases of failure of adjuvant chemotherapy after retroperitoneal lymph node dissection of Stage II nonseminomatous germ cell tumors are described. In both cases, initial surgical resection was complete, and two cycles of chemotherapy with cisplatin, vinblastine, and bleomycin were administered in an appropriate dose and schedule. Although one patient remains without evidence of disease 12 months after initiation of salvage chemotherapy with cisplatin, etoposide, and bleomycin, the other patient died of progressive disease despite intensive treatment with cisplatin and etoposide. Adjuvant therapy for Stage II germ cell tumors is not conventional treatment, and should be applied only in investigative settings where the long term effects and toxicity can be monitored, and does not reduce the need for frequent and thorough follow-up of treated patients.
.A
Bernstein JI; Freiha F; Breeden J; Torti FM.
.I 54908
.U
88001918
.S
Cancer 8801; 60(8):1731-3
.M
Adenocarcinoma, Papillary/DT; Antineoplastic Agents, Combined/*TU; Ascites/DT; Case Report; Catheters, Indwelling; Cisplatin/AD; Cytarabine/AD; Dermatitis Medicamentosa/*ET; Extravasation of Diagnostic and Therapeutic Materials/*; Female; Human; Infusions, Parenteral/*; Middle Age; Mitoxantrone/AD.
.T
Drug extravasation along the route of a peritoneal catheter during intraperitoneal chemotherapy.
.P
JOURNAL ARTICLE.
.W
A patient receiving intraperitoneal chemotherapy with cisplatin and cytosine arabinoside developed an abdominal skin rash similar in appearance to Cullen's sign. She subsequently received intraperitoneal mitoxantrone, which became visible in the skin close to the peritoneal catheter tract in the region of the skin rash within 24 hours of drug administration. There was no evidence for drug extravasation from the entry portal of the peritoneal catheter or visible fluid leakage. Although the clinical picture was dramatic there was no significant clinical sequela to the extravasation of these drugs. The potential significance of this event is discussed.
.A
Kerr IG; Deangelis C; Assaad DM; Hanna SS.
.I 54909
.U
88001921
.S
Cancer 8801; 60(8):1741-4
.M
Adult; Case Report; Combined Modality Therapy; Female; Hodgkin's Disease/DI/*SC/TH; Human; Magnetic Resonance Imaging; Mechlorethamine/AD; Prednisone/AD; Procarbazine/AD; Radiotherapy Dosage; Spinal Cord Neoplasms/DI/*SC/TH; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Tomography, X-Ray Computed; Vincristine/AD.
.T
Intramedullary spinal cord metastasis in Hodgkin's disease. Rapid diagnosis and treatment resulting in neurologic recovery.
.P
JOURNAL ARTICLE.
.W
Intramedullary spinal cord metastases are uncommon in Hodgkin's disease and have a poor prognosis. This prognosis reflects the refractory or widely disseminated status of the disease at the time of development of neurological symptoms and difficulties in diagnosis. Computerized tomography and magnetic resonance imaging have enabled more rapid and specific diagnosis of spinal cord diseases. The authors report a patient who presented with Brown-Sequard syndrome due to intramedullary spinal cord infiltration from Hodgkin's disease. This patient was diagnosed promptly and with rapid initiation of radiation and chemotherapy, she has had neurologic recovery.
.A
Lyding JM; Tseng A; Newman A; Collins S; Shea W.
.I 54910
.U
88001922
.S
Cancer 8801; 60(8):1745-50
.M
Adult; Aged; Carcinoma/PA/*RA; Comparative Study; Female; Human; Lymph Nodes/PA; Lymphography/*; Middle Age; Neoplasm Staging; Pelvis; Physical Examination; Preoperative Care; Tomography, X-Ray Computed/*; Uterine Neoplasms/PA/*RA.
.T
Computed tomography and lymphography in the presurgical staging of early carcinoma of the uterine cervix.
.P
JOURNAL ARTICLE.
.W
The value of bipedal lymphography and computed tomography (CT) in the presurgical staging of early carcinoma of the uterine cervix was analysed in 62 patients by histologic examination of pelvic lymph nodes and parametrial extension at the time of surgery. Macroscopic invasion of the lymph nodes was detected in 33% of the patients by CT and in 17% by lymphography. Microscopic invasion was suspected in 9% by CT scan and in 38% by lymphography. Physical examination with measurement of the tumor diameter was more predictive for regional extension of the disease as compared to lymphography and CT. CT may detect subclinical parametrial invasion but overestimation of the extent of the disease is common. Bipedal lymphography and CT add only limited information to the routine presurgical staging of cancer of the uterine cervix.
.A
Vercamer R; Janssens J; Usewils R; Ide P; Baert A; Lauwerijns J; Bonte J.
.I 54911
.U
88001923
.S
Cancer 8801; 60(8):1751-6
.M
Antigens, Neoplasm/AN; Bone Marrow/PA; Case Report; Hodgkin's Disease/IM/*PA; Human; Leukemia, Hairy Cell/IM/*PA; Lymph Nodes/*PA; Male; Middle Age; Phenotype; Tumor Markers, Biological/AN; Tumor Stem Cells/PA.
.T
Hodgkin's disease in hairy cell leukemia. Phenotypic characterization of neoplastic cells.
.P
JOURNAL ARTICLE.
.W
A case of Hodgkin's disease (HD) in a patient with long-standing hairy cell leukemia (HCL) is reported. The diagnosis of HCL was confirmed by clinical features (chronic illness with marked splenomegaly) and hematopathologic findings (increase of characteristic hairy cells with tartrate-resistant acid phosphatase activity in peripheral blood and bone marrow). Cervical lymphadenopathy first appeared 6 years after the diagnosis of HCL, and histologic features of the node were characteristic of HD. As it was possible that the neoplastic cells of both lesions might have originated from a single clone, their phenotypic features were defined. The hairy cells were found to bear surface immunoglobulin, receptors for complement components, leukocyte common antigen, and antigen defined by LN-1 monoclonal antibody, whereas lymph node lesion was characterized as HD because the Reed-Sternberg-like cells were positive for Leu M1 antigen, lysozyme, alpha-1-antitrypsin, and nonspecific cross-reacting antigen. Since there was no evidence indicating a common clonal origin, it is more likely to consider that both lesions are derived from different clones.
.A
Nakamine H; Okamoto Y; Tsuda T; Shimizu E; Nishino E; Ohta K; Takenaka T; Maeda J.
.I 54912
.U
88001924
.S
Cancer 8801; 60(8):1757-62
.M
Animal; Carcinoma/PA; Cell Line; Colony-Forming Units Assay/*; Culture Media; Hematopoietic Stem Cells/*CY; Human; Methylcellulose; Mice; Sarcoma, Experimental/PA; Support, Non-U.S. Gov't; Tumor Stem Cell Assay/*; Tumor Stem Cells/*CY.
.T
Stromal cell effects on clonal growth of tumors.
.P
JOURNAL ARTICLE.
.W
Clonal growth of tumor cell lines originating from a variety of solid tumors was studied. The seeding efficiency of these tumors in methylcellulose medium was in the range of 0.036 to 0.177. Stromal cell lines from mouse bone marrow as well as primary stromal cells from human bone marrow stimulated the growth of HCT and oat human carcinoma cells 32-fold and 25-fold, respectively. In contrast, these stromal cells inhibited the in vitro cloning of human and mouse sarcoma cell lines. Both activities of the stromal cells diffused through agar layers and operated across species barriers. Despite the diffusable nature of the factors involved, no biologic activity was observed in concentrated conditioned media prepared in the presence or absence of serum. Human foreskin fibroblasts tested under identical conditions, could neither stimulate nor inhibit the clonal growth of tumors. This preferential growth of tumor cells in the presence of tissue specific stroma may be used as an in vitro model for the study of the role of stromal cells in tumor cell spread.
.A
Zipori D; Krupsky M; Resnitzky P.
.I 54913
.U
88001925
.S
Cancer 8801; 60(8):1763-6
.M
Cerebellar Neoplasms/*AN/UL; Eye Proteins/*AN; Female; Human; Immunohistochemistry; Male; Medulloblastoma/*AN/UL; Nerve Tissue Protein S 100/*AN; Photoreceptors/*AN; Retinal Pigments/*AN; Support, Non-U.S. Gov't.
.T
Immunocytochemical evidence of molecular photoreceptor markers in cerebellar medulloblastomas.
.P
JOURNAL ARTICLE.
.W
With the use of antisera against bovine retinal S-antigen and bovine opsin the authors demonstrate that in cerebellar medulloblastomas certain tumor cells display immunocytochemical properties characteristic of retinal photoreceptors and pinealocytes. S-antigen-like and opsin-like immunoreactions occur in nine of 28 medulloblastomas investigated. All tumors displaying S-antigen-like immunoreactive neoplastic cells also contain opsin-like immunoreactive cells; however, the opsin-like immunoreactive cells were less frequent than the S-antigen-like immunoreactive cells throughout all positive cases. The immunoreactive cells displayed several long processes. Generally, both S-antigen and opsin-like immunoreactive cells considerably vary in number among individual tumors. The results indicate that certain neoplastic cells of medulloblastoma are capable of expression of photoreceptor-specific proteins and, thus, may be closely related to tumor cells of retinoblastoma and pineocytomas previously shown to bind antisera against retinal S-antigen and opsin. No S-antigen and opsin-like immunoreaction was found in malignant teratomas and germinomas of the pineal gland, oat cell tumors, astrocytomas, ependymomas, oligodendrogliomas, glioblastomas, gangliogliomas, gangliocytoma, ganglioneuroblastomas, neuroblastomas, and esthesioneuroblastoma.
.A
Korf HW; Czerwionka M; Reiner J; Schachenmayr W; Schalken JJ; de Grip W; Gery I.
.I 54914
.U
88001926
.S
Cancer 8801; 60(8):1767-70
.M
Adenocarcinoma/*PA/SU; Carcinoma, Papillary/*PA/SU; Female; Human; Lymphatic Metastasis; Male; Neck; Radical Neck Dissection; Thyroid Gland/*PA; Thyroid Neoplasms/*PA/SU; Thyroidectomy.
.T
New subgrouping of small thyroid carcinomas.
.P
JOURNAL ARTICLE.
.W
Clinicopathologic findings on small thyroid carcinomas measuring 10 mm or less in diameter were analyzed in 78 thyroidectomied cases. The authors divided small thyroid tumors into two subgroups according to diameter: 0 less than or equal to 5 mm (classified as minute carcinoma) and 5 less than 0 less than or equal to 10 mm (classified as tiny carcinomas). Characteristics including sex, age, histologic type, extrathyroid invasion, and lymph node metastasis were examined in each subgroup. In patients with minute carcinoma, very few incidences of extrathyroid invasion and lymph node metastasis were found. However, these involvements, especially lymph node metastasis, were found more frequently in patients with tiny carcinoma. The incidence of cervical lymph node metastasis was 13% in minute carcinoma and 59% in tiny carcinoma. (P less than 0.01). These findings suggest the need for more careful observation and treatment of tiny carcinomas, especially with respect to lymph node metastasis. In accordance with World Health Organization (WHO) classification, the histologic types of thyroid carcinoma were classified into papillary and follicular carcinomas. The papillary carcinoma and follicular carcinoma ratios were compared between the two subgroups. The discovery rate of follicular carcinoma was significantly higher in minute carcinoma than in tiny carcinoma (P less than 0.005). This suggests that the papillary carcinoma/follicular carcinoma ratio (p/f) increases as the size of the carcinoma increases, and that follicular carcinoma is the "seed," or initial form, of thyroid cancer. The female-male ratio in small thyroid cancer suggests that there is no sex difference in carcinogenesis but that there is more probability for cancer development in the thyroid in women.
.A
Kasai N; Sakamoto A.
.I 54915
.U
88001930
.S
Cancer 8801; 60(8):1787-9
.M
Biopsy; Female; Fever/*ET; Hodgkin's Disease/*CO/PA; Human; Inflammation; Lymph Nodes/PA; Male; Necrosis; Sex Factors.
.T
Inflammation and/or necrosis of tumors cannot account for fever in most febrile patients with Hodgkin's disease.
.P
JOURNAL ARTICLE.
.W
Inflammation and/or necrosis (I/N) of the tumor are generally believed to be a cause of fever in patients with Hodgkin's disease. However, there have been few studies in the literature which can corroborate this common belief. Inflammation and/or necrosis were studied in biopsy specimens of 140 untreated patients with Hodgkin's disease (57 febrile and 83 afebrile). In 37 of the 140 tumors I/N were readily observed; 18 were from febrile patients, and 19 from afebrile. Thus, it is evident that I/N cannot account for fever in the majority of febrile patients, necessitating an alternative explanation. Among the patients with I/N of their tumor, fever occurred most often in male patients and in virtually all patients who had histologic types other than nodular sclerosis. However, it was peculiarly absent in the great majority of patients whose tumors were of the nodular sclerosis type. This paradoxic inverse correlation of fever with I/N of tumors in patients with the nodular sclerosing histologic type has not been described previously.
.A
Ree HJ; Pezzullo JC.
.I 54916
.U
88001931
.S
Cancer 8801; 60(8):1790-9
.M
Actins/AN; Adult; Aged; Desmin/AN; Female; Human; Ileal Neoplasms/IM/*PA; Ileum/*PA; Immunohistochemistry; Jejunal Neoplasms/IM/*PA; Jejunum/*PA; Leiomyosarcoma/IM/*PA; Male; Microscopy, Electron; Middle Age; Vimentin/AN.
.T
A clinicopathologic and immunohistochemical study of 16 patients with small intestinal leiomyosarcoma. Limited utility of immunophenotyping.
.P
JOURNAL ARTICLE.
.W
Clinicopathologic data including immunophenotypic expression of 16 new cases of small intestinal leiomyosarcoma are presented. Patient age ranged from 27 to 87 years (mean, 61 years) with a 2.2:1 male-female ratio. Eighty-eight percent of tumors occurred distally, i.e., in the jejunoileum. Considerable histologic heterogeneity was noted including epithelioid, myxoid, and sclerotic variants. Stratification by histologic grade suggests important clinical subsets. Only in grade I tumors is surgical extirpation alone potentially curative. Grade II tumors are associated with meaningful survival usually measured in years, however, nearly all patients can be expected to die from their tumors. Grade III sarcomas are fully malignant and rapidly progressive: except for one case with limited follow-up, all patients with Grade III sarcomas died of disease with a mean survival of only nine months (median, 2 months). Immunostaining with antibodies directed against vimentin, muscle-specific actin, desmin, and S-100 protein were performed. Only antivimentin was uniformly reactive. Sixty-three percent of cases tested showed actin immunoreactivity, and no tumors revealed immunohistochemically detectable desmin or S-100 protein. Although many small bowel stromal sarcomas appear "poorly differentiated" by immunohistochemical methods presently available, that they are indeed leiomyosarcomas seems most likely from their intramural location and light histologic study. The limited utility of immunophenotyping and the importance of histologic grading are stressed.
.A
Ricci A Jr; Ciccarelli O; Cartun RW; Newcomb P.
.I 54917
.U
88001934
.S
Cancer 8801; 60(8):1815-22
.M
Acridine Orange/DU; Aneuploidy; Bladder/*PA; Bladder Neoplasms/GE/*PA/TH; Carcinoma, Transitional Cell/GE/*PA/TH; Comparative Study; Diploidy; DNA, Neoplasm/*AN; Flow Cytometry/*MT; Human; Irrigation; RNA, Neoplasm/*AN; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Acridine-orange flow cytometry of urinary bladder washings for the detection of transitional cell carcinoma of the bladder. The influence of prior local therapy.
.P
JOURNAL ARTICLE.
.W
Analysis of cellular DNA and RNA contents of 249 bladder irrigation specimens from 129 patients with a history of transitional cell carcinoma (TCC) of the bladder was performed using acridine-orange flow cytometry (FCM). Washings from patients with prior intravesical chemotherapy or radiation therapy were compared to those from patients with no history of treatment other than tumor resection to evaluate the reliability of FCM for the detection of tumor and the influence of prior local therapy on that reliability. Five FCM patterns were defined on the basis of DNA and RNA indexes in relationship to peripheral blood lymphocytes. FCM results were compared to cytologic findings in 237 cases, cystoscopic findings in 230 cases, and histologic data in 99 cases. Presence of a single diploid stem line was associated with absence of bladder tumor in 71% of cases from patients treated with surgery alone or with radiation therapy, but there was residual tumor in 53% of patients exposed to prior local chemotherapy. An elevated RNA content in a diploid cell population did not provide additional diagnostic information. Presence of an aneuploid stem line was associated with tumor in 85% of cases, regardless of prior therapy. Aneuploidy predicted the appearance of tumor in four of six patients with a negative cystoscopy. Tetraploidy (greater than 10% of total cell population) was associated with tumor in 79% of patients treated with surgery alone, whereas no tumor was found in more than 50% of patients who had undergone prior chemotherapy or radiation therapy. This study stresses the importance of prior treatment history in evaluating the results of DNA-FCM for bladder cancer. It demonstrates the unreliability of FCM diploid and tetraploid cell populations in patients previously treated by local chemotherapy or radiation. However, it also supports prior observations that DNA-aneuploidy and DNA-tetraploidy are useful for detecting and predicting bladder cancer in patients submitted to surgery alone.
.A
Tetu B; Katz RL; Kalter SP; von Eschenbach AC; Barlogie B.
.I 54918
.U
88001937
.S
Cancer 8801; 60(8):1836-41
.M
Animal; Antigens, Neoplasm/AN; Antineoplastic Agents/PD; Cell Line; Drug Screening/MT; Human; Karyotyping; Lactate Dehydrogenase Isoenzymes/AN; Melanoma/IM/*PA; Mice; Mice, Nude; Subrenal Capsule Assay/*; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Tumor Markers, Biological/AN.
.T
Use of nude mouse xenografts as preclinical screens. Characterization of xenograft-derived melanoma cell lines.
.P
JOURNAL ARTICLE.
.W
Cell lines derived from human melanoma xenografts were characterized for surface markers, karyotype abnormalities, and in vitro drug sensitivity. Xenografts were established using metastatic explants from untreated patients and passaged in nude mice. Cell lines were readily established from melanoma xenografts, and formed colonies when plated in semisolid media. The lines expressed human melanoma-associated and other surface antigens, human lactate dehydrogenase (LDH) isoenzymes, and contained only human chromosomes. They failed to express murine histocompatibility determinants and were negative for murine viruses by mouse antibody production assay. Karyotypes showed abnormalities of chromosomes 3, 6, and 7 similar to other melanomas. In vitro chemosensitivity profiles were compared using cell line and xenograft colony-forming assays. Values were similar for the original xenografts and their cell lines. Xenograft-derived human melanoma lines resemble other melanoma cell lines and primary melanomas with respect to surface antigens and karyotype abnormalities, and are appropriate models for studying in vitro drug sensitivity. When used as a model for transition from solid tumor to cell line, these studies suggest cell lines closely mirror in vitro chemosensitivities of parent tumor cells. However, occasional, unpredictable changes in sensitivity to some drugs occurs during this transition.
.A
Taetle R; Jones OW; Honeysett JM; Abramson I; Bradshaw C; Reid S.
.I 54919
.U
88001938
.S
Cancer 8801; 60(8):1842-6
.M
Aged; Copper/BL; Female; Human; Leukemia, Lymphocytic/*BL/PA; Male; Middle Age; Neoplasm Staging; Support, Non-U.S. Gov't; Trace Elements/*BL; Zinc/BL.
.T
Observations of serum trace elements in chronic lymphocytic leukemia.
.P
JOURNAL ARTICLE.
.W
Serum trace elements (STE) were measured in 50 patients with chronic lymphocytic leukemia (CLL) and 100 normal subjects. Copper was higher in patients than in controls (1.50 +/- 0.06 versus 1.10 +/- 0.02 micrograms/ml, P less than 0.001), increased steadily from Stage 0 to Stage 4 (P = 0.002), and correlated with the lymphocyte count and serum lactate dehydrogenase (P less than 0.01) but not with acute phase reactants. Zinc was lower in patients than in controls (0.94 +/- 0.03 versus 1.10 +/- 0.02 micrograms/ml, P less than 0.001). Zinc (NS), selenium (P = 0.039), and calcium (P = 0.033), were decreased in Stages 3-4 as compared to Stages 0-2. The copper-to-zinc ratio (CZR) increased continuously from Stage 0 to Stage 4 (P less than 0.001). Discriminant analysis between two groups, Stage 0-2 and Stage 3-4, based on serum copper, zinc, calcium, and protein levels, allowed for a correct classification of 94% of the patients. Moreover, the clinical staging of the remaining 6% was modified retrospectively according to the results of discriminant analysis. It was concluded that (1) serum copper and CZR are useful indices of the extent of disease, (2) they are independent of a nonspecific acute phase reaction, (3) STE determination could be helpful in the staging of a limited number of CLL patients, and (4) zinc deficiency could contribute to immune dysfunction in CLL.
.A
Beguin Y; Brasseur F; Weber G; Bury J; Delbrouck JM; Roelandts I; Robaye G; Fillet G.
.I 54920
.U
88001939
.S
Cancer 8801; 60(8):1847-55
.M
Adult; Aged; Case Report; Combined Modality Therapy; Cranial Nerve Neoplasms/*EP/RT; Female; Follow-Up Studies; Glioma/*EP/RT; Human; Male; Middle Age; Optic Chiasm/*; Optic Nerve/*; Optic Nerve Diseases/*EP; Prognosis; San Francisco; Support, Non-U.S. Gov't.
.T
Optic gliomas. A reanalysis of the University of California, San Francisco experience.
.P
JOURNAL ARTICLE.
.W
Thirty-eight cases of optic gliomas seen at the University of California, San Francisco, were reviewed. Two patients died in the postoperative period and were excluded from the follow-up analysis. Twenty-nine cases (76%) involved the optic chiasm, nine (24%) cases were confined to one optic nerve. Most tumors were slow growing and progressive although there were three cases of adult chiasmal gliomas which exhibited unusually aggressive behavior. The three cases are presented in detail. After a mean follow-up period of 9.4 years, the 10-year overall actuarial survival was 87%. Relapse-free survival was 55% at 10 years. Chiasmal tumors had a poorer prognosis compared to optic nerve tumors with 56% of chiasmal tumors recurring versus 22% of optic nerve tumors. Radiotherapy was beneficial in chiasmal gliomas, initially improving vision in 35% (6/17) and decreasing recurrence from 86% (6/7) without radiation therapy to 45% (9/20) with radiation therapy. Optic gliomas are not benign, self-limiting lesions, and therefore require treatment. Radiotherapy is effective in chiasmal gliomas and should be used early in the management of these tumors. No advantage to radiotherapy could be demonstrated for optic nerve gliomas, although the number of these cases analyzed was small.
.A
Wong JY; Uhl V; Wara WM; Sheline GE.
.I 54921
.U
88001940
.S
Cancer 8801; 60(8):1856-61
.M
Carcinoma, Squamous Cell/PA/*SU; Female; Frozen Sections/*; Head and Neck Neoplasms/PA/*SU; Human; Intraoperative Care/MT; Male; Microsurgery/*MT; Microtomy/*; Middle Age; Mucous Membrane/PA.
.T
Microscopically oriented histologic surgery for head and neck mucosal cancer.
.P
JOURNAL ARTICLE.
.W
Frozen section directed surgery, called MOHS, has been successfully utilized in the resection of primary epidermoid tumors of the head and neck. For the 93 cases reviewed in this study, 70% had microscopically identified tumor 1 cm away from clinically evident disease. Tumor spread was along planes of least resistance, most commonly in the submucosa. Microscopically directed excisions were able to trace and remove these tumor extensions. Local control in 93 patients with 2-year follow-up was 91% and, with salvage of recurrences, was 95%. The authors' observations suggest three important concepts. First, epidermoid cancer of the head and neck grows as a continuous neoplasm. Second, this work casts serious doubt on the concept of "field cancerization" or multiple primaries as a cause of local recurrence. Third, conventional frozen section analysis of surgical margins is highly unlikely to discover microscopic extensions because many tumor extensions are thin, finger-like projections which require examination of the entire surgical margin to detect.
.A
Davidson TM; Haghighi P; Astarita R; Baird S; Seagren S.
.I 54922
.U
88001941
.S
Cancer 8801; 60(8):1862-5
.M
Adenocarcinoma/*CO; Case Report; Ethmoid Sinus/*; Human; Interior Design and Furnishings; Magnetic Resonance Imaging; Male; Middle Age; Occupational Diseases/CO; Paranasal Sinus Neoplasms/*CO; Spinal Cord Compression/DI/*ET.
.T
Spinal cord compression due to ethmoid adenocarcinoma.
.P
JOURNAL ARTICLE.
.W
Adenocarcinoma of the ethmoid sinus is a rare tumor which has been epidemiologically linked to woodworking in the furniture industry. It has a low propensity to metastasize and has not been previously reported to cause spinal cord compression. A symptomatic epidural spinal cord compression was confirmed on magnetic resonance imaging (MRI) scan in a former furniture worker with widely disseminated metastases. The clinical features of ethmoid sinus adenocarcinoma and neoplastic spinal cord compression, and the comparative value of MRI scanning in the neuroradiologic diagnosis of spinal cord compression are reviewed.
.A
Johns DR; Sweriduk ST.
.I 54923
.U
88001942
.S
Cancer 8801; 60(8):1866-71
.M
Biopsy, Needle/*; Breast/*; Breast Neoplasms/*DI; Female; Human; Mammography/*; Palpation/*; Physical Examination; Prospective Studies.
.T
Diagnostic reliability of combined physical examination, mammography, and fine-needle puncture ("triple-test") in breast tumors. A prospective study.
.P
JOURNAL ARTICLE.
.W
A prospective study of 622 consecutively registered patients with 650 breast tumors was performed to appraise the reliability of combined physical examination, mammography, and fine-needle puncture (triple test) in the preoperative diagnosis of such tumors. All malignant as well as benign test results were confirmed by subsequent histologic examination. The diagnostic accuracy of the triple test at benign changes is comparable to that of histologic examination, but participation of experienced radiologists and cytologists as well as persons skilled in fine-needle puncture is required. Twenty-eight percent of the planned excisional biopsies were made superfluous by the fine-needle puncture, which immediately revealed the tumor as a cyst, abscess, or hematoma. For this reason, too, fine-needle puncture is recommended as a routine procedure.
.A
Hermansen C; Skovgaard Poulsen H; Jensen J; Langfeldt B; Steenskov V; Frederiksen P; Jensen OM.
.I 54924
.U
88001943
.S
Cancer 8801; 60(8):1872-5
.M
Aged; Aged, 80 and over; Case Report; Cimetidine/TU; Diagnosis, Differential; Human; Lymphoma/DT/*PA; Male; Metoclopramide/TU; Neoplasm Regression, Spontaneous/*; Ranitidine/TU; Remission Induction; Stomach/*PA; Stomach Neoplasms/DT/*PA.
.T
Spontaneous regression of gastric lymphoma.
.P
JOURNAL ARTICLE.
.W
Two cases of spontaneous regression of histologically diagnosed large cell lymphoma of the stomach are reported. Regressions occurred after nonspecific therapy including the H-2 antagonist cimetidine and were documented surgically. Spontaneous regression of intermediate and high-grade non-Hodgkin's lymphoma is distinctly uncommon. The possible role of cimetidine in these cases is discussed.
.A
Strauchen JA; Moran C; Goldsmith M; Greenberg M.
.I 54925
.U
88001945
.S
Cancer 8801; 60(8):1883-90
.M
Adenocarcinoma, Papillary/*CO; Adult; Aged; Bile Duct Neoplasms/*CO; Case Report; Cholangioma/*CO; Common Bile Duct/*AB; Common Bile Duct Diseases/*CN/CO; Cysts/*CN/CO; Dilatation, Pathologic/CN; Female; Gallbladder Neoplasms/*CO; Human; Male; Pancreatic Ducts/*AB.
.T
Coexistent carcinoma in congenital dilatation of the bile duct and anomalous arrangement of the pancreatico-bile duct. Carcinogenesis of coexistent gall bladder carcinoma.
.P
JOURNAL ARTICLE.
.W
From 1972 to 1985, 40 cases of congenital dilatation of the bile duct (CDBD) were experienced in the department of the authors. Those consisted of 19 cases of anomalous arrangement of the pancreatico-bile duct (P-B anomaly), five of bile duct carcinoma, and two of gall bladder carcinoma. In addition, four patients who showed no dilatation of the bile duct in spite of the presence of a P-B anomaly were experienced, and coexistent gall bladder carcinoma was present in three of four cases. The incidence of bile duct carcinoma associated with CDBD is very high. However, coexistent gall bladder carcinoma in CDBD is a new topic, and coexistent intrahepatic bile duct carcinoma in CDBD is extremely rare. This report presents interesting and rare cases of coexistent carcinomas in these anomalies and investigates their carcinogenesis, particularly that of gall bladder carcinoma.
.A
Sameshima Y; Uchimura M; Muto Y; Maeda J; Tsuchiyama H.
.I 54926
.U
88001946
.S
Cancer 8801; 60(8):1891-5
.M
Anemia, Aplastic/*; Antibiotics/*TU; Bacterial Infections/*PC; Catheters, Indwelling/AE; Female; Heart Catheterization/*AE; Human; Immunosuppression; Leukemia/*; Lymphoma/*; Male; Premedication/*; Silicone Elastomers.
.T
The value of prophylactic antibiotics during the insertion of long-term indwelling silastic right atrial catheters in cancer patients.
.P
JOURNAL ARTICLE.
.W
Over a 3.5 year period from August 1982 to December 1985, 200 Hickman catheters (Evermed, Medina, WA) were inserted into patients at the King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Saudi Arabia. One hundred sixty catheters were placed in patients with malignant disease, many of whom were immunosuppressed at the time of catheter insertion. Seventy of 160 (44%) patients received prophylactic antibiotics and 90 (56%) did not. The mean age of each group was 23 years (range, 2 to 70 years), and the patients in each group were statistically similar in sex, underlying disease, and routine preoperative hematologic and biochemical evaluation. Exit-site wound infections occurred in 50 of 90 (55.5%) patients who did not receive prophylaxis and in 12 of 70 (17%) patients who received prophylaxis (P less than 0.0001). There was no statistically significant difference in the incidence of tunnel and incision site infections. The mean duration of antibiotic prophylaxis was 2.9 days (SD, 1.2 days). Organisms cultured from catheter associated infections, included Staphylococcus epidermidis 36, S. aureus 30, Klebsiella pneumoniae 1, Pseudomonas aeruginosa 3, Escherichia coli 1, and diphtheroids non-CDC-JK 3. Vancomycin was used as antibiotic prophylaxis in 64 patients, Kefzol (Eli Lilly, Indianapolis, IN) in one, oxacillin in three, nafcillin in one, and Septra (Burroughs Wellcome, Research Triangle Park, NC) in one. The data indicate that the use of intravenous antibiotic prophylaxis significantly reduces exit site infection and may reduce both tunnel and incision site infection. Prophylactic antibiotic coverage should be provided to patients during insertion of long-term indwelling right atrial catheters.
.A
Al-Sibai MB; Harder EJ; Faskin RW; Johnson GW; Padmos MA.
.I 54927
.U
88001950
.S
Cancer 8801; 60(8):1909-14
.M
Esophageal Neoplasms/*EP/ET; Female; Food; Food Contamination; Food Habits/EH; Heat/*AE; Human; Iran; Male; Risk Factors; Support, Non-U.S. Gov't; Tea/*.
.T
Thermal irritation and esophageal cancer in northern Iran.
.P
JOURNAL ARTICLE.
.W
The ingestion of hot food and beverages has repeatedly been postulated as a risk factor for cancer of the esophagus. Although several studies have been performed on the correlation of the consumption of hot tea and esophageal cancer, no research has heretofore documented, by actually measuring, the temperature at which the tea is consumed. Therefore, a tea temperature measurement study was carried out in the Caspian Littoral of Iran, where the frequency of esophageal cancer is the highest in the world. The study was conducted during a population-food-habits survey in 1968 to 1969, which was performed before statistics were available regarding the incidence rate or geographic distribution of this disease in the region. Ten years later, when the results of the Caspian Cancer Registry were analyzed, the data from this nutritional study was compared with the regional distribution of esophageal cancer. A geographic correlation exists between the frequency of consumption of hot tea and the incidence of esophageal cancer. Seventy-two percent of the people in the low-risk region of esophageal cancer drank their tea at the relatively moderate temperature of below 55 degrees C, compared with only 3% in the high risk region. More importantly, 62% of the adult population in the high-risk region, as opposed to 19% in the low-risk region, drank their tea at a temperature of over 65 degrees C. In addition to the thermal irritation of hot tea, the following considerations cannot be ignored: the carcinogenicity role of tannins; the cancer-promoting effect of phenols; and the absorption facilitating role of hot tea. Alcohol and tobacco, the most important risk factors for cancer of the esophagus in many countries, play a negligible role in the cause of this disease in northern Iran. In this region, nutritional deficiencies--a special diet for pregnant women composed of sour pomegranite seeds, black pepper, and garlic; consumption of bread contaminated with silica fibre; and ingestion of opium and opium dross--combined with long-lasting and daily thermal irritation of the esophagus with very hot tea play an important role in the development of this disease. The inhabitants of the high-risk area consumed roughly 2.5 times more tea than their counterparts in the low-risk area. In addition, the mean daily consumption of tea leaves per person (average) was 5.7 g and 3.8 g, respectively.
.A
Ghadirian P.
.I 54928
.U
88001952
.S
Cancer 8801; 60(8):1921-30
.M
Health Surveys; Human; Male; Physician's Practice Patterns/*; Prognosis; Support, Non-U.S. Gov't; Testicular Neoplasms/*EP/MO/TH; United States.
.T
National survey of patterns of care for testis cancer.
.P
JOURNAL ARTICLE.
.W
A national survey of testicular cancer documented recent trends in disease characteristics, treatment, and outcome, providing a basis for progress being achieved on a community basis. A long-term study of 3285 patients diagnosed between 1970 and 1975 was compared with a short-term study of 1887 patients diagnosed in 1983. An increase of the symptom of a lump in the testis from 23.1% to 31.2% and a mass as a sign of cancer from 44.5% to 53.8% suggests earlier detection of testis cancer by the patient and physician. Changes in the methods of diagnosis reflect the changing technology of tumor diagnosis. The 10-year survival rates for pathologic Stage I seminoma (82.6% of all seminomas) exceeded 96%. For pathologic Stage I nonseminomatous germ cell tumors (51.7% of all NSGCT), 10-year survival was 87.1%; whereas for Stage III (18.7% of all NSGCT) it was 22.1%. The impact of the important advances in chemotherapy is reflected in the increase of 1-year survival of Stage III NSGCT from 50.5% to 78.4%. Testis cancer can be cured in most patients.
.A
Kennedy BJ; Schmidt JD; Winchester DP; Peace BL; Natarajan N; Mettlin C.
.I 54929
.U
88001953
.S
Cancer 8801; 60(8 Suppl):1931-2136
.M
Female; Genital Neoplasms, Female/*; Human.
.T
American Cancer Society National Conference. Gynecologic cancer--1986. Atlanta, Georgia, September 17-19, 1986. Proceedings.
.P
JOURNAL ARTICLE.
.I 54930
.U
88001954
.S
Cancer 8801; 60(8 Suppl):1931-3
.M
Female; Genital Neoplasms, Female/DI/*TH; Human; Neoplasms/TH.
.T
An era of therapeutic translation.
.P
JOURNAL ARTICLE.
.W
Diagnostic advances currently have exceeded therapeutic gain. The present, however, is a transition phase. Chemotherapy, for example, has become curative for some tumors in recent years, rather than merely palliative, due to the precision permitted by advances in molecular biology. At this time, acceleration in the basic oncologic sciences has surpassed therapeutic advance, but therapeutic translation has begun and we will require clinical scientists to increase the bridge from laboratory to bedside if we are to speed the contribution of the so-called biologic revolution to cancer control.
.A
Gusberg SB.
.I 54931
.U
88001959
.S
Cancer 8801; 60(8 Suppl):1965-9
.M
Female; Genital Neoplasms, Female/*MO/TH; Hospitals; Human; Time Factors; United States.
.T
End results, interhospital differences, and trends in patterns of care for gynecologic cancer.
.P
JOURNAL ARTICLE.
.W
Survival rates represent one measure of population-wide progress in cancer control. Data from the Surveillance, Epidemiology and End Results (SEER program of the National Cancer Institute (NCI) document that, during the 1970s, survival rates for several cancers improved. For the major gynecologic cancers and breast cancer, improvements are evident for some sites but, areas of decline also are observed. Black women in the US have a poorer survival rate than white women and the trend in recent years suggest that this gap may be widening. Comparisons of survival rates from comprehensive cancer centers and population-based rates indicate differences in outcomes associated with the treatment setting. Data from the American College of Surgeons (ACS) patterns of care surveys suggest substantial interhospital variability in cancer survival which is largely explained by characteristics of the patient populations served. Recent studies of patterns of care document major shifts in treatment practices in the US and provide insight concerning the rate at which treatment changes are adopted at the community level.
.A
Mettlin C.
.I 54932
.U
88001960
.S
Cancer 8801; 60(8 Suppl):1970-8
.M
Attitude of Health Personnel; Cost Control; Emotions; Health Education; Human; Medical Records; Motivation/*; Neoplasms/DI/*PC; Physicians, Family/*/PX; Referral and Consultation; United States.
.T
Barriers and incentives for primary-care physicians in cancer prevention and detection.
.P
JOURNAL ARTICLE.
.W
The American Cancer Society (ACS) estimates that nearly a million new cases of cancer will occur and that approximately 500,000 lives will be lost in 1987. These figures may double by the year 2000 primarily because of our aging population, with age being the leading risk factor for cancer. It is believed that most cancers can either be prevented or treated successfully if they are diagnosed early. Primary-care physicians and other health professionals delivering information on prevention and performing early diagnostic studies in various ambulatory settings represent the key to the reduced complications and mortality of cancer by virtue of their position in the health care delivery system within communities. Barriers and incentives for delivering these all important health measures are examined and suggestions are made for their accomplishment. It is recommended that the primary thrust should be toward the development of methodology which will allow the primary care physician to institute these measures in his regular medical practice and to coordinate them with other health maintenance and early diagnostic activities in the ambulatory setting.
.A
Williams PA; Williams M.
.I 54933
.U
88001961
.S
Cancer 8801; 60(8 Suppl):1979-83
.M
Adult; Breast Neoplasms/*RA; Female; Human; Mammography/*; Middle Age; Patient Compliance; Risk Factors.
.T
The use of screening mammography.
.P
JOURNAL ARTICLE.
.W
Screening mammography, breast x-ray examination of women without any symptoms or signs of breast cancer, is a safe and efficacious procedure. Modern mammography, which is a low-dose radiographic examination, allows safe and correct diagnosis of about 90% of the cancers. Occult breast cancers, those found only with screening mammography, have a much lower rate of axillary node metastases and a much better prognosis, when compared with palpable breast cancers. With screening mammography, minimal breast cancers that are early in their development and have a remarkably improved prognosis can often be detected also. It is generally agreed that women with minimal cancers do not require mastectomies.
.A
Frankl G.
.I 54934
.U
88001965
.S
Cancer 8801; 60(8 Suppl):2021-4
.M
Adaptation, Psychological; Family/*; Female; Genital Neoplasms, Female/*PX; Human.
.T
Psychological evaluation and preparation of the patient and family.
.P
JOURNAL ARTICLE.
.W
The suspected and confirmed diagnosis of cancer places stress on the patient and the family. In addition to the feelings of helplessness, guilt, frustration, alienation, and vulnerability that a diagnosis of cancer provokes, the diagnosis of gynecologic cancer can exacerbate these feelings due to its relationship to the perceived physiologic core of femininity, sexuality, and motherhood. Evaluation of the patient's existing coping skills, perceived seriousness of the illness, anticipated loss of control over physical functioning, and available family support is an essential part of the treatment plan. Preparing the patient and family for diagnosis and treatment is enhanced by supportive intervention techniques such as provision of accurate information, exploration of the patient's fears and fantasies, restoration of degrees of control in the patient's life, and exposure to peer support groups.
.A
Holmes BC.
.I 54935
.U
88001967
.S
Cancer 8801; 60(8 Suppl):2035-41
.M
Female; Human; Lymphatic Metastasis; Neoplasm Invasiveness; Prognosis; Risk Factors; Support, U.S. Gov't, P.H.S.; Uterine Neoplasms/*PA/SU.
.T
Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study.
.P
JOURNAL ARTICLE.
.W
The surgical pathologic features of 621 patients with Stage I carcinoma of the endometrium are presented. All patients were treated with primary surgery consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, selective pelvic and paraaortic lymphadenectomy and peritoneal cytology. An appreciable number of patients (144-22%) with Stage I cancers have disease outside of the uterus (lymph node metastasis, adnexal disease, intraperitoneal spread and/or malignant cells in peritoneal washings). Multiple prognostic factors particularly grade and depth of invasion are related to extrauterine disease. This study adds credence to the primary surgical approach with individualized postoperative therapy as indicated.
.A
Creasman WT; Morrow CP; Bundy BN; Homesley HD; Graham JE; Heller PB.
.I 54936
.U
88001971
.S
Cancer 8801; 60(8 Suppl):2064-7
.M
Cervix Neoplasms/RT; Female; Genital Neoplasms, Female/*RT; Human; Ovarian Neoplasms/RT; Radiotherapy Dosage; Uterine Neoplasms/RT; Vaginal Neoplasms/RT.
.T
Altered fractionation radiation therapy for gynecologic cancers.
.P
JOURNAL ARTICLE.
.W
Altered fractionation radiation therapy is one of the attempts to improve the therapeutic ratio in the hope of controlling locally advanced tumors by radiation therapy alone. This includes hypofractionation, split course fractionation, hyperfractionation, accelerated hyperfractionation, and others. Various fractionation schemes are reviewed in terms of dose and time modification for the management of various gynecologic malignancies. Of these, accelerated hyperfractionation with 10% to 15% dose reduction from conventional or traditional once daily radiation therapy appears to hold the most promise. One and one half Grays per fraction, two fractions per day were used for whole pelvis irradiation and 1.0 Gy per fraction, two fractions per day were used for whole abdomen irradiation with 4 hours between fractions, 5 days a week. Various gynecologic malignancies have been treated with these programs since 1982. Gray for Gray, tumors tend to regress more rapidly than, and the acute and late effects were quite similar to conventional once-daily radiation therapy with 1.8 Gy to 2.0 Gy per fraction. The accelerated hyperfractionation programs were generally well tolerated and deserve a randomized trial.
.A
Wang CC.
.I 54937
.U
88002688
.S
Circ Res 8801; 61(4):498-503
.M
Action Potentials; Animal; Calcium/*ME; Heart/*PH; Heart Ventricle; Membrane Potentials; Myocardial Contraction; Myocardium/CY/*ME; Rats; Rats, Inbred Strains; Sarcoplasmic Reticulum/*ME; Time Factors.
.T
Synchronous occurrence of spontaneous localized calcium release from the sarcoplasmic reticulum generates action potentials in rat cardiac ventricular myocytes at normal resting membrane potential.
.P
JOURNAL ARTICLE.
.W
Under certain conditions, spontaneous release of Ca2+ from the sarcoplasmic reticulum occurs in resting mammalian myocardium. In single rat ventricular myocytes, such spontaneous Ca2+ release appears localized rather than homogeneous. When the increase in cytosolic Ca2+ is present in a single locus within a cell, it causes a small depolarization, which, at the normal resting potential, is subthreshold for generating an action potential. However, when spontaneous Ca2+ release occurs simultaneously at more than a single discrete locus, the resultant sarcolemmal depolarization is augmented to levels that can induce an action potential, even when this depolarization begins at the normal resting membrane potential. Thus, the synchronous occurrence of multifocal localized increases in cytosolic Ca2+ due to spontaneous Ca2+ release from the sarcoplasmic reticulum within ventricular myocytes is a mechanism for "abnormal automaticity."
.A
Capogrossi MC; Houser SR; Bahinski A; Lakatta EG.
.I 54938
.U
88002689
.S
Circ Res 8801; 61(4):504-13
.M
Electrocardiography/*MT; Human; Mathematics; Models, Anatomic/*; Models, Cardiovascular; Support, Non-U.S. Gov't; Thoracic Radiography; Tomography, X-Ray Computed.
.T
Forward and inverse electrocardiographic calculations using resistor network models of the human torso.
.P
JOURNAL ARTICLE.
.W
An automated method of modelling the electrical properties of the human thorax from horizontal section data such as computerized tomographic scans has been used to develop both forward and inverse transformations between epicardial and body surface potential distributions. Eleven torso models with varying geometry and organ configurations have been studied. For the forward calculations, a standard dipole-like source is placed along the axis of the heart. Inverse calculations are performed using a measured body surface potential distribution and are based on a division of the surface of the heart into 25 source regions, producing epicardial potentials on these regions. A regularization method is used to stabilize the inverse solutions. Both forward and inverse solutions show substantial differences between models. These findings imply that matching models with patient geometry may be necessary in order to use such solutions in a clinical setting.
.A
Walker SJ; Kilpatrick D.
.I 54939
.U
88002691
.S
Circ Res 8801; 61(4):523-30
.M
Animal; Biological Transport; Calcium/PD/*PK; Electron Probe Microanalysis; Hypothermia/ME; Magnesium/*PK; Male; Mitochondria, Muscle/*ME; Muscle, Smooth, Vascular/*ME; Ouabain/PD; Rabbits; Sodium/ME; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Calcium and magnesium transport by in situ mitochondria: electron probe analysis of vascular smooth muscle.
.P
JOURNAL ARTICLE.
.W
The extent, time course, and reversibility of mitochondrial Ca2+ uptake secondary to cellular Ca2+ influx stimulated by massive Na+ efflux were evaluated by electron probe microanalysis of rabbit portal vein smooth muscle. Strips of portal vein were Na+ loaded for 3 hours at 37 degrees C in a K+-free 1 mM ouabain solution, after which rapid Na+ efflux was induced by washing with a Na+-free K+-Li+ solution (1 mM ouabain). Li+ washing Na+-loaded portal vein produced a large transient contraction accompanied by an increase (over 100-fold) in mitochondrial Ca2+ and also significant (p less than 0.05) increases in phosphorus and Mg2+. The Ca2+ loading of the mitochondria was reversed during prolonged Li+ wash, and by 2 hours, mitochondrial Ca2+, Mg2+, and phosphorus had returned to control levels. The maximal contractile response to stimulation remained normal, demonstrating that pathologic Ca2+ loading of mitochondria is reversible in situ and compatible with normal maximal force developed by the smooth muscle. Mitochondrial Ca2+ and phosphorus uptake were reduced but still significant when the Li+ wash contained 0.2 mM Ca2+ or when ouabain was omitted. The fact that mitochondrial Ca2+ loading accompanied submaximal contractions during 0.2 mM Ca2+-Li wash suggests "supranormal" affinity of mitochondria for Ca2+ and may be due, in part, to reverse operation of the mitochondrial Na+-Ca2+ exchanger. Mitochondrial Ca2+, Mg2+, and phosphorus uptake were eliminated when the Li+ wash was performed at 2 degrees C or when the wash contained no Ca2+.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Broderick R; Somlyo AP.
.I 54940
.U
88002692
.S
Circ Res 8801; 61(4):531-8
.M
Animal; Capillary Permeability/*; Dextrans/ME; Kidney Glomerulus/*BS; Models, Biological; Nephritis/*ME; Pressure; Rats; Rats, Inbred Strains; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Role of abnormally high transmural pressure in the permselectivity defect of glomerular capillary wall: a study in early passive Heymann nephritis.
.P
JOURNAL ARTICLE.
.W
To explore the mechanism of glomerular permselectivity defect in passive Heymann nephritis, an experimental model of human membranous glomerulopathy, Munich-Wistar rats were subjected to both micropuncture assessment of glomerular hemodynamics and whole kidney clearance measurements of graded size dextrans 10 days after injection of sheep anti-rat tubular antigen (anti-Fx1A). Compared with normal control rats, anti-Fx1A-treated animals were characterized by marked proteinuria (65 +/- 8 micrograms/min versus 6 +/- 1, p less than 0.001), markedly and significantly higher glomerular transcapillary hydraulic pressure difference (40 +/- 1 mm Hg versus 33 +/- 1, p less than 0.001), depressed ultrafiltration coefficient and impaired glomerular size-selective function as determined by fractional clearance of dextrans. Calculation of membrane parameters based on a recently defined heteroporous membrane model revealed abnormally high availability of non-size selective, large pore pathways in the glomerular capillary wall of the rats with passive Heymann nephritis. To ascertain the role of the altered hemodynamic pattern in the observed defect in the size-selective function of the glomerular capillary wall, glomerular transcapillary hydraulic pressure difference was manipulated experimentally in these proteinuric rats by intra-aortic infusion of acetylcholine or angiotensin II. These agents respectively suppressed and augmented glomerular transcapillary hydraulic pressure difference and brought about a decline of and a further rise in fractional clearance of larger dextrans along with parallel changes in both urine protein excretion rate and availability of nonselective channels. These results indicate that the permselectivity defect in passive Heymann nephritis is attributable, at least in part, to impaired size selectivity of the glomerular capillary wall caused by a prevailing abnormally high transcapillary hydraulic pressure difference.
.A
Yoshioka T; Rennke HG; Salant DJ; Deen WM; Ichikawa I.
.I 54941
.U
88002693
.S
Circ Res 8801; 61(4):539-47
.M
Animal; Dogs; Guinea Pigs; Heart Ventricle; Membranes/ME; Muscles/EN; Myocardial Contraction/*; Myocardium/*EN; Rats; Solubility; 3',5'-Cyclic AMP Phosphodiesterase/*CL/IP/ME/PH.
.T
Subclasses of cyclic AMP-specific phosphodiesterase in left ventricular muscle and their involvement in regulating myocardial contractility.
.P
JOURNAL ARTICLE.
.W
Ventricular muscle contains a low Km, cyclic AMP-specific form of phosphodiesterase (PDE III), which is believed to represent the site of action for several of new cardiotonic agents including imazodan (CI-914), amrinone, cilostamide, and enoximone. However, species differences in the inotropic response to these agents have raised questions about the relationship between PDE III inhibition and cardiotonic activity. The present study demonstrates that these differences can be accounted for by the presence of two subclasses of PDE III in ventricular muscle and variations in the intracellular localization of these two enzymes. For these experiments, PDE III was initially isolated from canine, guinea pig, and rat left ventricular muscle. The results demonstrate that canine left ventricular muscle contains two functional subclasses of PDE III: an imazodan-sensitive form, which is membrane bound, and an imazodan-insensitive form, which is soluble. Although only weakly inhibited by imazodan, this latter enzyme is potently inhibited by the selective PDE III inhibitors, Ro 20-1724 and rolipram. Guinea pig ventricular muscle also contains the imazodan-sensitive subclass of PDE III. Unlike canine left ventricle, however, thi enzyme is soluble in the guinea pig. No membrane-bound subclass of PDE III was observed in the guinea pig. Rat left ventricle possesses only the soluble form of PDE III, which apparently represents a mixture of the imazodan-sensitive and imazodan-insensitive subclasses of PDE III. Measurement of in vivo contractility in these three species showed that imazodan exerts a potent positive inotropic effect only in the dog, in which the imazodan-sensitive subclass of PDE III is membrane bound.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Weishaar RE; Kobylarz-Singer DC; Steffen RP; Kaplan HR.
.I 54942
.U
88002696
.S
Circ Res 8801; 61(4):560-9
.M
Animal; Calcium/*ME/PD; Contracture/*PP; Diacetyl/AA/PD; Female; Heart/*; Intracellular Membranes/ME; Microscopy, Electron; Myocardium/*ME/UL; Osmolar Concentration; Perfusion; Rats; Rats, Inbred Strains; Sodium/ME; Support, Non-U.S. Gov't.
.T
Contracture and the calcium paradox in the rat heart.
.P
JOURNAL ARTICLE.
.W
The role of contracture in the manifestation of calcium paradox-induced damage was examined using 2,3-butanedione monoxime (BDM) to inhibit myofibrillar activity. Calcium and sodium gain, loss of intracellular components, and changes in structure were monitored. If 30 mM BDM was added at the time of calcium repletion after 10 minutes of calcium-free perfusion, some protection was afforded, particularly at the early stages of calcium repletion. However, much greater protection was obtained if BDM was present during the final 2 minutes of calcium-free perfusion and throughout repletion. Sodium gain and loss of intracellular components were markedly attenuated, as was the incidence of severely contracted cells. Calcium gain, although significantly reduced during the period of repletion, was not abolished. After 10 minutes of repletion, a calcium content of 11.44 +/- 1.57 mumol/g dry wt was observed. This suggests that other noncontracture related routes of calcium entry are involved. If BDM is removed after 5 minutes of calcium repletion and perfusion is continued with BDM-free perfusate, there is a rapid gain of sodium, further gain of calcium, loss of intracellular components and the cells contract severely, tearing away from neighboring cells. It is evident, therefore, that returning calcium to hearts after a period of calcium-free perfusion under conditions that significantly reduce the typical calcium paradox-associated damage does not necessarily repair the underlying defect. These results support the hypothesis that contracture-induced sarcolemmal disruption may be responsible for the terminal manifestation of the calcium paradox.
.A
Daly MJ; Elz JS; Nayler WG.
.I 54943
.U
88002698
.S
Circ Res 8801; 61(4):581-5
.M
Adult; Blood Pressure; Blood Vessels/DE/ME; Comparative Study; Female; Fingers/*BS; Heart Rate; Human; Male; Receptors, Adrenergic/*ME; Regional Blood Flow; Sex Characteristics/*; Support, U.S. Gov't, P.H.S.; Vasoconstrictor Agents/PD; Vasodilator Agents/PD.
.T
Sex differences in peripheral vascular adrenergic receptors.
.P
JOURNAL ARTICLE.
.W
Although the incidence of many vascular diseases differs in men and women, sex differences in vascular physiology have not been extensively examined in human in vivo studies. The present study compared finger blood flow responses of normal men and women with brachial artery infusions of adrenergic agonists and with other neurally and nonneurally mediated procedures. In response to phenylephrine and clonidine, men showed significant dose-related vasoconstriction while women did not. In response to isoproterenol, men showed significant dose-related vasodilation while women did not. There were no sex differences in response to intra-arterial nitroglycerin or digoxin or to reactive hyperemia, procedures that do not act through adrenergic receptors. These data show that the sensitivity and/or density of peripheral vascular adrenergic receptors is lower in women than in men. There were no sex differences in response to reflex vasoconstriction or to intra-arterial tyramine, suggesting that neurally released norepinephrine acts at alpha-adrenergic receptors that are spatially removed from those that respond to circulating catecholamines.
.A
Freedman RR; Sabharwal SC; Desai N.
.I 54944
.U
88002699
.S
Circ Res 8801; 61(4):586-93
.M
Acetylcholine/PD; Animal; Arteries; Electrophysiology; Female; Leg/*BS; Male; Muscle, Smooth, Vascular/CY/DE/*PH; Neural Transmission/DE; Norepinephrine/PD; Oxotremorine/PD; Parasympathomimetics/*PD; Rabbits; Sympathetic Nervous System/DE/PH; Vasoconstriction; Vasodilator Agents/*PD.
.T
Electrical responses of smooth muscle cells during cholinergic vasodilation in the rabbit saphenous artery.
.P
JOURNAL ARTICLE.
.W
Isolated smooth muscle tissues of the rabbit saphenous artery precontracted with norepinephrine (NE) were relaxed by acetylcholine (ACh, greater than 10(-7) M) or oxotremorine (greater than 10(-7) M), through the activation of muscarinic receptors, only when the endothelial cells were intact. ACh (greater than 10(-7) M) transiently hyperpolarized the membrane (1-4 minutes) with an associated decrease in the membrane resistance, either in the presence or absence of NE, and these changes ceased during the continuous application of ACh. The ACh-induced transient hyperpolarization was not generated after mechanically removing the endothelium or by treatment with atropine. Oxotremorine (up to 10(-5) M) did not alter the membrane potential in the presence or absence of the endothelium. NE (10(-6) M) depolarized the smooth muscle membrane, which remained unchanged by additional application of ACh or oxotremorine for more than 5 minutes, or after removal of the endothelium. The excitatory junction potential generated by perivascular nerve stimulation was inhibited by ACh (greater than 10(-9) M) or oxotremorine (greater than 10(-9) M) in a concentration-dependent manner. These inhibitory actions of ACh or oxotremorine were blocked by atropine but were not affected by removal of the endothelial cells. These results suggest that the inhibitory actions of muscarinic agonists on electrical responses of smooth muscle cells of the rabbit saphenous artery were mainly indirect, i.e., a release of inhibitory substances from the endothelial cells and the inhibition of adrenergic transmission. The former required higher concentrations of ACh or oxotremorine, thereby suggesting that the latter may be more important for vasodilation related to cholinergic mechanisms.
.A
Komori K; Suzuki H.
.I 54945
.U
88002700
.S
Circ Res 8801; 61(4):594-600
.M
Acetylcholine/*PD; Acidosis/*ME/PP; Adenine Nucleotides/ME; Adenosine/*ME; Animal; Blood Pressure/DE; Coronary Circulation/DE; Endothelium, Vascular/*PH/PP; Guinea Pigs; Heart Ventricle; In Vitro; Isoproterenol/*PD; Male; Myocardium/*ME; Support, U.S. Gov't, P.H.S.; Vascular Resistance/DE.
.T
Adenosine release by the isolated guinea pig heart in response to isoproterenol, acetylcholine, and acidosis: the minimal role of vascular endothelium.
.P
JOURNAL ARTICLE.
.W
The objective of this study was to determine the contribution of endothelial cells to adenosine appearing in venous effluent of isolated perfused guinea pig hearts. The adenine nucleotide pool of endothelial cells was selectively labelled by infusing 3H-adenosine (5 X 10(-8) M) into the heart for 30 minutes. Selective labelling of the endothelial adenine nucleotides was confirmed by measuring the relative specific activities of the nucleotides of coronary endothelial cells (removed from the heart by enzyme treatment). Endothelial ATP, ADP, and AMP had relative specific activities that were 49, 25, and 7 times higher, respectively, than their nucleotide counterparts in total myocardial tissue. Isoproterenol increased the release of both total adenosine and radioactive adenosine, but the relative specific activity of venous adenosine decreased dramatically. Acetylcholine, at a concentration that caused no change in left ventricular pressure but caused a decrease in coronary vascular resistance, increased the release of total adenosine. However, both radioactive adenosine release and the relative specific activity of venous effluent adenosine were decreased with acetylcholine. Infusion of hydrochloric acid caused a sustained reduction in left ventricular pressure and coronary vascular resistance. Total adenosine release fell within one minute and remained reduced during HCl. Radioactive adenosine release was elevated at 15 seconds but fell below control values at 2 minutes and remained reduced during steady-state acidosis. We conclude that the majority of the adenosine released in response to isoproterenol and acetylcholine originates from an unlabelled compartment, most likely the myocytes. Acidosis results in decreased release of adenosine from both the labelled endothelium and the unlabelled cells in the heart.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Bardenheuer H; Whelton B; Sparks HV Jr.
.I 54946
.U
88002701
.S
Circ Res 8801; 61(4):601-3
.M
Animal; Arterioles/DE; Bradykinin/*PD; Cerebrovascular Circulation/*DE; Endothelium, Vascular/*PH; Free Radicals; Hydroxides/PD; Male; Mice; Mice, Inbred ICR; Muscle Contraction/*; Muscle Relaxation/*; Support, U.S. Gov't, P.H.S..
.T
Hydroxyl radical mediates the endothelium-dependent relaxation produced by bradykinin in mouse cerebral arterioles.
.P
JOURNAL ARTICLE.
.W
Bradykinin relaxes arterioles on the brain's surface. This response is endothelium-dependent. The data presented here confirm the hypothesis that hydroxyl free radical mediates this response and may be the endothelium-dependent relaxing factor for bradykinin in this microvascular bed. The response to a locally applied bolus of bradykinin (80 micrograms/ml) was monitored by intravital TV microscopy. The response was significantly inhibited or totally blocked by the presence of superoxide dismutase 60 U/ml, catalase 46 U/ml, or deferoxamine 0.1 or 0.2 mM. The superoxide dismutase scavenges superoxide radical, which is known to enter the subarachnoid space as a consequence of cyclooxygenase activation. Cyclooxygenase is activated by bradykinin. The superoxide can form H2O2, scavenged by catalase, and the two together generate hydroxyl. The formation of hydroxyl radical is catalyzed by iron. Deferoxamine 0.1 mM scavenges the iron, blocking the generation of hydroxyl. Deferoxamine 0.2 mM also directly scavenges the hydroxyl. None of the pharmacologic probes had an effect on arteriolar diameter when locally applied without bradykinin. Since the dilation produced by bradykinin was inhibited or totally blocked by probes that prevented hydroxyl formation or directly scavenged hydroxyl radical, that radical is either an essential mediator of the arteriolar relaxation, or is the endothelium-dependent relaxing factor for bradykinin in pial arterioles.
.A
Rosenblum WI.
.I 54947
.U
88002703
.S
Circ Res 8801; 61(4 Pt 2):I1-5
.M
Animal; Bay K 8644/*PD; Calcium/*ME; Cell Separation; Electrophysiology; Guinea Pigs; Ion Channels/*PH; Myocardium/CY/*ME; Rats; Stereoisomers; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Voltage-dependent modulation of cardiac calcium channel current by optical isomers of Bay K 8644: implications for channel gating.
.P
JOURNAL ARTICLE.
.W
This study investigated the voltage-dependent actions of the stereoisomers of the 1,4-dihydropyridine Bay K 8644 on calcium channel currents in heart cells. Whole-cell currents were recorded from enzymatically dispersed ventricular myocytes using the patch-clamp technique. Both enantiomers of this compound modulate calcium channel current in a voltage-dependent manner. The most prominent effect of (+)-Bay K 8644 is an inhibition of calcium channel current, which is more pronounced when currents are measured from depolarized holding potentials. (-)-Bay K 8644 resembles the racemic compound; it enhances or inhibits currents depending on holding potential. The results of this study suggest that the dual activity of the racemic compound is not because of opposing actions of its component enantiomers.
.A
Kass RS.
.I 54948
.U
88002704
.S
Circ Res 8801; 61(4 Pt 2):I10-6
.M
Animal; Calcium/*ME; Dihydropyridines/PD; Electrophysiology; Ion Channels/*CL/DE/PH; Kinetics; Muscle, Smooth, Vascular/*ME; Rabbits; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Two types of calcium channels in single smooth muscle cells from rabbit ear artery studied with whole-cell and single-channel recordings.
.P
JOURNAL ARTICLE.
.W
Freshly dispersed rabbit ear artery cells were studied using patch-clamp techniques to measure membrane currents in whole cells and single-channel currents in membrane patches. Whole-cell calcium currents recorded at physiologic extracellular calcium concentrations were small (approximately 10 pA). Recordings with 110 mM external barium gave much larger currents and revealed two current components with properties similar to those in other vascular smooth muscle preparations and to the calcium currents designated as T and L in heart cells and neurons. T current was activated with weak depolarizations and inactivated rapidly, while L current was activated with relatively strong depolarizations and inactivated more slowly. L current was increased by dihydropyridine agonists and decreased by dihydropyridine antagonists, while T current was unaffected. Recordings from cell-attached and outside-out membrane patches with 100 mM external barium showed unitary calcium channel currents with conductances of 8 and 25 pS. The small conductance channels had kinetic properties that accounted for T current in the whole-cell recordings, while the 25-pS channels showed the voltage dependence, the time dependence, and the dihydropyridine sensitivity expected for L-type channels. We conclude that vascular smooth muscle cells contain two types of calcium channels with properties very similar to those described for T- and L-type calcium channels in other cell types; the L current appears to be the predominant current component in whole-cell recordings.
.A
Benham CD; Hess P; Tsien RW.
.I 54949
.U
88002705
.S
Circ Res 8801; 61(4 Pt 2):I100-4
.M
Animal; Chemistry; Disulfides/ME; Dithiothreitol/PD; Dogs; Dose-Response Relationship, Drug; Ethylene Glycols/PD; Lung/ME; Membranes/ME; Rats; Receptors, Adrenergic, Alpha/*/ME; Receptors, Adrenergic, Beta/ME; Sodium Chloride/PD; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Structural properties of the alpha 1-adrenergic receptor: studies with membrane and purified receptor preparations.
.P
JOURNAL ARTICLE.
.W
The contribution of hydrophobic, ionic, and disulfide bonds in the alpha 1-adrenergic receptor structure was evaluated using rat hepatic plasma membrane and purified receptor preparations. In addition, the findings were compared with similar structural evaluations of the beta 2-adrenergic receptor purified from canine lung. Both the alpha 1- and beta 2-adrenergic receptors contain a disulfide bond critical for ligand binding. However, the disulfide bond in the beta-receptor structure is accessible to solvent, while the disulfide bond within the alpha-receptor structure is "masked" and inaccessible to solvent. Reduction of this disulfide bond requires initial denaturation of the alpha 1-receptor. Although the tertiary structures of both receptor proteins appear to be stabilized by strong hydrophobic interactions, differential sensitivities are observed with a variety of structural perturbants, including high concentrations of sodium chloride, guanidine hydrochloride, and ethylene glycol.
.A
Parini A; Homcy CJ; Graham RM.
.I 54950
.U
88002707
.S
Circ Res 8801; 61(4 Pt 2):I17-23
.M
Animal; Calcium/*ME; Dihydropyridines/ME; Guinea Pigs; Heart Ventricle; Ion Channels/DE/ME/*PH; Lipid Bilayers/*ME; Myocardium/CY/*ME; Phospholipids/*; Phosphorylation; Receptors, Drug/ME; Support, Non-U.S. Gov't; Sympathomimetics/PD.
.T
Modulation of calcium channel function by phosphorylation in guinea pig ventricular cells and phospholipid bilayer membranes.
.P
JOURNAL ARTICLE.
.W
L-type calcium channel activity of some excitable cells is markedly enhanced by beta-adrenergic agents. The enzymatic cascade underlying this important modulatory effect has been studied with patch-clamp techniques in single dialyzed ventricular cells from guinea pig heart. The steps between the binding of agonist to the beta-receptor and the increase in calcium influx can be summarized as follows: Agonist binding to beta-receptor greater than adenylate cyclase increases greater than cAMP increases greater than cA-kinase increases greater than protein phosphorylation greater than altered calcium channel properties greater than ICa increases A basal phosphorylation reaction seems not to be a prerequisite for calcium channel function. By combining molecular and functional approaches, the purified dihydropyridine-receptor complex from rabbit skeletal muscle transverse-tubules can be reconstituted in phospholipid bilayer membranes to form a functional 20-pS calcium channel that retains the principal regulatory, biochemical, and pharmacologic properties of membrane-bound L-type calcium channels.
.A
Trautwein W; Cavalie A; Flockerzi V; Hofmann F; Pelzer D.
.I 54951
.U
88002709
.S
Circ Res 8801; 61(4 Pt 2):I30-6
.M
Affinity Labels; Animal; Azides/DU; Calcium/*ME; Chemistry; Dihydropyridines/DU/ME; Guinea Pigs; Ion Channels/*ME; Ligands/*ME; Male; Muscles/ME; Myocardium/ME; Rabbits; Receptors, Drug/ME; Support, Non-U.S. Gov't.
.T
Interaction between calcium channel ligands and calcium channels.
.P
JOURNAL ARTICLE.
.W
Distinct drug receptors for 1,4-dihydropyridines, phenylalkylamines, and the benzothiazepine d-cis-diltiazem exist on voltage-dependent calcium channels. The drug receptors show reciprocal allosteric communication and are linked to calcium binding sites. The 1,4-dihydropyridine-selective receptor (probed with [3H]nimodipine) has a size (measured by radiation inactivation) identical in heart, skeletal muscle, and brain (180 kDa). To compare the sizes of 1,4-dihydropyridine receptors in different tissues, pure tritiated enantiomers of the arylazido photoaffinity probe [3H]azidopine were used to irreversibly label the purified 1,4-dihydropyridine receptor (155, 65, and 32 kDa) from guinea pig skeletal muscle transverse tubules and the membrane-bound cardiac receptor. The 155 kDa polypeptide region, but not the 65 or 32 kDa bands, was specifically labelled by (-)-[3H]azidopine. (+)-[3H]Azidopine did not label any of the polypeptides in the purified receptor preparation. In contrast with the results from other investigators, a 155 kDa polypeptide was also specifically labelled in cardiac membranes by (-)-[3H]azidopine. A 34 kDa photolabelled band carries a low-affinity 1,4-dihydropyridine binding site that has no obvious relation to the channel but is abundant in heart membranes and has apparently led to erroneous results in previous affinity or photoaffinity labelling experiments. Antibodies raised against the purified skeletal muscle channel precipitate the 125I-labelled 155 kDa channel polypeptide from skeletal muscle and precipitate the three drug receptor sites from both crude and purified channel preparations. We conclude that all three drug receptor sites are localized on this polypeptide.
.A
Glossmann H; Striessnig J; Ferry DR; Goll A; Moosburger K; Schirmer M.
.I 54952
.U
88002711
.S
Circ Res 8801; 61(4 Pt 2):I46-52
.M
Calcium/*ME; Comparative Study; Electrochemistry; Ion Channels/*ME; Kinetics; Lipid Bilayers/*ME; Phosphatidylethanolamines/*ME; Phosphatidylserines/*ME; Phospholipids/*ME; Stereoisomers; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Planar bilayer reconstitution of calcium channels: lipid effects on single-channel kinetics.
.P
JOURNAL ARTICLE.
.W
Sodium current in the absence of divalents was measured through single calcium channels of skeletal muscle transverse tubules incorporated into planar bilayers composed of the negatively charged lipid phosphatidylserine (PS) and neutral lipid phosphatidylethanolamine (PE). Channel kinetics in PE and PS are characterized by the simultaneous presence of openings of long duration (greater than 200 msec) and openings of brief duration (less than 20 msec) grouped into bursts. Accordingly, exponential distributions of open-channel lifetimes could be fitted with at least two time constants. An increase in bilayer mole fraction of PS, from XPS = 0 (pure PE) to XPS = 1.0 (pure PS), decreased open-channel lifetimes by approximately twofold to threefold. Calculations using the Gouy-Chapman theory indicate that channel lifetimes do not correlate with bilayer surface potentials generated by PS.
.A
Coronado R.
.I 54953
.U
88002712
.S
Circ Res 8801; 61(4 Pt 2):I53-9
.M
Animal; Blood Pressure/*; Cats; Decerebrate State; Diencephalon/*PH; Electric Stimulation; Extremities; Locomotion/*; Muscles/IR; Nervous System/PP; Paralysis/PP; Respiration/*; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Diencephalic regulation of respiration and arterial pressure during actual and fictive locomotion in cat.
.P
JOURNAL ARTICLE.
.W
The purpose of this study was to examine by experimentation the hypothesis that the respiratory and circulatory responses during exercise are attributable to command signals that emanate from the suprapontine brain. We studied the relations between locomotion (exercise) and phrenic nerve activity and arterial pressure in cats that walked or ran on a treadmill and in animals during fictive locomotion, i.e., locomotor activity in motor nerves to legs. Anesthetized cats with intact brains and unanesthetized decorticated cats were used. All preparations exhibited spontaneous actual and fictive locomotion. Electrical stimulation or microinjection of picrotoxin, a GABA antagonist, of the subthalamic locomotor areas always caused locomotion to develop. Phrenic nerve activity and arterial pressure increased in proportion to the level of locomotor activity despite control or ablation of feedback signals from chemoreceptors and vagal receptors. Similar relations were measured during fictive locomotion despite the absence of muscular contraction and limb movement and the lack of change in metabolic rate. These findings provide experimental support for the central command hypothesis for the genesis of the respiratory hyperpnea and increased cardiovascular function that occur during exercise. We believe that the command signals emanate from the subthalamic locomotor area of the diencephalon.
.A
Millhorn DE; Eldridge FL; Waldrop TG; Kiley JP.
.I 54954
.U
88002713
.S
Circ Res 8801; 61(4 Pt 2):I6-9
.M
Animal; Calcium/*ME; Cell Separation; Elapid Venoms/*PD; Electrophysiology; Guinea Pigs; Ion Channels/*DE/PH; Myocardium/CY/*ME; Neurotoxins/*PD; Support, U.S. Gov't, P.H.S..
.T
Neurotoxins that act selectively on voltage-dependent cardiac calcium channels.
.P
JOURNAL ARTICLE.
.W
We searched for and found a toxin that acts specifically on cardiac calcium channels. This toxin, which we have designated TaiCatoxin (TCX), was purified from the venom of the Australian Taipan snake (Oxyuranus s. scutellatus), one of the world's most poisonous snakes. TCX is a highly charged, basic polypeptide with a molecular weight of 8,000. It blocks high- but not low-threshold cardiac calcium channels in a voltage-dependent manner and has no effect on potassium or sodium channels. The block occurs at nanomolar concentrations, is reversible, and is due to binding at an extracellularly facing site on the channel itself.
.A
Brown AM; Yatani A; Lacerda AE; Gurrola GB; Possani LD.
.I 54955
.U
88002714
.S
Circ Res 8801; 61(4 Pt 2):I60-5
.M
Animal; Blood Pressure/*; Diencephalon/*PH; Electric Stimulation; Ischemia/PP; Locomotion/*; Muscle Contraction; Muscles/BS/*IR/ME; Neurons, Afferent/*PH; Physical Stimulation; Potassium/ME/PD; Rabbits; Respiration/*; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Discharge properties of group III and IV muscle afferents: their responses to mechanical and metabolic stimuli.
.P
JOURNAL ARTICLE.
.W
Static contraction of the hind limb muscles induced by electrical stimulation of the ventral roots has been firmly established to reflexly increase cardiovascular and ventilatory function. Moreover, Group III and IV afferents are known to compose the afferent arm of this reflex arc. The present experiments investigated the discharge properties of Group III and IV afferents whose activation is responsible for the pressor reflex response to static contraction. In general, we found that Group III afferents were more responsive to mechanical stimuli, such as distortion of their receptive fields and tendon stretch, than were Group IV afferents. In contrast, Group IV afferents were more responsive to ischemic contraction than were Group III afferents. In addition, equal percents of Group III and IV afferents were found to be stimulated by increasing interstitial potassium to levels that were similar to those found during muscular contraction. The afferents' response to potassium adapted within seconds, while the interstitial concentration of this ion remained elevated for several minutes. This rapidly adapting response casts doubt on the effectiveness of potassium as the metabolite that signals blood supply and demand in a working muscle are improperly matched.
.A
Kaufman MP; Rybicki KJ.
.I 54956
.U
88002715
.S
Circ Res 8801; 61(4 Pt 2):I66-71
.M
Animal; Bay K 8644/PD; Calcium/*PD; Calcium Channel Blockers/DU; Potassium/*PD; Pressoreceptors/*DE; Rats; Sodium/*PD; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Ionic sensitivity of baroreceptors.
.P
JOURNAL ARTICLE.
.W
Baroreceptors respond to distortion of their receptor regions by producing action potentials and, thus, provide information to the central nervous system for cardiovascular control. The mechanisms converting mechanical events to electrical signals are unknown. Since it has not been possible to record a receptor potential in the mechanosensitive terminals, studies rely on interpretation of axonal discharge of baroreceptor endings. In the present study, the ionic sensitivity of in vitro preparations of both low- and high-pressure receptors are compared in studies in which the ionic composition of the extracellular fluid is controlled. The results taken together with previous work suggest uniformity of response to calcium, sodium, and potassium across a variety of cardiovascular receptor types supporting common mechanoelectrical transduction mechanisms. Decreased extracellular sodium produced increased threshold and decreased slopes of pressure-discharge curves for both aortic arch baroreceptors and for low-pressure baroreceptors in the atrium. Results are consistent with data for other mechanoreceptors where it is believed that distortion activates a relatively poorly selective cation-conducting channel through the membrane. As with arterial baroreceptors, increases in external calcium levels caused a decrease in the excitability of atrial baroreceptors. Substitution of half the external calcium with the inorganic calcium channel blocker cobalt failed to alter baroreceptor function. Bay K 8644, a calcium channel agonist of the dihydropyridine class of calcium channel blockers, tended to inhibit baroreceptor discharge with effects consistent with smooth muscle activation within the vessel wall. Several hypotheses of potential underlying mechanisms are discussed. These new experiments are consistent with the results achieved with alterations of ionic calcium and suggest that calcium entry does not play a detectable role in baroreceptor transduction.
.A
Andresen MC; Kunze DL.
.I 54957
.U
88002716
.S
Circ Res 8801; 61(4 Pt 2):I72-5
.M
Animal; Blood Pressure/DE; Heart/*PP; Hypertension, Renal/*PP; Lumbosacral Region; Lung/*PP; Male; Plasma Substitutes/PD; Pressoreceptors/*PP; Rabbits; Reflex/*PH; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Sympathetic Nervous System/*PP; Vagus Nerve/*PP.
.T
Control of lumbar sympathetic nerve traffic by vagal cardiopulmonary baroreflexes in renal hypertension.
.P
JOURNAL ARTICLE.
.W
Renal nerve traffic is inhibited during volume expansion mainly because of stimulation of vagal cardiopulmonary baroreflexes. These responses are impaired in rabbits with renal hypertension caused by impaired cardiopulmonary baroreflexes. Previous studies have suggested that there may be differences in the extent to which renal hypertension alters reflex control of lumbar as compared with renal sympathetic nerve activity. The goals of this study were to determine if the responses to volume expansion of lumbar sympathetic nerve traffic also are impaired in renal hypertension and if this abnormality, if present, is caused by abnormalities in the vagal cardiopulmonary baroreflex. Experiments were done in alpha-chloralose-anesthetized normotensive (n = 9) and renal hypertensive (n = 7; 1 kidney, 1 wrap) rabbits. Infusion of dextran in saline raised arterial and left atrial pressures in both groups and decreased lumbar nerve traffic by -4.4 +/- 0.4% mm Hg rise in arterial pressure in the normotensive group and by -1.5 +/- 0.1% mm Hg in the hypertensive group (p less than 0.01). These responses were nearly abolished by sinoaortic denervation in both groups. These data indicate that the responses of lumbar nerve traffic to volume expansion are impaired in renal hypertension; this is mainly because of impaired arterial baroreflexes since vagal cardiopulmonary baroreceptors have minimal influence on lumbar nerve traffic, even in normotensive rabbits. These findings for the lumbar nerves are strikingly different from those reported previously for reflex control of the renal nerves in both normotensive and hypertensive rabbits.
.A
Thames MD; Yuih SN; Fortner CA; Brands DB.
.I 54958
.U
88002717
.S
Circ Res 8801; 61(4 Pt 2):I76-81
.M
Animal; Argipressin/PD; Consciousness; Kidney/*IR; Models, Cardiovascular; Pressoreceptors/DE/*PH; Rabbits; Reflex/DE/*PH; Regression Analysis; Support, U.S. Gov't, P.H.S.; Sympathetic Nervous System/DE/*PH.
.T
Baroreflex control of renal nerve activity in conscious animals.
.P
JOURNAL ARTICLE.
.W
This study quantitates the effect of three different doses of vasopressin on the arterial baroreflex control of renal sympathetic nerve activity and heart rate. The lowest dose of vasopressin (0.4 mU/kg X min), which had no significant effect on resting mean arterial pressure, heart rate, or renal sympathetic nerve activity, increased the inhibitory influence of arterial baroreflexes on renal sympathetic nerve activity in response to an increase in pressure. During infusions of higher doses of vasopressin (1.5 and 3.0 mU/kg X min), which significantly decreased resting heart rate and renal sympathetic nerve activity but had no significant effect on mean arterial pressure, the mean arterial pressure-renal sympathetic nerve activity relation showed a significant decrease in maximum renal sympathetic nerve activity when compared with control. The highest dose of vasopressin resulted in a significant shift of the relation to the left toward lower pressures and in a decrease in maximum gain. The relation exhibited a parallel shift toward lower pressure, with no change in gain, at the higher dose of vasopressin. Based on these results, we conclude that vasopressin exerted a dose-related effect on arterial baroreflex such that lower doses of vasopressin may sensitize the central baroreflex neurons to afferent input, while the higher doses of vasopressin caused direct excitations of these neurons, resulting in a reduction in resting sympathetic outflow.
.A
Bishop VS; Hasser EM; Nair UC.
.I 54959
.U
88002718
.S
Circ Res 8801; 61(4 Pt 2):I82-6
.M
Blood Pressure/DE; Coronary Vessels; Dobutamine/*TU; Female; Heart Failure, Congestive/BL/*DT/PP; Hemodynamics/DE; Human; Injections; Male; Middle Age; Myocardial Contraction/*DE; Norepinephrine/BL; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Sympathomimetics/*TU.
.T
Beta-adrenergic inotropic responsiveness of patients with heart failure: studies with intracoronary dobutamine infusion.
.P
JOURNAL ARTICLE.
.W
Although there is theoretical and indirect evidence to suggest that patients with severe congestive heart failure may have desensitization of myocardial beta-adrenergic responsiveness, there is little direct evidence in patients. The purpose of this study was to determine whether myocardial beta-adrenergic inotropic responsiveness is reduced in patients with severe congestive heart failure and markedly elevated plasma norepinephrine levels. To assess myocardial beta-adrenergic inotropic responsiveness, the beta-adrenergic agonist dobutamine was infused directly into the left main coronary artery, and the change in +dP/dt was measured as an index of change in inotropic state. Eight patients with severe New York Heart Association functional Class III and IV congestive heart failure were compared with 4 patients without significant congestive heart failure. The increase in +dP/dt at an intracoronary dobutamine infusion rate of 25 micrograms/min in patients with severe congestive heart failure was significantly less than in the patients without heart failure (heart failure, 33 +/- 8%; no heart failure, 69 +/- 12%; p less than 0.05). Although the maximum intracoronary dobutamine infusion rate was substantially higher in patients with heart failure (94 +/- 25 micrograms/min) compared with patients without heart failure (38 +/- 7 micrograms/min), the increase in +dP/dt at maximum infusion rates was also significantly less in patients with heart failure (heart failure, 52 +/- 8%; no heart failure, 93 +/- 24%; p less than 0.05). Plasma norepinephrine concentration was normal in the 4 patients without heart failure and was markedly elevated (range, 307-3,967 ng/l) in the patients with severe heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Colucci WS; Leatherman GF; Ludmer PL; Gauthier DF.
.I 54960
.U
88002719
.S
Circ Res 8801; 61(4 Pt 2):I87-90
.M
Adult; Heart Failure, Congestive/*BL/PP; Heart Rate; Human; Kinetics; Male; Middle Age; Norepinephrine/*BL; Posture/*; Stress/*BL/PP; Support, U.S. Gov't, P.H.S..
.T
Norepinephrine kinetics during orthostatic stress in congestive heart failure.
.P
JOURNAL ARTICLE.
.W
To evaluate the determinants of the plasma norepinephrine (NE) response to orthostatic stress, NE kinetics were measured during steady-state infusion of [3H]NE of high-specific activity for two consecutive 90-minute periods; the first was supine, and the second was during 60 degrees head-up tilt. In 6 normal subjects, plasma NE increased from 242 to 570 pg/ml, and NE clearance decreased from 1.43 to 1.00 l/min X M2. In 6 patients with congestive heart failure, there was no significant change in plasma NE during orthostatic stress. This has been interpreted previously to indicate that there was little activation of the baroreflex arc. In fact, NE clearance decreased from 1.08 to 0.79 l/min X M2; however, there was a decrease in NE spillover from 4.04 to 2.88 nmol/min X M2. A reduction of organ blood flow with tilt could be responsible for the reduced NE clearance by both groups, but the mechanism for the reduction in NE spillover with tilt in congestive heart failure is unclear.
.A
Davis D; Sinoway LI; Robison J; Minotti JR; Day FP; Baily R; Zelis R.
.I 54961
.U
88002720
.S
Circ Res 8801; 61(4 Pt 2):I91-5
.M
Aged; Coronary Disease/*PP; Dose-Response Relationship, Drug; Female; Heart/*DE; Heart Diseases/*PP; Heart Ventricle; Human; Isoproterenol/PD; Male; Middle Age; Propanolamines/PD; Receptors, Adrenergic, Beta/*PH; Support, Non-U.S. Gov't; Sympathomimetics/*PD.
.T
Left ventricular sensitivity to beta-adrenoceptor-stimulating drugs in patients with ischemic heart disease and varying degrees of ventricular dysfunction.
.P
JOURNAL ARTICLE.
.W
The left ventricular sensitivity to sympathomimetic amines was assessed in 47 patients with ischemic heart disease and varying degrees of left ventricular dysfunction. Patients were divided into 3 subgroups according to their basal ejection fraction (less than or equal to 35%, between 36 and 54%, and greater than or equal to 55%). After injection of a bolus of isoproterenol (2 micrograms), the isovolumic indexes of inotropic state increased significantly less in patients with an ejection fraction less than or equal to 35% than in other patients, but the heart rate changes and the acceleration in the rate of isovolumic pressure fall were comparable in all subgroups. The dose-response curves to cumulative doses of xamoterol, a beta 1-adrenoceptor partial agonist, confirmed that the magnitude of the inotropic response was reduced during beta 1-stimulation in patients with an ejection fraction less than or equal to 35% when compared with patients with a greater ejection fraction. However, the dose of xamoterol necessary to produce 50% of the maximal inotropic response was not increased in patients with an ejection fraction less than or equal to 35% (range, 1.5-5.2 micrograms/kg; median 2.5 vs. median values of 2.3 and 3.3 micrograms/kg in the other subgroups; NS), and there was no shift to the right of the dose-response curve. It is concluded that in moderate ischemic heart failure, the magnitude of the inotropic response to isoproterenol or xamoterol is reduced. The absence of shift to the right of the dose-response curve to a beta 1-partial agonist suggests that this alteration in myocardial performance is not primarily caused by a decrease in beta-adrenoceptor responsiveness.
.A
Pouleur H; Rousseau MF; Hanet C; Marlow HF; Charlier AA.
.I 54962
.U
88002742
.S
Circulation 8801; 76(4):746-52
.M
Health Promotion; Human; San Francisco; Smoking/*PC; Tobacco Smoke Pollution/*AE/PC.
.T
Achieving a smokefree society.
.P
JOURNAL ARTICLE.
.A
Glantz SA.
.I 54963
.U
88002744
.S
Circulation 8801; 76(4):759-67
.M
Adult; Aged; Atrioventricular Node/*PH/PP; Cardiac Pacing, Artificial/*; Electrocardiography/*; Female; Heart Block/*PP; Heart Conduction System/*PH; Human; Male; Middle Age; Refractory Period, Neurologic.
.T
Beat-to-beat changes in atrioventricular nodal excitability and its modulation by concealed conduction during functional 2:1 block in man.
.P
JOURNAL ARTICLE.
.W
An atrial pacing model of functional 2:1 block was used in 10 patients to investigate for the first time the electrophysiologic properties of the human atrioventricular node during intermittent conduction. By varying the terminal portion of the 2:1 atrial train and using the extrastimulus technique, we characterized atrioventricular nodal (AVN) conduction and refractoriness after five different methods of AVN activation: a conducted beat (method I), a conducted beat with omission of the prior blocked beat (method II), a blocked beat (method III), a blocked beat "converted" to one that conducts by omission of the prior conducted beat (method IV), and finally, 1:1 conduction at twice the cycle length of the 2:1 train (control method V). Observed AVN conduction times obeyed the following relationship: method I greater than method II greater than method V, indicating a cumulative effect of concealed penetration by the blocked beats. During 2:1 block, the AVN effective refractory period (ERP) alternated with a mean beat-to-beat difference of at least 100 msec, due mostly to marked ERP abbreviation during AVN activation by method III (vs both 2:1 train cycle length and activation by method V). Concealed penetration by the blocked beat prolonged AVN ERP for the propagated beat (vs that with methods II and V), but to a lesser extent than conduction time was increased. Moreover, the AVN recovery curve with method I was displaced upward and to the right compared with that with methods II to V.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Steinman RT; Lehmann MH.
.I 54964
.U
88002745
.S
Circulation 8801; 76(4):768-76
.M
Aged; Angina, Unstable/PP; Coronary Disease/*PP; Echocardiography; Female; Heart Ventricle/PP; Human; Image Interpretation, Computer-Assisted; Male; Middle Age; Movement; Myocardial Contraction/*; Myocardial Infarction/PP; Support, Non-U.S. Gov't; Systole/*.
.T
Hierarchy of levels of ischemia-induced impairment in regional left ventricular systolic function in man.
.P
JOURNAL ARTICLE.
.W
We tested the hypothesis that different subsets of ischemia-induced wall motion disorders are characterized by specific patterns of abnormal regional left ventricular systolic function. Regional contraction was quantitatively assessed from two-dimensional echocardiograms by an automated integrative analysis considering the time course of wall motion during the entire contraction sequence in 20 patients with chronic myocardial infarction, in 13 patients with impending myocardial infarction (less than 2 hr after the onset of symptoms), and in nine patients during transient myocardial ischemia. Wall motion abnormalities were detected in all patients by the integrative analysis. In contrast, the sensitivity for detecting wall motion abnormalities was 80% during chronic infarction, 77% during impending infarction, and 56% during transient ischemia if only end-diastolic and end-systolic frames were compared for assessment of overall regional systolic function. There were distinct differences in the time course of abnormal wall excursion between the three groups. Chronic infarction was characterized by a monophasic contraction pattern, with abnormal synergy in regional contractile events occurring predominantly during early systole. In contrast, transient ischemia caused predominantly mid-to-late systolic abnormal synergy followed by late systolic shortening corresponding to a polyphasic contraction pattern. During impending infarction, an intermediate temporal contraction pattern was present with both early and mesosystolic abnormal synergy.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Zeiher AM; Wollschlaeger H; Bonzel T; Kasper W; Just H.
.I 54965
.U
88002746
.S
Circulation 8801; 76(4):777-85
.M
Adult; Aged; Echocardiography/*; Female; Heart Ventricle/PP/RA; Human; Male; Middle Age; Mitral Valve Insufficiency/DI/*ET/PP; Myocardial Infarction/*CO/PP; Papillary Muscles/PP; Support, Non-U.S. Gov't.
.T
Mechanism of mitral regurgitation in patients with myocardial infarction: a study using real-time two-dimensional Doppler flow imaging and echocardiography.
.P
JOURNAL ARTICLE.
.W
The aim of the present study was to elucidate the mechanisms of mitral regurgitation accompanying myocardial infarction. Severity and site of mitral regurgitation was evaluated by the real-time two-dimensional Doppler flow imaging technique in 81 patients with old myocardial infarction. The incidence of mitral regurgitation did not depend on the region of infarction. There was, however, a close relationship between the site of regurgitation and the region of infarction. In patients with mitral regurgitation spurting from the posteromedial area of the valve, the inferior wall was involved in infarction without exception and in some of these patients, the posteromedial papillary muscle was also found to be affected by myocardial infarction; in those with regurgitation spurting from the anterolateral area, the anterior wall showed asynergy. On the other hand in patients with mitral regurgitation spurting from the central area, the region of infarction varied. In these patients, however, the larger the diameter of the mitral anulus, the more severe the grade of regurgitation. The extent of asynergy was another factor related to the severity of mitral regurgitation. Both longitudinally and transversely, broad infarction leads to the enlargement of the mitral anulus. However, even if the mitral anulus is not so dilated, severe involvement of either commissural area results in severe mitral regurgitation from the same commissural side. Thus, there are two major causative factors of mitral regurgitation: (1) asynergy of the papillary muscle or the ventricle that results in mitral regurgitation located in the commissural area of the same side as asynergy, and (2) enlargement of mitral anulus, which results in regurgitation from the central area of the orifice.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Izumi S; Miyatake K; Beppu S; Park YD; Nagata S; Kinoshita N; Sakakibara H; Nimura Y.
.I 54966
.U
88002748
.S
Circulation 8801; 76(4):792-801
.M
Acute Disease; Aged; Angioplasty, Transluminal/*AE; Coronary Disease/PP/RA/*TH; Coronary Vessels/*PP/RA; Female; Human; Male; Middle Age; Myocardial Infarction/ET; Pressure; Prognosis; Risk Factors.
.T
The transstenotic pressure gradient trend as a predictor of acute complications after percutaneous transluminal coronary angioplasty.
.P
JOURNAL ARTICLE.
.W
The transstenotic pressure gradient recorded during coronary angioplasty (PTCA) reflects the dynamic relationship that exists between coronary blood flow and the effective cross-sectional area of the arterial lumen. An apparent relationship between the dynamic behavior of the pressure gradient and subsequent acute vessel closure was observed in our catheterization laboratory. We therefore examined the usefulness of the pressure gradient trend in predicting acute complications after 463 attempted PTCA procedures. Two pressure gradient trend patterns were identified: (1) a rising trend pattern identified by an increasing pressure gradient in the interval after deflation of the angioplasty, and (2) a stable trend pattern identified by a constant or decreasing pressure gradient. The incidence of acute vessel closure (17% vs 4%, p = .0001), emergency CABG (5.6% versus 1%, p less than .05), and myocardial infarction (13% versus 2%, p less than .0001) after the PTCA procedure was significantly higher among patients with rising trend patterns when compared with patients with stable trend patterns. Multivariate analysis identified independent predictors for an acute closure event as rising trend pattern (p less than .001), post-PTCA gradient (p less than .05), and post-PTCA percent diameter stenosis (p less than .02). Independent predictors for emergency coronary artery bypass grafting and myocardial infarction were post-PTCA gradient (p less than .001) and a rising trend pattern (odds ratio = 2.91, p less than .001), respectively. The dynamic behavior of the gradient trend provides additional useful information about the results of dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Redd DC; Roubin GS; Leimgruber PP; Abi-Mansour P; Douglas JS Jr; King SB 3d.
.I 54967
.U
88002749
.S
Circulation 8801; 76(4):802-9
.M
Aged; Amiodarone/*TU; Arrhythmia/*ET/PP; Cardiac Pacing, Artificial; Coronary Disease/*CO; Female; Follow-Up Studies; Heart Ventricle/PP; Human; Male; Middle Age; Predictive Value of Tests; Recurrence; Risk Factors; Support, U.S. Gov't, P.H.S.; Tachycardia/*DT/ET/PP.
.T
Predictors of efficacy of amiodarone and characteristics of recurrence of arrhythmia in patients with sustained ventricular tachycardia and coronary artery disease.
.P
JOURNAL ARTICLE.
.W
The value of serial electropharmacologic testing during long-term oral amiodarone therapy for prediction of long-term drug efficacy as well as characteristics of arrhythmia recurrence is controversial. One-hundred four consecutive patients with coronary artery disease and sustained ventricular tachyarrhythmias (VT) underwent initial electrophysiologic (EP) evaluation in the drug-free state and again after an amiodarone loading period of 25 +/- 14 days (mean +/- SD). Twenty-six patients (25%) had no inducible ventricular tachyarrhythmia during therapy with amiodarone (VT control group), whereas arrhythmia inducibility persisted in the remaining 78 patients (VT noncontrol group). During 17.4 +/- 13.7 months of follow-up, two patients in the VT control group either had VT recurrence or died suddenly compared with 21 VT recurrences and eight sudden cardiac deaths in the VT noncontrol group (actuarial event rates at 36 months of 0.11 and 0.56, respectively, p = .0065). The cycle lengths of recurrent VT in these 21 patients in the VT noncontrol group were compared with those observed at final EP testing. A significant linear correlation was demonstrated (r = .76, p = .0001). Subgroup analysis of patients in the VT noncontrol group showed no EP predictors of outcome, including cycle length of induced VT. However, patients dying suddenly during the follow-up period had a higher prevalence of new or worsening congestive heart failure (75%) compared with patients with VT recurrence (19%) or those with no arrhythmic event (29%) (p less than .02).2off
.A
Zhu J; Haines DE; Lerman BB; DiMarco JP.
.I 54968
.U
88002750
.S
Circulation 8801; 76(4):810-8
.M
Adult; Atrioventricular Node/DE/PP; Dose-Response Relationship, Drug; Electrocardiography; Female; Follow-Up Studies; Human; Male; Middle Age; Receptors, Adrenergic, Beta/DE; Sotalol/BL/PD/*TU; Support, Non-U.S. Gov't; Wolff-Parkinson-White Syndrome/*DT/PP.
.T
Electropharmacology of sotalol in patients with Wolff-Parkinson-White syndrome.
.P
JOURNAL ARTICLE.
.W
The beta-adrenoceptor-blocking and class III effects of sotalol were assessed in 11 patients with inducible orthodromic reciprocating tachycardia. Serum sotalol concentration, maximum exercise heart rate, and electrophysiologic study data were obtained at control, at the beta-adrenoceptor-blocking dosage (407 +/- 149 mg/day, 1.4 +/- 0.5 micrograms/ml), and at the maximum well-tolerated dosage (924 +/- 337 mg/day, 3.2 +/- 1.3 micrograms/ml). Class III effects (increases in anterograde and retrograde accessory connection effective refractory periods, ventricular effective refractory period, and the QT interval during fixed-rate atrial pacing) were evident at the beta-adrenoceptor-blocking dosage of sotalol and became more marked at the maximum well-tolerated dosage. For example, the mean anterograde accessory connection effective refractory period was significantly increased over control (272 +/- 41 msec) by the beta-adrenoceptor blocker (324 +/- 52 msec) and was further significantly increased by the maximum well-tolerated dose (364 +/- 37 msec). Similarly, the minimum preexcited RR interval during atrial fibrillation was increased in all patients at each dosage tested. Antiarrhythmic efficacy, defined by the absence of inducible, sustained, orthodromic reciprocating tachycardia and a minimum preexcited RR interval during atrial fibrillation of 300 msec or greater, was achieved in four patients at the beta-adrenoceptor-blocking dosage and in another four patients at the maximum well-tolerated dosage. These eight patients received long-term sotalol therapy and none has had recurrent, sustained reciprocating tachycardia during 15 +/- 12 months of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Mitchell LB; Wyse DG; Duff HJ.
.I 54969
.U
88002753
.S
Circulation 8801; 76(4):835-42
.M
Animal; Aorta/PA/PP; Blood Pressure; Constriction, Pathologic; Coronary Circulation/*; Dogs; Exertion/*; Heart Enlargement/ET/*PP; Hypertension, Renal/CO/*PP; Stroke Volume; Support, U.S. Gov't, P.H.S.; Vascular Resistance.
.T
Myocardial blood flow during exercise in dogs with left ventricular hypertrophy produced by aortic banding and perinephritic hypertension.
.P
JOURNAL ARTICLE.
.W
This study tested the hypothesis that for similar degrees of left ventricular hypertrophy, subendocardial blood flow would be facilitated by the increased diastolic coronary perfusion pressure associated with arterial hypertension, as compared with hypertrophy produced by banding the ascending aorta. Left ventricular hypertrophy was produced with perinephritic hypertension in seven adult dogs and by banding the ascending aorta in nine adult dogs. Left ventricular/body weight ratios were 6.15 +/- 0.59 g/kg in the hypertensive animals and 6.87 +/- 0.47 g/kg in dogs with aortic banding, as compared with 4.23 +/- 0.23 g/kg in seven normal dogs (p less than .01). Studies were performed at rest and during two stages of treadmill exercise to achieve heart rates of 195 and 260 beats/min. Diastolic aortic pressure was increased in animals with hypertension but not in dogs with aortic banding. Systolic ejection period was prolonged in dogs with aortic banding but not in hypertensive dogs. Mean blood flow per gram of myocardium measured with microspheres was similar at rest and during light exercise in all three groups of animals, whereas during heavy exercise blood flow was significantly greater than normal in both groups with hypertrophy. In normal dogs subendocardial/subepicardial (endo/epi) flow ratios did not change significantly during exercise. In both groups with hypertrophy, endo/epi ratios were normal at rest but decreased significantly during exercise. During heavy exercise the endo/epi ratio decreased to 0.73 +/- 0.08 in dogs with aortic banding as compared with 1.07 +/- 0.12 in hypertensive dogs (p less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Bache RJ; Dai XZ; Alyono D; Vrobel TR; Homans DC.
.I 54970
.U
88002754
.S
Circulation 8801; 76(4):843-9
.M
Animal; Blood Pressure; Dogs; Extracellular Space/ME; Hemodynamics; Lung/ME/PA/*PP; Lung Volume Measurements; Pericardial Effusion/*CO/PA/PP; Pulmonary Edema/*ET/PA/PP; Pulmonary Gas Exchange; Support, U.S. Gov't, P.H.S..
.T
Pericardial effusion causes interstitial pulmonary edema in dogs.
.P
JOURNAL ARTICLE.
.W
The pulmonary effects of pericardial effusion were studied in eight anesthetized dogs, with emphasis on lung mechanics, O2 exchange, and extravascular thermal lung volume (ETV) accumulation, while warm saline was instilled into the pericardium to elevate pericardial pressure. The results were compared with those from four time-controlled and sham-operated dogs. ETV, as measured by a double-indicator technique, increased from 8.1 +/- 0.8 ml/kg at a pericardial pressure of 0 mm Hg to 12.9 +/- 2.1 ml/kg at 11.0 mm Hg (p less than .01). In the control group, ETV increased from 6.5 +/- 0.7 to 8.2 +/- 0.5 ml/kg over an equal time span. This increase in ETV in the experimental dogs was inversely related to pulmonary compliance, which decreased by 29% as ETV increased (p less than .05), whereas in the time-controlled group of animals it decreased by 8.8%. Arterial PO2 did not deteriorate during the protocol in either group. Histologic examination showed increased interstitial fluid, but neither alveolar fluid nor septal edema, and gravimetric measurements of lung liquid were also consistent with interstitial fluid accumulation in experimental but not control animals. These findings are concordant with the clinical observation that alveolar edema is rarely seen in the presence of pericardial tamponade. Conceivably, progression from interstitial to alveolar edema did not occur both because of the low pulmonary blood flow that occurs as part of pericardial tamponade physiology and/or because the hydrostatic pressures were not elevated enough to produce higher rates of fluid transudation.
.A
Sznajder JI; Evander E; Pollak ER; Becker C; Little AG.
.I 54971
.U
88002755
.S
Circulation 8801; 76(4):850-9
.M
Animal; Comparative Study; Coronary Circulation; Coronary Disease/*DI/PA/PP; Dogs; Echocardiography/*/MT; Myocardial Contraction/*; Myocardial Infarction/*DI/PA/PP; Myocardium/UL.
.T
Two-dimensional ultrasonic tissue characterization: backscatter power, endocardial wall motion, and their phase relationship for normal, ischemic, and infarcted myocardium.
.P
JOURNAL ARTICLE.
.W
To understand the possible differences in reflected ultrasonic energy from normal, ischemic, and infarcted myocardium, we studied 20 open-chest dogs with a commercially available two-dimensional ultrasonic scanner. Echocardiographic radiofrequency images of anterior myocardium were obtained serially during complete coronary occlusion for 2 hr (n = 15) or 5 hr (n = 10), or after temporary coronary clamping for 15 min with release for 1 hr (n = 5). We investigated two variables: the cyclic backscatter power and the phase difference among endocardial wall motion (EWM), cyclic backscatter power (BSP), and left ventricular pressure (LVP). The cyclic BSP decreased from a control (nonischemic) level of 5.1 +/- 0.8 to 2.3 +/- 0.7 dB during ischemia (up to 30 min after coronary ligation). The phase difference between the EWM and BSP progressed from a control (nonischemic) value of 38 +/- 20 to 115 +/- 23 degrees during ischemia. For the infarction period (2 to 5 hr after coronary ligation), the cyclic BSP progressively returned toward baseline control levels to 4.0 +/- 1.2 dB, but the phase had increased further to 170 +/- 28 degrees. The reperfusion study showed a similar decrease in cyclic BSP and an increase in phase after arterial clamping and both returned to near-normal nonischemic values upon arterial release. Simultaneous LVP recordings were performed to assess the phase contribution of endocardial dyskinesis to the total phase difference measurement. At 5 hr the dyskinesis had contributed 46% to the total phase difference, while the backscatter power contributed 54%. However, the EWM contribution occurred immediately while BSP contribution changed progressively during the 5 hr study period.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Fitzgerald PJ; McDaniel MD; Rolett EL; Strohbehn JW; James DH.
.I 54972
.U
88002756
.S
Circulation 8801; 76(4):860-74
.M
Animal; Comparative Study; Dogs; Electrophysiology; Endocardium/PP; Heart Ventricle/PP; Microelectrodes; Myocardial Infarction/PA/*PP; Papillary Muscles/PA/*PP; Purkinje Fibers/PP; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Time Factors.
.T
Alterations in endocardial activation of the canine papillary muscle early and late after myocardial infarction.
.P
JOURNAL ARTICLE.
.W
Permanent coronary occlusion produces time-dependent changes in surviving subendocardial cellular properties. We compared the functional alterations in Purkinje (P) and ventricular muscle (VM) activation early (24 hr) and late (4 weeks or greater) after permanent coronary occlusion in an in vitro preparation of canine papillary muscle. High-density extracellular (1 to 2 mm resolution) and selected intracellular recordings were made in five animals early and seven animals late during stimulation of a free-running P strand. Activation patterns of P and VM layers from ischemic and unaffected papillary muscles were compared in the same animal. Average P layer conduction velocity was determined in normal and ischemic regions with the use of a linear array of recording and stimulating electrodes. Purkinje activation was altered little in the early phase of infarction, while healing was associated with a generalized 25% reduction in P layer conduction velocity and localized block and fragmentation of P waveforms. Intracellular recordings at sites of nonsynchronous P activation revealed electrotonic interaction between cell groups. At 24 hr, small groups of VM were present but with abnormal activation patterns in regions of necrosis with fragmented and delayed extracellular waveforms produced by partially uncoupled groups of cells. Local delay and block could be modulated by rate and site of stimulation. After healing, VM activation abruptly stopped at the visual infarct border, marked by a characteristic "end potential." These studies demonstrate important differences in the functional attributes of the P and VM layers studied early and late after coronary occlusion. Alterations in cell-to-cell relationships are likely very important in determining abnormalities of activation in both settings.
.A
Kienzle MG; Tan RC; Ramza BM; Young ML; Joyner RW.
.I 54973
.U
88002757
.S
Circulation 8801; 76(4):875-83
.M
Angiotensin II/*PD; Animal; Dogs; Ferricyanides/*PD; Heart Ventricle/PH; Nitroprusside/*PD; Pericardium/*PH; Pressure; Regional Blood Flow/DE; Splanchnic Circulation/DE; Stroke Volume/*DE; Support, Non-U.S. Gov't; Vascular Resistance/*DE.
.T
Modulation of vascular capacitance by angiotensin and nitroprusside: a mechanism of changes in pericardial pressure.
.P
JOURNAL ARTICLE.
.W
The aim of the present study was to test the hypothesis that vasoactive drugs may modify left ventricular diastolic function by shifting blood between the systemic vascular bed and the heart, thereby changing pericardial and left ventricular pressure. The experiments were done in 10 open-chest, anesthetized, previously splenectomized dogs in which changes in pericardial surface pressure in response to intravenous sodium nitroprusside and angiotensin were related to changes in blood volume in the abdominal region. Blood volume was determined by blood pool scintigraphy (99mTc) and regions of interest were drawn in the liver and in the mesenteric area. Angiotensin was infused at rates that were adjusted to increase mean aortic pressure by 20 and 30 mm Hg, and nitroprusside was infused at rates to decrease mean aortic pressure by 30 and 50 mm Hg. Angiotensin increased pericardial pressure by 3 and 5 mm Hg at the respective doses and there were increments in left ventricular end-diastolic pressure (LVEDP) and left ventricular diameter (sonomicrometry). Angiotensin decreased blood volume in the mesenteric region by 14% and 17%, but did not significantly change blood volume in the liver region. Angiotensin increased portal venous pressure and decreased mesenteric blood volume, suggesting decreased mesenteric venous compliance. Nitroprusside had opposite effects: pericardial pressure was decreased by 5.5 and 6.5 mm Hg by the respective doses. The doses of nitroprusside increased blood volume in the mesenteric region by 14% and 20%, but did not significantly change blood volume in the liver region.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Smiseth OA; Manyari DE; Lima JA; Scott-Douglas NW; Kingma I; Smith ER; Tyberg JV.
.I 54974
.U
88002759
.S
Circulation 8801; 76(4):891-7
.M
Angiography; Angioplasty, Transluminal/AE/*IS; Animal; Aspirin/TU; Coronary Vessels/*RA/UL; Dipyridamole/TU; Dogs; Equipment Failure; Microscopy, Electron, Scanning; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Time Factors; Warfarin/TU.
.T
Early and late results of intracoronary arterial stenting after coronary angioplasty in dogs.
.P
JOURNAL ARTICLE.
.W
Intimal dissection with acute closure represents the major complication associated with percutaneous transluminal coronary angioplasty (PTCA). Intracoronary stent devices offer the possibility of treatment for this sequela. We developed a balloon catheter-mounted, flexible coil stent for use in such cases. To determine the utility of this device and its immediate and long-term influence on arterial patency, 39 mongrel dogs had the stent placed after PTCA of the left circumflex or left anterior descending coronary arteries. Thirteen animals were treated before and after the procedure with warfarin. In this group there were three early deaths associated with stent thrombosis. Twenty-six animals were subsequently treated before and after with aspirin and dipyridamole. There were no early thrombotic events associated with stent placement in these animals. Late arteriographic examination revealed patent vessels in all dogs. Diameter stenosis for warfarin-treated dogs was 8 +/- 5% (mean +/- SD) at 2 months (n = 9), 6 +/- 4% at 6 months (n = 5), and 11 +/- 7% at 12 months (n = 3). Diameter stenosis for aspirin/dipyridamole-treated dogs was 9 +/- 3% at 2 months (n = 8), 8 +/- 5% at 6 months (n = 12), and 5% at 12 months (n = 1). Light and scanning electron microscopic analyses of stented arteries demonstrated incorporation of the stent wires into the arterial wall. Early findings included mild thrombosis localized to areas of wire entrenchment followed by rapid regrowth of endothelial and/or pseudoendothelial cells over trenches, exposed wires, and elastica.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Roubin GS; Robinson KA; King SB 3d; Gianturco C; Black AJ; Brown JE; Siegel RJ; Douglas JS Jr.
.I 54975
.U
88002761
.S
Circulation 8801; 76(4):906-15
.M
Adenosine Triphosphate/ME; Animal; Coronary Circulation/*DE; Coronary Disease/DT/ME/*PP; Deferoxamine/*PD; Electron Spin Resonance; Female; Free Radicals; Iron/*ME; Iron Chelates/PD; Myocardium/*ME; Oxygen/ME; Perfusion; Phosphocreatine/ME; Rabbits; Support, U.S. Gov't, P.H.S..
.T
Improvement of postischemic myocardial function and metabolism induced by administration of deferoxamine at the time of reflow: the role of iron in the pathogenesis of reperfusion injury.
.P
JOURNAL ARTICLE.
.W
Reperfusion of ischemic myocardium has been postulated to result in a specific oxygen radical-mediated component of tissue injury. In a previous study we demonstrated improved recovery of ventricular function and metabolism when the superoxide radical scavenger superoxide dismutase was administered at the time of postischemic reflow. Studies in vitro, have suggested that superoxide toxicity might be mediated via the generation of more reactive hydroxyl radicals in an iron-catalyzed reaction. The present study was designed to test the hypothesis that myocardial reperfusion injury might be reduced by administration of the iron chelator deferoxamine at the time of reflow, most likely by preventing hydroxyl radical formation. Sixteen isolated Langendorff rabbit hearts, perfused within the bore of a superconducting magnet, were subjected to 30 min of normothermic (37 degrees C) total global ischemia followed by 45 min of reperfusion. At reflow eight treated hearts received a 10 ml bolus containing 50 mumol of deferoxamine followed by an infusion of 11 mumol/min for the first 15 min of reflow. The hearts were then perfused with standard perfusate for an additional 30 min. Eight untreated control hearts received a similar bolus of perfusate followed by 45 min of standard reperfusion. Serial 5 min 31P nuclear magnetic resonance spectra were recorded. Myocardial phosphocreatine (PCr) content fell to 5% to 7% of control during ischemia in both groups of hearts. Deferoxamine-treated hearts recovered 99 +/- 10% of control PCr content, while untreated hearts recovered 60 +/- 16% (p less than .05). Intracellular pH fell to 5.9 during ischemia in both groups, before showing more rapid and complete recovery in treated hearts (p less than .01). Recovery of developed pressure reached 70 +/- 6% of control in treated hearts compared with 35 +/- 10% in untreated hearts (p less than .05). Iron content of the perfusate was 7 microM, and by electron paramagnetic resonance spectroscopy was in the form of Fe3+-EDTA complexes. In the effluent of treated hearts iron was in the form of Fe3+-deferoxamine chelates. In summary, administration of the iron chelator deferoxamine at the time of postischemic reflow results in greater recovery of myocardial function and energy metabolism, which supports the hypothesis that iron plays an important role in the pathogenesis of reperfusion injury.
.A
Ambrosio G; Zweier JL; Jacobus WE; Weisfeldt ML; Flaherty JT.
.I 54976
.U
88002762
.S
Circulation 8801; 76(4):916-28
.M
Adenine Nucleotides/ME; Adenosine Triphosphate/ME; Animal; Comparative Study; Coronary Circulation/DE; Coronary Disease/DT/*ME/PP; Dogs; Energy Metabolism/DE; Fatty Acids, Nonesterified/ME; Female; Glucose/ME; Hemodynamics/DE; Isosorbide Dinitrate/*PD; Male; Myocardium/*ME; Nicotinamide/*AA/PD; Oxygen/BL/ME; Recurrence; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Salutary action of nicorandil, a new antianginal drug, on myocardial metabolism during ischemia and on postischemic function in a canine preparation of brief, repetitive coronary artery occlusions: comparison with isosorbide dinitrate.
.P
JOURNAL ARTICLE.
.W
The effects of two antianginal drugs, nicorandil and isosorbide dinitrate (ISDN), on metabolism and function of the ischemic myocardium were studied in a preparation of multiple coronary occlusions in barbital-anesthetized dogs. The preparation consisted of three 5 min occlusions of the left anterior descending coronary artery interspersed by 30 min of reperfusion. An equihypotensive dose of nicorandil (7.5 micrograms/kg/min) or ISDN (12.5 micrograms/kg/min) was infused 15 min before and during the second occlusion period. Hemodynamics, myocardial segment shortening (%SS), tissue blood flow, and myocardial oxygen consumption were determined throughout. Uptake of free fatty acids (FFA), glucose, and lactate were determined during control and ischemic periods. At the end of the final 30 min reperfusion period, biopsy samples of transmural tissue were taken for analysis of phosphocreatine, adenine nucleotides, and total tissue water content. No major hemodynamic changes were produced by either drug except for a 5 to 10 mm Hg decrease in mean aortic pressure. Compared with untreated and ISDN-treated hearts, hearts of dogs treated with nicorandil exhibited reversal of a significant increase in FFA uptake during recurrent ischemia. This was accompanied by an attenuation of the increase in oxygen extraction and CO2 production in the ischemic zone by nicorandil, but not by ISDN. Nicorandil, but not ISDN, improved %SS during reperfusion. Endocardial ATP and total adenine nucleotides were preserved in both nicorandil- and ISDN-treated hearts. Tissue edema was also attenuated by both compounds. Thus, nicorandil improved both function and metabolism during recurrent myocardial ischemia independent of a hemodynamic effect, whereas ISDN only attenuated the loss of adenine nucleotides and increase in tissue water.
.A
Pieper GM; Gross GJ.
.I 54977
.U
88002763
.S
Circulation 8801; 76(4):929-42
.M
Animal; Blood Flow Velocity; Coronary Circulation; Coronary Disease/PA/*PP; Dogs; Electrocardiography; Heart/*PP; Hemodynamics; Models, Cardiovascular/*; Myocardial Contraction; Myocardium/*PA; Support, U.S. Gov't, P.H.S..
.T
The functional border zone in conscious dogs.
.P
JOURNAL ARTICLE.
.W
Studies focusing on the functional border zone have been performed largely with anesthetized, open-chest preparations. Therefore, we instrumented 14 dogs at sterile surgery with sonomicrometers arrayed to measure systolic wall thickening across the perfusion boundary produced by circumflex coronary occlusion. We fitted sigmoid curves to the data to model the distribution of wall thickening impairment as a function of distance from the perfusion boundary, which was delineated with myocardial blood flow (15 micron diameter microspheres) maps. Using this approach, we defined the functional border zone as the distance from the perfusion boundary to 97.5% of the sigmoid curve's nonischemic asymptote. The lateral extent of the functional border zone, measured 10 min and 3 hr after occlusion, was 32 and 28 degrees of circumference, respectively. To evaluate the severity of nonischemic dysfunction, we measured average systolic wall thickening within the functional border zone. It was reduced from 3.69 +/- 1.10 (mean +/- SD) mm to 2.98 +/- 1.07 mm (p less than .01) and 2.74 +/- 1.12 mm (p less than .01) early and late after coronary occlusion. Thus, a narrow functional border zone was evident during circumflex coronary occlusion in conscious dogs. Its lateral extent was limited to approximately 30 degrees (similar to findings in open-chest, anesthetized dogs), severe dysfunction was restricted to the immediate vicinity of the perfusion boundary, and the average severity of nonischemic dysfunction within the functional border zone was mild.
.A
Gallagher KP; Gerren RA; Ning XH; McManimon SP; Stirling MC; Shlafer M; Buda AJ.
.I 54978
.U
88002764
.S
Circulation 8801; 76(4):943-51
.M
Animal; Comparative Study; Coronary Circulation/DE; Coronary Disease/*DI/PP; Diagnostic Imaging; Dipyridamole/*DU; Dobutamine/*DU; Dogs; Echocardiography; Male; Microspheres; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
The physiologic basis of dobutamine as compared with dipyridamole stress interventions in the assessment of critical coronary stenosis.
.P
JOURNAL ARTICLE.
.W
Noninvasive cardiac imaging with echocardiography or thallium-201 scintigraphy utilizing pharmacologic agents as alternatives to exercise is gaining popularity. We investigated the physiologic rationale underlying the optimal choice of pharmacologic stress for functional versus perfusion imaging. With the use of an open-chest dog model, a critical stenosis of the left circumflex coronary artery was produced with total ablation of hyperemic response to a 15 sec period of complete occlusion. Regional left ventricular wall thickening was assessed by quantitative two-dimensional echocardiography. Regional myocardial blood flow was determined by microspheres in both the flow-restricted left circumflex area and the control area supplied by the left anterior descending artery. Eight dogs received 15 micrograms/kg/min dobutamine intravenously for 10 min, and nine dogs received 0.14 mg/kg/min dipyridamole intravenously for 4 min. Dobutamine induced wall thickening abnormalities in all dogs while dipyridamole induced dysfunction in only 55% of the animals studied (p less than .01). Subendocardial blood flow to the left circumflex area was unchanged after both dobutamine and dipyridamole when compared with baseline blood flow. However, subendocardial blood flow increased markedly after dipyridamole in the control area. Regional subendocardial blood flow ratio (left anterior descending/left circumflex) was 3.74 +/- 0.09 (mean +/- SEM) after dipyridamole versus 1.27 +/- 0.09 after dobutamine (p less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Fung AY; Gallagher KP; Buda AJ.
.I 54979
.U
88002765
.S
Circulation 8801; 76(4):952-9
.M
Animal; Coronary Circulation/*; Coronary Disease/*PP; Dogs; Drug Antagonism; Epinephrine/BL; Hemodynamics; In Vitro; Ketanserin/PD; Male; Muscle Contraction/DE; Muscle, Smooth, Vascular/PH; Platelet Aggregation/DE; Prostaglandin Endoperoxides/*PH; Prostaglandin Endoperoxides, Synthetic/*PH; Prostaglandins H/*PH; Rats; Receptors, Prostaglandin/*PH; Receptors, Serotonin/*PH; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Thromboxane A2/*PH.
.T
Cooperative mediation by serotonin S2 and thromboxane A2/prostaglandin H2 receptor activation of cyclic flow variations in dogs with severe coronary artery stenoses.
.P
JOURNAL ARTICLE.
.W
We have reported previously that thromboxane A2/prostaglandin (PG)H2 and serotonin independently mediate the occurrence of cyclic flow variations (CFVs) in a canine preparation of severe coronary artery narrowing. This may be due to an effect of these substances on platelets and/or the vascular wall. We tested the hypothesis that there is a cooperative effect between thromboxane A2/PGH2 and serotonin receptor stimulation in the development of CFVs in this animal preparation. After placement of a hard plastic cylindrical constrictor around the left anterior descending coronary artery, CFVs develop and are characterized by repetitive cycles of declines in coronary blood flow and abrupt increases in flow. In a control group of dogs, CFV frequency (cycles/hour) and severity (lowest coronary blood flow just before its restoration) did not change significantly over a 3 hr interval. In a second group of dogs, CFVs were established after constrictor placement, abolished with the serotonin (5HT2) receptor antagonist ketanserin, and reestablished by the continuous infusion of serotonin into the left atrium. Serotonin-induced CFVs were then abolished with a thromboxane A2/PGH2 receptor antagonist, SQ29,548, or a thromboxane synthetase inhibitor, dazoxiben (UK37,248). The relative specificity of the respective antagonists, SQ29,548 and ketanserin, was determined in canine platelets and rat aortic vascular strips. No significant cross-reactivity between ketanserin and SQ29,548 was found. Thus, the data obtained in these studies demonstrate a cooperative interaction between thromboxane A2/PGH2 and serotonin S2 receptors that contributes to the development of CFVs in this experimental preparation.
.A
Ashton JH; Ogletree ML; Michel IM; Golino P; McNatt JM; Taylor AL; Raheja S; Schmitz J; Buja LM; Campbell WB; et al.
.I 54980
.U
88002768
.S
Circulation 8801; 76(4 Pt 2):IV1-IV655
.M
Animal; Cardiovascular Diseases/*; Cardiovascular System/*PH; Heart/*PH; Heart Diseases/*; Human.
.T
Abstracts from the 60th scientific sessions. American Heart Association. Anaheim, November 16-19, 1987.
.P
JOURNAL ARTICLE.
.I 54981
.U
88003093
.S
Clin Nephrol 8801; 28(2):102-3
.M
Comparative Study; Fibrinopeptides A/AN; Hemodialysis/*IS; Heparin/*TU; Human; Needles.
.T
Heparin requirement in hemodialysis, a comparison between single-needle and two-needle dialysis [letter]
.P
LETTER.
.A
Lins LE; Ljungberg B; Soderstrom PO.
.I 54982
.U
88003094
.S
Clin Nephrol 8801; 28(2):103
.M
Case Report; Female; Human; Kidney Failure, Acute/*CI; Middle Age; Nephrotic Syndrome/*CI; Propionates/*AE; Propionic Acids/*AE.
.T
Severe nephrotic syndrome with acute renal failure after fenbufen [letter]
.P
LETTER.
.A
Levy M; Rondeau E; Leleu-Nahmias G; Mougenot B; Sraer JD.
.I 54983
.U
88003095
.S
Clin Nephrol 8801; 28(2):103-4
.M
Aged; Case Report; Diclofenac/*AE; Female; Human; Kidney Failure, Acute/*CI; Kidney Tubular Necrosis, Acute/*CI; Pyelonephritis/*DT.
.T
Acute tubular necrosis associated with acute pyelonephritis and concomitant diclofenac therapy [letter]
.P
LETTER.
.A
Hannedouche T; Dehaine V; Noel LH; Jungers P.
.I 54984
.U
88003096
.S
Clin Nephrol 8801; 28(2):104
.M
Acute Disease; Anemia, Macrocytic/*CI; Anemia, Megaloblastic/*CI; Case Report; Chloroguanide/*PO; Hemodialysis/*AE; Human; Kidney Failure, Chronic/TH; Male; Middle Age.
.T
Proguanil poisoning in a hemodialysis patient [letter]
.P
LETTER.
.A
Tattersall JE; Greenwood RN; Baker LR; Cattel WR.
.I 54985
.U
88003097
.S
Clin Nephrol 8801; 28(2):105-6
.M
Adult; Bartter's Disease/*CO/DT; Case Report; Female; Human; Hyperaldosteronism/*CO; Hypotension, Orthostatic/DT/*ET; Indomethacin/TU.
.T
Severe orthostatic hypotension due to Bartter's syndrome [letter]
.P
LETTER.
.A
Lasaridis AN; Pitsariotis B; Syrganis C; Gatzis C; Brettou E; Tourkantonis A.
.I 54986
.U
88003102
.S
Clin Nephrol 8801; 28(2):81-6
.M
Administration, Oral; Child; Female; Human; Male; Nephrotic Syndrome/BL/*DT; Pyridoxal Phosphate/*BL; Pyridoxine/AD/*PD; Serum Albumin/AN.
.T
The effect of pyridoxine supplementation on plasma pyridoxal-5'-phosphate levels in children with the nephrotic syndrome.
.P
JOURNAL ARTICLE.
.W
Nineteen children with low plasma pyridoxal-5'-phosphate (PLP) levels in the nephrotic syndrome due to a variety of histological entities were successfully supplemented with oral pyridoxine hydrochloride. A dose of approximately 2 mg/kg/day of pyridoxine hydrochloride was found to effect adequate plasma PLP levels in most cases. A significant (p less than 0.001) positive correlation (r = 0.83) was found between plasma albumin and PLP levels prior to supplementation and after supplementation both in relapse and remission. Although vitamin B6 repletion led to no demonstrable effect on the clinical course of the syndrome, in view of the possible role which vitamin B6 deficiency may play in defective immune response and thromboembolic phenomena, both being known complications of the nephrotic syndrome, the administration of vitamin B6 supplements is recommended in the active disease state.
.A
van Buuren AJ; Louw ME; Shephard GS; Labadarios D.
.I 54987
.U
88003103
.S
Clin Nephrol 8801; 28(2):87-92
.M
Adult; Dietary Proteins/*AD; Dopamine/*PD; Female; Glomerular Filtration Rate/DE; Human; Kidney/DE/*PP; Kidney Function Tests; Male; Middle Age; Renal Circulation/DE.
.T
Measurement of renal functional reserve of the single kidney in man.
.P
JOURNAL ARTICLE.
.W
The renal functional reserve capacity (RFRC) and response of the single kidney to a low protein diet (LPD) were investigated. Effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) were measured using a single injection of I125 Hippuran and Cr51 EDTA during a dopamine infusion (3 micrograms/kg/min) and after 2 weeks on a LPD (0.6 g/kg/day). Dopamine increased ERPF but the associated rise in GFR was not significant. There was a significant decrease in both ERPF and GFR on LPD. The change in GFR during dopamine infusion, but not during LPD, correlated inversely with baseline GFR. Dopamine and LPD had no effect on heart rate or blood pressure and LPD did not alter urinary sodium excretion. These results suggest that the single kidney lacks functional reserve capacity and that protein restriction may be useful in preserving long term function.
.A
Wheeler DC; Cosgriff PS; Bennett SE; Walls J.
.I 54988
.U
88003105
.S
Clin Nephrol 8801; 28(2):99-101
.M
Age Factors; Aged; Biopsy; Case Report; Female; Human; Kidney/*PA; Nephrosis, Lipoid/*PA.
.T
Minimal change glomerulonephritis in the elderly--the role of renal biopsy.
.P
JOURNAL ARTICLE.
.W
We describe the case histories of three septuagenarians with nephrotic syndrome who would not have been thought likely to have had minimal change disease on clinical grounds. Yet in the three patients all non-sclerosed glomeruli were normal on light microscopy and glomerular immunofluorescence was negative. All three showed a good clinical response to steroids. It is clear from our findings that, in the elderly, clinical criteria are not a reliable guide to renal histology and may lead to a potentially treatable condition, minimal change nephropathy, being overlooked. Because of the high incidence of side effects, a trial of steroids in the elderly is hazardous. From the evidence given we conclude that renal biopsy, in adults with nephrotic syndrome, becomes increasingly useful with advancing age.
.A
Allen MJ; Thomas AC; Eastwood JB.
.I 54989
.U
88003147
.S
Clin Obstet Gynecol 8801; 30(3):485-630
.M
Anesthesia, Obstetrical/*; Female; Human; Infant, Newborn; Pregnancy.
.T
Obstetric analgesia and anesthesia.
.P
JOURNAL ARTICLE.
.I 54990
.U
88003161
.S
Clin Obstet Gynecol 8801; 30(3):631-778
.M
Child; Female; Genital Diseases, Female/*; Gynecology/*; Human; Pediatrics/*.
.T
Pediatric gynecology.
.P
JOURNAL ARTICLE.
.I 54991
.U
88003183
.S
Clin Orthop 8801;  (223):11-9
.M
Adult; Athletic Injuries/DI/SU/TH; Case Report; Human; Male; Shoulder Dislocation/*DI/SU/TH; Syndrome; Time Factors.
.T
Recurrent transient anterior subluxation of the shoulder. The "dead arm" syndrome.
.P
JOURNAL ARTICLE.
.W
The recurrent transient anterior subluxation (the "dead arm" syndrome) is an accepted clinical syndrome seen most commonly in young athletes or individuals whose arms have been forcefully hyperextended in elevation and external rotation. Care must be taken to differentiate other causes of painful shoulder. With an accurate diagnosis, the results of conservative or operative treatment are most favorable. If surgical treatment is carried out, careful layer-by-layer dissection is required to properly identify and correct anatomic abnormalities.
.A
Rowe CR.
.I 54992
.U
88003184
.S
Clin Orthop 8801;  (223):113-25
.M
Arthroscopy/*; Human; Joint Diseases/*PA/SU; Joint Instability/PA/SU; Joint Loose Bodies/PA/SU; Shoulder Joint/*AH/IN/PA.
.T
The shoulder joint. An arthroscopist's perspective of anatomy and pathology.
.P
JOURNAL ARTICLE.
.W
Arthroscopy has had a great impact on shoulder surgery by adding another dimension to the surgical anatomy. The present benefits of arthroscopy of the shoulder include the establishment of an accurate diagnosis in the glenohumeral joint, subacromial space, and acromioclavicular joint. Various pathologic entities can be visualized. The efficacy and end results of several arthroscopic surgical procedures are under investigation. Patient selection, the pathologic diagnosis, and end results are important considerations in evaluating newly devised arthroscopic methods of treatment of shoulder syndromes.
.A
Johnson LL.
.I 54993
.U
88003185
.S
Clin Orthop 8801;  (223):126-36
.M
Adult; Female; Human; Male; Methods; Middle Age; Nerve Compression Syndromes/*DI/SU; Shoulder Joint/*IN.
.T
Suprascapular nerve entrapment. Diagnosis and treatment.
.P
JOURNAL ARTICLE.
.W
Nine patients were found to have suprascapular nerve entrapment confirmed by electromyographic studies after the diagnosis was suspected. Eight patients who had a surgical release of the suprascapular ligament had good and excellent results. Except in rare cases, a positive electromyogram (EMG) including a delayed nerve conduction (using a coaxial needle) is necessary confirming evidence of the need for surgical treatment. The recommended surgical technique involves detaching the trapezius muscle from the spine of the scapula and opening the space overlying the suprascapular ligament. The trapezius is retracted cephalad while the supraspinatus is retracted caudad. This exposure avoids injury to the spinal accessory nerve and promotes a rapid rehabilitation. Suprascapular nerve entrapment should be suspected and included in the differential diagnosis of ill-defined shoulder pain.
.A
Post M; Mayer J.
.I 54994
.U
88003186
.S
Clin Orthop 8801;  (223):137-44
.M
Acromion/*SU; Adult; Female; Human; Male; Methods; Middle Age; Pain/*ET/TH; Retrospective Studies; Scapula/*SU; Shoulder/*.
.T
Conservative open anterior acromioplasty.
.P
JOURNAL ARTICLE.
.W
The records of 29 consecutive patients treated by a pure, open, anterior acromioplasty were reviewed retrospectively. Excluded from consideration were patients with the following pathologic diagnoses or histories: (1) previously attempted acromioplasty on the same shoulder; (2) intraoperatively confirmed rotator cuff tear; (3) any surgically treatable biceps tendon or acromioclavicular abnormality; (4) lost to follow-up study. Three different techniques were employed to perform the acromioplasties. The first technique required partial deltoid origin detachment with an osteotome. The second technique spared the deltoid origin, while again using an osteotome to perform the acromioplasty. The third technique also spared the deltoid origin but used a high-speed burr to perform the acromioplasty. Evaluated in terms of patient satisfaction, residual pain, length of convalescence, suboptimal results, and complications, the first technique proved to be the least effective. The second technique produced early, excellent results. The third technique, in which a burr was employed through an intact deltoid origin, was most effective; technically, the method was also relatively simple and reliable.
.A
McShane RB; Leinberry CF; Fenlin JM Jr.
.I 54995
.U
88003187
.S
Clin Orthop 8801;  (223):145-54
.M
Case Report; Human; Intervertebral Disk/*SU; Intervertebral Disk Displacement/*SU; Lumbar Vertebrae/SU; Male; Methods; Middle Age.
.T
Percutaneous posterolateral discectomy. Anatomy and mechanism.
.P
JOURNAL ARTICLE.
.W
The evacuation and decompression of the herniated lumbar disc through a sheath inserted dorsolaterally represents a new concept in the treatment of radiculopathy associated with disc herniation. Only a small portion of the spinal nerve before its decent and positioning anterior to the transverse process is subject to insult by an instrument introduced into the intervertebral disc through a posterolateral approach. The chance of injury to the spinal nerve is further minimized when the instruments are introduced a distance of approximately 9-10 cm from the midline, parallel to the vertebral plates, and penetrating the annulus at 10 o'clock or 2 o'clock. The rapid decline of intradiscal pressure after dorsolateral fenestration of the annulus appears to be an important factor in the relief of sciatic pain following percutaneous posterolateral discectomy. The evacuation and decompression of an extruded intervertebral disc with a straight instrument may not be possible. Patients with sequestered disc require laminectomy.
.A
Kambin P; Brager MD.
.I 54996
.U
88003188
.S
Clin Orthop 8801;  (223):155-63
.M
Aged; Case Report; Cervical Vertebrae/SU; Human; Intervertebral Disk/*SU; Male; Pseudarthrosis/*ET/SU; Spinal Fusion/*AE; Spinal Osteophytosis/SU.
.T
Nonunion following two-level anterior cervical discectomy and fusion.
.P
JOURNAL ARTICLE.
.W
Nonunion is a potential complication of anterior cervical discectomy and fusion (ACDF). There are reports that cite the prevalence of nonunion for two-level ACDF with various fusion techniques, but they do not recommend treatment alternatives. Pseudarthrosis after a two-level ACDF occurred in a 69-year-old man. Posterior cervical wiring and autograft resulted in a successful fusion anteriorly and posteriorly. Posterior fusion augments stability, enhances the potential for eventual anterior fusion, avoids the risks of an additional anterior procedure, and is an excellent therapeutic alternative to a second anterior attempt at stabilization.
.A
Lindsey RW; Newhouse KE; Leach J; Murphy MJ.
.I 54997
.U
88003189
.S
Clin Orthop 8801;  (223):164-9
.M
Adolescence; Child; Female; Human; Male; Orthotic Devices/*; Scoliosis/RA/*TH; Spine/*RA.
.T
Influence of the Wilmington brace on spinal decompensation in adolescent idiopathic scoliosis.
.P
JOURNAL ARTICLE.
.W
The Wilmington brace is a custom-molded thoracolumbosacral orthosis for decompensated adolescent idiopathic curves. Using the roentgenographic measurement of Rudicel and Renshaw, 71 patients with pretreatment curves that were decompensated greater than 1.0 cm were investigated in detail. The average follow-up period was two years. There was no correlation between pretreatment Cobb angle and the magnitude of spinal decompensation. Pretreatment decompensation averaged 1.9 cm for 22 thoracic curves, 2.5 cm for 32 thoracolumbar-lumbar curves, and 2.4 cm for 17 double-structural curves. Overall, decompensation was improved in 50 patients (70%). Improvement in spinal decompensation averaged 1.4 cm for thoracic, 1.4 cm for thoracolumbar-lumbar, and 1.5 cm for double-structural curves, with decompensation in 27 patients (38%) measuring less than 1.0 cm at follow-up evaluation. An increase in spinal decompensation, averaging 1.2 cm, was found in 6% (one thoracic, two thoraco-lumbar-lumbar, and one double-structural curve). Spinal compensation is favorably influenced in the majority of patients treated with Wilmington brace for adolescent idiopathic scoliosis.
.A
Bassett GS; Bunnell WP.
.I 54998
.U
88003190
.S
Clin Orthop 8801;  (223):170-4
.M
Adolescence; Child; Female; Follow-Up Studies; Fracture Fixation, Internal/*; Human; Humeral Fractures/*SU; Male.
.T
Operative treatment of Medial epicondyle fractures in children.
.P
JOURNAL ARTICLE.
.W
Thirty-one patients with fractures of the medial epicondyle displaced more than 2 mm were evaluated an average of four years after their injury. Twenty-three patients had good results regardless of the degree of displacement or the presence of an elbow dislocation. One patient, had a poor result due to a technical error in pin placement. The remaining seven patients had the fracture fragment trapped in the joint and did worse, with three poor results. There was no correlation between range of motion and degree of displacement, length of immobilization, time from injury to surgery, presence of a dislocation, or open versus percutaneous treatment. Operative treatment of medial epicondyle fractures displaced greater than 2 mm gave consistently good results with a good range of motion, good stability, no ulnar nerve symptoms, and no deformity.
.A
Hines RF; Herndon WA; Evans JP.
.I 54999
.U
88003191
.S
Clin Orthop 8801;  (223):175-80
.M
Adult; Aged; Arthritis/*SU; Elbow Joint/*SU; Follow-Up Studies; Human; Joint Prosthesis/*; Middle Age; Postoperative Complications.
.T
Capitellocondylar total elbow arthroplasty. Two-to eight-year experience.
.P
JOURNAL ARTICLE.
.W
A series of 35 capitellocondylar total elbow arthroplasties was performed on 29 patients. The average patient age at the time of surgery was 58 years (range, 28-71 years). Follow-up study averaged 5.6 years (range, 2-8 years). The complication rate was 57%. There were three infections, three dislocations, and two intraoperative fractures. Transient ulnar nerve palsy occurred in nine patients, postoperative hematomas in two patients, and intraoperative perforation of the ulna cortex in one patient. Aseptic loosening occurred around the humeral component of one elbow. No ulnar components developed aseptic loosening. Range of motion increased in all planes, except extension. Pain relief was achieved in all but one patient. There were no unstable elbows.
.A
Trancik T; Wilde AH; Borden LS.
.I 55000
.U
88003192
.S
Clin Orthop 8801;  (223):181-7
.M
Adult; Case Report; Comparative Study; Femur Head/*PA; Femur Head Necrosis/*DI/PA; Human; Magnetic Resonance Imaging/*; Male.
.T
Ischemic necrosis of the femoral head. Correlation of magnetic resonance imaging and histologic sections.
.P
JOURNAL ARTICLE.
.W
Magnetic resonance (MR) images were correlated with matched histologic sections of a resected ischemic necrotic femoral head and neck. Preoperative radiographs had revealed Stage 3 ischemic necrosis. Preoperative MR images disclosed foci of abnormally low signal intensity alternating with normal-appearing foci of high signal intensity. Surgical resection of the femoral head and neck was followed by MR imaging and pathologic sectioning, fixation, and staining, enabling the individual sections to be compared with the postoperative MR slices. A subchondral focus of diminished signal intensity was shown to represent saponified fat and consisted of a transudate of proteinaceous material with probable calcifications. The subjacent region of normal, high signal intensity represented "mummified" fat. The next lower stratum of diminished signal intensity was composed of fibrous and vascular tissues and histiocytic infiltrates that had extensively or completely replaced the fatty marrow.
.A
Bassett LW; Mirra JM; Cracchiolo A 3d; Gold RH.
.I 55001
.U
88003193
.S
Clin Orthop 8801;  (223):188-93
.M
Adult; Anticoagulants/TU; Filtration/IS; Hip Fractures/*SU; Hip Prosthesis/*; Human; Postoperative Complications/*PC; Thrombophlebitis/*PC; Tourniquets; Venae Cavae.
.T
Survey of prophylaxis against venous thromboembolism in adults undergoing hip surgery.
.P
JOURNAL ARTICLE.
.W
Venous thromboembolic disease (VTED) is the most common and potentially the most serious immediate postoperative complication of hip surgery. Prophylaxis of VTED remains controversial and its practice is widely variable. Since the last survey of VTED prophylaxis as practiced by American orthopedists, published in 1974, the literature has expanded tremendously and the number of orthopedists has doubled. The authors surveyed 10% of American orthopedists and the chiefs of training programs and/or major teaching hospitals to assess current practices. The average practicing orthopedist responding was 44-years-old and had performed 17.6 total hip arthroplasties and treated operatively 30.6 hip fractures per year during the last five years. The average responding chief surgeon, was 49 years old and had performed 49 total hip arthroplasties and treated operatively 20.5 hip fractures per year during the last five years. Most surgeons use pharmacologic prophylaxis or external pneumatic compression for total hip arthroplasty patients (84.4%) and hip fracture patients (74%). Warfarin has been tried and abandoned by 50% of all respondents, largely because of bleeding complications. Aspirin was the most popular agent. However, more than 25% of the respondents stated that at least one of their patients who had elective total hip arthroplasties had died of pulmonary embolism during the last five years.
.A
Paiement GD; Wessinger SJ; Harris WH.
.I 55002
.U
88003194
.S
Clin Orthop 8801;  (223):194-7
.M
Aged; Case Report; Clostridium Infections/*CO; Female; Hip Prosthesis; Human; Joint Diseases/*ET; Joint Prosthesis/*; Knee Prosthesis; Middle Age; Pneumococcal Infections/*CO; Septicemia/*CO; Time Factors.
.T
Delayed postbacteremic prosthetic joint infection.
.P
JOURNAL ARTICLE.
.W
Deep infection of a prosthetic joint is a devastating complication. One proposed mechanism of late prosthetic joint infection involves hematogenous spread from an extraarticular focus of infection. Two cases clearly demonstrate hematogenously acquired prosthetic joint infections, one caused by Clostridium perfringens and the other by Streptococcus pneumoniae. These cases were unusual in that a long asymptomatic period intervened between the primary bacteremic illness and the subsequent prosthetic infection. Patients with prosthetic joints who develop bacteremic infection at extraarticular sites should be treated promptly and aggressively with appropriate antibiotics. Prophylactic antibiotics should be strongly considered in the patient with a prosthetic joint who undergoes procedures likely to be associated with a bacteremia. Transient arthralgias at the time of bacteremia may represent the onset of the joint infection and should not be overlooked or attributed a priori to the patient's underlying arthritic or medical condition.
.A
Maniloff G; Greenwald R; Laskin R; Singer C.
.I 55003
.U
88003195
.S
Clin Orthop 8801;  (223):198-207
.M
Human; Implants, Artificial; Joint Instability/*DI/ET; Knee Injuries/*SU; Ligaments, Articular/*IN/SU; Orthopedic Equipment/*; Polytetrafluoroethylene; Tendon Transfer.
.T
The clinical relevance of instrumented testing for ACL insufficiency. Experience with the UCLA clinical knee testing apparatus.
.P
JOURNAL ARTICLE.
.W
An instrumented clinical testing device developed at UCLA records a continuous anteroposterior force versus displacement curve of the tibia with respect to the femur at 20 degrees of flexion. Laxity and stiffness are calculated from the response curve. With this device, 95% of normal knees have an anterior laxity less than 7.5 mm and a side-to-side difference less than 2 mm. In contrast, an anterior cruciate ligament (ACL) absent knee has a mean anterior laxity of 10 mm and a mean side-to-side difference of 5 mm. In a small group of patients with an intraarticular ACL substitution using the medial or lateral one-third of the patellar tendon, laxity and stiffness of the injured knees were returned to within the normal range and remained constant three years after surgery. In a group of 76 patients treated with ACL substitution using the torn meniscus, 51% of the patients still had an anterior laxity outside the normal range 3.5 years after surgery. In a preliminary study of 19 patients receiving a Gore-Tex synthetic ACL substitution, 55% of the patients still had a side-to-side difference greater than 2 mm two years after the procedure. These studies illustrate the advantages of impartial, objective measurements of knee stability. Laxity and stiffness values can supplement, but never replace, a thorough patient examination and patient history. As sports medicine matures as a scientific discipline, improved instrumented test devices may ultimately provide a standardized means for reporting knee stability parameters.
.A
Markolf KL; Amstutz HC.
.I 55004
.U
88003196
.S
Clin Orthop 8801;  (223):20-31
.M
Adult; Female; Human; Joint Instability/DI; Male; Postoperative Complications/*DI; Shoulder Dislocation/*SU; Syndrome; Thoracic Outlet Syndrome/*DI.
.T
The relationship between dead arm syndrome and thoracic outlet syndrome.
.P
JOURNAL ARTICLE.
.W
A relationship exists between anterior shoulder subluxation and thoracic outlet syndrome that is responsible for the more florid symptoms of dead arm syndrome (DAS) in some patients. This relationship was demonstrated in eight of 27 patients (30%) in a consecutive series of Bankart operations for treatment of subluxation. The mechanism is associated with a disturbance in the kinesiology of the shoulder-joint complex that alters the position of the scapula relative to the rib cage and neurovascular supply to the upper limb. Therapy is directed toward restoration of the stability of the glenohumeral joint so that normal biomechanics can be reestablished. In advanced stages of thoracic outlet syndrome, however, DAS may initially require surgical decompression of the nerves and vessels. Careful attention to postural mechanics is essential for rational diagnosis and treatment of DAS.
.A
Leffert RD; Gumley G.
.I 55005
.U
88003197
.S
Clin Orthop 8801;  (223):208-12
.M
Adult; Aged; Female; Hip Prosthesis/*; Human; Male; Middle Age; Prosthesis Design; Prosthesis Failure.
.T
Femoral component geometry. A factor in total hip arthroplasty durability.
.P
JOURNAL ARTICLE.
.W
The theoretically conceived geometric design for femoral components, including a longer length, an extended width, and a stiffer modulus, is expressed in the clinical design of the Buck-32 prosthesis. This prosthesis was used in 110 patients with 122 hip arthroplasties between 1975 and 1979, giving a follow-up period of five to nine years (average, 7 years). Femoral loosening requiring revision surgery occurred in 2.3% of the patient population. Radiolucencies were noted in 24% of the cases but were progressive in only 17%. Complications were minimal, as were bone changes about the prosthetic units. There is clinical evidence in the literature, substantiated by this study, that geometric design does influence the durability of a cemented femoral component.
.A
Mallory TH.
.I 55006
.U
88003198
.S
Clin Orthop 8801;  (223):213-9
.M
Ankle Joint/*; Human; Joint Diseases/*PP; Knee Joint/*; Tibial Fractures/*PP; Wound Healing.
.T
A method of determining the angular malalignments of the knee and ankle joints resulting from a tibial malunion.
.P
JOURNAL ARTICLE.
.W
Malalignments of the knee and ankle joints resulting from tibial angular malunion can be determined using mathematical analysis. The angular deformity of the tibia is equal to the sum of the angular malalignments formed by the knee and ankle joints in relation to the horizontal plane. These malalignments are not equal. A larger percentage of the deformity is reflected inferiorly as the deformity approaches the ankle joint. A table was formulated to provide the corresponding degrees of joint malalignment (knee and ankle) for tibial angular deformities at different positions along the tibia. The analysis provides a useful tool to quantify the knee and ankle joint malalignments secondary to tibial angular malunion. Although designation of prognosis at different degrees of angular deformity is beyond the scope of this study, it does provide improved correlation between tibial angular deformities and the clinical outcome, e.g., degenerative arthroses of the adjacent joints, in future studies on tibial fractures.
.A
Puno RM; Vaughan JJ; von Fraunhofer JA; Stetten ML; Johnson JR.
.I 55007
.U
88003199
.S
Clin Orthop 8801;  (223):220-4
.M
Adult; Aged; Aged, 80 and over; Female; Human; Knee Prosthesis/*; Male; Middle Age; Patella/*SU; Prognosis.
.T
Total knee arthroplasty following patellectomy.
.P
JOURNAL ARTICLE.
.W
Eleven patients with a previous patellectomy and primary total knee arthroplasty (TKA) had chart reviews, recent clinical examinations, evaluation of roentgenograms, rating of knee arthroplasty on a standard scale, and quantitation of quadriceps and hamstring torque using an isokinetic dynamometer. Good to excellent results were present in only five of the 11 knees studied, compared with 11 of 11 patients in a control group with intact patellae. Quadriceps and hamstring torque and strength were diminished relative to the control groups. Factors that correlated with a success or failure of TKA in patients with previous patellectomy included: number of previous knee operations, three or less; presence of severe arthritic changes roentgenographically; and quadriceps performance of greater than 40 ft-lb at 30 degrees/second testing speed. Patients without patellae who lack these favorable prognostic factors for a successful TKA should be strongly considered for bracing or primary arthrodesis, rather than knee arthroplasty.
.A
Lennox DW; Hungerford DS; Krackow KA.
.I 55008
.U
88003200
.S
Clin Orthop 8801;  (223):225-36
.M
Adolescence; Child; Child, Preschool; Female; Gait/*; Human; Knee Joint/*PP; Male; Neuromuscular Diseases/*PP; Support, Non-U.S. Gov't.
.T
Contralateral compensation with knee impairment.
.P
JOURNAL ARTICLE.
.W
Knee motion of four healthy teenagers was unilaterally impaired by means of cast braces. Computerized analysis from video recording of walking was used to study the compensatory effects and to compare them with six patients. Restricted knee flexion caused little change in stance-phase knee motion on the restricted side. The unimpaired knee displayed exaggerated stance phase flexion and phase shifts, which in turn produced pelvic vaulting. The forces on the braces were high. Impairments to extension produced bilateral crouch without loss of flexion extension patterns within the limits of the impairment. Fatigue was more prominent than with blocks to flexion. Circumduction was found to be overrated as a compensation for stiff-leggedness. Lateral shift to the well side, combined with freezing of the well-side stance adduction, was a frequently used effective clearance mechanism. Phasic changes in motion of many body parts may combine to produce low-level pelvic displacement, especially when clinical weakness is present. Shortened stride length is the most sensitive indicator of this phenomenon. Graphs of individual joint motion do not easily convey the important phasic relationships that are fundamental to that motion and to the interpretation of its effects. Stick figures were better for analysis of this aspect of motion analysis, even though they are more subjective.
.A
Nuzzo RM; Jolly J; Langrana NA.
.I 55009
.U
88003201
.S
Clin Orthop 8801;  (223):237-46
.M
Adolescence; Bone Neoplasms/*SU; Case Report; Human; Knee/*SU; Male; Methods; Osteoma, Osteoid/*SU; Tibia/*SU.
.T
Limited posterolateral surgical approach to the knee for excision of osteoid osteoma.
.P
JOURNAL ARTICLE.
.W
An 18-year-old man suffered four years of undiagnosed knee pain until a CAT scan revealed an epiphyseal osteoid osteoma of the tibia located subchondrally, just medial to the proximal tibiofibular joint. A nidus in this location is not easily accessible, and its proximity to the joint surface raised concerns about damage to the tibial plateau. To facilitate excision of the tumor, cadaveric dissections were performed to develop a limited posterior approach to the proximal, lateral portion of the tibia. The CAT scan was used to calculate the precise dimensions of the tumor and its relation to the posterior tibial cortex and the proximal tibiofibular joint. With the use of the exposure developed in the laboratory and the calculations derived from the CAT scan, the tumor could be excised by removing a single block of bone 15 mm3. Intraoperative radiographs confirmed the presence of the nidus within the excised block of bone. This case report reaffirms the frequent difficulties and tardiness in diagnosing osteoid osteomas and the need to include these tumors in the differential diagnosis of knee pain and epiphyseal lesions. Before CAT scans were used, the working diagnoses were torn meniscus, juvenile rheumatoid arthritis, and bone hemangiomatosis.
.A
Minkoff J; Jaffe L; Menendez L.
.I 55010
.U
88003202
.S
Clin Orthop 8801;  (223):247-51
.M
Aged; Aged, 80 and over; Ankle Joint/*; Anticoagulants/*AE; Arthritis/*ET; Case Report; Hemarthrosis/*CI; Human; Male; Warfarin/AE.
.T
Destructive monarticular arthritis secondary to anticoagulant therapy.
.P
JOURNAL ARTICLE.
.W
Hemarthrosis secondary to anticoagulant therapy is a well-known clinical problem. The pathologic process usually occurs in large joints and is reversible with the discontinuation of the anticoagulant medication. The condition presented for consideration here is unusual for two reasons. First, it is relatively uncommon for the ankle joint to be involved. Second, the destructive arthritis progressed after the medication was discontinued. Resting the involved joint until symptoms subside is often adequate treatment for anticoagulant-induced hemarthrosis. In an 84-year-old man, an arthrodesis was necessary to achieve a symptom-free ankle joint. Hemarthrosis secondary to anticoagulant medication may not be a benign disease process.
.A
Riley SA; Spencer GE Jr.
.I 55011
.U
88003203
.S
Clin Orthop 8801;  (223):252-6
.M
Accidents, Traffic/*; Adolescence; Adult; Alcoholic Intoxication/CO; Costs and Cost Analysis; Female; Fractures/EC/*ET; Head Injuries/EC/*ET; Head Protective Devices; Hospitalization/*EC; Human; Length of Stay/EC; Male; Middle Age; Motorcycles/*/EC.
.T
Medical and economic parameters of motorcycle-induced trauma.
.P
JOURNAL ARTICLE.
.W
A retrospective study was conducted on all patients injured in a motorcycle accident who were admitted to the authors' institution during a one-year period. The 71 patients evaluated averaged 26 years of age; 79% were men, 75% were not wearing a helmet, and 24% were legally intoxicated. Sixty-six percent required surgical intervention and 36% a second procedure. There were 167 fractures, with an average of 2.4 per patient. The 27 patients requiring a blood transfusion averaged 10.5 units per patient. Motorcyclists not wearing a helmet had an increased risk of head injury (p less than .01). Those with head injuries had an increased need for intensive care (p less than .0001) and a ventilator (p less than .001). Patients with head injuries more commonly sustained fractures about the shoulder (p less than .015) than fractures to the lower extremity (p less than .005). The average hospital stay was 13 days, with a cost of $16,408 per patient. The cost was significantly higher in patients with a head injury ($21,945) than in patients without a head injury ($11,941). Patients sustaining a head injury were less likely to return to baseline functioning (p less than .001).
.A
Bried JM; Cordasco FA; Volz RG.
.I 55012
.U
88003204
.S
Clin Orthop 8801;  (223):257-64
.M
Adolescence; Adult; Extremities/*IN/SU; Human; Ilium/*TR; Male; Metacarpus/IN/SU; Middle Age; Surgical Flaps/*MT; Tibia/IN/SU; Wounds and Injuries/SU.
.T
Postoperative course of patients treated with iliac osteocutaneous free flaps. A two- to five-year follow-up study.
.P
JOURNAL ARTICLE.
.W
The clinical and radiologic course was reviewed in seven patients treated with an iliac osteocutaneous free flap (iliac flap) for treatment of large bone defects in the tibia and first metacarpal bone and overlying skin. Application of the iliac flap was followed by free bone grafting in four patients and aesthetic surgery in four patients. All patients obtained solid bony union and good skin coverage; none had complaints upon walking. An iliac flap was useful as a salvage procedure for the treatment of massive defect of bone and skin in extremities, especially in the lower one-third of the lower leg. Transient osteoporosis occurred before osteosclerosis and bony union. Bone remodeling with change in the trabecular pattern preceded transformation from cancellous to cortical bone.
.A
Suematsu N; Hirayama T; Atsuta Y; Takemitsu Y.
.I 55013
.U
88003205
.S
Clin Orthop 8801;  (223):265-74
.M
Computer Simulation/*; Fracture Fixation, Internal/*IS; Human; Models, Theoretical; Orthopedic Fixation Devices/*.
.T
Behavior of an external fixation frame incorporating an angular separation of the fixator pins. A finite element approach.
.P
JOURNAL ARTICLE.
.W
A finite element model has been developed to simulate the deformation that occurs at the fracture site of an externally fixed bone as a result of applied bending, compression, and torsional loads. The pin configuration in this model is constructed to allow an angular separation of the fixator pins. The mechanical effect of this angular separation and of the distribution of the pins along the fixator bar is examined. The model shows that an angular separation of the pins provides a more symmetric deformation of the fracture site when a bending load is applied in different directions to the bone and thereby protects a fracture from excessive movement in any direction. The torsional stability of an external fixation frame is considerably increased by incorporating an angular separation of the pins. The model also shows that the most stable configuration for the fixator uses a wide separation of the pins along the fixator bar.
.A
Egan JM; Shearer JR.
.I 55014
.U
88003206
.S
Clin Orthop 8801;  (223):275-81
.M
Adult; Case Report; Femoral Fractures/*SU; Femur/*SU; Fractures, Open/*SU; Human; Male; Replantation/*MT; Sterilization/*MT.
.T
Management of open fractures with sterilization of large, contaminated, extruded cortical fragments.
.P
JOURNAL ARTICLE.
.W
The literature provides surprisingly little guidance for the management of Grade III open fractures with large extruded segments of long bones. A 10-cm segment of femoral diaphysis was reimplanted successfully in a 24-year-old man with a comminuted segmental open fracture. For basic information, laboratory studies were performed to determine the relative efficacies of various methods of sterilization of contaminated bovine metatarsals. Bovine bone segments were given one of the following treatments: (1) saline rinse; (2) povidone-iodine scrub/saline rinse; (3) povidone-iodine scrub/autoclaving; (4) povidone-iodine scrub/thimerosal immersion; (5) povidone-iodine scrub/povidone-iodine immersion; or (6) chlorhexidine gluconate scrub antibiotic solution immersion. The segments were then cultured. Only the povidone-iodine/autoclave and chlorhexidine gluconate/orthopedic antibiotic solution treatments were 100% effective in eliminating bacterial growth. Contaminated extruded segments of long bones can be adequately sterilized for reimplantation by surgical cleansing with chlorhexidine gluconate followed by brief soaking in antibiotic solution.
.A
van Winkle BA; Neustein J.
.I 55015
.U
88003207
.S
Clin Orthop 8801;  (223):282-6
.M
Human; Methylmethacrylates/*; Tobramycin/*/AD.
.T
Noncommercial fabrication of antibiotic-impregnated polymethylmethacrylate beads. Technical note.
.P
JOURNAL ARTICLE.
.W
Antibiotic-impregnated polymethylmethacrylate (PMMA) beads were fabricated by means of injections in specially designed molds to produce small and large beads. In vitro concentrates from these beads for 30 days were found to release tobramycin in an exponential function.
.A
Flick AB; Herbert JC; Goodell J; Kristiansen T.
.I 55016
.U
88003209
.S
Clin Orthop 8801;  (223):296-302
.M
Alloys/*; Bone Cements/*; Joint Prosthesis; Surface Properties.
.T
Optimum pore size for bone cement fixation.
.P
JOURNAL ARTICLE.
.W
The interface shear properties of porous coated Ti-6Al-4V alloy embedded in bone cement were examined as a function of pore size. Cylindric Ti-6Al-4V alloy push-out specimens were coated with two layers of spheric powders having particle size ranges of 297-420 microns, 420-500 microns, 595-707 microns, and 850-1400 microns. Sintering resulted in mean pore sizes of 165, 285, 345, and 550 microns, respectively, and porosities in the range of 40%-44%. There was a statistically significant difference between the mean pore sizes obtained from the four particle size ranges. There were no differences between the mean porosities. The porous-coated specimens were embedded in bone cement and mechanical push-out testing was performed. Non-coated specimens having a satin surface finish were also embedded in bone cement and tested. The noncoated metal specimens displayed an interface shear strength of 4.2 +/- 0.4 MPa, whereas the shear strengths for the porous-coated specimens were significantly higher and increased as pore size increased. The mean interface shear strengths determined were 17.0 +/- 2.1 MPa (165 microns pore size), 18.1 +/- 2.3 MPa (285 micron pore size), 23.6 +/- 1.7 MPa (345 microns pore size), and 25.4 +/- 3.4 MPa (550 microns pore size). Significant differences in shear strength for the porous-coated specimens were found between the two smaller particle sizes and the two larger particle sizes. As pore size increased from 285 microns to 345 microns, a statistically significant increase in shear strength from 18.1 MPa to 23.6 MPa was observed.
.A
Cook SD; Thongpreda N; Anderson RC; Thomas KA; Haddad RJ Jr; Griffin CD.
.I 55017
.U
88003211
.S
Clin Orthop 8801;  (223):303-7
.M
Adult; Bone Neoplasms/PA/*SC; Case Report; Femoral Neoplasms/PA/SC; Hidradenoma/PA/*SC; Human; Male; Sweat Gland Neoplasms/*PA; Tibia/PA.
.T
Malignant eccrine poroma with metastatic involvement of the long bones.
.P
JOURNAL ARTICLE.
.W
A case report of a malignant eccrine poroma metastasizing to long bones is described. This rare tumor of intraepidermal eccrine sweat duct origin usually metastasized to visceral organs. This is the second reported case of bone metastasis. Although a hip disarticulation was performed for ipsilateral femoral and tibial metastases presenting seven years after resection of the primary tumor, this 43-year-old man died six months later, from pulmonary metastases.
.A
Grober A; Goldberg I; Rotem A.
.I 55018
.U
88003212
.S
Clin Orthop 8801;  (223):308-12
.M
Case Report; Child; Diagnosis, Differential; Femoral Neoplasms/*DI; Femur Neck; Hip Joint/*; Human; Male; Osteoma, Osteoid/*DI; Synovitis/*DI.
.T
Osteoid osteoma of the femoral neck stimulating an inflammatory synovitis.
.P
JOURNAL ARTICLE.
.W
The case report presents a nine-year-old child with an osteoid osteoma of the femoral neck, simulating an inflammatory synovitis. Osteoid osteoma is a common benign bone tumor. However, when intracapsular lesions occur they may pose a diagnostic challenge. Nonspecific clinical signs and symptoms, such as inflammatory synovitis, joint effusion, and soft tissue swelling, may pose a problem in diagnosis and treatment. The delay in diagnosis can range from six months to two years. When the hip is involved, the patient may have nonspecific pain, limp, restricted motion, and thigh atrophy. An accurate diagnosis may be difficult to elicit, requiring detailed history and physical examination and culminating in the use of computed tomography.
.A
Alani WO; Bartal E.
.I 55019
.U
88003214
.S
Clin Orthop 8801;  (223):44-50
.M
Adolescence; Adult; Child; Female; Human; Joint Instability/CO/RA/SU; Male; Middle Age; Pain/*ET/TH; Shoulder/*; Syndrome.
.T
Rotator interval lesion.
.P
JOURNAL ARTICLE.
.W
Arthrography and surgical exploration reveal the pathogenesis of a painful shoulder syndrome characterized by inferior instability in the rotator interval (RI). The RI is the space between the subscapularis and the adjacent supraspinatus interval. Two types of RI lesions can be identified. Type I, a contracted state, is characterized by inflammatory changes in superficial bursal area. In Type II, an unstable condition is associated with extensive inflammation of deeper tissues in the RI. In a series of 101 patients, including 106 shoulders with RI lesions, surgical repair of the RI was performed with the shoulder in an externally rotated position. This position ensured a close fit of the supraspinatus and the subscapularis attachments. Of 78 shoulders evaluated in a follow-up study, 96% were graded good or excellent, and 4% poor. This investigation presents evidence for the importance of diagnosis and treatment of RI lesions in patients with persistent pain in the shoulder.
.A
Nobuhara K; Ikeda H.
.I 55020
.U
88003215
.S
Clin Orthop 8801;  (223):51-8
.M
Adult; Bursa, Synovial/*RA; Female; Human; Male; Middle Age; Shoulder Joint/*IN/RA/SU; Tendons, Para-Articular/*IN/RA/SU.
.T
Incomplete thickness rotator cuff tears diagnosed by subacromial bursography.
.P
JOURNAL ARTICLE.
.W
Incomplete thickness rotator cuff tears (ITRCT) adjacent to the bursal sac were diagnosed preoperatively by subacromial bursography and confirmed by surgical exposure. There were five men and one woman with an average age of 41.8 years. The preoperative duration of shoulder pain ranged from four to 36 months (average, 15.8 months). Clinical manifestations included crepitus and a painful arc in five of the six cases. Glenohumeral arthrography was normal in all cases. Subacromial bursography, subsequently performed, revealed pooling of the contrast medium in a torn area of the bursal side of the rotator cuff in all cases. Surgical treatment was recommended after the failure of conservative treatment for three to ten months. The surgical treatment consisted of both anterior acromioplasty and tendon suture. Wedge resection and shoelace suture repair of the tendon produced satisfactory results in all cases followed for ten to 72 months (average, 44.3 months). ITRCT adherent to the bursal sac were noted in 2.4% of a cadaver survey. Subacromial bursography can be a useful diagnostic procedure for this specific entity in subacromial impingement syndrome.
.A
Fukuda H; Mikasa M; Yamanaka K.
.I 55021
.U
88003216
.S
Clin Orthop 8801;  (223):59-64
.M
Female; Human; Joint Diseases/*DI/TH; Shoulder Joint/*.
.T
The frozen shoulder. Diagnosis and management.
.P
JOURNAL ARTICLE.
.W
The differentiation between the stiff and painful shoulder without any joint capsule involvement and with capsule involvement (true adhesive capsulitis) must be established before a rational treatment can be prescribed. Arthrography establishes the correct diagnosis of adhesive capsulitis. Treatment of the stiff and painful shoulder is through prevention and exercise. The treatment of adhesive capsulitis includes prevention, exercises, manipulation, and capsulotomy. Each treatment method is determined by specific criteria. Arthroscopy is not useful for either diagnosis or treatment of adhesive capsulitis but may be useful for recognition of the four stages of the disease.
.A
Neviaser RJ; Neviaser TJ.
.I 55022
.U
88003217
.S
Clin Orthop 8801;  (223):65-76
.M
Activities of Daily Living; Adult; Aged; Arthrodesis/*; Female; Follow-Up Studies; Human; Male; Middle Age; Osteoarthritis/PP/*SU; Shoulder Joint/PP/*SU; Sports; Work Capacity Evaluation.
.T
A functional analysis of shoulder fusions.
.P
JOURNAL ARTICLE.
.W
Seventeen shoulder fusions with relatively normal musculature were analyzed with particular interest to the ability of the fused extremity to perform activities of daily living. Joints fused for paralysis were excluded. No patient was able to work overhead or with arms abducted as required for activities such as hammering, house painting, or climbing a ladder. Many patients had difficulty functioning at head level for hygienic purposes. Many were unable to perform functions behind the back, although waist-level function approached normal. The position of rotation was the most critical factor in approaching optimum function. Fusions in positions of internal rotation reduced the ability to comb hair, wash the face, or to otherwise use the hand at head level. Fusion in a position of excessive external rotation made it impossible for the patient to reach the opposite axilla or belt buckle. There was a range of acceptability of abduction of forward flexion that did not appear to compromise the eventual functional result. The recommended position is 25 degrees to 40 degrees abduction, 20 degrees to 30 degrees flexion, and 25 degrees to 30 degrees of internal rotation. Even at the ideal position, shoulder fusion produces significant limitations in function. For patients with painful, nonfunctional shoulders who need arthrodesis, these limitations should be clearly discussed, along with the pros and cons of surgical treatment in general.
.A
Hawkins RJ; Neer CS 2d.
.I 55023
.U
88003219
.S
Clin Orthop 8801;  (223):86-93
.M
Acromioclavicular Joint/*PP/RA/SU; Aged; Arthritis, Rheumatoid/*PP/RA/SU; Female; Human; Male; Middle Age; Support, Non-U.S. Gov't.
.T
The acromioclavicular joint in rheumatoid arthritis.
.P
JOURNAL ARTICLE.
.W
The acromioclavicular (AC) joint was clinically and roentgenographically examined in 49 rheumatic patients with painful shoulders. Clinically, the AC joint was tender and painful in about one-third of the shoulders. Roentgenographically, AC changes were encountered in 85% of the shoulders. The AC joint destruction was frequently associated with the glenohumeral joint disease. There was a time-dependent progression of subchondral bone erosion, tapering, and osteolysis of the acromial end of the clavicle corresponding to the duration and/or severity of the rheumatoid disease.
.A
Petersson CJ.
.I 55024
.U
88003224
.S
Clin Pediatr (Phila) 8801; 26(10):505-11
.M
Child; Child Behavior; Child, Preschool; Female; Human; Infant; Male; Sleep Disorders/*/EP/GE/PX.
.T
The natural history of night terrors.
.P
JOURNAL ARTICLE.
.W
Night terrors are a sleep disorder, resulting from a partial arousal during slow-wave sleep. They usually occur within 2 hours of sleep onset and are characterized by agitation and unresponsiveness to external stimuli. Nineteen children (ten males, nine females) with onset of night terrors before age 7.5 years were studied by means of a questionnaire. Mean observation time (time from onset age to age at survey) was 8.5 years, but longer than 10 years in nine subjects. Seventy percent of the children had their initial frequency of night terrors as their peak frequency, with a tendency for shorter duration of the parasomnia in this group. Children with onset age less than 3.5 years may be expected to attain a peak frequency of at least one episode per week. Children with onset after 3.5 years, but before 7.5 years, may expect to attain a peak frequency of 1-2 episodes per month. There was a mean duration of 3.9 years, with a tendency for longer duration in children with positive family histories of sleep walking. Fifty percent stopped by age 8 years; 36 percent continued into adolescence. No common abnormal behavioral profile or psychopathology was found. Common precipitants of attacks were not identified.
.A
DiMario FJ Jr; Emery ES 3d.
.I 55025
.U
88003226
.S
Clin Pediatr (Phila) 8801; 26(10):517
.M
Child; Cryptorchism/*DT; Gonadotropins, Chorionic/*TU; Human; Male.
.T
Commentary on HCG stimulation in children with cryptorchidism [letter]
.P
LETTER.
.I 55026
.U
88003227
.S
Clin Pediatr (Phila) 8801; 26(10):518-23
.M
Depression/DI; Failure to Thrive/*PX; Family/*; Feeding Behavior/*; Female; Human; Infant; Infant Care; Male; Mother-Child Relations/*; Sibling Relations.
.T
Family interactions surrounding feedings of infants with nonorganic failure to thrive.
.P
JOURNAL ARTICLE.
.W
Family interactional processes surrounding infant feedings in 34 consecutive cases of nonorganic failure to thrive (NFT) admitted to a university teaching hospital are reported. Observations of family interactions for 90 minutes, including one feeding, yielded clinically useful information not readily available from other sources. Behaviors that supported inadequate feedings were reliably identified in 79 percent of the families. Failure of mothers to appropriately respond to their infants' cues, coupled with few signs of emotional attachment, were present in only 26 percent of cases, and inadequate child-care knowledge and skills in only 6 percent. Thus, widely held conceptual models explained perpetuation of inadequate feedings in only 32 percent of cases. Instead, sibling rivalry, displaced maternal anger, and undermined mother were among the problems found. Assessments of family members' interactions surrounding feedings have the potential to enhance the current management of NFT.
.A
Fosson A; Wilson J.
.I 55027
.U
88003228
.S
Clin Pediatr (Phila) 8801; 26(10):524-7
.M
Child; Communication; Education, Special; Handicapped/*; Human; Interprofessional Relations/*; Mainstreaming (Education); Physician's Role/*; Role/*; Schools/*; United States.
.T
Physician/school teacher collaboration. Some practical considerations.
.P
JOURNAL ARTICLE.
.W
Physician/school teacher collaboration is crucial if exceptional students are to receive appropriate educational services mandated by Public Law 94-142 and Public Law 99-457. There is little in the professional literature to guide physicians who may be interested in working more closely with school personnel. The present article provides specific suggestions and recommendations to private practitioners for initiating and managing interprofessional collaboration with school personnel.
.A
Marshall RM; Wuori DF; Hudler M; Cranston CS.
.I 55028
.U
88003229
.S
Clin Pediatr (Phila) 8801; 26(10):528-31
.M
Catheters, Indwelling/*AE; Equipment Contamination/*; Human; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Malassezia/IP; Mycoses/DI/EP/*ET.
.T
Malassezia furfur fungemia in infancy.
.P
JOURNAL ARTICLE.
.W
Malassezia furfur was recovered from blood cultures obtained through an indwelling line in seven severely ill infants hospitalized in a neonatal intensive care unit. While two of the patients were asymptomatic, the other patients had signs and symptoms compatible with sepsis. One patient had evidence of endocarditis.
.A
Alpert G; Bell LM; Campos JM.
.I 55029
.U
88003231
.S
Clin Pediatr (Phila) 8801; 26(10):536-8
.M
Adolescence; Anemia, Sickle Cell/*CO; Case Report; Cerebral Hemorrhage/ET; Exophthalmos/*ET/RA; Hematoma, Epidural/*ET/RA; Human; Infarction/*ET; Male; Skull/*BS; Tomography, X-Ray Computed.
.T
Proptosis, skull infarction, and retro-orbital and epidural hematomas in a child with sickle cell disease.
.P
JOURNAL ARTICLE.
.W
A Saudi child with homozygous sickle cell disease (SS) presented with bilateral periorbital swelling, right-sided proptosis, skull bone infarcts, and retro-orbital and epidural hematomas. The findings of skull bone infarcts, retro-orbital and epidural hematomas are rare in patients with sickle cell disease.
.A
Mallouh AA; Young M; Hamdan J; Salamah MM.
.I 55030
.U
88003234
.S
Clin Pediatr (Phila) 8801; 26(10):548-9
.M
Communication; Human; Office Management/*; Pediatrics/*; Professional-Family Relations/*.
.T
The initial family interview: clinical practice suggestion.
.P
JOURNAL ARTICLE.
.A
Karofsky PS.
.I 55031
.U
88003269
.S
Clin Sci 8801; 73(2):135-41
.M
Adult; Aged; Blood Pressure/*; Echocardiography; Female; Hemodynamics; Hospitalization/*; Human; Hypertension/CL/*PP/TH; Kidney/PP; Male; Middle Age; Prospective Studies; Renal Circulation; Renin-Angiotensin System.
.T
Multifactorial evaluation of blood pressure fall upon hospitalization in essential hypertensive patients.
.P
JOURNAL ARTICLE.
.W
1. Studies were prospectively performed on 72 hospitalized patients with essential hypertension. Blood pressure was normalized within 1 week of admission in 33 patients (group I), but did not decrease in 39 patients (group II). To determine the factors that differentiate group I from group II, cardio-renal haemodynamic and endocrinological indices were evaluated using multivariate analysis. 2. Systolic, diastolic and mean blood pressures on admission were higher in group II (P less than 0.001), whose optic fundi showed more severe changes (P less than 0.001). Although group II had greater left ventricular posterior wall thickness (P less than 0.02), left ventricular mass index (P less than 0.05) and systemic vascular resistance (P less than 0.01) on echocardiography, their cardiac index and ejection fraction were comparable with those of group I. 3. Renal blood flow (P less than 0.05) and glomerular filtration rate (P less than 0.01) were lower in group II than in group I. Renal vascular resistance was more elevated (P less than 0.01) in group II than in group I. 4. After severe sodium depletion and ambulation, group I showed a greater increase in plasma noradrenaline and adrenaline (P less than 0.05). On multivariate analysis, those with lower systolic blood pressure, better renal function and more reactive sympathetic nervous system were discriminated as group I. 5. These data suggest that group I patients have lower systolic blood pressure on admission, greater sympathetic reactivity and better renal function, all of which contribute to their spontaneous blood pressure fall after admission.
.A
Nishimura H; Nishioka A; Kubo S; Suwa M; Kino M; Kawamura K.
.I 55032
.U
88003271
.S
Clin Sci 8801; 73(2):151-7
.M
Administration, Oral; Adult; Angiotensin I/UR; Carbidopa/*PD; Dopamine/*UR; Furosemide/AD/*PD; Hemodynamics/DE; Human; Indomethacin/*PD; Injections, Intravenous; Male; Natriuresis/DE; Support, Non-U.S. Gov't; Urodynamics/DE.
.T
The effect of intravenous frusemide on urine dopamine in normal volunteers: studies with indomethacin and carbidopa.
.P
JOURNAL ARTICLE.
.W
1. The urine dopamine response to intravenous frusemide (30 mg) was investigated in 15 salt replete male volunteers. The effects of oral indomethacin (100 mg) and oral carbidopa (100 mg) given before intravenous frusemide were studied in the same group of subjects. 2. Frusemide produced a significant increase in urine dopamine output within 15 min. 3. Indomethacin attenuated the natriuretic and renin responses to frusemide, but did not alter urine dopamine output. 4. Carbidopa lowered urine dopamine to undetectable levels, but did not significantly affect the natriuretic and renin responses to frusemide. 5. We conclude that urine dopamine excretion after frusemide is not directly related to increased sodium excretion or renin response and it is not mediated by the prostaglandins. In addition, dopamine does not contribute to the renal actions of frusemide under normal conditions.
.A
Jeffrey RF; Macdonald TM; Rutter M; Freestone S; Brown J; Samson RR; Lee MR.
.I 55033
.U
88003272
.S
Clin Sci 8801; 73(2):159-63
.M
Alcohol, Ethyl/*PD; Animal; Diet; Fatty Acid Synthetase Complex/ME; Fatty Acids/*BI; Lipids/BI; Liver/*DE/ME; Male; Rats; Rats, Inbred Strains; Triglycerides/*ME.
.T
Fatty acid synthesis and triacylglycerol accumulation in rat liver after chronic ethanol consumption.
.P
JOURNAL ARTICLE.
.W
1. Liver slices from chronically alcohol-fed rats incubated with 3H2O showed less than half the fatty acid synthesis rates of pair-fed controls. Addition of 50 mmol/l ethanol or of 10 mmol/l lactate and 1 mmol/l pyruvate to the incubation medium did not alter the fatty acid synthesis rates in either groups. Hepatic fatty acid synthesis rates measured in vivo with 3H2O were also significantly reduced in alcohol-fed rats. 2. Time-course experiments showed that after 1 week on the ethanol diet hepatic fatty acid synthesis rates in vitro were similar to control rats, although the liver triacylglycerol content was significantly increased. From the second week of feeding, fatty acid synthesis rates were significantly lower in alcohol-fed rats and the liver triacylglycerol content progressively increased compared with controls. 3. Fatty acid synthase activity in liver cytosolic fractions were similar to controls in the alcohol-fed group after 1 week of feeding but were significantly lower in alcohol-fed rats from the second week onwards. 4. These results indicate that hepatic triacylglycerol accumulation after alcohol feeding is not due to increased fatty acid synthesis. The reduced fatty acid synthesis observed is a consequence of triacylglycerol accumulation.
.A
Venkatesan S; Ward RJ; Peters TJ.
.I 55034
.U
88003277
.S
Clin Sci 8801; 73(2):189-96
.M
Animal; Carbohydrates/*PK/UR; Intestinal Absorption/*; Intestine, Small/*ME; Male; Molecular Weight; Permeability; Rats; Rats, Inbred Strains; Support, Non-U.S. Gov't.
.T
Permeability of the rat small intestine to carbohydrate probe molecules.
.P
JOURNAL ARTICLE.
.W
1. Absorption of carbohydrate probe molecules from ligated loops of rat small intestine was studied. Absorption was determined by measuring recovery of molecules in the urine, corrected for incomplete recovery after intravenous injection, and was examined for correlation with several parameters of molecular dimension. 2. Absorption depended on molecular volume rather than relative molecular mass, molecular radius or molecular area. 3. Molecules with a molecular volume below 225 X 10(-3) nm3 were absorbed to a greater extent than larger molecules, and absorption was affected critically by molecular volume, small changes in volume producing considerable variation in absorption. 4. Absorption of larger molecules was not affected by changes in volume within the range 362 X 10(-3)-1128 X 10(-3) nm3. 5. These findings support the concept that there are at least two aqueous diffusion pathways across the intestinal mucosa. small molecules diffusing through a small channel of finite dimension, compatible with a transcellular aqueous pore, whilst large molecules diffuse through a less frequent pathway of considerably larger dimensions.
.A
Hamilton I; Rothwell J; Archer D; Axon AT.
.I 55035
.U
88003280
.S
Clin Sci 8801; 73(2):211-5
.M
Acid-Base Imbalance/*BL; Anesthesia, General; Animal; Bicarbonates/BL; Blood Pressure/DE; Calcium/BL; Comparative Study; Hydralazine/PD; Hydrogen-Ion Concentration; Hypertension/*BL/ET; Male; Rats; Rats, Inbred Strains/*BL; Rats, Inbred SHR/*BL; Rats, Inbred WF; Rats, Inbred WKY; Species Specificity; Support, Non-U.S. Gov't.
.T
Disturbance of acid-base balance in the young spontaneously hypertensive rat.
.P
JOURNAL ARTICLE.
.W
1. The acid-base status of young spontaneously hypertensive rats (SHR) was compared with that of Wistar-Kyoto rats (WKY) in the steady state, after acid loading and after blood pressure had been maintained at normal levels from weaning. Whole blood ionized calcium was measured simultaneously. 2. In the prehypertensive stage (4 weeks of age), plasma bicarbonate was significantly lower in SHR than in WKY, while blood pH did not differ significantly. 3. After 6 weeks of age, blood pH and plasma bicarbonate were significantly lower in both anaesthetized and conscious SHR than in corresponding WKY. After 7 days administration of NH4Cl in the drinking fluid, both parameters decreased significantly in both strains and the difference in pH remained constant (0.05 pH unit, P less than 0.01). 4. In none of the groups investigated did non-pH-adjusted ionized calcium differ significantly between the SHR and WKY. 5. Prevention of the development of hypertension in SHR by hydralazine treatment from weaning did not increase pH or bicarbonate compared with untreated SHR, indicating that the metabolic acidosis in the SHR was not a consequence of raised blood pressure. 6. Disturbance in acid-base balance may be involved in the pathogenesis of raised blood pressure in this animal model of genetic hypertension.
.A
Lucas PA; Lacour B; McCarron DA; Drueke T.
.I 55036
.U
88003281
.S
Clin Sci 8801; 73(2):217-22
.M
Absorption; Adsorption; Adult; Female; Histamine/PD; Human; Iodine Radioisotopes/DU; Irrigation; Male; Middle Age; Nasal Mucosa/DE/*SE; Support, Non-U.S. Gov't; Technetium Tc 99m Aggregated Albumin/DU.
.T
Measurement of secretion in nasal lavage.
.P
JOURNAL ARTICLE.
.W
1. The amount of admixture in nasal lavage fluids was determined by addition of 99mTc labelled albumin, providing a correction factor for measurements of cellular material and humoral substances in nasal lavage return as well as a quantitative measure of nasal secretions. 2. Albumin was chosen as marker molecule, since only negligible amounts were absorbed or adsorbed to the mucosa during the nasal lavage. 3. Labelling of the albumin with 99mTc ensured an accuracy of measurements only limited by the precision of the weighing. The isotope allowed for the determination of the amount of admixed secretion to be carried out on the whole sample of lavage fluid, thereby avoiding the necessity of complete admixture between marker and lavage fluid which would be pertinent to marker molecules measured chemically. The radiation from a nasal lavage is minimal and the procedure is fully acceptable for repeated use in humans. 4. The nasal lavage technique adopted allowed the return of 99.2% (median value) of the instilled volume. The area irrigated was visualized on a gamma-camera, and was demonstrated to cover an area larger than the area reached by challenge from a pumpspray, i.e. a large part of the nose, yet not the oropharynx. 5. A dose related increase in nasal secretion harvested by the nasal lavage in 10 persons challenged with histamine chloride could be demonstrated by this technique. 6. It is concluded that the use of 99mTc-albumin in a nasal washing provides a safe, simple and quick method for determination of the admixed nasal secretion with a remarkable degree of accuracy.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Bisgaard H; Krogsgaard OW; Mygind N.
.I 55037
.U
88003283
.S
Clin Sci 8801; 73(2):227-34
.M
Adult; Aluminum/ME; Anthropometry; Bone and Bones/*DE/ME/PA; Deferoxamine/*AE; Female; Hemodialysis/*/AE; Human; Male; Middle Age; Minerals/ME; Osteomalacia/DT/ET/ME/PA.
.T
Deferoxamine-induced bone changes in haemodialysis patients: a histomorphometric study.
.P
JOURNAL ARTICLE.
.W
1. The histological effects of deferoxamine therapy were assessed on transiliac bone biopsies taken after double tetracycline labelling from 16 uraemic patients undergoing chronic haemodialysis, all having aluminium deposits in bone. Eight patients had osteomalacia, five had an "aplastic" bone lesion and three a high bone turnover with a marked increase in osteoid volume. 2. Deferoxamine was administered intravenously once a week at doses ranging from 1 to 6 g for a mean duration of 7.6 +/- 3.3 (SD) months. 3. Deferoxamine therapy was associated with significant reductions in stainable aluminium deposits, osteoid volume, osteoid surfaces and thickness index of osteoid seams. The osteoblastic osteoid surfaces as well as the bone formation rates also increased significantly. 4. A rise in resorption parameters and in serum parathyroid hormone levels was observed in patients with osteomalacia. The percentage reductions in stainable aluminium and in osteoid volume were correlated with the degree of hyperparathyroidism. 5. These data show that deferoxamine therapy reduces stainable bone aluminium and improves bone mineralization in low turnover osteomalacia and that the presence of hyperparathyroidism is associated with an increased response to deferoxamine therapy.
.A
Charhon SA; Chavassieux P; Boivin G; Parisien M; Chapuy MC; Traeger J; Meunier PJ.
.I 55038
.U
88003284
.S
Clin Sci 8801; 73(2):235-7
.M
Adolescence; Adult; Aged; Female; Glutathione/*ME; Human; Hyperthyroidism/*ME; Liver/*ME; Male; Middle Age; Sulfobromophthalein/*ME.
.T
Relationship between hepatic levels of glutathione and sulphobromophthalein retention in hyperthyroidism.
.P
JOURNAL ARTICLE.
.W
1. Sulphobromophthalein (BSP) retention and liver glutathione levels were studied in uncomplicated hyperthyroid patients. 2. BSP retention was increased in 52.5% of the subjects at admission (n = 40) and in 28% of the cases after 3 months of propylthiouracil treatment (300-400 mg/day) (n = 25). 3. Hepatic levels of glutathione were measured in six patients and significant inversed power correlation with BSP retention was observed (r = 0.968, P less than 0.001). 4. These data support the contention that the alteration of the BSP retention observed in hyperthyroidism could be due to a decreased availability of hepatic glutathione for conjugation.
.A
Sir T; Wolff C; Soto JR; Perez G; Merino RA.
.I 55039
.U
88003285
.S
Clin Sci 8801; 73(2):239
.M
Blood Pressure/*; Female; Human; Hypertension/PP; Nigeria; Pregnancy; Puerperal Disorders/PP; Puerperium/*PH; Seasons.
.T
Blood pressure in the puerperium [letter]
.P
LETTER.
.A
Davidson NM.
.I 55040
.U
88003286
.S
Clin Sci 8801; 73(2):239-40
.M
Human; Respiratory Dead Space/*.
.T
Measurement of dead-space volume [letter]
.P
LETTER.
.A
Harris EA.
.I 55041
.U
88003289
.S
Clin Sci 8801; 73(3):247-52
.M
Adult; Aldosterone/BL; Anthropometry; Electrolytes/BL; Female; Hemodialysis/*; Homeostasis/*; Human; Male; Middle Age; Peritoneal Dialysis, Continuous Ambulatory; Potassium/*ME; Rectum/*ME; Support, Non-U.S. Gov't; Uremia/BL/*ME.
.T
Evidence for large intestinal control of potassium homoeostasis in uraemic patients undergoing long-term dialysis.
.P
JOURNAL ARTICLE.
.W
1. The role of the large intestine in the maintenance of K+ balance in uraemic patients established on long-term dialysis was studied with a rectal dialysis technique in 14 normal subjects, ten normokalaemic patients undergoing chronic ambulatory peritoneal dialysis (CAPD), and seven patients undergoing haemodialysis. Dietary K+ intakes in the normal subjects, CAPD patients and haemodialysis patients were 80-100 mmol/24 h, 70-80 mmol/24 h and 60-70 mmol/24 h, respectively. 2. At an initial intraluminal K+ concentration of 45 mmol/l, rectal K+ secretion in the CAPD patients (2.4 +/- 0.4 mumol h-1 cm-2) was greater than in normal subjects (1.2 +/- 0.2 mumol h-1 cm-2, P less than 0.02). Under similar conditions, rectal K+ secretion was also greater in the haemodialysis patients than in normal subjects, both predialysis (3.7 +/- 0.4 mumol h-1 cm-2, P less than 0.001) and postdialysis (2.4 +/- 0.5 mumol h-1 cm-2, P less than 0.05), even though haemodialysis decreased plasma K+ concentration from 5.3 +/- 0.1 mmol/l to 3.5 +/- 0.2 mmol/l (P less than 0.001). 3. There were no significant differences in rectal Na+ absorption, rectal potential difference, plasma aldosterone concentration, or total body K+ content (measured by whole-body counting of 40K), between the normal subjects and either the CAPD or the haemodialysis patients. 4. These results indicate that K+ homoeostasis is maintained in uraemic patients undergoing long-term dialysis by a combination of K+ losses during dialysis, and enhanced large intestinal K+ excretion.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Sandle GI; Gaiger E; Tapster S; Goodship TH.
.I 55042
.U
88003290
.S
Clin Sci 8801; 73(3):253-8
.M
Analysis of Variance; Animal; Blood Pressure/DE; Desoxycorticosterone; Heart Rate/DE; Hypertension/CI/*DT; Male; Nifedipine/*TU; Rats; Rats, Inbred Strains; Sympathetic Nervous System/*PH; Vasopressins/*PD.
.T
Influence of the sympathetic nervous system and vasopressin on the blood pressure lowering effect of nifedipine in deoxycorticosterone acetate-salt hypertensive rats.
.P
JOURNAL ARTICLE.
.W
1. The role of the sympathetic nervous system and the effect of vasopressin (AVP) on the hypotensive action of nifedipine (Nf) were evaluated in conscious, unrestrained normotensive and DOCA-salt hypertensive rats. 2. The hypotensive response to Nf was much greater in DOCA rats than in the controls. 3. Solitary blockade of the sympathetic nervous system or AVP, did not alter the Nf effect in either DOCA or control rats. However, a combination clearly diminished the effect of Nf in the DOCA group, but enhanced it in the controls. The inhibition of angiotensin II (ANG II) augmented the hypotensive effect of Nf in control animals, but not in the DOCA rats. The percentage fall in blood pressure with Nf was much the same in both groups after the combined inhibition of the sympathetic nervous system and AVP. 4. The enhanced hypotensive action of Nf in DOCA rats may be dependent on the hyperactivity of the sympathetic nervous system and AVP, which facilitates calcium influx, and in the normotensive animals the depressor response to Nf may relate to blockade of the calcium influx, independent of the sympathetic nervous system, AVP and ANG II.
.A
Takata Y; Yamashita Y; Takishita S; Fujishima M.
.I 55043
.U
88003292
.S
Clin Sci 8801; 73(3):267-9
.M
Blood Pressure; Female; Forearm/*BS; Human; Hypertension/*PP; Posture/*; Pregnancy; Pregnancy Complications, Cardiovascular/*PP.
.T
The effects of posture on abnormalities of forearm venous tone in women with pregnancy-induced hypertension.
.P
JOURNAL ARTICLE.
.W
1. Forearm venous tone was measured in the left lateral supine position and in response to passive leg elevation in a group of women with pregnancy-induced hypertension and compared with a group of normotensive pregnant women and a group of non-pregnant women. 2. The women with pregnancy-induced hypertension were venoconstricted in the supine position compared with the normal pregnant women (P less than 0.002). There was no difference in forearm venous tone between the women with pregnancy-induced hypertension and the non-pregnant women. 3. In response to passive leg elevation the women with pregnancy-induced hypertension venodilated (P less than 0.002) whereas there was no change in forearm venous tone in the normotensive pregnant women and the non-pregnant women. There was no change in blood pressure in any of the women after 35 min of leg elevation. 4. These results demonstrate that the abnormal venous vasoconstriction that occurs in women with pregnancy-induced hypertension in the supine position is corrected by passive leg elevation, a manoeuvre which leads to an increase in central blood volume.
.A
Stainer K; Pickles C; Cowley AJ.
.I 55044
.U
88003296
.S
Clin Sci 8801; 73(3):291-7
.M
Biological Transport; Blood Proteins/AN/PD; Female; Fetal Blood/*ME; Human; Infant, Newborn; Leukocytes/*ME; Omentum/ME; Pregnancy; Sodium/*AI/BL.
.T
Evidence for an inhibitor of leucocyte sodium transport in the serum of neonates.
.P
JOURNAL ARTICLE.
.W
1. In confirmation of previous studies, serum obtained from cord blood demonstrated endogenous digoxin-like immunoreactivity (EDLI). Sera from pregnant women in the third trimester also demonstrated EDLI, which disappeared after delivery. 2. Cord serum inhibited the total sodium efflux rate constant of a mixed leucocyte preparation when compared with the effect of control serum. This inhibition resulted from a depression of the ouabain-sensitive (sodium pump) component of the rate constant. 3. An ultrafiltrate of the serum (mol. wt. less than 30,000) also inhibited ouabain-sensitive leucocyte sodium transport when compared with filtrate obtained from control serum. 4. DHA-S Dehydroepiandrosterone sulphate (DHA-S) and cortisone, both present in high concentration in cord serum, demonstrated EDLI but did not affect leucocyte sodium transport in the cells of normal subjects. 5. DHA-S had no effect on sodium transport or vasoconstrictor activity in human omental resistance vessels. 6. It is concluded that EDLI of cord serum is associated with sodium transport inhibitory activity. This is unlikely to be attributable to DHA-S or cortisone.
.A
Morris JF; McEachern MD; Poston L; Smith SE; Mulvany MJ; Hilton PJ.
.I 55045
.U
88003298
.S
Clin Sci 8801; 73(3):305-10
.M
Animal; Bumetanide/ME; Diuretics/*ME; Ethacrynic Acid/ME; Furosemide/ME; Human; In Vitro; Mucoproteins/*ME; Rabbits; Serum Albumin/ME; Support, Non-U.S. Gov't.
.T
Loop-acting diuretics do not bind to Tamm-Horsfall urinary glycoprotein.
.P
JOURNAL ARTICLE.
.W
1. Binding between the radiolabelled loop-acting diuretics ([14C]frusemide, [14C]ethacrynic acid and [3H]bumetanide) and human Tamm-Horsfall glycoprotein or human serum albumin in vitro was evaluated by equilibrium dialysis. 2. The diuretic action and binding to urinary Tamm-Horsfall glycoprotein of the radiolabelled diuretics in vivo, after intravenous administration, were examined in rabbits. 3. In vitro, all three radiolabelled diuretics bound strongly to human serum albumin, but not to Tamm-Horsfall glycoprotein. 4. Radiolabelled frusemide and bumetanide, but not ethacrynic acid, caused a diuresis in rabbits, but no binding between the drugs and Tamm-Horsfall glycoprotein was seen in vivo. 5. Binding to Tamm-Horsfall glycoprotein does not appear to be an important mechanism in the action of loop diuretics.
.A
Brunisholz MC; Lynn KL; Hunt JS.
.I 55046
.U
88003301
.S
Clin Sci 8801; 73(3):329-32
.M
Animal; Catalase/ME; Female; Hydrogen Peroxide/*ME; Kidney Glomerulus/*DE; Nephrotic Syndrome/*CI; Proteinuria/CI; Puromycin/*/AA; Puromycin Aminonucleoside/*; Rats; Rats, Inbred Strains; Superoxide/*ME; Superoxide Dismutase/ME; Support, Non-U.S. Gov't.
.T
The role of superoxide anion and hydrogen peroxide in glomerular injury induced by puromycin aminonucleoside in rats.
.P
JOURNAL ARTICLE.
.W
1. The nephrotic syndrome was induced in inbred female Wistar rats by the intravenous injection of puromycin aminonucleoside (PA) (5 mg/100 g body weight). 2. One group (n = 12) received superoxide dismutase (SOD) (15 mg/kg body weight), a second group (n = 12) received polyethylene glycol coupled catalase (PEG-catalase) (5000 i.u./kg body weight) and the third (n = 9) saline (150 mmol/l NaCl) via the intraperitoneal route, in addition to the PA. 3. SOD and PEG-catalase reduced the 24 h urine protein on days 8 and 15 compared with unmodified puromycin treated animals and this difference was significant on day 15 for SOD (P less than 0.05) and for PEG-catalase (P less than 0.01). Glomerular filtration rate, as measured by the creatinine clearance, was lower in the PEG-catalase group but did not differ significantly from the saline treated group. 4. These data suggest that superoxide anion and hydrogen peroxide, or their reaction products, are involved in the glomerular injury of puromycin nephropathy.
.A
Beaman M; Birtwistle R; Howie AJ; Michael J; Adu D.
.I 55047
.U
88003317
.S
Clin Lab Med 8801; 7(3):499-719
.M
Drug Therapy/*; Human; Monitoring, Physiologic/*.
.T
Therapeutic drug monitoring--II: Patient care and applications.
.P
JOURNAL ARTICLE.
.I 55048
.U
88003440
.S
Contact Dermatitis 8801; 17(1):1-9
.M
Adult; Animal; Case Report; Chromatography, High Pressure Liquid; Dermatitis, Contact/*ET; Fatty Alcohols/*AE/AN; Female; Guinea Pigs; Human; Male; Middle Age; Patch Tests; Plant Extracts/AN; Plants, Toxic; Support, Non-U.S. Gov't.
.T
Allergic and irritant contact dermatitis from falcarinol and didehydrofalcarinol in common ivy (Hedera helix L.).
.P
JOURNAL ARTICLE.
.W
Experimental and chemical investigations revealed that common ivy (Hedera helix susp. helix) contains 3 compounds which are powerful irritants and moderate sensitizers. Only 2 of these constituents, falcarinol and didehydrofalcarinol, are present in the plant during the whole year. Besides Panax ginseng and Schefflera arboricola, this is the third species of the Araliaceae in which these polyacetylenic sensitizers have been found. Falcarinol and didehydrofalcarinol also occur in Hedera helix subsp. canariensis. 4 patients have been patch tested. Even in low concentrations (0.03%), the main allergen falcarinol elicited strong reactions in all of them. One of the authors became sensitized during the investigations.
.A
Hausen BM; Brohan J; Konig WA; Faasch H; Hahn H; Bruhn G.
.I 55049
.U
88003441
.S
Contact Dermatitis 8801; 17(1):10-2
.M
Adipic Acids/AD/AE; Administration, Topical; Alcohols, Amyl/AD/AE; Animal; Dermatitis, Contact/ET; Dermatologic Agents/*AD/AE; Drug Evaluation; Female; Guinea Pigs; Human; Male; Occupational Dermatitis/*PC; Ointments; Patch Tests; Propanediols/AD/AE; Rabbits; Rats; Silica/AD/AE; Xylenes/AD/AE.
.T
Safety evaluation of a barrier cream.
.P
JOURNAL ARTICLE.
.W
A barrier cream containing propylene glycol, silica, xylene, dioctyl adipate and amyl acetate was applied topically for 3 months in 3 species of animal. Patch tests were carried out in human volunteers up to 72 h. The cream produced slight erythema in rats, guinea pigs and rabbits, but the irritation indices remained within safe limits. Histologically, mild focal thickening and moderate thickening of stratum corneum were observed in rats and guinea pigs, respectively, after 3 months of daily application. Patch testing in human volunteers indicated that the barrier cream is reasonably safe for human use.
.A
Gupta BN; Shanker R; Viswanathan PN; Mathur AK; Shukla L; Singh A.
.I 55050
.U
88003442
.S
Contact Dermatitis 8801; 17(1):13-6
.M
Adult; Animal; Callosities/*ET; Fingers; Food-Processing Industry/*; Hand Dermatoses/*ET; Human; Male; Occupational Dermatitis/*ET; Poultry/*.
.T
Knuckle pads in live-chicken hangers.
.P
JOURNAL ARTICLE.
.W
A study of live-chicken hangers in a poultry processing plant demonstrated a high prevalence of callosities over the knuckles (knuckle pads) of both hands. Knuckle pads were observed in 56% (23/41) of live-chicken hangers, but in no (0/41) workers from other departments (p less than 0.001). The probable cause was the repeated striking and sliding of the knuckles against metal shackles in which live birds were being placed. Additional medical and ergonomic evaluation would be worthwhile to confirm the probable cause, to determine whether associated tissue disorders are present in the digits of chicken hangers who develop knuckle pads, and to suggest preventive measures.
.A
Richards TB; Gamble JF; Castellan RM; Mathias CG.
.I 55051
.U
88003443
.S
Contact Dermatitis 8801; 17(1):17-20
.M
Dermatitis, Atopic/*CI; Dinitrochlorobenzene/*AE; Human; Occupational Dermatitis/*CI; Patch Tests; Rubber/*.
.T
Dermatitis in a rubber tyre factory.
.P
JOURNAL ARTICLE.
.W
An outbreak of occupational dermatitis in a rubber tyre factory is reported. An unusual clinical picture was recognized. Patch tests revealed a high sensitization rate to the MBT derivative used: 2-(2'-4'dinitrophenylthio)benzothiazole. Since tests with MBT mix and dinitrophenol were negative; sensitization to a contaminant was suspected. DNCB was traced as the substance responsible.
.A
Zina AM; Bedello PG; Cane D; Bundino S; Benedetto A.
.I 55052
.U
88003444
.S
Contact Dermatitis 8801; 17(1):21-2
.M
Adolescence; Adult; Animal; Dermatitis, Atopic/*ET; Female; Human; Pruritus/ET; Skin Tests; Wool/*AE.
.T
Itching from wool fibres in atopic dermatitis.
.P
JOURNAL ARTICLE.
.W
In 24 girls with atopic dermatitis and a history of irritation to wool, more intense itching was provoked on normal skin on the abdomen by a material with coarse wool fibres (36 microns) than with thinner fibres (20 microns). The probability of the materials causing itching could be predicted by the girls by handling the materials.
.A
Bendsoe N; Bjornberg A; Asnes H.
.I 55053
.U
88003446
.S
Contact Dermatitis 8801; 17(1):26-34
.M
Adolescence; Adult; Aged; Child; Cosmetics/*AE; Dermatitis, Contact/*ET; Excipients/*AE; Facial Dermatoses/ET; Female; Human; Male; Middle Age; Perfume/AE.
.T
Contact allergy to cosmetics: causative ingredients.
.P
JOURNAL ARTICLE.
.W
Of 1781 patients with contact dermatitis seen during a period of 6 years (1981-1986), 75 (4.2%) had allergy to cosmetic products. The face was most frequently affected. In many cases, the dermatitis was limited to the eyelids (18.7%) or the face (40.0%). Skin care products (moisturizing and cleansing cream/lotion/milk) accounted for more than half (52.3%), followed by nail cosmetics (8.0%), shaving preparations (8.0%) and deodorants (6.8%). The ingredients most often responsible were fragrances (45.1%), followed by the preservative Kathon CG (11.0%) and the emulsifier oleamidopropyl dimethylamine (9.8%). In 14 patients (18.7%), patch tests with the responsible cosmetic product were negative. In them, the diagnosis was made by use tests and/or repeated open application tests. Compulsory declaration of ingredients on cosmetic product labels in the EEC, analagous to the USA situation, would be of great benefit both to patients and to physicians.
.A
de Groot AC.
.I 55054
.U
88003447
.S
Contact Dermatitis 8801; 17(1):35-40
.M
Dermatitis, Atopic/*DI/EP; Dermatitis, Contact/*DI/EP; Eczema/*DI/EP; Female; Food Additives/AE; Human; Hypersensitivity, Immediate/DI; Male; Metals/AE; Patch Tests/*MT; Seborrhea/DI/EP; Skin Tests/*MT; Support, Non-U.S. Gov't.
.T
Diagnostic procedures for eczema patients.
.P
JOURNAL ARTICLE.
.W
Of 7887 patients with eczema seen in a private dermatological practice over a period of 2 years and 4 months, a specific final diagnosis was found in 5376 (68%), while a final diagnosis of non-specific eczema was made in 2511 cases (32%). The most common final diagnoses were seborrhoeic dermatitis (1351), contact dermatitis (1317), atopic dermatitis (1009) and nummular eczema (822). Battery patch testing was the initial diagnostic procedure performed, and 897 of the 3164 patients who were patch tested had one or more positive patch tests. In 545 cases, the reactions were considered of relevance to the current dermatitis. Tests for immediate-type allergy were carried out in 618 patients, and 284 of these had one or more positive tests. In 86 patients, these test results were of diagnostic significance. 257 patients with positive patch tests were challenged orally with the relevant substance, and 53 of 156 reacted to metal salts, most commonly nickel, while 25 of 101 reacted to orally ingested balsam of Peru. Among patch-test-negative patients, 66 of 408 had positive reactions to one or more metal salts; 41 of 180 reacted to balsam of Peru, while 15 of 41 reacted to various food additives.
.A
Veien NK; Hattel T; Justesen O; Norholm A.
.I 55055
.U
88003448
.S
Contact Dermatitis 8801; 17(1):41-2
.M
Adult; Benzalkonium Compounds/*AE; Case Report; Dermatitis, Contact/*ET; Emollients/AE; Hair Preparations/AE; Human; Male; Patch Tests; Pyridinium Compounds/*AE.
.T
Contact dermatitis to lauryl pyridinium chloride and benzoxonium chloride.
.P
JOURNAL ARTICLE.
.A
Bruynzeel DP; de Groot AC; Weyland JW.
.I 55056
.U
88003449
.S
Contact Dermatitis 8801; 17(1):42-4
.M
Adult; Case Report; Dermatitis, Contact/*ET; Facial Dermatoses/*CI; Female; Human; Naphthalenes/*AE; Patch Tests; Phenylenediamines/*AE; 2-Naphthylamine/AA/*AE.
.T
Unusual allergic contact dermatitis to aromatic amines.
.P
JOURNAL ARTICLE.
.A
Conde-Salazar L; Guimaraens D; Romero LV; Gonzalez MA.
.I 55057
.U
88003451
.S
Contact Dermatitis 8801; 17(1):45-6
.M
Acne/DT; Adult; Case Report; Dermatitis Medicamentosa/*ET; Facial Dermatoses/*CI; Female; Human; Lactates/*AE; Patch Tests.
.T
Allergic contact dermatitis to ethyl lactate.
.P
JOURNAL ARTICLE.
.A
Marot L; Grosshans E.
.I 55058
.U
88003452
.S
Contact Dermatitis 8801; 17(1):46-7
.M
Adult; Betamethasone/AA/AE/TU; Case Report; Cresols/*AE; Dermatitis Medicamentosa/CI; Female; Human; Hypersensitivity, Delayed/*CI; Hypersensitivity, Immediate/*CI; Occupational Dermatitis/CI/DT; Ointments/AE; Skin Tests.
.T
Immediate and delayed sensitivity to chlorocresol.
.P
JOURNAL ARTICLE.
.A
Goncalo M; Goncalo S; Moreno A.
.I 55059
.U
88003453
.S
Contact Dermatitis 8801; 17(1):47-8
.M
Adult; Case Report; Dermatitis, Contact/*ET; Facial Dermatoses/*CI; Hand Dermatoses/*CI; Human; Male; Naphthalenes/*AE; Patch Tests; Phenylenediamines/*AE; 2-Naphthylamine/AA/*AE.
.T
Unusual sensitization to black rubber.
.P
JOURNAL ARTICLE.
.A
Dooms-Goossens A; Degreef H; de Veylder H; Maselis T.
.I 55060
.U
88003455
.S
Contact Dermatitis 8801; 17(1):49
.M
Adult; Amines/*AE; Case Report; Cross Reactions; Dermatitis Medicamentosa/DT/*ET; Human; Hypersensitivity, Delayed/*CI; Male; Patch Tests; Prednisone/TU; Sulfanilamides/*AE.
.T
Primary sensitivity to sulphonamide and secondary sensitization to aromatic amines.
.P
JOURNAL ARTICLE.
.A
Rudzki E; Rebandel P.
.I 55061
.U
88003456
.S
Contact Dermatitis 8801; 17(1):50-1
.M
Air Pollutants, Occupational/*AE; Case Report; Dermatitis, Contact/*ET; Female; Human; Middle Age; Occupational Dermatitis/*ET; Patch Tests; Tobacco/*.
.T
Airborne contact dermatitis to tobacco.
.P
JOURNAL ARTICLE.
.A
Pecegueiro M.
.I 55062
.U
88003457
.S
Contact Dermatitis 8801; 17(1):51
.M
Acrylates/*AE; Adhesives/*AE; Adult; Case Report; Dermatitis, Contact/*ET; Hand Dermatoses/*CI; Human; Male; Methacrylates/*AE; Occupational Dermatitis/*CI; Patch Tests.
.T
Contact dermatitis to Loctite 221 and 270.
.P
JOURNAL ARTICLE.
.A
Kokelj F; Patussi V; Basei R; Marcolina M.
.I 55063
.U
88003458
.S
Contact Dermatitis 8801; 17(1):52-3
.M
Adult; Case Report; Coal Tar/*AE; Dermatitis, Contact/*ET; Female; Hand Dermatoses/*CI; Human; Ink/*; Newspapers/*; Patch Tests.
.T
Contact sensitivity to newsprint: a rare manifestation of coal tar allergy.
.P
JOURNAL ARTICLE.
.A
Illchyshyn A; Cartwright PH; Smith AG.
.I 55064
.U
88003459
.S
Contact Dermatitis 8801; 17(1):53-4
.M
Acridines/*AE; Adult; Case Report; Dermatitis, Contact/*ET; Erythema Multiforme/*CI; Human; Male; Patch Tests; Proflavine/*AE; Purpura/*CI.
.T
Erythema multiforme-like and purpuric eruption due to contact allergy to proflavine.
.P
JOURNAL ARTICLE.
.A
Goh CL.
.I 55065
.U
88003460
.S
Contact Dermatitis 8801; 17(1):54-5
.M
Adult; Case Report; Dermatitis, Contact/*ET; Drug Industry/*; Facial Dermatoses/CI; Hand Dermatoses/CI; Human; Leg Dermatoses/CI; Male; Occupational Dermatitis/*CI; Ranitidine/*AE.
.T
Allergic contact dermatitis due to ranitidine.
.P
JOURNAL ARTICLE.
.A
Alomar A; Puig L; Vilaltella I.
.I 55066
.U
88003461
.S
Contact Dermatitis 8801; 17(1):55-6
.M
Adult; Amantadine/*AA/AE/TU; Case Report; Dermatitis Medicamentosa/*ET; Herpes Labialis/DT; Human; Male; Patch Tests.
.T
Allergic contact dermatitis to tromantadine.
.P
JOURNAL ARTICLE.
.A
Miranda A; Gomez S; del Pozo LJ; Quinones PA.
.I 55067
.U
88003462
.S
Contact Dermatitis 8801; 17(1):56-7
.M
Aged; Atropine/*AE; Case Report; Dermatitis Medicamentosa/*ET; Eyelid Diseases/*CI; Facial Dermatoses/*CI; Female; Human; Male; Ophthalmic Solutions; Patch Tests.
.T
Periocular dermatitis from atropine.
.P
JOURNAL ARTICLE.
.A
van der Willigen AH; de Graaf YP; van Joost T.
.I 55068
.U
88003463
.S
Contact Dermatitis 8801; 17(1):57-8
.M
Case Report; Dermatitis, Contact/*ET; Facial Dermatoses/*CI; Hair Preparations/*AE; Human; Male; Middle Age; Patch Tests; Quinolines/*AE; Scalp Dermatoses/*CI.
.T
Allergic contact dermatitis to D & C yellow 11 in a hair cream.
.P
JOURNAL ARTICLE.
.A
Monk B.
.I 55069
.U
88003464
.S
Contact Dermatitis 8801; 17(1):58-9
.M
Adult; Alopecia/DT; Case Report; Dermatitis Medicamentosa/*ET; Facial Dermatoses/*CI; Human; Male; Minoxidil/*AE/TU; Patch Tests; Scalp Dermatoses/*CI.
.T
Allergic contact dermatitis from minoxidil.
.P
JOURNAL ARTICLE.
.A
Valsecchi R; Cainelli T.
.I 55070
.U
88003465
.S
Contact Dermatitis 8801; 17(1):59-60
.M
Administration, Topical; Adult; Case Report; Dermatitis Medicamentosa/*ET; Drugs, Chinese Herbal/*AE; Facial Dermatoses/*CI; Female; Human.
.T
Allergic contact dermatitis to yunnan paiyao.
.P
JOURNAL ARTICLE.
.A
Lee TY; Lam TH.
.I 55071
.U
88003466
.S
Contact Dermatitis 8801; 17(1):61-2
.M
Dermatitis, Contact/*DI; Diagnosis, Differential; Human; Patch Tests; Thermography/*MT.
.T
Contact thermography--towards the Sherlock Holmes magnifying glass for solving allergic and irritant patch test reactions? [letter]
.P
LETTER.
.A
Serup J.
.I 55072
.U
88003467
.S
Contact Dermatitis 8801; 17(1):62-3
.M
Antioxidants/*AE; Artificial Limbs/*; Catechols/*AE; Dermatitis, Contact/*ET; Human.
.T
Artificial limb dermatitis [letter]
.P
LETTER.
.A
Freeman S.
.I 55073
.U
88003468
.S
Contact Dermatitis 8801; 17(2):100-3
.M
Administration, Oral; Double-Blind Method; Eczema/*CI; Female; Food Additives/*AE; Human; Male.
.T
Oral challenge with food additives.
.P
JOURNAL ARTICLE.
.W
A randomized, placebo-controlled oral challenge with food additives (preservatives and food colorings) was carried out in 101 patients with eczema of undetermined origin who suspected that the intake of certain foods aggravated their dermatitis. 37 reacted to 1 or more of the food additives but not to a placebo, while 16 reacted to the placebo, or both the placebo and food additives. 48 had no reactions. The difference between the number of reactions to the food additives and the number of reactions to the placebo was not statistically significant. The reactions could be reproduced in only 1/3 of those challenged twice. It was not possible to correlate the reactions to food additives to reactivity to specific foodstuffs containing the same additives. If intolerance to food additives is suspected, an elimination diet seems warranted, regardless of whether the patient reacts to oral challenge with food additives.
.A
Veien NK; Hattel T; Justesen O; Norholm A.
.I 55074
.U
88003469
.S
Contact Dermatitis 8801; 17(2):104-7
.M
Adult; Age Factors; Allergens/*DU; Chromates/AE; Dermatitis, Contact/EP/ET; Female; Human; Male; Middle Age; Nickel/AE; Patch Tests/*MT; Sex Factors; Skin Tests/*MT; Time Factors.
.T
Patch test results with standard allergens over a decade.
.P
JOURNAL ARTICLE.
.W
The results of 10 years of patch testing with standard allergens are reported. An increase of sensitivity was found in nickel. Sensitivity to chromate had decreased. Sex and age differences in the incidence of allergy to metals were analysed. Nickel allergy appeared to be more common among women and was of most importance in the younger age groups.
.A
Young E; Houwing RH.
.I 55075
.U
88003470
.S
Contact Dermatitis 8801; 17(2):108-9
.M
Adolescence; Adult; Dermatitis, Contact/*ET; Female; Human; Ketoprofen/*AE; Male; Middle Age; Patch Tests; Phenylpropionates/*AE; Photosensitivity Disorders/*CI.
.T
Photo-contact dermatitis from ketoprofen.
.P
JOURNAL ARTICLE.
.A
Cusano F; Rafenelli A; Bacchilega R; Errico G.
.I 55076
.U
88003471
.S
Contact Dermatitis 8801; 17(2):109-10
.M
Adult; Air Pollutants, Occupational/*AE; Botany/*; Case Report; Human; Male; Occupational Dermatitis/*CI; Plant Extracts/*AE.
.T
Airborne contact dermatitis to Coleus.
.P
JOURNAL ARTICLE.
.A
Dooms-Goossens A; Borghijs A; Degreef H; Devriese EG; Geuns JM.
.I 55077
.U
88003473
.S
Contact Dermatitis 8801; 17(2):111-2
.M
Case Report; Human; Male; Metallurgy/*; Middle Age; Occupational Dermatitis/*ET; Patch Tests; Rhodium/*AE.
.T
Contact dermatitis to rhodium.
.P
JOURNAL ARTICLE.
.A
Bedello PG; Goitre M; Roncarolo G; Bundino S; Cane D.
.I 55078
.U
88003474
.S
Contact Dermatitis 8801; 17(2):112-3
.M
Case Report; Eczema/ET; Human; Male; Middle Age; Occupational Dermatitis/*ET; Pollen/*AE; Skin Tests.
.T
Orchid allergy.
.P
JOURNAL ARTICLE.
.A
MacAulay JC.
.I 55079
.U
88003475
.S
Contact Dermatitis 8801; 17(2):113-4
.M
Adult; Case Report; Dermatitis, Contact/*ET; Diseases in Twins/*; Environment; Female; Hand Dermatoses/*ET; Human; Nickel/*AE; Patch Tests; Twins, Monozygotic.
.T
Hand dermatitis and contact sensitivity in twins.
.P
JOURNAL ARTICLE.
.A
Tosti A; Melino M; Veronesi S.
.I 55080
.U
88003476
.S
Contact Dermatitis 8801; 17(2):114-5
.M
Aged; Case Report; Dermatitis Medicamentosa/*ET; Human; Male; Patch Tests; Photosensitivity Disorders/*CI; Triamterene/*AE.
.T
Photodermatitis from triamterene.
.P
JOURNAL ARTICLE.
.A
Fernandez de Corres L; Bernaola G; Fernandez E; Leanizbarrutia I; Munoz D.
.I 55081
.U
88003477
.S
Contact Dermatitis 8801; 17(2):115-6
.M
Adult; Case Report; Contraceptive Devices/*; Dermatitis, Contact/*ET; Female; Human; Patch Tests; Pyrans/*AE; Spermatocidal Agents/*AE.
.T
Allergy to spermicidal lubricant in a contraceptive.
.P
JOURNAL ARTICLE.
.A
van Ulsen J; Stolz E; van Joost T; Geursen-Reitsma AM.
.I 55082
.U
88003478
.S
Contact Dermatitis 8801; 17(2):116-7
.M
Adolescence; Dermatitis Medicamentosa/*ET; Female; Human; Leg Ulcer/*DT; Male; Patch Tests; Protein C/*DF.
.T
Medicament dermatitis around leg ulcers due to lack of protein C.
.P
JOURNAL ARTICLE.
.A
Pigatto PD; Fumagalli M; Polenghi MM; Mozzanica N; Altomare GF.
.I 55083
.U
88003479
.S
Contact Dermatitis 8801; 17(2):117-8
.M
Adolescence; Age Factors; Child; Child, Preschool; Dermatitis, Atopic/*ET; Female; Human; Male; Patch Tests/*; Skin Tests/*.
.T
Patch testing in children.
.P
JOURNAL ARTICLE.
.A
Rudzki E; Grzywa Z; Rebandel P.
.I 55084
.U
88003481
.S
Contact Dermatitis 8801; 17(2):119-21
.M
Bandages/*; Case Report; Dermatitis, Contact/*ET; Human; Male; Middle Age; Patch Tests; Phenylenediamines/*AE.
.T
IPPD contact allergy from an orthopedic bandage.
.P
JOURNAL ARTICLE.
.A
Carlsen L; Andersen KE; Egsgaard H.
.I 55085
.U
88003482
.S
Contact Dermatitis 8801; 17(2):121
.M
Administration, Cutaneous; Adult; Case Report; Dermatitis Medicamentosa/*ET; Dermatitis, Contact/*ET; Human; Indomethacin/AD/*AE; Male; Patch Tests.
.T
Contact dermatitis to indomethacin.
.P
JOURNAL ARTICLE.
.A
Beller U; Kaufmann R.
.I 55086
.U
88003483
.S
Contact Dermatitis 8801; 17(2):122-3
.M
Administration, Topical; Aminoglycosides/AD/AE; Antibiotics/AD/*AE; Case Report; Child; Dermatitis Medicamentosa/*ET; Dermatitis, Contact/*ET; Human; Male; Patch Tests.
.T
Lichenoid contact dermatitis due to aminoglycoside antibiotics.
.P
JOURNAL ARTICLE.
.A
Lembo G; Balato N; Patruno C; Pini D; Ayala F.
.I 55087
.U
88003484
.S
Contact Dermatitis 8801; 17(2):123-4
.M
Adult; Aged; Female; Human; Male; Middle Age; Patch Tests/*; Quinolines/*AE; Skin Tests/*.
.T
Incidence and relevance of patch testing to quinoline-mix.
.P
JOURNAL ARTICLE.
.A
Ayadi M; Martin P; Bergoend H.
.I 55088
.U
88003485
.S
Contact Dermatitis 8801; 17(2):124-5
.M
Adult; Case Report; Cosmetics/*AE; Dermatitis, Contact/*ET; Eyelid Diseases/CI; Female; Formaldehyde/AE; Human; Skin Tests/MT; Urea/AA/AE.
.T
Hidden contact allergy to formaldehyde in imidazolidinyl urea.
.P
JOURNAL ARTICLE.
.A
de Groot AC; Weyland JW.
.I 55089
.U
88003486
.S
Contact Dermatitis 8801; 17(2):126
.M
Aged; Case Report; Dermatitis Medicamentosa/*ET; Dermatitis, Contact/*ET; Eczema/ET; Female; Human; Male; Middle Age; Patch Tests; Resorcinols/*AE; Rosaniline Dyes/AE.
.T
Allergic contact dermatitis from resorcinol.
.P
JOURNAL ARTICLE.
.A
Langeland T; Braathen LR.
.I 55090
.U
88003488
.S
Contact Dermatitis 8801; 17(2):69-72
.M
Adult; Dermatologic Agents/*TU; Female; Glass/*AE; Human; Irritants/AE; Male; Middle Age; Occupational Dermatitis/ET/*PC; Pruritus/ET/PC.
.T
Glass fibre irritation and protective creams.
.P
JOURNAL ARTICLE.
.W
5 commercial products were tested pairwise as prophylaxis against itching and irritation from glass fibres: a commercial cream for glass fibre itching, a silicone spray, an emollient cream, a fatty ointment, and a "cream-ointment". The preparations were found to have very limited value in protection against glass fibre irritation. Some workers even experienced exacerbated itching from all the preparations, including the cream marketed for protection against glass fibre irritation. Only 25% of a group of workers with severe glass fibre itching still used an emollient cream after 12 weeks.
.A
Bendsoe N; Bjornberg A; Lowhagen GB; Tengberg JE.
.I 55091
.U
88003491
.S
Contact Dermatitis 8801; 17(2):85-8
.M
Adolescence; Adult; Citrus Fruits/AE; Dermatitis, Contact/*EP/ET; Female; Hand Dermatoses/*EP/ET; Human; Middle Age; Nickel/AE; Nigeria; Occupational Dermatitis/EP/ET; Patch Tests.
.T
Contact dermatitis in Nigeria (i). Hand dermatitis in women.
.P
JOURNAL ARTICLE.
.W
Of 545 consecutive contact dermatitis clinic patients, 271 (49.7%) were women, 29 (10.7%) of whom had hand dermatitis alone. 17 (58.6%) of these hand cases were allergic, the main sensitizers being nickel and essential oils in oranges. Dress makers were mostly affected by nickel, while orange sellers and peelers were positive to orange peel, fragrance mix, balsam of Peru and formaldehyde in varying combinations. 8 (27.6%) of the hand cases were due to irritants and wet jobs, and possibly to allergens not tested. 24 (83%) of the hand cases were occupational. Only 1 Nigerian woman had true housewife's hand dermatitis. It was not possible to define the role of atopy because of unreliable histories. 2 cases of pompholyx and a negative patch test occurred in the first trimester of pregnancy.
.A
Olumide Y.
.I 55092
.U
88003492
.S
Contact Dermatitis 8801; 17(2):89-91
.M
Adult; Air Pollutants, Occupational/*AE; Case Report; Dermatitis, Contact/ET; Electronics; Human; Male; Occupational Dermatitis/*ET; Resins/*AE.
.T
Airborne contact dermatitis to colophony in soldering flux.
.P
JOURNAL ARTICLE.
.W
Soldering flux is a common cause of occupational dermatitis in the electronics industry. Several constituents of flux such as colophony, hydrazine and aminoethylethanolamine are contact allergens. A machine operator of a wave-soldering machine developed airborne allergic contact dermatitis to colophony in the flux.
.A
Goh CL; Ng SK.
.I 55093
.U
88003499
.S
Crit Care Med 8801; 15(10):915-7
.M
Comparative Study; Evaluation Studies; Hemodynamics/*; High-Frequency Jet Ventilation/*MT; Human; Postoperative Care/*; Random Allocation; Respiration/*.
.T
Synchronous versus nonsynchronous high-frequency jet ventilation: effects on cardiorespiratory variables and airway pressures in postoperative patients.
.P
JOURNAL ARTICLE.
.W
In order to compare the differences of high-frequency jet ventilation (HFJV) synchronized with the cardiac cycle (sync) to that nonsynchronized with the cardiac cycle (async), ten stable postoperative ICU patients, without heart failure, in sinus rhythm were ventilated randomly in either mode. The async mode was HFJV at 100 cycle/min, while the sync mode was HFJV triggered by the R-wave of the ECG tracing. The heart rate ranged between 64 and 127 beat/min. Synchronization was studied at one of two periods, sync 0 and sync 60. Sync 0 consisted of inspiration triggered by the R-wave, with jet ventilation occurring early in systole; sync 60 represented a 60% delay of the time between the succeeding R-waves, with jet ventilation occurring in mid-diastole. There was no significant difference in the cardiorespiratory data when async was compared to either sync 0 or sync 60. Therefore, in these patients without heart failure, the selection of async vs. either sync mode appeared to have neither adverse nor beneficial hemodynamic effects.
.A
Bayly R; Sladen A; Guntupalli K; Klain M.
.I 55094
.U
88003500
.S
Crit Care Med 8801; 15(10):918-22
.M
Critical Care; Gestational Age; Human; Infant, Low Birth Weight; Infant, Newborn; Intubation, Intratracheal; Pulmonary Surfactants/AD/*TU; Random Allocation; Respiration, Artificial; Respiratory Distress Syndrome/RA/*TH; Support, Non-U.S. Gov't.
.T
Endotracheal administration of surfactant in very low birth weight infants with respiratory distress syndrome.
.P
JOURNAL ARTICLE.
.W
This study was designed to evaluate whether the ventilatory maneuvers associated with surfactant replacement would, per se, influence oxygenation in newborn infants with severe respiratory distress syndrome. Eight patients (700 to 1400 g), all requiring mechanical ventilation with fraction of inspired oxygen greater than 0.6, were included in the trial; four were randomized to receive surfactant, and the others served as controls. Porcine surfactant (2 ml/kg; phospholipid concentration, 100 mg/ml) was instilled via a naso-endotracheal tube at end-expiration and dispersed into the lungs during a period of standardized "sighing" mediated by the ventilator: two prolonged ventilatory cycles (10 sec each) with an inspiration/expiration ratio of 4:1, followed by a 6-min ventilation with a frequency of 60 breath/min and an inspiration/expiration ratio of 4:1. Control babies received no surfactant but were otherwise subjected to the same ventilatory maneuvers. Surfactant-treated infants showed a rapid increase in transcutaneous oxygen associated with improved lung aeration in chest x-rays; the response was transient in three babies and persistent in one. No improvement was observed in control babies. We conclude that the beneficial effect of surfactant replacement cannot be attributed to the ventilatory maneuvers associated with the instillation procedure.
.A
Svenningsen N; Robertson B; Andreason B; Berggren P; Jonson B; Lindroth M.
.I 55095
.U
88003501
.S
Crit Care Med 8801; 15(10):923-9
.M
Adolescence; Adult; Aged; Child; Heart Rate/*; Hemodynamics; Human; Intensive Care Units; Middle Age; Prognosis; Shock, Septic/MO/*PP.
.T
Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: heart rate as an early predictor of prognosis.
.P
JOURNAL ARTICLE.
.W
Forty-eight septic shock patients with positive blood cultures had conventional serial hemodynamic evaluations until recovery or death to identify early cardiovascular variables that predicted outcome. There were 19 (40%) survivors and 29 nonsurvivors. At the initial evaluation, both survivors and nonsurvivors demonstrated an elevated cardiac index (CI), low systemic vascular resistance index (SVRI), and normal stroke volume index. However, only an initial heart rate (HR) less than 106 beat/min significantly predicted survival. Twenty-four hours after the onset of shock, both an HR less than 95 beat/min and an SVRI greater than 1529 dyne.sec/cm5.m2 predicted survival. Comparing the hemodynamic profiles from the initial to the 24 h time point, a decrease in HR greater than 18 beat/min or a decrease in CI greater than 0.5 L/min.m2 predicted survival. Twenty-two deaths occurred in the first week of study, of which 18 (82%) were due primarily to low SVRI and four (18%) to low CI. Seven deaths occurred after 1 wk, all of which were due to multiple organ failure.
.A
Parker MM; Shelhamer JH; Natanson C; Alling DW; Parrillo JE.
.I 55096
.U
88003502
.S
Crit Care Med 8801; 15(10):930-2
.M
Adult; Aged; Cross Infection/EP/*ET/MI/MO; Female; Human; Intensive Care Units/*; Male; Middle Age; Pneumonia/EP/*ET/MI/MO; Prospective Studies; Respiration, Artificial.
.T
ICU pneumonias: a multi-institutional study.
.P
JOURNAL ARTICLE.
.W
We conducted a prospective multi-institutional study of nosocomial and community-acquired pneumonias in 1378 patients admitted to the ICUs of six hospitals. We also investigated 1005 of these patients who were intubated and mechanically ventilated for a reason other than pneumonia, the risk of developing pneumonia, and the relationship between the incidence of pneumonia and the length of time during which the patients were mechanically ventilated. A bacteriologic diagnosis was made in 38% of the nosocomial and 21% of the community-acquired pneumonias. The total mortality rate was 40%; 47% of the patients with nosocomial and 17% of the patients with community-acquired pneumonias died. Because it was difficult to make an etiologic diagnosis in two-thirds of the cases, the treatment had to be based on an assumed causative organism.
.A
Ruiz-Santana S; Garcia Jimenez A; Esteban A; Guerra L; Alvarez B; Corcia S; Gudin J; Martinez A; Quintana E; Armengol S; et al.
.I 55097
.U
88003503
.S
Crit Care Med 8801; 15(10):933-8
.M
Animal; Dogs; Female; Hemodynamics/DE; Male; Oxygen Consumption; Shock, Hemorrhagic/*PP; Support, Non-U.S. Gov't; Thyroidectomy; Triiodothyronine/BL; Triiodothyronine, Reverse/*AE.
.T
Detrimental effect of reverse triiodothyronine in hemorrhagic shock.
.P
JOURNAL ARTICLE.
.W
To examine whether reverse triiodothyronine (rT3), generally considered devoid of biological activity, could influence outcome in circulatory collapse, 23 anesthetized mongrel dogs were subjected to hemorrhagic shock. In 10 dogs, 15 micrograms/kg of rT3 were administered iv 30 min before hemorrhage. In 13 other dogs, an equal volume of saline was injected. The dogs were bled rapidly to a mean arterial pressure of 40 mm Hg, and after 60 min the reservoir line was clamped for 30 min. The shed blood was then reinfused over 30 min. After one hour of hemodynamic monitoring, the dogs were returned to the kennel and observed for at least 3 days. During shock there were few significant intergroup hemodynamic-metabolic differences. In the control group, six of 13 dogs died, whereas nine of ten dogs given rT3 died (p less than .03). This study strongly suggests that rT3 exerts detrimental biological activity in canine hemorrhagic shock. Hence, rT3 may play a causative role in the euthyroid sick ("low T3") syndrome.
.A
Shigematsu H; Smith RA; Shatney CH.
.I 55098
.U
88003504
.S
Crit Care Med 8801; 15(10):939-43
.M
Animal; Blood Pressure; Cardiac Output/*; Cerebrovascular Circulation/*; Comparative Study; Dogs; Evaluation Studies; Microspheres; Nitrous Oxide/ME; Resuscitation/*MT.
.T
Slow versus rapid closed-chest cardiac compression during cardiopulmonary resuscitation in puppies.
.P
JOURNAL ARTICLE.
.W
The recommended rates for closed-chest cardiac compressions during CPR are based on physiologic variations with increasing age rather than experimental data. Using puppies, we compared mean arterial pressure, cardiac index (CI), and cerebral blood flow (CBF) at a slow (40/min, group 1) and a rapid (120/min, group 2) rate. CBF was measured in all experiments by N2O uptake before and during CPR from cardiac arrest induced with KCl. Both CI and CBF were measured in half of the subjects with radiolabeled microspheres. Groups 1 and 2 were similar in terms of baseline mean weight, mean arterial pressure, CI, CBF, and arterial and venous blood gases. During resuscitation for group 1, the mean CI was 221 ml/min . m2, and the mean CBF was 4 ml/100 g . min determined by N2O uptake (2 ml/100 g.min by microspheres); in group 2, the respective means were 248 ml/min . m2 and 4 ml/100 g . min with both techniques. The values for mean CI and CBF (N2O or microspheres) did not differ significantly at either rate of compression. The N2O uptake and microsphere techniques for measuring CBF correlated closely during spontaneous cardiac contractions and mechanical chest compressions. We conclude that a) closed-chest cardiac compressions at either rate studied provided inadequate CBF, and b) the N2O uptake and microsphere techniques give similar measures of CBF under conditions of normal and low flow.
.A
Fleisher G; Delgado-Paredes C; Heyman S.
.I 55099
.U
88003511
.S
Crit Care Med 8801; 15(10):971-7
.M
Critical Care/*ST; Curriculum/*; Fellowships and Scholarships/*; Human; Societies, Medical; United States.
.T
Recommendations for program content for fellowship training in critical care medicine. Task Force on Guidelines. Society of Critical Care Medicine.
.P
JOURNAL ARTICLE.
.I 55100
.U
88003512
.S
Crit Care Med 8801; 15(10):977
.M
Critical Care/*ST; Education, Continuing/*; Fellowships and Scholarships; Human.
.T
Recommendations for the qualifications of a director of a fellowship training program in critical care medicine. Task Force on Guidelines. Society of Critical Care Medicine.
.P
JOURNAL ARTICLE.
.I 55101
.U
88003513
.S
Crit Care Med 8801; 15(10):978
.M
Accreditation/*; Canada; Critical Care/*; Education, Medical; Specialties, Medical/*.
.T
Accreditation without certification: critical care training in Canada.
.P
JOURNAL ARTICLE.
.A
King EG.
.I 55102
.U
88003514
.S
Crit Care Med 8801; 15(10):979-82
.M
Canada; Critical Care/*; Education, Medical/*; Specialties, Medical.
.T
Educational objectives for critical care training in Canada. Royal College of Physicians and Surgeons of Canada.
.P
JOURNAL ARTICLE.
.I 55103
.U
88003515
.S
Crit Care Med 8801; 15(10):983-4
.M
Case Report; Disseminated Intravascular Coagulation/DT/*ET; Female; Heparin/TU; Human; Middle Age; Pulmonary Embolism/*CO/DT.
.T
Pulmonary embolus-induced disseminated intravascular coagulation.
.P
JOURNAL ARTICLE.
.W
Pulmonary embolus as a cause of disseminated intravascular coagulation has only recently been recognized. The hemorrhagic disorder reported in the past was associated with little or no bleeding. We report a case of pulmonary embolus associated with life-threatening disseminated intravascular coagulation.
.A
Pesola GR; Carlon GC.
.I 55104
.U
88003516
.S
Crit Care Med 8801; 15(10):985-6
.M
Adult; Airway Obstruction/*TH; Anoxemia/ET; Bronchoscopy; Case Report; Female; Fiber Optics; Hemoptysis/CO/*TH; Human; Male; Middle Age; Respiratory Insufficiency/ET/*TH.
.T
Emergency airway clot removal in acute hemorrhagic respiratory failure.
.P
JOURNAL ARTICLE.
.W
Three cases of respiratory failure and severe hypoxemia caused by blood clot obscuring the central airway are described. A technique to clear the airway using a no. 6 Fogarty balloon-tip embolectomy catheter inserted through a flexible fiberoptic bronchoscope was used in all three cases. Marked improvement and stabilization occurred while definitive therapy was undertaken.
.A
Allen RP; Siefkin AD.
.I 55105
.U
88003517
.S
Crit Care Med 8801; 15(10):987-8
.M
Adult; Blood Pressure; Case Report; Diazepam/TU; Epinephrine/BL; Human; Infusions, Intravenous; Magnesium Sulfate/*TU; Male; Norepinephrine/BL; Tetanus/*DT/PP.
.T
Autonomic dysfunction in severe tetanus: magnesium sulfate as an adjunct to deep sedation.
.P
JOURNAL ARTICLE.
.W
We studied the use of continuous iv magnesium (Mg) infusion to control the sympathetic crises in a patient with severe tetanus characterized by pronounced autonomic nervous system instability. Our results suggested that Mg is a useful adjunct to the CNS depressants traditionally used. This therapy controlled the sympathetic crises and also suppressed the release of catecholamines, although Mg infusions alone appeared to be inadequate therapy.
.A
Lipman J; James MF; Erskine J; Plit ML; Eidelman J; Esser JD.
.I 55106
.U
88003518
.S
Crit Care Med 8801; 15(10):989
.M
Cardiac Output/*; Comparative Study; Computers/*; Human; Thermodilution/*.
.T
Comparison of thermodilution cardiac output measured by different computers [letter]
.P
LETTER.
.A
Matthew EB; Vender JS.
.I 55107
.U
88003519
.S
Crit Care Med 8801; 15(10):989-90
.M
Human; Intubation, Intratracheal; Work of Breathing/*.
.T
Minimizing work of a breathing through endotracheal tubes [letter]
.P
LETTER.
.A
Hendrickx HH.
.I 55108
.U
88003520
.S
Crit Care Med 8801; 15(10):990-1
.M
Home Nursing; Human; Infant; Infant, Newborn; Monitoring, Physiologic; Oximetry/*; Sleep Apnea Syndromes/*DI.
.T
Impedance pneumography for apnea detection [letter]
.P
LETTER.
.A
Josten KU.
.I 55109
.U
88003641
.S
Chest 8801; 92(4):579
.M
Anoxemia/*PP; Circadian Rhythm/*; Human; Lung Diseases, Obstructive/*PP; Sleep/PH.
.T
Nocturnal hypoxemia in COPD [editorial]
.P
EDITORIAL.
.A
Hudgel DW.
.I 55110
.U
88003642
.S
Chest 8801; 92(4):580-1
.M
Ambroxol/*TU; Bromhexine/*AA; Clinical Trials/*; Expectorants/*TU; Human; Random Allocation.
.T
Rigorous evaluation. Greater need than ever [editorial]
.P
EDITORIAL.
.A
Guyatt GH; Newhouse MT.
.I 55111
.U
88003643
.S
Chest 8801; 92(4):581-2
.M
Angina Pectoris/*ET; Angina, Unstable/*ET/PA/RA; Coronary Vessels/PA/RA; Human.
.T
On the pathogenesis of unstable angina [editorial]
.P
EDITORIAL.
.A
Ambrose JA; Hjemdahl-Monsen C.
.I 55112
.U
88003644
.S
Chest 8801; 92(4):582-4
.M
Airway Obstruction/*ET; Human; Lung Diseases/*CO; Sarcoidosis/*CO.
.T
Airflow obstruction in sarcoidosis [editorial]
.P
EDITORIAL.
.A
Lewis MI; Horak DA.
.I 55113
.U
88003645
.S
Chest 8801; 92(4):584-5
.M
Dysarthria/DI/*ET; Human; Sleep Apnea Syndromes/*CO; Speech Disorders/*ET.
.T
Listening to our patients takes on new meaning [editorial]
.P
EDITORIAL.
.A
Littner MR; Hanson WR.
.I 55114
.U
88003647
.S
Chest 8801; 92(4):594-603
.M
Adolescence; Adult; Air Pollutants, Environmental/*AE; California; Child; Comparative Study; Female; Human; Lung/*PP; Lung Diseases, Obstructive/*PP; Male; Middle Age; Oxidants, Photochemical/AE; Oxides/AE; Respiratory Function Tests; Sulfates/AE; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Urban Population.
.T
The UCLA population studies of chronic obstructive respiratory disease. 9. Lung function changes associated with chronic exposure to photochemical oxidants; a cohort study among never-smokers.
.P
JOURNAL ARTICLE.
.W
Two cohorts of never-smoking residents of Los Angeles were studied on two occasions five years apart. One cohort (N = 1,099) lived in a community with moderate levels of photochemical pollution and low levels of other pollutants, and the second (N = 1,117) lived in a community with very high levels of photochemical oxidant and relatively high levels of sulfates and particulates. Studies included measurement of forced expiratory volumes and flow rates and single-breath nitrogen washout, as well as use of a standardized questionnaire. The data represent 47 percent of 2,340 and 58 percent of 1,935 residents, respectively, of the original community samples. Mean baseline spirometry and nitrogen washout for those who were and those who were not retested were similar, reflecting the fact that loss to follow-up was primarily due to changes of residence. In the more polluted area there were significantly worse lung function test results for both men and women at baseline and significantly more rapid deterioration at follow-up. Mean changes in nitrogen washout were significantly greater in the more polluted community for both sexes and for all age groups including children. Most of the spirometric test results showed significantly more rapid decline among adults in the more polluted community. These results are consistent with the hypothesis that chronic exposures to a mix of photochemical oxidants, sulfates and particulates are associated with increased loss of lung function, which is especially marked among tests that reflect function of the small airways.
.A
Detels R; Tashkin DP; Sayre JW; Rokaw SN; Coulson AH; Massey FJ Jr; Wegman DH.
.I 55115
.U
88003648
.S
Chest 8801; 92(4):604-8
.M
Aged; Circadian Rhythm; Electrocardiography; Electroencephalography; Electromyography; Human; Lung Diseases, Obstructive/*PP; Male; Middle Age; Oxygen/BL; Oxyhemoglobins/*AN; Partial Pressure; Respiratory Function Tests; Sleep, REM/*PH; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Nocturnal oxyhemoglobin desaturation in COPD patients with arterial oxygen tensions above 60 mm Hg.
.P
JOURNAL ARTICLE.
.W
We studied 152 COPD patients with a daytime PaO2 greater than or equal to 60 mm Hg using formal polysomnography (EEG, airflow, respiratory muscle movement, ear oximeter) to detect the presence of nocturnal, nonapneic, oxyhemoglobin desaturation. Nine subjects were disqualified by the unexpected discovery of sleep apnea, as were another eight because they could not sleep in the laboratory setting. Of the remaining 135 subjects, 37 (27 percent) desaturated below a baseline sleep saturation of 90 percent for five minutes or more, reaching a nadir saturation of at least 85 percent. Anthropomorphic, pulmonary function, and historic factors comparing desaturators and nondesaturators failed to separate the groups. Awake PaO2 at rest in the desaturators was significantly lower than in the nondesaturators. The PaCO2 was higher in the desaturators. Reversibility of the desaturation phenomenon was demonstrated in three patients during subsequent polysomnographic studies following periods of clinical improvement. Continuous oxyhemoglobin monitoring during sleep remains the only reliable tool for detecting nocturnal desaturation.
.A
Fletcher EC; Miller J; Divine GW; Fletcher JG; Miller T.
.I 55116
.U
88003649
.S
Chest 8801; 92(4):609-12
.M
Aged; Angina Pectoris/*PA; Angina, Unstable/*PA/RA; Coronary Vessels/*PA/RA; Female; Human; Male; Middle Age; Retrospective Studies.
.T
Coronary arteriographic lesion of unstable angina.
.P
JOURNAL ARTICLE.
.W
The morphology of the coronary arteriographic lesions in 109 patients with coronary disease was correlated with their clinical history. Unstable angina, characterized by new onset of angina, angina at rest, or an increase in frequency or ease of precipitation of attacks within the previous two months, was present in 73 patients (group A). The other 36 patients had no history of instability within two months (group B). "Type T" lesions, defined as eccentric narrowing with jagged irregular borders with overlapping or undermined areas, or intraluminal filling defects circumferentially outlined by contrast material were found in 73 percent of group 1 vs 47 percent of group B (p less than 0.01). The presence of these angiographic lesions suggests that a ruptured atherosclerotic plaque and/or thrombus commonly plays a role in the etiology of unstable angina.
.A
Haft JI; Goldstein JE; Niemiera ML.
.I 55117
.U
88003650
.S
Chest 8801; 92(4):613-7
.M
Aged; Agricultural Workers' Diseases/CO; Asthma/EC/*EP/ET; Environmental Exposure; Female; Human; Male; Middle Age; Occupations; Pneumoconiosis/*EP; Risk; Support, Non-U.S. Gov't; United States; Workmen's Compensation.
.T
Occupational asthma in a national disability survey.
.P
JOURNAL ARTICLE.
.W
The contribution of workplace exposures to the prevalence of asthma in adults has been minimized in the epidemiology of this illness. Analysis of the 1978 Social Security Disability Survey provides a population-based assessment as a novel approach utilizing self-attributed, occupationally related asthma as a measure of disease. Of 6,063 respondents, 468 (7.7 percent) identified asthma as a personal medical condition; 72 (1.2 percent [15.4 percent of all those with asthma]) attributed it to workplace exposures. These subjects were older and included more men and cigarette smokers than groups of both asthmatic and nonasthmatic subjects. The relative risk for occupationally attributed asthma was elevated among industrial and agricultural workers as compared with white collar and service occupations. Analysis of disability benefit status did not indicate that this introduced major reporting bias in this survey. This study suggests that occupational factors may have a greater role in adult asthma than previously thought.
.A
Blanc P.
.I 55118
.U
88003654
.S
Chest 8801; 92(4):631-7
.M
Adult; Airway Resistance; Anthropometry; Diet, Reducing; Female; Human; Hydrogen-Ion Concentration; Male; Middle Age; Obesity/DT/*PP; Oxyhemoglobins/AN; Pharynx/*PP; Respiration/*; Sleep Apnea Syndromes/*PP; Spirometry; Support, U.S. Gov't, P.H.S..
.T
Changes in breathing and the pharynx after weight loss in obstructive sleep apnea.
.P
JOURNAL ARTICLE.
.W
The effect of weight loss following dietary restriction on disordered breathing on the pharyngeal airway is controversial in patients with obstructive sleep apnea (OSA). We therefore prospectively studied eight patients before and after dietary-induced weight loss. Mean weight loss was 20.6 kg +/- 12.8 SD. After weight loss there were significant improvements in PO2 and PCO2 measured during wakefulness, and in the number of desaturation episodes per hour of sleep, average desaturation per episode, and number of movement arousals. The number of apneas and hypopneas significantly decreased in six of eight patients. There was a significant correlation between body mass index and number of disordered breathing events. Nasopharyngeal collapsibility and pulse flow resistance decreased in awake patients after weight loss. We conclude that moderate weight loss in obese patients with OSA improves oxygenation during both sleep and wakefulness, decreases the number of disordered breathing events in many patients, decreases the collapsibility of the nasopharyngeal airway.
.A
Suratt PM; McTier RF; Findley LJ; Pohl SL; Wilhoit SC.
.I 55119
.U
88003655
.S
Chest 8801; 92(4):638-44
.M
Adult; Cocaine/*AD; Comparative Study; Female; Human; Male; Marijuana Smoking/*AE; Middle Age; Pulmonary Diffusing Capacity/DE; Respiratory Function Tests; Respiratory System/*DE; Smoking/*AE; Support, U.S. Gov't, P.H.S..
.T
Respiratory effects of cocaine "freebasing" among habitual users of marijuana with or without tobacco.
.P
JOURNAL ARTICLE.
.W
Use of cocaine by smoking its alkaline precursor ("freebasing") has become increasingly prevalent. Recent studies of small numbers of cocaine users suggest that freebasing frequently causes cough, dyspnea, and abnormalities in diffusing capacity (DCO), although these findings could have been due to concomitant use of other drugs. We therefore evaluated the relationship between cocaine use by freebasing and chronic respiratory symptoms and lung dysfunction in a large sample of habitual smokers of marijuana with or without tobacco who denied intravenous drug abuse. The findings suggested that, among habitual marijuana smokers, "moderate" cocaine smoking damaged both large and small airways, as reflected by functional changes that were independent of concomitant marijuana use and appeared to be synergistic with the effects of tobacco. On the other hand, no adverse influence of cocaine smoking on the pulmonary microcirculation was demonstrated in our sample of freebase users.
.A
Tashkin DP; Simmons MS; Coulson AH; Clark VA; Gong H Jr.
.I 55120
.U
88003656
.S
Chest 8801; 92(4):645-50
.M
Adult; Aorta, Thoracic/*PP; Blood Flow Velocity; Diastole; Female; Heart Failure, Congestive/*PP; Human; Magnetic Resonance Imaging/*; Male; Middle Age; Pulmonary Artery/*PP; Support, Non-U.S. Gov't; Systole.
.T
Magnetic resonance imaging of blood flow in thoracic vessels of patients with impaired left ventricular function.
.P
JOURNAL ARTICLE.
.W
In order to test the ability of magnetic resonance (MR) in the detection of pathologic flow conditions in man, we imaged 10 normal volunteers and 10 patients with congestive heart failure (CHF) with ECG-gated MR. We used a single spin-echo sequence on a transverse plane through the main vessels of the upper chest. The analysis of the variation of the mean signal intensity vs time from the ascending aorta (AA), descending aorta (DA), and pulmonary artery (PA) of the ten normal volunteers on the TE = 30 ms images, showed a common pattern characterized by an end-diastolic intraluminal signal not present in other moments of the cardiac cycle. On the contrary, in patients with CHF, we did not observe the systolic disappearance of the intraluminal MR signal. The main difference between CHF patients and control subjects was found in the DA where an abnormally high signal intensity was present for the whole cardiac cycle. The MR imaging can offer blood flow information underlying the behavior of intraluminal signal intensity and could provide functional information in patients with heart failure.
.A
Casolo GC; Bucciolini M; Giani M; Bisi G.
.I 55121
.U
88003657
.S
Chest 8801; 92(4):651-6
.M
Adult; Angiocardiography; Aortic Diseases/PP/SU; Aortic Valve Insufficiency/*PP/SU; Chronic Disease; Cineangiography; Comparative Study; Echocardiography; Female; Heart/*PP; Heart Ventricle/PP; Human; Male; Middle Age; Myocardial Contraction; Stroke Volume.
.T
Serial evaluation of cardiac function with aortic regurgitation caused by serious aortic lesions. A preliminary comparative study with isolated chronic aortic incompetence.
.P
JOURNAL ARTICLE.
.W
Clinical and hemodynamic appearances of aortic regurgitation caused by serious aortic lesions (AR-Ao-group) seemed more deteriorated than those with isolated chronic aortic regurgitation (AR-group). Often postoperative course and operative outcome are smooth and satisfactory in the AR-Ao-group. To support this observation, serial changes of left ventricular (LV) function and LV sphericity were evaluated before and after operation in ten cases in the AR-Ao-group and compared with those in the AR-group. Before operation, there were no significant differences in LV function between the two groups. Postoperative improvement of LV sphericity and LV function were statistically better in the AR-Ao-group. The LV function reserve was considered sufficiently retained in the AR-Ao-group. Results with this study supported that clinical observation. Therefore, the total correction, at the same time of aortic incompetence and aortic lesions is recommended.
.A
Nawa S; Irie H; Nakayama Y; Uchida H; Senoo Y; Teramoto S.
.I 55122
.U
88003661
.S
Chest 8801; 92(4):676-8
.M
Adult; Aged; Ambulatory Care/*; Biopsy, Needle/*/AE; Comparative Study; Female; Hospitalization/*; Human; Lung/*PA; Lung Diseases/*PA; Lung Diseases, Obstructive/PA; Lung Neoplasms/PA; Male; Middle Age; Pneumothorax/ET.
.T
Transthoracic needle biopsy of lung in nonhospitalized patients.
.P
JOURNAL ARTICLE.
.W
To confirm the safety of transthoracic needle biopsy of the lung (TNB) in the outpatient setting, we reviewed our experience with 106 such procedures over three years. We compared the operating characteristics and morbidity with the 65 similar procedures we were asked to perform on hospitalized patients during the same period. Outpatients did not differ from inpatients in mean age, sex, incidence of clinically apparent COPD, size and location of lesion, or number of needle passes. The operating characteristics of the biopsy were the same for the two groups. Pneumothorax occurred in 29 (27 percent) of 106 outpatient and 26 (40 percent) of 65 inpatient TNBs. Few pneumothoraces not present upon completion of biopsy developed during four hours of observation or later. The requirement for chest tube drainage was similar for both groups, 5.7 and 4.6 percent, respectively. With appropriate caution, TNB can be performed safely on an outpatient basis and the cost of an uncomplicated procedure reduced by 27 percent.
.A
Poe RH; Kallay MC.
.I 55123
.U
88003662
.S
Chest 8801; 92(4):679-82
.M
Aged; Drinking/*; Elasticity; Female; Forced Expiratory Volume; Human; Lung Diseases, Obstructive/*ME; Male; Middle Age; Sputum/*SE; Support, Non-U.S. Gov't; Viscosity.
.T
Lack of effect of hydration on sputum production in chronic bronchitis.
.P
JOURNAL ARTICLE.
.W
Patients with chronic lung disease productive of sputum are generally encouraged to drink a large amount of fluid to facilitate sputum production. This clinical practice has not been tested systematically. Twelve outpatients with chronic obstructive pulmonary disease in clinically stable condition who had daily sputum production were asked in random sequence: 1) to drink one glass of fluid every waking hour after supper and upon waking the next morning (hydration), 2) to drink no fluid after supper and upon waking the next morning (dry), and 3) to drink fluid ad lib (ad lib). Each morning sputum collection was started upon waking and continued for four hours. The differences in volume, elasticity of sputum, respiratory symptoms, and ease of expectoration were not significant. We conclude that moderate hydration and dehydration have no effect on volume expectorated, the elasticity of sputum, respiratory symptoms or forced expiratory volume in one second.
.A
Shim C; King M; Williams MH Jr.
.I 55124
.U
88003664
.S
Chest 8801; 92(4):686-91
.M
Adult; Aged; Alprostadil/*TU; Female; Hemodynamics/*DE; Human; Hydralazine/TU; Hypertension, Pulmonary/*DT/PP; Male; Middle Age; Nifedipine/TU; Oxygen/BL; Pulmonary Circulation/*DE; Pulmonary Gas Exchange/DE; Vasodilator Agents/*TU.
.T
Prostaglandin E1 as a screening vasodilator in primary pulmonary hypertension.
.P
JOURNAL ARTICLE.
.W
Pulmonary vasodilators are variably efficacious in primary pulmonary hypertension (PPH). None has consistently improved hemodynamics enough to obviate the need for complex and potentially hazardous testing of several vasodilators. Prostaglandin E1 (PGE1), a potent, short-acting pulmonary vasodilator, was administered to seven patients with PPH in order to determine whether PGE1 could accurately predict the hemodynamic and gas exchange effects of other commonly used vasodilators. Prostaglandin E1, nifedipine and hydralazine were administered to the patients while measuring pulmonary and systemic hemodynamics and arterial blood gases. Prostaglandin E1 was easily titrated but was inconsistent as a predictor of the effects of the other vasodilators with respect to pulmonary artery pressure, cardiac output and adverse effects on arterial oxygenation. This study suggests that patients with PPH must still receive carefully monitored trials of several vasodilators to determine whether there is a beneficial response and to select the appropriate treatment.
.A
Halpern SM; Shah PK; Lehrman S; Goldberg HS; Jasper AC; Koerner SK.
.I 55125
.U
88003666
.S
Chest 8801; 92(4):696-703
.M
Adult; Comparative Study; Computer Graphics; Exertion/*; Heart/*PH; Human; Lung/*PH; Male; Medical Informatics Applications/*; Microcomputers; Monitoring, Physiologic/*IS; Random Allocation.
.T
Microprocessor exercise physiology systems vs a nonautomated system. A comparison of data output.
.P
JOURNAL ARTICLE.
.W
Several microprocessor exercise physiology systems have been introduced recently. Comparison of the data output between these systems and more traditional nonautomated systems has not been reported extensively. Twelve normal adult men were exercised in random sequence on different days on a Sensormedics MMC Horizon system, the Medical Graphics Corporation System 2000, and a nonautomated system. heart rate, minute ventilation, tidal volume, respiratory frequency, oxygen consumption, and carbon dioxide production were compared at each level of work during a maximal incremental test and during a constant work load test. The overall data output between the three systems was comparable. However, minute ventilation was consistently higher on the Medical Graphics system, oxygen consumption was consistently lower on the Horizon system, and a technical error was discovered in the Medical Graphics system which resulted in a systematic overestimation of carbon dioxide production. Different methods of analyzing the data from the same test (60-s average, 15-s average, breath-by-breath, and 8-breath average) resulted in differences of up to 20 percent in the maximal values. This was greater than the differences between the three systems. Despite the comparability of the data output, important differences did exist which can be potentially significant when data output from one system are compared to predicted normal values obtained under different conditions.
.A
Matthews JI; Bush BA; Morales FM.
.I 55126
.U
88003668
.S
Chest 8801; 92(4):709-12
.M
Adult; Aged; Calcinosis/*ET/RA; Environmental Exposure; Female; Greece; Human; Male; Middle Age; Paint/*AE; Pleural Diseases/EP/*ET/RA; Silica/*AE; Silicic Acid/*AE; Support, Non-U.S. Gov't; Tomography, X-Ray Computed.
.T
Tremolite whitewashing and pleural calcifications.
.P
JOURNAL ARTICLE.
.W
Radiologic screening of 688 inhabitants of the Metsovo area in Northwest Greece revealed that 323 (46.9 percent) had pleural calcifications. The percentage of positive examinations rose with age. Calcifications were observed in all four villages of the area where a material ("luto" soil) had been extensively used for whitewashing until 1940 to 1950. In four other villages in the immediate vicinity, where "luto" had never been used, pleural calcifications were not observed. Results suggest that Metsovo tremolite may have caused pleural calcifications to all individuals born in Metsovo before 1940. This is the first study indicating that environmental asbestos exposure can cause abnormalities in everyone exposed to it.
.A
Constantopoulos SH; Saratzis NA; Kontogiannis D; Karantanas A; Goudevenos JA; Katsiotis P.
.I 55127
.U
88003669
.S
Chest 8801; 92(4):713-6
.M
Adult; Aged; Blood Gas Analysis/EC; Clinical Protocols; Comparative Study; Costs and Cost Analysis; Evaluation Studies; Female; Human; Lung Diseases/BL/*TH; Male; Middle Age; Oximetry/*EC; Oxygen/BL; Oxygen Inhalation Therapy/*; Random Allocation.
.T
Pulse oximetry for tapering supplemental oxygen in hospitalized patients. Evaluation of a protocol.
.P
JOURNAL ARTICLE.
.W
In a randomized study, we determined the clinical and financial effects of replacing arterial blood gas measurements with finger pulse oximeter readings during the process of tapering supplemental oxygen in hospitalized patients. The 16 patients in the control group, whose management followed conventional practice in our hospital, received a total of 57 arterial blood gas measurements during the 6.6 (mean) days it took for them to taper to their discharge supplemental oxygen level (usually room air). The 13 patients randomized to the oximeter study group had their arterial oxygen saturation monitored by pulse oximetry. The physicians of patients in the oximeter group were at liberty to obtain arterial blood gas determinations during the study if they desired. The oximeter study group had fewer (p less than 0.005) arterial punctures for blood gas measurements (total of 16 for the group) and fewer (p less than 0.001) days on supplemental oxygen (mean of 2.7 days per patient). We conclude that substituting noninvasive pulse oximetry for arterial blood gas measurements during reductions of supplemental oxygen shortened the days of oxygen use and decreased the number of arterial blood gas determinations in our patients. In addition to reducing the discomfort to patients, the use of oximetry was of financial benefit in that it reduced medical personnel time, blood gas analyzer use, and duration of oxygen administration.
.A
King T; Simon RH.
.I 55128
.U
88003670
.S
Chest 8801; 92(4):717-20
.M
Adult; Antibiotics/TU; Case Report; Combined Modality Therapy; Cysts/*ET/TH; Drainage/MT; Female; Human; Lung Diseases/ET/TH; Pneumonia, Lobar/*CO; Pneumonia, Staphylococcal/CO; Pneumothorax/CO/*ET; Respiration, Artificial.
.T
Pneumatocele formation in adult pneumonia.
.P
JOURNAL ARTICLE.
.W
Pneumatocele formation is unusual in adult pneumonia, particularly in pneumococcal pneumonia. We report three cases of pneumatocele formation in adults, including one with probable pneumococcal pneumonia. All three patients were severely ill and two expired. Although they are usually asymptomatic, pneumatoceles may enlarge and compress the adjacent lung and mediastinum. This occurred in two patients causing respiratory insufficiency and cardiovascular compromise. The placement of a chest tube into the enlarging pneumatocele resulted in successful decompression.
.A
McGarry T; Giosa R; Rohman M; Huang CT.
.I 55129
.U
88003671
.S
Chest 8801; 92(4):721-7
.M
Catheterization, Swan-Ganz/*UT; Evaluation Studies; Heart Failure, Congestive/ET/PP; Human; Length of Stay; Massachusetts; Monitoring, Physiologic/IS; Myocardial Infarction/CO/*PP; Population Surveillance; Prognosis; Pulmonary Artery/*; Retrospective Studies.
.T
A community-wide assessment of the use of pulmonary artery catheters in patients with acute myocardial infarction.
.P
JOURNAL ARTICLE.
.W
As part of an on-going population-based study of patients hospitalized with acute myocardial infarction (MI) in all 16 hospitals in the Worcester, Massachusetts Standard Metropolitan Statistical Area, temporal trends in the use of the pulmonary artery (PA) catheter were examined. Three thousand two hundred and sixty-three patients with validated acute MI during the calendar years 1975, 1978, 1981 and 1984 comprised the study population. There has been a consistent and significant increase in PA catheter use in patients with acute MI over time, from 7.2 percent in 1975, 13.8 percent in 1978, 14.8 percent in 1981 to 19.9 percent in 1984 (p less than .001). Ninety-six percent of patients undergoing PA catheter investigation had either congestive heart failure (CHF), hypotension or cardiogenic shock. For the combined time periods, the in-hospital case fatality rate (CFR) for patients in CHF with a PA catheter was 44.8 percent compared to 25.3 percent for patients without a PA catheter (p less than .001). For patients with hypotension and a PA catheter, in-hospital CFR was 48.3 percent compared to 32.2 percent for hypotensive patients not receiving a PA catheter (p less than .001). In contrast, for patients in cardiogenic shock the in-hospital CFR was 74.4 percent for those receiving a PA catheter as compared to 79.1 percent for patients in shock not receiving a catheter. The use of a PA catheter was associated with an increased length of hospital stay irrespective of the development of acute clinical complications. Long-term prognosis for discharged hospital survivors who had a complicated MI, for up to a five-year follow-up period was similar whether the patient did or did not receive a PA catheter during the acute period of hospitalization. In conclusion, we could not demonstrate a beneficial effect associated with the use of the PA catheter on selected patient outcomes, including in-hospital and long-term prognosis and average hospital stay, in this community-wide study of patients hospitalized with acute MI.
.A
Gore JM; Goldberg RJ; Spodick DH; Alpert JS; Dalen JE.
.I 55130
.U
88003672
.S
Chest 8801; 92(4):727-31
.M
Catheterization, Swan-Ganz/*AE/MO; Diagnostic Errors; Heart Failure, Congestive/MO/PP; Human; Myocardial Infarction/*MO/PP; Pulmonary Wedge Pressure; Risk Factors.
.T
Death by pulmonary artery flow-directed catheter. Time for a moratorium?
.P
JOURNAL ARTICLE.
.A
Robin ED.
.I 55131
.U
88003673
.S
Chest 8801; 92(4):732-6
.M
Adrenergic Beta Receptor Agonists/*AD; Asthma/CO/*DT; Biopsy; Case Report; Female; Heart Failure, Congestive/*CI; Human; Male; Middle Age; Myocardium/PA.
.T
Drug-induced left ventricular failure in patients with pulmonary disease. Endomyocardial biopsy demonstration of catecholamine myocarditis.
.P
JOURNAL ARTICLE.
.W
Three patients with severe chronic lung disease had left ventricular failure develop with marked impairment of cardiac function. Ejection fractions by radioactive blood pool ventriculography were 0.17, 0.24, and 0.20. Right ventricular endomyocardial biopsy specimens showed interstitial hemorrhage and foci of interstitial polymorphonuclear leukocytes, strongly suggestive of catecholamine myocarditis. These patients had used beta-adrenergic agonist inhalants and methylxanthines. One of them clearly abused the inhalant and had elevated levels of urinary catecholamines. Progressive deterioration of pulmonary and cardiac function occurred in two patients, with death within three months of the initial myocardial biopsy. Concomitant use of beta-adrenergic agonists and methylxanthines may cause myocarditis with left ventricular failure in susceptible patients.
.A
Nino AF; Berman MM; Gluck EH; Conway MM; Fisher JP; Dougherty JE; Rossi MA.
.I 55132
.U
88003674
.S
Chest 8801; 92(4):737-8
.M
Angina Pectoris/*CO; Case Report; Human; Immunoglobulins/AN; Male; Middle Age; Pulmonary Fibrosis/*CO/IM/RA.
.T
Angina pectoris and bilateral diffuse infiltrates. Lymphoplasmacytoid lymphoma.
.P
JOURNAL ARTICLE.
.A
Boersma WG; van de Jagt EJ; Ilic D; Postmus PE.
.I 55133
.U
88003675
.S
Chest 8801; 92(4):739-40
.M
Angina Pectoris/*PP; Chest Pain/PP; Coronary Disease/*PP; Human.
.T
The uncertain relation between coronary artery disease and anginal pain.
.P
JOURNAL ARTICLE.
.A
Altschule MD.
.I 55134
.U
88003676
.S
Chest 8801; 92(4):741-4
.M
Aged; Case Report; Electrocardiography; Exercise Test/*; Human; Male; Myocardial Infarction/PP/*RH; Prognosis; Risk Factors.
.T
Exercise test for identification of the high risk patient.
.P
JOURNAL ARTICLE.
.A
Callaham P; Froelicher VF.
.I 55135
.U
88003677
.S
Chest 8801; 92(4):745-6
.M
Aged; Case Report; Female; Heart Block/*DI/ET/TH; Human; Myocardial Infarction/*CO; Pacemaker, Artificial.
.T
Wenckebach block in the distal conduction system complicating a non-Q wave acute myocardial infarction.
.P
JOURNAL ARTICLE.
.A
Strasberg B; Sclarovsky S; Agmon J.
.I 55136
.U
88003678
.S
Chest 8801; 92(4):747-8
.M
Acute Disease; Adult; Case Report; Chylomicrons/*BL; Human; Hyperlipidemia/BL; Male; Pancreatitis/*CO; Skin Diseases/*ET; Support, Non-U.S. Gov't; Syndrome; Xanthomatosis/*ET.
.T
Eruptive abdominal pain. Chylomicronemia.
.P
JOURNAL ARTICLE.
.A
Schneiderman H; Murray J; Hager WD; Malchoff C.
.I 55137
.U
88003679
.S
Chest 8801; 92(4):749-51
.M
Biopsy, Needle/*AE; Case Report; Cerebral Embolism and Thrombosis/*ET/RT; Embolism, Air/*ET/TH; Female; Human; Hyperbaric Oxygenation; Lung/PA; Lung Diseases/PA; Middle Age; Tomography, X-Ray Computed.
.T
Air embolism complicating percutaneous thin needle biopsy of lung.
.P
JOURNAL ARTICLE.
.W
Percutaneous thin needle biopsy, a widely used method for diagnosis of lung conditions, is generally safe and effective. A near-fatal air embolism is reported that occurred during percutaneous thin needle aspiration biopsy of the lung. Successful treatment was accomplished by hyperbaric oxygen therapy. Physicians should be aware of this possible complication and identify the location of the nearest chamber for possible transfer.
.A
Cianci P; Posin JP; Shimshak RR; Singzon J.
.I 55138
.U
88003680
.S
Chest 8801; 92(4):751-2
.M
Case Report; Endocarditis, Bacterial/*DI; Female; Human; Middle Age; Skin Diseases/*DI/MI; Streptococcal Infections/*DI/MI; Streptococcus sanguis/IP.
.T
The utility of Osler's nodes in the diagnosis of infective endocarditis.
.P
JOURNAL ARTICLE.
.W
The etiology of Osler's nodes remains controversial. We describe a patient with endocarditis in whom Streptococcus sanguis was grown from the biopsy of such a lesion. Bacterial embolic events are likely to be the major pathogenetic event in the development of Osler's nodes, and recognition of the etiology of infective endocarditis may be found through biopsy of them.
.A
Yee J; McAllister CK.
.I 55139
.U
88003681
.S
Chest 8801; 92(4):753-5
.M
Brain Neoplasms/SC; Carcinoma, Oat Cell/*CO; Case Report; Diabetes Insipidus/*ET; Diagnosis, Differential; Human; Lung Neoplasms/*CO; Male; Middle Age; Paraneoplastic Syndromes/CO.
.T
Atypical diabetes insipidus in small cell lung cancer. Paraneoplastic syndrome or metastatic disease?
.P
JOURNAL ARTICLE.
.W
A 54-year old man was admitted with extensive disease: small cell lung cancer, and severe central diabetes insipidus. Computer assisted tomography of the brain was negative for metastatic spread to the hypothalamus or pituitary gland. Basic levels of antidiuretic hormone were within normal limits, yet the hormone failed to increase secondary to elevated osmotic load. We hypothesize that in this patient, hypothalamus and pituitary gland were morphologically intact, and that diabetes insipidus was induced by the inhibitory action of ectopic opiates on the release of antidiuretic hormone. Nevertheless, since post-mortem studies were refused, metastatic diabetes insipidus could not be definitely excluded, in which case, the source of plasmatic antidiuretic hormone would be the tumor itself.
.A
Wassermann K; Eckert G; Muller KM; Nakhosteen JA.
.I 55140
.U
88003682
.S
Chest 8801; 92(4):756-7
.M
Adult; Case Report; Fibroma/*ET/RA; Human; Lung Neoplasms/*ET/RA; Male; Q Fever/*CO/DT; Tetracycline/TU.
.T
Q fever inflammatory pseudotumor of the lung.
.P
JOURNAL ARTICLE.
.W
A 36-year-old man presented with malaise, myalgia, fever, and weight loss. Liver function tests were moderately abnormal and chest x-ray film revealed an irregular mass in the right lower lobe. Bronchoscopy with cytology was not helpful. Serology revealed markedly elevated titers to Q fever. The mass was presumed to represent the presence of a Q fever pseudotumor. The patient responded to therapy with resolution of symptoms and chest x-ray film and decrease in titers to Q fever.
.A
Lipton JH; Fong TC; Gill MJ; Burgess K; Elliott PD.
.I 55141
.U
88003683
.S
Chest 8801; 92(4):757-8
.M
Aged; Case Report; Dilatation/*AE; Esophageal Perforation/*CO/ET; Esophageal Stenosis/TH; Human; Male; Mediastinal Emphysema/*ET; Self Care.
.T
Pneumomediastinum after self-dilation of the esophagus.
.P
JOURNAL ARTICLE.
.W
Pneumomediastinum following esophageal perforation is a known complication of Eder Puestow dilation for esophageal stenosis. This is the first reported case of esophageal perforation and pneumomediastinum occurring after instrumental self-dilation of a stenotic esophageal lesion. The observed 0.02 percent perforation rate in this patient (compared to the reported 0.3 percent in Eder Puestow "hetero"-dilation) makes the Eder Puestow auto-dilation procedure seem justifiable in a well-trained and well-informed patient.
.A
Noppen MM; Corne L; Peters O; Smekens L; Musch W; Vincken W.
.I 55142
.U
88003684
.S
Chest 8801; 92(4):758-61
.M
Case Report; Coronary Disease/PP; Electrocardiography/*; Extrasystole/*PP; Heart Conduction System/*PP; Human; Male; Middle Age.
.T
Bigeminal and trigeminal distribution of ventricular extrasystoles as an expression of "atypical" concealed bigeminy.
.P
JOURNAL ARTICLE.
.W
This report reflects a case of bigeminal and trigeminal ventricular extrasystoles where bigeminal extrasystoles are associated with short coupling intervals, while trigeminal extrasystoles manifest long coupling intervals. The arrhythmia is interpreted as an "atypical" form of concealed bigeminy.
.A
Oreto G; Luzza F; Satullo G; Schamroth L.
.I 55143
.U
88003685
.S
Chest 8801; 92(4):761-3
.M
Adult; Aged; Evaluation Studies; Human; Intubation, Intratracheal/*IS; Middle Age; Respiration, Artificial/IS/*MT; Thoracic Surgery/*.
.T
A new tube for single lung ventilation.
.P
JOURNAL ARTICLE.
.W
A recently developed endotracheal tube with a movable bronchial blocker (Univent tube) was used for single lung ventilation. A total of 50 intubations were undertaken for a wide variety of thoracic procedures. Each case was analyzed with respect to ease or difficulty of intubation, tube dislodgment, efficacy of lung collapse, and adequacy of single lung ventilation. Successful, safe selective intubation was accomplished in all cases.
.A
Karwande SV.
.I 55144
.U
88003686
.S
Chest 8801; 92(4):763-5
.M
Case Report; Diagnosis, Differential; Electrocardiography/*; Human; Male; Middle Age; Tachycardia/*DI; Tachycardia, Supraventricular/*DI.
.T
Standard limb lead QRS concordance during wide QRS tachycardia. A new surface ECG sign of ventricular tachycardia.
.P
JOURNAL ARTICLE.
.W
The differentiation of ventricular tachycardia from supraventricular conducted with aberration constitutes a perennial challenge. We report a new surface ECG clue, hitherto undescribed, the presence of which, during wide QRS tachycardia, indicates that the tachycardia in question is ventricular rather than supraventricular with aberrant conduction.
.A
Reddy GV; Leghari RU.
.I 55145
.U
88003687
.S
Chest 8801; 92(4):766
.M
Aorta, Thoracic/*AB/RA; Comparative Study; Echocardiography; Human; Tomography, X-Ray Computed.
.T
Diagnosing cervical aortic arch [letter]
.P
LETTER.
.A
D'Cruz IA.
.I 55146
.U
88003688
.S
Chest 8801; 92(4):766
.M
Airway Obstruction/*TH; Helium/*AD; Human; Oxygen/*AD; Respiratory Therapy/*MT.
.T
Helium/oxygen therapy [letter]
.P
LETTER.
.A
Hutcheon MA; Hyland RH.
.I 55147
.U
88003689
.S
Chest 8801; 92(4):766-7
.M
Azathioprine/TU; Case Report; Human; Liver Cirrhosis/*CO/DT; Male; Middle Age; Prednisolone/TU; Pulmonary Fibrosis/*CO/DT.
.T
Primary biliary cirrhosis in a patient with interstitial lung fibrosis [letter]
.P
LETTER.
.A
Izdebska-Makosa Z; Zielinski J.
.I 55148
.U
88003690
.S
Chest 8801; 92(4):767
.M
Adult; Case Report; Cocaine/*; Human; Male; Myocardial Infarction/*ET; Recurrence; Substance Abuse/*CO.
.T
Cocaine and MI [letter]
.P
LETTER.
.A
Zimmerman FH; Lipton B.
.I 55149
.U
88003691
.S
Chest 8801; 92(4):767-8
.M
Bronchial Neoplasms/*DT; Carcinoma, Squamous Cell/*DT; Female; Hematoporphyrin Photoradiation; Human; Lasers/TU; Male.
.T
HpD-PDT for cancer treatment in bronchology [letter]
.P
LETTER.
.A
Andouin H; Patrice T; Foultier MT; Courtin V; Dabouis G.
.I 55150
.U
88003692
.S
Chest 8801; 92(4):768-9
.M
Adult; Case Report; Female; Human; Pulmonary Embolism/*ET/RA; Recurrence; Vena Cava, Inferior/*AB/RA.
.T
Inferior vena caval defects and the venous circulation [letter]
.P
LETTER.
.A
Todisco T; Dottorini M; Parise P; Boschetti E; Lupattelli L.
.I 55151
.U
88003693
.S
Chest 8801; 92(4):769
.M
Acquired Immunodeficiency Syndrome/*CO; Human; Socioeconomic Factors; Tuberculosis, Pulmonary/*CO/EP; United States.
.T
Tuberculosis and the acquired immunodeficiency syndrome [letter]
.P
LETTER.
.A
Maguire FE; Bagley PH; Murray KM; Schillaci RF.
.I 55152
.U
88003919
.S
Dis Colon Rectum 8801; 30(10):743-6
.M
Antibiotics/*TU; Bacterial Infections/*PC; Clinical Trials/*MT/ST; Colon/*SU; Colonic Diseases/SU; Evaluation Studies; Great Britain; Human; Prospective Studies; Random Allocation/*; Rectal Diseases/SU; Rectum/*SU; Research Design/*; Support, Non-U.S. Gov't.
.T
The inadequacy of published random control trials of antibacterial prophylaxis in colorectal surgery.
.P
JOURNAL ARTICLE.
.W
Fifty-six papers published between 1979 and 1986 that tested regimens of antibacterial bowel preparation before elective colorectal operations were studied using a numerical score devised for assessing publications of random control clinical trials. A maximum score of 100 was allotted: 50 for 15 aspects of design, 30 for ten aspects of analysis, and 20 for eight aspects of presentation. The 56 papers scored from 33 to 89, (mean, 61.6, standard deviation, 11.9). Only 13 (23 percent) reached a score of more than 70. The most frequent errors in design were the use of placebos in the control group (27 percent) and faulty methods of randomization (36 percent). Errors in analysis resulted in penalization of more papers than any other aspect; these included the almost universal omission of confidence limits, confusion of exclusions and withdrawals (46 percent), not recording the fate of withdrawals (80 percent) and incorrect use of statistical tests (55 percent). Ten papers reported results showing important clinical differences that did not achieve statistical significance, but only two mentioned the Type II error. Defects in presentation were less frequently encountered; the most common were inaccessibility of raw data (66 percent), lack of sufficient information to allow replication of methods (43 percent), and the drawing of firm conclusions from shaky data (50 percent). It was particularly disappointing that no evidence of improvement in the standard of these reports over the seven years studied was found.
.A
Evans M; Pollock AV.
.I 55153
.U
88003920
.S
Dis Colon Rectum 8801; 30(10):747-50
.M
Acute Disease; Adolescence; Adult; Colectomy/AE; Colitis, Ulcerative/*SU; Evaluation Studies; Female; Follow-Up Studies; Human; Ileostomy/AE/MT; Male; Rectum/SU; Retrospective Studies; Surgical Wound Infection/ET; Time Factors.
.T
Surgery for ulcerative colitis in the pediatric population. Indications, treatment, and follow-up.
.P
JOURNAL ARTICLE.
.W
To evaluate the outcome of surgery for ulcerative colitis in pediatric and adolescent patients, the experience at the Cleveland Clinic Foundation was reviewed retrospectively. Fifty-nine percent of the patients presented with acute toxic colitis and sepsis; 94 percent underwent staged procedures with creation of a temporary or permanent ileostomy. Sepsis was the most frequent postoperative complication (38 percent), and accounted for all three deaths (5 percent). Long-term disability was minimal, and 90 percent of the patients were fully active at the time of follow-up.
.A
Trudel JL; Lavery IC; Fazio VW; Jagelman DG; Weakley FL; Oakley JR.
.I 55154
.U
88003923
.S
Dis Colon Rectum 8801; 30(10):758-60
.M
Colonic Neoplasms/DI/*SU; Cystoscopy; Diagnostic Tests, Routine/*; Evaluation Studies; Human; Male; Preoperative Care; Prospective Studies; Rectal Neoplasms/DI/*SU; Sigmoid Neoplasms/DI/SU; Urography/*.
.T
The value of routine preoperative urologic evaluation in patients with colorectal carcinoma.
.P
JOURNAL ARTICLE.
.W
Routine preoperative intravenous pyelography was performed in a series of 105 consecutive male patients with rectal or rectosigmoid carcinomas who were totally free of urinary symptoms. Abnormal findings were present in 26 percent of those patients. Postoperative intravenous pyelograms were performed in 61 patients. Twenty-one percent of patients with negative preoperative intravenous pyelograms and 42 percent of patients with positive preoperative intravenous pyelograms had abnormal findings in the postoperative intravenous pyelograms. Preoperative cystoscopy was performed in 52 patients. Thirty-one percent of patients with negative preoperative intravenous pyelograms and 76 percent of patients with positive preoperative intravenous pyelograms had abnormal cystoscopic findings. The overwhelming majority of cystoscopic findings in patients with negative preoperative intravenous pyelograms were not related to the primary tumor. The findings of this prospective study suggest that routine preoperative intravenous pyelography is indicated in patients with rectosigmoid or rectal tumors without symptoms related to the urinary tract. Postoperative intravenous pyelography is indicated only in patients with positive preoperative intravenous pyelograms. Preoperative cystoscopy is indicated when the preoperative intravenous pyelogram is positive and especially if intravenous pyelography findings are suggestive of bladder-wall defect or extrinsic pressure.
.A
Vezeridis MP; Petrelli NJ; Mittelman A.
.I 55155
.U
88003924
.S
Dis Colon Rectum 8801; 30(10):761-4
.M
Antibodies, Monoclonal/*DU; Antigens, Neoplasm/IM; Colon and Rectal Surgery (Specialty)/*IS/MT; Colonic Neoplasms/RI/*SU; Evaluation Studies; False Positive Reactions; Glycoproteins/IM; Human; Intraoperative Period; Iodine Radioisotopes/*DU; Isotope Labeling; Neoplasm Recurrence, Local/RI/SU; Rectal Neoplasms/RI/*SU; Sigmoid Neoplasms/RI/SU; Support, Non-U.S. Gov't.
.T
Radioimmunoguided surgery using the monoclonal antibody B72.3 in colorectal tumors.
.P
JOURNAL ARTICLE.
.W
The authors have developed a hand-held gamma-detecting probe (GDP) for intraoperative use that improves the sensitivity of external radioimmunodetection. Radiolabeled monoclonal antibody (MAb) B72.3 was injected in six patients with primary colorectal cancer and 31 patients with recurrent colorectal cancer an average of 16 days preoperatively. The GDP localized the MAb B72.3 in 83 percent of sites. The technique, known as a radioimmunoguided surgery (RIGS) system did not alter the surgical procedure in patients with primary colorectal cancer but did alter the approach in 26 percent (8/31) of patients with recurrent colorectal cancer. Two patients avoided unnecessary liver resections and two underwent extraabdominal approaches to document their disease. The RIGS system may influence the short-term morbidity and mortality of surgery for colorectal cancer. Larger series and longer follow-up are needed to determine whether the RIGS system confers a survival advantage to the patient with colorectal cancer.
.A
Sickle-Santanello BJ; O'Dwyer PJ; Mojzisik C; Tuttle SE; Hinkle GH; Rousseau M; Schlom J; Colcher D; Thurston MO; Nieroda C; et al.
.I 55156
.U
88003925
.S
Dis Colon Rectum 8801; 30(10):765-71
.M
Adult; Aged; Aged, 80 and over; Cineradiography; Constipation/SU; Defecation; Female; Follow-Up Studies; Human; Ligation; Male; Methods; Middle Age; Rectal Prolapse/*SU; Rectum/*SU; Surgical Staplers.
.T
Rectal reservoir reduction procedures for internal rectal prolapse.
.P
JOURNAL ARTICLE.
.W
Forty-four patients presenting with painful outlet constipation had internal rectal intussusception documented by cinedefecography. Rectal reservoir reduction by multiple elastic ligation or staple excision of redundant mucosa effectively improved bowel function and outlet symptoms in the majority of patients. Rectal reduction procedures were performed under intravenous sedation with antibiotic coverage, no postoperative sepsis, and a single case of significant postoperative bleeding. Associated abnormalities on defecography were unaffected.
.A
Berman IR; Harris MS; Leggett IT.
.I 55157
.U
88003928
.S
Dis Colon Rectum 8801; 30(10):782-5
.M
Adult; Aged; Aged, 80 and over; Anus Neoplasms/*PA/SU; Bowen's Disease/*PA/SU; Carcinoma in Situ/PA/SU; Carcinoma, Squamous Cell/*PA/SU; Evaluation Studies; Female; Follow-Up Studies; Human; Male; Middle Age; Neoplasm Recurrence, Local/SU; Neoplasms, Multiple Primary/*; Sex Factors; Skin Neoplasms/*PA/SU.
.T
Perianal Bowen's disease and associated malignancies. Results of a survey.
.P
JOURNAL ARTICLE.
.W
In 1959, Graham and Helwig reported that 80 percent of patients with Bowen's disease developed associated cutaneous or internal malignancies. Subsequent to the publication of this report, extensive and invasive workup of patients with Bowen's disease became the standard of practice. The authors' personal experience with perianal Bowen's disease suggested a substantially lower correlation between that disease and associated malignancies. Therefore a survey was initiated by contacting active members of the American Society of Colon and Rectal Surgeons to investigate further. Analysis of 106 cases demonstrated a lower incidence of associated malignancies (4.7 percent) subsequent to diagnosis of perianal Bowen's disease. The data further indicated, however, that these patients are at risk to develop recurrent Bowen's disease (9.4 percent) and invasive carcinoma (5.7 percent). It is concluded that an extensive and invasive workup of patients with perianal Bowen's disease is not indicated and that the patient's greatest risk is development of recurrent or invasive disease.
.A
Marfing TE; Abel ME; Gallagher DM.
.I 55158
.U
88003931
.S
Dis Colon Rectum 8801; 30(10):800-1
.M
Case Report; Colonoscopy; Female; Follow-Up Studies; Human; Metronidazole/*TU; Middle Age; Pneumatosis Cystoides Intestinalis/*DT; Sigmoid Diseases/*DT.
.T
Treatment of pneumatosis coli with metronidazole. Endoscopic follow-up of one case.
.P
JOURNAL ARTICLE.
.W
A case of pneumatosis cystoides intestinalis in the large bowel with complete resolution after eight weeks of metronidazole treatment is reported. This symptomatic case, with an acute onset classified as the primary (idiopathic) type, became asymptomatic after a few days and was followed until complete endoscopic and radiologic resolution. No recurrence was noticed during 15-month follow-up. This lends support to the assumption that anaerobic bacteria contribute to the etiopathogenesis of this condition. The choice of metronidazole as an easy ambulatory therapy is encouraged.
.A
Jauhonen P; Lehtola J; Karttunen T.
.I 55159
.U
88003932
.S
Dis Colon Rectum 8801; 30(10):802-4
.M
Adult; Case Report; Colitis, Ulcerative/*CO/PA/SU; Colonic Polyps/*CO/DI/PA; Colonoscopy; Diagnosis, Differential; Female; Human.
.T
Localized giant pseudopolyposis of the colon in ulcerative colitis. Report of a case.
.P
JOURNAL ARTICLE.
.W
Localized giant pseudopolyposis of the colon is a rare complication of both ulcerative colitis and Crohn's disease. It is not regarded as being premalignant, but it may masquerade clinically as a malignancy. This report presents a case and reviews others reported in the literature.
.A
Ferguson CJ; Balfour TW; Padfield CJ.
.I 55160
.U
88003933
.S
Dis Colon Rectum 8801; 30(10):805-8
.M
Aged; Carcinoma, Mucinous/PA/*SC/SU; Case Report; Colonic Neoplasms/*PA; Female; Human; Muscular Diseases/*PA/SU; Soft Tissue Neoplasms/PA/*SC/SU; Thigh/*.
.T
Colon carcinoma metastatic to the thigh--an unusual site of metastasis. Report of a case.
.P
JOURNAL ARTICLE.
.W
Metastasis from colorectal carcinoma occurs by either lymphatic or hematogenous spread. The pattern of metastasis in patients with colorectal malignancy has been characterized by numerous clinical, surgical, and autopsy studies. The most common sites of colorectal metastasis are the liver and lung. Only two previous instances of colorectal carcinoma metastatic to skeletal muscle have been reported. The present report documents the third case of colorectal cancer metastatic to skeletal muscle and reviews the typical pattern of distant metastasis from colorectal carcinoma.
.A
Torosian MH; Botet JF; Paglia M.
.I 55161
.U
88003934
.S
Dis Colon Rectum 8801; 30(10):809-11
.M
Adult; Aged; Anastomosis, Surgical; Case Report; Colon/*SU; Glucagon/TU; Human; Male; Myasthenia Gravis/*DT; Neostigmine/*AE; Postoperative Complications/*ET.
.T
Colonic anastomotic disruption in myasthenia gravis. Report of two cases.
.P
JOURNAL ARTICLE.
.W
Anticholinesterases are the mainstay in the treatment of myasthenia gravis. They are also used in the reversal of neuromuscular blocking agents used during general anesthesia. Their use in gastrointestinal surgery, especially involving anastomosis of the distal ileum or colon, has been implicated in anastomotic disruptions. This paper discusses the controversy in the use of reversal agents (anticholinesterases) in colon surgery and specifically in patients with myasthenia gravis.
.A
Herz BL.
.I 55162
.U
88003938
.S
Dig Dis Sci 8801; 32(10):1065-70
.M
Adult; Aged; Bicarbonates/SE; Caerulein/DU; Dose-Response Relationship, Drug; Female; Human; Male; Middle Age; Pancreas/*DE/SE; Pancreatic Juice/DE/SE; Proteins/SE; Secretin/DU; Somatostatin/*PD.
.T
Effect of somatostatin 14 on pure human pancreatic secretion.
.P
JOURNAL ARTICLE.
.W
While it is well known that large doses of somatostatin inhibit human pancreatic enzyme secretion, it is still unknown whether low doses are also effective and whether the peptide is able to inhibit bicarbonate production. Eight subjects with external transduodenal drainage of the main pancreatic duct performed after biliary tract surgery were studied. Somatostatin was infused at progressively increasing rates of 0.05, 0.15, 0.45, and 1.35 micrograms/kg/hr, for 30 min/dose, during pancreatic stimulation with secretin, 25 ng/kg/hr, and cerulein, 10 ng/kg/hr. Somatostatin, at the dose of 0.05 microgram/kg/hr (shown to produce blood levels similar to those measured after a meal) did not affect pancreatic secretion in any of the subjects. The successive three higher doses caused a significant and dose-dependent inhibition of protein concentration and output and of bicarbonate output. Bicarbonate concentration was slightly but significantly reduced only by the two highest doses of somatostatin. At each dose level, the inhibition of protein output was much more marked than the inhibition of bicarbonate output. The maximal inhibition of protein output (at 1.35 micrograms/kg/hr somatostatin) was 73.9 +/- 5.4%, and that of bicarbonate output was 55.9 +/- 6.4%. The results demonstrate that: (1) the administration of somatostatin at a low dose level does not affect human exocrine pancreatic secretion, at least under the experimental conditions of this study; and (2) the administration of larger doses of somatostatin inhibits pancreatic secretion of both protein and bicarbonate dose-dependently. The inhibitory effect on protein output is significantly greater than that on water and bicarbonate production.
.A
Gullo L; Priori P; Scarpignato C; Baldoni F; Mattioli G; Barbara L.
.I 55163
.U
88003939
.S
Dig Dis Sci 8801; 32(10):1071-4
.M
Adolescence; Anthracenes; Child; Cystic Fibrosis/*ME; Dietary Carbohydrates/*ME; Dietary Fats/ME; Dietary Proteins/ME; Fatty Acids/ME; Feces/AN; Female; Human; Hydrogen-Ion Concentration; Intestinal Absorption/*; Male; Nitrogen/ME; Support, U.S. Gov't, P.H.S..
.T
Carbohydrate malabsorption is minimal in school-age cystic fibrosis children.
.P
JOURNAL ARTICLE.
.W
Fifteen school-age cystic fibrosis children, participating in a year-long nutritional management study, were hospitalized at six-month intervals for balance studies during which they continued "free-choice" diets and their usual enzyme supplementation. Stools were analyzed for fat and protein by conventional methods and for carbohydrate using a recently validated anthrone method. Despite persistent fat and protein malabsorption, less than 1% of ingested carbohydrate was lost intact in the stools. Comparison of baseline and placebo balance studies showed fecal excretion of carbohydrate to be independent of intake, in contrast to the fat and protein results. Using a thin-layer chromatography method capable of detecting microgram quantities of urinary organic acids, no short-chain fatty acids were detected in the stool. Further exploration of carbohydrate as a dietary energy source for this patient group with increased energy demands should be pursued.
.A
Hoffman RD; Isenberg JN; Powell GK.
.I 55164
.U
88003942
.S
Dig Dis Sci 8801; 32(10):1088-91
.M
Breath Tests; Colonic Polyps/*ME; Dietary Carbohydrates/*ME; Dietary Fiber/AD; Female; Gastrointestinal Transit; Human; Hydrogen/AN; Intestinal Absorption/*; Lactulose/ME; Male; Middle Age; Potatoes; Risk Factors; Starch/*ME.
.T
Super-efficient starch absorption. A risk factor for colonic neoplasia?
.P
JOURNAL ARTICLE.
.W
We tested the hypothesis that super-efficient starch absorption, by reducing the supply of carbohydrate to the colon, may be associated with and possibly promote colonic neoplasia. By means of breath hydrogen measurements following a potato meal and comparison with the hydrogen response to lactulose, the amount of starch escaping small bowel absorption was measured in 10 patients who had a colonic adenoma removed endoscopically and in 10 controls. The subjects' consumption of starch and fiber was assessed. Percentage unabsorbed starch was approximately half as much in the patients (5.3%) compared with the controls (10.9%, P less than 0.05). Consumption of starch and dietary fiber, and mouth-to-cecum transit times were not significantly different. Unabsorbed starch was calculated to contribute to 6.0 g/day colonic carbohydrate in the patients and 10.9 g/day in the controls (P less than 0.05). This study confirms that unabsorbed starch provides an important quantity of colonic carbohydrate and suggests that super-efficient starch absorption, by reducing this provision, may promote colonic neoplasia.
.A
Thornton JR; Dryden A; Kelleher J; Losowsky MS.
.I 55165
.U
88003944
.S
Dig Dis Sci 8801; 32(10):1097-103
.M
Adult; Enzyme Stability; Gastric Juice/ME; Gastrointestinal Transit/*; Glycoside Hydrolases/*ME; Human; In Vitro; Isoamylase/AI/*ME/SE; Isoelectric Focusing; Jejunum; Middle Age; Pancreas/EN; Pancreatic Function Tests/MT; Saliva/*EN; Stomach/*ME; Support, Non-U.S. Gov't; Trypsin/SE.
.T
Passage of salivary amylase through the stomach in humans.
.P
JOURNAL ARTICLE.
.W
With an inhibitor assay technique rates of passage of salivary and pancreatic isoamylase through the jejunum were measured in six healthy volunteers after different liquid, intragastric meals. In all subjects and in 13/17 experiments, more than 2500 units of salivary amylase were passed over 200 postcibal minutes. Salivary amylase comprised 13.8 +/- 3.9% (mean +/- SEM) of the total amylase and appeared predominantly as single, distinct peak. The inhibitor method was validated by isoelectric focusing (r = 0.988; P less than 0.001; N = 7). The frequency of detection of salivary amylase in gastric or jejunal samples fell as gastric pH fell below 3.0. In vitro, amylase was inactivated in gastric juice as pH fell between 3.8 and 3.3. Salivary amylase accounted for 11% of total amylase output in a normal and 27% in an achlorhydric subject after a hamburger meal. We conclude that amylase should not be measured in postprandial studies of pancreatic secretion in humans without correction for salivary amylase.
.A
Fried M; Abramson S; Meyer JH.
.I 55166
.U
88003945
.S
Dig Dis Sci 8801; 32(10):1104-12
.M
Adult; Aged; Anus/PP; Chronic Disease; Colon/PA; Colonic Pseudo-Obstruction/PA/*PP; Female; Gastrointestinal Motility; Human; Intestinal Pseudo-Obstruction/*PP; Male; Middle Age; Pressure; Rectum/*PP; Sigmoid/*PP; Support, U.S. Gov't, P.H.S..
.T
Changes in colorectal function in patients with chronic colonic pseudoobstruction.
.P
JOURNAL ARTICLE.
.W
Motility studies of the lower bowel, radiology to exclude other gastrointestinal involvement, and rectal biopsies were carried out in 11 patients, age 21-60 years, with isolated chronic colonic pseudoobstruction. Repeated plain abdominal x-rays during symptomatic periods revealed massive gaseous colonic distension in all. Seven patients had the primary form while four patients had an underlying disease which could have been responsible for the chronic colonic pseudoobstruction. Lower bowel motility was decreased in patients with the primary form. Rectal wall elasticity was increased in both the primary and secondary form. Some of the abnormalities measured may suggest myogenic abnormalities of the sigmoid or rectal wall. No specific neural or muscular morphologic defect was identified in colonic transmural sections in eight patients except in the patient with Hirschsprung's disease. Five of seven patients with primary colonic pseudoobstruction achieved symptomatic relief only after subtotal colectomy and ileoproctostomy.
.A
Loening-Baucke VA; Anuras S; Mitros FA.
.I 55167
.U
88003948
.S
Dig Dis Sci 8801; 32(10):1125-9
.M
Animal; Female; Gastrointestinal Hormones/*PD; Intestinal Absorption/*DE; Leucine/*ME; Male; Neurotensin/BL/PD; Peptides/*PD; Radioimmunoassay; Rats; Rats, Inbred Strains; Secretin/PD; Sincalide/PD; Somatostatin/BL/PD; Vasoactive Intestinal Peptide/BL/PD.
.T
Effect of vasoactive intestinal peptide, somatostatin, neurotensin, cholecystokinin octapeptide, and secretin on intestinal absorption of amino acid in rat.
.P
JOURNAL ARTICLE.
.W
The effects of vasoactive intestinal peptide (VIP), somatostatin (SRIF), neurotensin (NT), cholecystokinin octapeptide (CCK-8), and secretin (SEC) on the intestinal absorption of amino acid were investigated. Six groups of Wistar rats were studied: (1) controls; (2) VIP treated; (3) SRIF treated; (4) NT treated; (5) CCK-8 treated; (6) SEC treated. [3H]Leucine was given intraluminally through a cannula at the ligament of Treitz, a number of blood samples were obtained through a superior mesenteric vein catheter 1-60 min after administration of [3H]leucine, and the radioactivity of plasma was measured to evaluate the absorption of [3H]leucine. It was shown that VIP and SRIF significantly inhibited the absorption of [3H]leucine (by 59.1% and 38.7%, respectively), whereas NT, CCK-8, and SEC significantly enhanced absorption (by 44.2%, 49.6%, and 39.1%, respectively). Radioimmunoassays of VIP, SRIF, and NT showed that at least some of the hormones or peptides exerted their effects on absorption of leucine at or near their physiological concentrations.
.A
Chen YF; Feng ZT; Wen SH; Lu GJ.
.I 55168
.U
88003949
.S
Dig Dis Sci 8801; 32(10):1130-5
.M
Animal; Esophagogastric Junction/DE/*IR; Female; Ganglia, Parasympathetic/PH; Hexamethonium Compounds/PD; Male; Manometry; Muscle Relaxation/DE; Neural Transmission; Opossums; Parasympatholytics/PD; Receptors, Muscarinic/*CL/DE; Support, U.S. Gov't, P.H.S.; Vagus Nerve/*PH.
.T
Subtypes of muscarinic receptors in vagal inhibitory pathway to the lower esophageal sphincter of the opossum.
.P
JOURNAL ARTICLE.
.W
We assessed the characteristics of muscarinic neural transmission in the vagal inhibitory pathway to the lower esophageal sphincter (LES) of anesthetized opossums. LES relaxation was induced by electrical stimulation of the cervical vagus. Measurements were made of LES relaxation before and after intravenous administration of nicotinic (hexamethonium), serotonergic (5-Meo-DMT), nonselective muscarinic (atropine), and selective muscarinic (pirenzepine-M1 and 4-DAMP-M2) antagonists. The latency of LES relaxation was increased substantially by pirenzepine and atropine, increased slightly by hexamethonium, but was not affected by 4-DAMP or 5-Meo-DMT. Given as concurrent intravenous infusions, hexamethonium, 5-Meo-DMT and 4-DAMP added to pirenzepine or atropine did not significantly increase LES relaxation latency above that caused by pirenzepine or atropine alone. None of the antagonists alone had a significant effect on percent LES relaxation. The combination of pirenzepine or 4-DAMP with hexamethonium and 5-Meo-DMT did not affect percent LES relaxation. The combination of atropine with hexamethonium and 5-Meo-DMT reduced LES relaxation to 18%. The combination of pirenzepine and 4-DAMP with hexamethonium and 5-Meo-DMT, however, had no effect on percent LES relaxation. We conclude that muscarinic participation in vagally induced LES relaxation exhibits two functional receptor subtypes: (1) M1 receptors that determine LES relaxation latency and are antagonized by pirenzepine or atropine, and (2) non-M1, non-M2 receptors (Mx receptors) that contribute to the magnitude of LES relaxation and are antagonized by atropine, but not by pirenzepine or 4-DAMP.
.A
Gilbert RJ; Dodds WJ.
.I 55169
.U
88003951
.S
Dig Dis Sci 8801; 32(10):1145-50
.M
Animal; Chemistry, Physical; Cholestyramine/PD; Disease Models, Animal; Gastric Mucosa/DE; Indomethacin/PD; Ligation; Male; Milk/*/AN; Phospholipids/IP/PH; Prostaglandins/PH; Pylorus/PH; Rats; Rats, Inbred Strains; Stomach Ulcer/*PC; Support, Non-U.S. Gov't.
.T
Milk protection against experimental ulcerogenesis in rats.
.P
JOURNAL ARTICLE.
.W
The antiulcer activity in pasteurized/homogenized bovine milk and a lipid extract of this milk was tested in an attempt to isolate and identify the active component. Using 0.6 N HCl as a damaging agent in pylorus-ligated rats, the protective property of milk appeared to be related to its phospholipid content and not its protein constituents. With intact (non-pylorus-ligated) rats, milk had demonstrable protective activity against 0.6 N HCl, as well as 100% ethanol and 160 mM taurocholic acid. The increasing phospholipid concentrations in skim, whole, and buttermilk paralleled their antiulcer efficacy. A lipid extract of whole milk showed significant protection against 0.6 N HCl when given alone or following indomethacin treatment. Measurements of the contact angle (hydrophobicity) of the gastric surface showed that it was maintained near control levels in the presence of 0.6 N HCl, if rats were first pretreated with milk. These results are consistent with the possibility that surface-active lipids in dairy milk, such as phospholipids, may account for a significant portion of milk's antiulcer activity by maintaining the hydrophobicity of the luminal surface of the gastric mucosa in the presence of a damaging agent.
.A
Dial EJ; Lichtenberger LM.
.I 55170
.U
88003953
.S
Dig Dis Sci 8801; 32(10):1155-7
.M
Amylases/AI/*ME; Animal; Digestion; Human; Infant; Intestines/ME; Pancreas/EN; Saliva/*EN; Starch/*ME; Stomach/ME.
.T
Role of salivary amylase in gastric and intestinal digestion of starch.
.P
JOURNAL ARTICLE.
.A
Lebenthal E.
.I 55171
.U
88003954
.S
Dig Dis Sci 8801; 32(10):1196-200
.M
Aged; Aneurysm/*RA; Case Report; Diagnosis, Differential; Hepatic Artery/*RA; Human; Male; Pancreatic Cyst/*RA; Pancreatic Pseudocyst/*RA; Tomography, X-Ray Computed/MT.
.T
Hepatic artery aneurysm simulating a cystic mass of the pancreas.
.P
JOURNAL ARTICLE.
.A
Barkin JS; Potash JB; Hernandez M; Casillas J; Morillo G.
.I 55172
.U
88003955
.S
Dig Dis Sci 8801; 32(10):1201-6
.M
Action Potentials; Aged; Case Report; Diarrhea/*PP; Electrodes; Female; Gastrointestinal Motility/*; Human; Intestine, Small/*PP; Intubation, Gastrointestinal.
.T
Migrating action potential complexes in a patient with secretory diarrhea.
.P
JOURNAL ARTICLE.
.W
A 70-year-old woman with secretory diarrhea was studied with a novel technique of recording small intestinal myoelectrical activity which allowed us to obtain long, uninterrupted records of slow waves and spikes at eight or more different intestinal levels simultaneously. Typical migrating action potential complexes (MAPCs) were observed, consisting of spike bursts that extended over more than one slow wave and migrated distally at the same propagation velocity as the slow waves. This motility pattern occurred frequently during the period the patient presented with secretory diarrhea and disappeared with the disappearance of the diarrhea. It was observed only once in a series of 10 normal control subjects. This is the first report on MAPC activity in man and on the association of this myoelectrical pattern with secretory diarrhea in man.
.A
Coremans G; Janssens J; Vantrappen G; Chaussade S; Ceccatelli P.
.I 55173
.U
88003956
.S
Dig Dis Sci 8801; 32(10):1207-11
.M
Aged; Bile Canaliculi/*DE/PA; Bile Duct Diseases/CI/PA; Bile Ducts, Intrahepatic/*DE; Case Report; Cholestasis, Intrahepatic/CI; Drug Hypersensitivity/*PA; Etretinate/*AE/TU; Human; Male; Psoriasis/DT.
.T
Hepatocanalicular injury associated with vitamin A derivative etretinate. An idiosyncratic hypersensitivity reaction.
.P
JOURNAL ARTICLE.
.W
A patient with pustular psoriasis developed jaundice, peripheral blood eosinophilia, and biochemical evidence of hepatocanalicular dysfunction four weeks after the initiation of etretinate therapy. A liver biopsy specimen showed bile duct damage, a periportal imflammatory infiltrate composed of neutrophils, eosinophils and lymphocytes, canalicular cholestasis, and focal hepatocyte necrosis. Clinical exclusion of other possible etiologic factors coupled with near resolution of the biochemical abnormalities within six weeks after complete discontinuation of the drug indicates that etretinate may induce an idiosyncratic hypersensitivity reaction. This is the first report to document etretinate associated bile duct injury.
.A
Khouri MR; Saul SH; Dlugosz AA; Soloway RD.
.I 55174
.U
88003957
.S
Dig Dis Sci 8801; 32(10):1212-3
.M
Human; Intubation, Gastrointestinal/*AE; Intubation, Intratracheal/*IS; Pneumothorax/*ET.
.T
Pneumothorax: complication of enteral feeding tube placement [letter]
.P
LETTER.
.A
Kools AM; Snyder LS; Cass OW.
.I 55175
.U
88004060
.S
Drug Intell Clin Pharm 8801; 21(9):702-6
.M
Biological Assay; Drug Therapy/*ST; Drug Utilization; Evaluation Studies; Hospitals, Teaching/ST; Human; Medical Audit; Medication Systems, Hospital/*ST; Random Allocation; Theophylline/BL/*TU.
.T
Evaluation of a therapeutic drug monitoring program for theophylline in a teaching hospital.
.P
JOURNAL ARTICLE.
.W
Studies concerning the value of therapeutic drug monitoring programs for theophylline have yielded contradictory findings. This study employed a prospective, single-blind, randomized, crossover design to evaluate the effect of a therapeutic drug monitoring program for theophylline. There were 410 serum theophylline assays performed in 169 patients. The average number of assays drawn incorrectly and the average number of assays used inappropriately were significantly reduced (from 1.87 to 1.32 and from 2.07 to 1.45, respectively) with therapeutic drug monitoring. When the program was withdrawn, no statistically significant change resulted, and when the program was reinstituted, there was improvement in audit criteria performance but the change was not statistically significant. Although the savings from the program would equal the cost in the first year, cost savings would be anticipated in the future.
.A
Wing DS; Duff HJ.
.I 55176
.U
88004062
.S
Drug Intell Clin Pharm 8801; 21(9):716-20
.M
Aged; Benzodiazepine Tranquilizers/*TU; Comparative Study; Diphenhydramine/*TU; Drug Evaluation; Female; Florida; Human; Hypnotics and Sedatives/*TU; Insomnia/*DT; Male; Neurologic Examination; Nursing Homes/*; Random Allocation; Temazepam/*TU.
.T
Evaluation of temazepam and diphenhydramine as hypnotics in a nursing-home population.
.P
JOURNAL ARTICLE.
.W
Seventeen nursing home residents with sleeping problems were enrolled in a randomized, double-blind, crossover trial of temazepam 15 mg, diphenhydramine (DPH) 50 mg, and placebo. Each drug was given for five consecutive nights with a 72-hour washout period between drugs. Subjects were assessed three times weekly with tests of psychomotor and cognitive function and four times weekly with observer sleep diaries and morning sleep questionnaires. Three subjects failed to complete the study. By report of the subjects, DPH resulted in shorter sleep latency than did placebo (t = 2.77, p less than 0.05). On the fifth night, use of DPH was associated with longer duration of sleep than temazepam (t = 2.88, p less than 0.05). No significant difference in tests of neurologic function was noted although, compared with placebo, subjects performed more poorly on seven of eight tests while taking temazepam and five of eight tests while taking DPH. Several instances of daytime hypersomnolence were noted in subjects taking temazepam and DPH, but none in subjects given placebo.
.A
Meuleman JR; Nelson RC; Clark RL Jr.
.I 55177
.U
88004063
.S
Drug Intell Clin Pharm 8801; 21(9):721-2
.M
Barium Sulfate/*AE; Case Report; Drug Hypersensitivity/ET; Enema/AE; Female; Glucagon/*AE; Heart Arrest/*CI; Human; Middle Age.
.T
Cardiopulmonary arrest following barium enema examination with glucagon.
.P
JOURNAL ARTICLE.
.W
This is a case report of a patient who presented to the hospital's ambulatory radiology suites for a barium enema to evaluate guaiac-positive stools. The patient, after receiving glucagon 0.5 mg iv and a small amount of rectally administered barium sulfate, experienced an "itchy tingling" feeling, vomited, became diaphoretic, and had a cardiopulmonary arrest. Despite a prompt response by the cardiac arrest team, the patient could not be resuscitated. This case demonstrates the potential for serious reactions during this procedure.
.A
Harrington RA; Kaul AF.
.I 55178
.U
88004064
.S
Drug Intell Clin Pharm 8801; 21(9):723-6
.M
Case Report; Cerebral Hemorrhage/*CO; Cerebrovascular Disorders/*CO; Dose-Response Relationship, Drug; Female; Human; Hypertension/*DT; Hypotension/*CI; Male; Middle Age; Prazosin/*AE; Risk Factors; Unconsciousness/*CI.
.T
Prazosin-induced first-dose phenomenon possibly associated with hemorrhagic stroke: a report of three cases.
.P
JOURNAL ARTICLE.
.W
A small initial dose of prazosin ranging from 0.5 to 1 mg has been recommended to avoid the first-dose phenomenon characterized by a sudden and severe drop in blood pressure after the administration of the first dose of prazosin. However, even with an initial dose of 0.5 mg, hypotension with consciousness disturbance developed in three hypertensive patients with recent cerebral hemorrhage. We present this report to alert physicians and pharmacists about the potential risk of the first-dose phenomenon even at the recommended initial doses of prazosin in hypertensive patients who have suffered a recent stroke.
.A
Lin MS; Hsieh WJ.
.I 55179
.U
88004065
.S
Drug Intell Clin Pharm 8801; 21(9):726-7
.M
Aged; Case Report; Female; Glycerin/*AE; Human; Hypothyroidism/*CI; Iodine/*AE; Potassium Iodide/AE; Thyroid Hormones/BL.
.T
Iodinated glycerol-induced hypothyroidism.
.P
JOURNAL ARTICLE.
.W
This report describes an adverse reaction to iodinated glycerol, an organic form of iodine prescribed as a mucolytic-expectorant. In a patient with a previous history of severe potassium iodide-induced hypothyroidism, administration of iodinated glycerol resulted in mild subclinical hypothyroidism. There is one report in the literature of goiter resulting from iodinated glycerol and physicians should be aware of the potential for hypothyroidism with this agent. Iodinated glycerol should be added to the list of iodine-containing organic compounds that interfere with thyroid function.
.A
Gomolin IH.
.I 55180
.U
88004067
.S
Drug Intell Clin Pharm 8801; 21(9):732-4
.M
Adult; Chloroquine/BL/*PK; Histamine H2 Receptor Blockaders; Human; Male; Metabolic Clearance Rate; Ranitidine/*PD.
.T
Effect of ranitidine on chloroquine disposition.
.P
JOURNAL ARTICLE.
.W
Ten healthy, male volunteers (aged 19-27 yr; weight 62-67 kg) were randomly distributed into control and test groups of five subjects each in a controlled study on the effect of ranitidine on chloroquine disposition. The control group subjects received two tablets of chloroquine sulfate (300-mg base) only. The test group subjects received ranitidine 250 mg hs for four days prior to the administration of chloroquine sulfate and throughout the sample collection period. Blood samples (5 ml) were collected from the time of the chloroquine administration to the seventh day after drug administration. The samples were analyzed for chloroquine content by a combination of thin-layer chromatography and ultraviolet spectrophotometry. The Wilcoxon test at 0.05 significance level was used to compare the disposition parameters between control and test groups. Ranitidine therapy was associated with no significant alterations in chloroquine oral clearance rate, elimination rate constant, and apparent volume of distribution. Unlike cimetidine, ranitidine does not interact pharmacokinetically with chloroquine. Ranitidine, therefore, may be the H2-receptor antagonist of choice for ulcer patients receiving chloroquine.
.A
Ette EI; Brown-Awala A; Essien EE.
.I 55181
.U
88004069
.S
Drug Intell Clin Pharm 8801; 21(9):739-40
.M
Epidemiology/*; Evaluation Studies/*; Human; Pharmacology/*; Product Surveillance, Postmarketing/*.
.T
Introduction to pharmacoepidemiology.
.P
JOURNAL ARTICLE.
.A
Hartzema AG; Porta MS; Tilson HH.
.I 55182
.U
88004071
.S
Drug Intell Clin Pharm 8801; 21(9):748-51
.M
Drug Information Services/*UT; Drug Interactions/*; Drug Therapy/*AE; Human; Medical Staff, Hospital/*; Nigeria; Pharmacists; Pharmacy Service, Hospital/*UT; Support, Non-U.S. Gov't.
.T
Determination of the drug information needs of the medical staff of a Nigerian hospital following implementation of clinical pharmacy services.
.P
JOURNAL ARTICLE.
.W
The types and frequency of questions asked of clinical pharmacists introducing clinical pharmacy services in the internal medicine wards of a Nigerian university hospital and the degree of compliance with pharmacists' recommendations were studied. Three faculty pharmacists collected data in two 30-working day study periods, separated by a year. Totals of 197 questions (an average of 6.57 +/- 1.33 questions/working day) and 271 questions (an average of 9.03 +/- 1.10 questions/working day) were answered by the pharmacists in the first and second study periods, respectively. Pharmacists recommended changes in patient-specific drug therapy that were implemented 52 percent and 69 percent of the time in the first and second study periods, respectively. The most common type of drug information request concerned the presence or the likelihood of an adverse drug reaction. Continuous interaction between pharmacists and physicians in the patient-care setting results in a better appreciation of the pharmacist's role as drug information consultant, and the consequence of this is a high degree of compliance with pharmacists' recommendations.
.A
Ette EI; Achumba JI; Brown-Awala EA.
.I 55183
.U
88004072
.S
Drug Intell Clin Pharm 8801; 21(9):752
.M
Adult; Case Report; Human; Hyperaldosteronism/*DT; Hypertension/DT; Ketoconazole/*TU; Male.
.T
Control of hyperaldosteronism by ketoconazole [letter]
.P
LETTER.
.A
Benito P; Corpas MS; Quesada JM; Jimenez JA.
.I 55184
.U
88004073
.S
Drug Intell Clin Pharm 8801; 21(9):752-3
.M
Adult; Aged; Endoscopy/*; Female; Human; Lidocaine/*BL; Male; Middle Age.
.T
Lidocaine serum concentrations following endoscopy [letter]
.P
LETTER.
.A
Fazio A; Patton LR; Karpowicz F; Pellecchia C.
.I 55185
.U
88004074
.S
Drug Intell Clin Pharm 8801; 21(9):753
.M
Adult; Case Report; Human; Male; Minoxidil/*AE; Pericardial Effusion/*CI.
.T
Minoxidil-associated pericardial effusion [letter]
.P
LETTER.
.A
Baker BA; Ruck B; Pellman E.
.I 55186
.U
88004075
.S
Drug Intell Clin Pharm 8801; 21(9):753-4
.M
Community Pharmacy Services/*; Drug Information Services/*; Human.
.T
Drug information needs [letter]
.P
LETTER.
.A
Spencer M.
.I 55187
.U
88004076
.S
Drug Intell Clin Pharm 8801; 21(9):754-5
.M
Adult; Alprazolam/*AE; Case Report; Diazepam/*TU; Human; Male; Substance Withdrawal Syndrome/*DT.
.T
Alprazolam withdrawal [letter]
.P
LETTER.
.A
Votolato NA; Batcha KJ; Olson SC.
.I 55188
.U
88004077
.S
Drug Intell Clin Pharm 8801; 21(9):755
.M
Asthma/*DT; Human; Theophylline/*TU.
.T
Theophylline activity in late asthmatic response [letter]
.P
LETTER.
.A
Pauwels R.
.I 55189
.U
88004078
.S
Drug Intell Clin Pharm 8801; 21(9):755
.M
Cystic Fibrosis/*DT; Human; Tobramycin/*PK.
.T
Tobramycin pharmacokinetics in cystic fibrosis [letter]
.P
LETTER.
.A
Fraser GL.
.I 55190
.U
88004263
.S
Emerg Med Clin North Am 8801; 5(3):399-404
.M
Delivery; Emergencies/*; Female; Genital Diseases, Female/*DI; Human; Nursing Assessment/*; Physical Examination; Pregnancy; Pregnancy Complications/DI; Rape; Triage; Wounds and Injuries/DI.
.T
Nursing assessment and general care of the gynecological patient.
.P
JOURNAL ARTICLE.
.W
This article explains the steps necessary for quick and effective triage and care of the gynecological patient. Because these patients may be emotionally upset, the ER nurse must make every attempt to reassure and calm the patient while at the same time prepare her for treatment.
.A
Krzyston D.
.I 55191
.U
88004264
.S
Emerg Med Clin North Am 8801; 5(3):399-647
.M
Emergencies; Female; Genital Diseases, Female/*; Human; Pregnancy; Pregnancy Complications/*.
.T
Obstetric and gynecologic emergencies.
.P
JOURNAL ARTICLE.
.I 55192
.U
88004266
.S
Emerg Med Clin North Am 8801; 5(3):425-8
.M
Abdomen, Acute/*PP; Emergencies; Female; Human; Medical History Taking; Pain/*DI; Pelvis/*PP; Physical Examination.
.T
Abdominal and pelvic pain.
.P
JOURNAL ARTICLE.
.W
Complaints of abdominal and pelvic pain account for a large number of Emergency Department presentations. Unfortunately, the subjective, often ambiguous, complaint of pain may represent a broad spectrum of pathology ranging from relatively benign disorders to acute, life-threatening illness. It is the duty of the Emergency Department physician to separate the potentially lethal disorders from the less acute illnesses, a task that this article aims to make easier.
.A
Walker JW.
.I 55193
.U
88004267
.S
Emerg Med Clin North Am 8801; 5(3):429-42
.M
Adolescence; Adult; Child; Emergencies; Female; Genitalia, Female/IN; Hemorrhage/*DI/ET; Human; Menstruation; Nursing Assessment; Pelvic Neoplasms/CO; Physical Examination; Uterine Hemorrhage/DI; Vaginal Diseases/CO/*DI.
.T
Vaginal bleeding.
.P
JOURNAL ARTICLE.
.W
Vaginal bleeding is one of the most common gynecologic symptoms for which the patient will come to the Emergency Department. It is usually associated with psychologic distress and can be frightening to the patient. Vaginal bleeding can be the first sign of life-threatening medical disorders such as carcinoma, bleeding disorders, and trophoblastic disease. As with bleeding from other sources, it is not uncommon for a patient with significant vaginal bleeding to lose large amounts of circulating volume. These facts make it essential that the emergency physician deal quickly and effectively with this symptom.
.A
Hochbaum SR.
.I 55194
.U
88004272
.S
Emerg Med Clin North Am 8801; 5(3):529-40
.M
Cesarean Section; Death; Delivery/*MT; Emergency Medical Services/*; Emergency Service, Hospital; Female; Fetal Monitoring; Human; Infant, Newborn; Labor Complications/TH; Pregnancy; Pregnancy Complications/*TH; Prognosis; Risk Factors; Triage.
.T
Emergency delivery: prehospital care, emergency department delivery, perimortem salvage.
.P
JOURNAL ARTICLE.
.W
The incidence of high-risk conditions complicating pregnancy is greater than one would suspect. Many times a pregnancy does not become high risk until labor starts. Prehospital and Emergency Department protocol should be directed at getting the mother to the labor and delivery suite as soon as possible. Most complications resulting in maternal-fetal morbidity and mortality are handled best in that setting. Prehospital and Emergency Department personnel should, however, be prepared to handle imminent delivery because it cannot be avoided when it occurs. Emergency Department personnel also should be familiar with the technique of perimortem cesarean delivery and use this technique when indicated for fetal-maternal salvage.
.A
Higgins SD.
.I 55195
.U
88004274
.S
Emerg Med Clin North Am 8801; 5(3):559-68
.M
Amenorrhea/TH; Dysmenorrhea/TH; Emergencies/*; Female; Human; Menorrhagia/TH; Menstruation Disorders/*TH; Metrorrhagia/TH; Oligomenorrhea/TH; Premenstrual Syndrome/TH.
.T
Emergency treatment of menstrual disorders in a nonpregnant woman.
.P
JOURNAL ARTICLE.
.W
Women who present to the Emergency room with menstrual-related problems are a common occurrence. In this article, we will concern ourselves with common problems that the nonpregnant woman in the reproductive years may present to the emergency room, including symptoms such as vaginal bleeding, painful menses, or premenstrual syndrome. Although the treatment within the emergency room is temporizing in nature, to better understand these problems and their appropriate management, these areas will be discussed as to their etiology, treatment, and prognosis.
.A
Shapiro AG.
.I 55196
.U
88004275
.S
Emerg Med Clin North Am 8801; 5(3):569-76
.M
Abscess/DI/TH; Emergencies/*; Female; Human; Ovarian Cysts/*TH; Ovarian Diseases/TH; Ovarian Neoplasms/*TH; Rupture, Spontaneous; Salpingitis/DI/TH; Torsion/TH.
.T
Emergency treatment of adnexal masses in a nonpregnant woman.
.P
JOURNAL ARTICLE.
.W
Both benign and malignant adnexal masses can present as an emergency. Differential diagnosis, as well as practical clinical maneuvers to differentiate the two, and initial treatment are discussed in this article.
.A
Lichtinger M.
.I 55197
.U
88004279
.S
Endocrinology 8801; 121(4):1209-14
.M
Androgens/*ME; Animal; Animals, Newborn/GD/*ME; Aromatase/*ME; Brain/EM/GD/*ME; Female; Fetus/ME; Hydroxylation; Kinetics; Male; Rats; Rats, Inbred Strains; Support, U.S. Gov't, P.H.S..
.T
19-Hydroxylation and aromatization of androgens in the developing rat brain.
.P
JOURNAL ARTICLE.
.W
Androgen aromatization in the human placenta proceeds through two successive hydroxylations at C-19, the products of which are then virtually completely converted to estrogens. In the neonatal rat brain, however, 19-hydroxylation has been shown to exceed significantly subsequent aromatization, suggesting that formation of 19-hydroxylated androgen metabolites might be important in brain differentiation in this species. Using [19-3H3]androstenedione, we found that the surplus activity of 19-hydroxylase relative to aromatase was independent of age, sex, and androgen substrate concentration, despite 100-fold differences in tissue aromatase activity during the course of development. In addition, the surplus 19-hydroxylation was not affected by several agents which otherwise decreased or increased the activity of the aromatase enzyme, including metyrapone, KCN, and cytochrome P-450 reductase, the latter indicating that the failure of the 19-hydroxylated products to proceed to aromatization was not due to a deficit of reducing equivalents. 19-Hydroxylation of androgens in the rat brain is a quantitatively significant metabolic pathway in this tissue, although present data do not confirm the existence of a steroid C-19 hydroxylase in the brain separate from that involved in aromatization.
.A
Michnovicz JJ; Hahn EF; Fishman J.
.I 55198
.U
88004280
.S
Endocrinology 8801; 121(4):1215-20
.M
Animal; Gonadotropins, Chorionic/BL/CL/*PK; Lectins/ME; Male; Metabolic Clearance Rate; Rats; Rats, Inbred Strains; Sialic Acids/ME.
.T
Similarity of the clearance rates of free alpha-subunit and alpha-subunit dissociated from intact human chorionic gonadotropin, despite differences in sialic acid contents.
.P
JOURNAL ARTICLE.
.W
It is well known that the MCR of proteins can be influenced by their carbohydrate structure; i.e. the presence of terminal galactose on proteins results in uptake by hepatic receptors for galactose-terminated glycoproteins. Thus, a protein with its galactose residues covered or removed exhibits a far longer half life in plasma than one with its galactose residues exposed. The free alpha-subunit of human CG (hCG) has been shown to have a different carbohydrate composition than does the alpha-subunit dissociated from the intact hormone. In our laboratory, analysis of alpha-subunits isolated from pregnancy urine indicated that the alpha-subunit dissociated from hCG (hCG alpha) contains primarily monosialylated oligosaccharides, whereas the free alpha-subunit contains more than one sialic acid per oligosaccharide. This difference in the degree of sialylation prompted us to examine the clearance rates of these two subunits. Accordingly, free alpha and hCG alpha were purified by affinity chromatography and labeled with 125I. The labeled subunits were injected iv into rats and serum samples were removed at various time intervals over a 2-h period. The amount of [125I]alpha-subunit remaining in the serum was determined by immunoprecipitation using an antiserum to hCG alpha. The disappearance curves for the two subunits were indistinguishable and could be analyzed by a biexponential model. The t 1/2 of the faster component was 5 min, while the t 1/2 of the slower component was 74 min. In order to determine whether or not terminal galactose was present on either the hCG alpha or the free alpha-subunit, the labeled molecules were subjected to lectin column chromatography using Ricin or peanut lectin linked to agarose. Both of these lectins bind galactose but have different specificities with respect to the penultimate sugar. Both subunit preparations contained only minor amounts of material which could bind or either lectin. However, after desialylation, both hCG alpha and free alpha bound extensively to Ricin, indicating the presence of penultimate galactose residues in both. We conclude that terminal galactose residues are not present on the oligosaccharides of either hCG alpha or free alpha-subunits, and that the difference observed in the sialic acid contents of the two subunits does not affect their rates of clearance.
.A
Blithe DL; Nisula BC.
.I 55199
.U
88004284
.S
Endocrinology 8801; 121(4):1242-50
.M
Adrenalectomy/*; Amylases/*GE/ME; Animal; Corticosterone/*PD; Gene Expressi